- Email: [email protected]
Management of posttraumatic vertigo
Scientific Session—Monday
correlation with the incidence and the rate of growth of sporadic vestibular schwannomas. 11:00
AM
Quality of Life in Hearing Impaired Adults: The Role of Cochlear Implants and Hearing Aids Seth M Cohen MD MPH (presenter); Robert F Labadie MD PhD; Mary S Dietrich PhD; David S Haynes MD Nashville TN; Nashville TN; Nashville TN; Nashville TN
Objectives: This study compares the quality-of-life (QOL) benefit received from cochlear implants and hearing aids among hearing-impaired adults. Methods: The experimental group consisted of 29 cochlear implant (CI) users older than 49 years with a control group of 56 hearing aid (HA) users older than 49 years. With Institutional Review Board approval, participants were mailed two copies of the Nijegmen QOL questionnaire at 2-week intervals. The first was for the pre-rehabilitation state (ie, without HA or CI use) and the second for the postrehabilitation state (ie, after use of an HA or CI for 12 months). These data as well as demographic and audiologic data were analyzed with appropriate statistical tests including multiple linear regression. Results: Twenty-seven CI users (93.1%) and 30 HA users (53.6%) responded (P ⬍ 0.001, chi-square). Both CI and HA patients had higher post-intervention QOL scores: 41.1 versus 66.9 (P ⬍ 0.001, signed rank test) and 60.0 versus 72.2 (P ⬍ 0.001, paired t test), respectively. All subdomains, except the advanced speech perception domain among HA patients, showed statistically significant increases (P ⬍ 0.01, paired t test). After controlling for confounding variables, the improvement in QOL in CI users showed a trend toward significance (P ⫽ 0.098, multiple linear regression) as compared to the HA users. Conclusions: Cochlear implants provide at least comparable benefit for those with profound hearing loss as hearing aids bring for those with less severe hearing loss. 11:08
AM
Management of Posttraumatic Vertigo Arne Ernst MD PhD; Rainer Seidl MD; Frank Zamani MD (presenter); Ingo Todt MD Berlin Germany; Berlin Germany; Berlin Germany; Berlin Germany
Objectives: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction with vertigo and to report the results of treatment after extensive diagnostics. Methods: 63 patients (2000-2002) treated at the department after blunt head and neck trauma (no fractures were included) who complained of vertigo immediately after the trauma (primary disorder) or after a delay of 3 weeks to 3 months (secondary disorder) were investigated by a neuroto-
logical follow-up before and after therapy. It included caloric, rotatory testing, dynamic posturography, and—if necessary— otolith testing and EcoG. Audiometric tests (PTA, OAE recordings) were included. Results: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorder (5), delayed endolymphatic hydrops (12), and canalolithiasis (reoccurring) (9). The patients (except those with cervicogenic vertigo) were free of vertigo after treatment which consisted of habituation training, medical, and surgical therapy options. Conclusions: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery is the most important prerequisite for a therapeutic success. Surgical measures (eg, saccotomy, canal occlusion, neurectomy) should be an integral part if conservative treatment is not effective. 11:16
AM
Intracranial Complications of Otitis Media: 15 Years of Experience with 33 Patients Norma Penido MD (presenter); Andrei Borin MD; Luiz C N Iha MD; Vinicius M Suguri MD; Ektor Onishi MD; Yotaka Fukuda MD; Oswaldo Laercio M Cruz MD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Moema Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: Central nervous system (CNS) complications of acute (AOM) and chronic otitis media (COM) are decreasing in number but still represent a challenger in early recognition, adequate treatment, and satisfactory results. This retrospective study analyzes the main factors for diagnosis and therapy efficiency based on our experience during the last 15 years. Methods: Charts of 6 patients with AOM and 26 with COM associated with CNS complications were analyzed regarding clinical aspects, image studies, and therapeutic approach. Results: Age ranged from 6 to 79 years old, with no gender preference. Persistent fever, headache, and purulent ear discharge were the main symptoms. Proteus mirabillis, enterococcus, and Pseudomonas aeruginosa were the most common agents in COM and pneumococo and haemophilus in AOM. 19 patients (58%) presented more than one complication in a total of 56 CNS complications: 26 encephalic abscesses, 21 meningitis, 5 lateral sinus thrombosis, 2 subdural empiema, 1 epidural empiema, and 1 meningocele. The first surgical intervention was craniotomy and drainage of abscess (n ⫽ 17), open mastoidectomy with abscess drainage through the mastoid (n ⫽ 10), open mastoidectomy without abscess drainage (n ⫽ 8), and closed mastoidectomy (n ⫽ 2).
MONDAY
P92
Otolaryngology– Head and Neck Surgery August 2003
correlation with the incidence and the rate of growth of sporadic vestibular schwannomas. 11:00
AM
Quality of Life in Hearing Impaired Adults: The Role of Cochlear Implants and Hearing Aids Seth M Cohen MD MPH (presenter); Robert F Labadie MD PhD; Mary S Dietrich PhD; David S Haynes MD Nashville TN; Nashville TN; Nashville TN; Nashville TN
Objectives: This study compares the quality-of-life (QOL) benefit received from cochlear implants and hearing aids among hearing-impaired adults. Methods: The experimental group consisted of 29 cochlear implant (CI) users older than 49 years with a control group of 56 hearing aid (HA) users older than 49 years. With Institutional Review Board approval, participants were mailed two copies of the Nijegmen QOL questionnaire at 2-week intervals. The first was for the pre-rehabilitation state (ie, without HA or CI use) and the second for the postrehabilitation state (ie, after use of an HA or CI for 12 months). These data as well as demographic and audiologic data were analyzed with appropriate statistical tests including multiple linear regression. Results: Twenty-seven CI users (93.1%) and 30 HA users (53.6%) responded (P ⬍ 0.001, chi-square). Both CI and HA patients had higher post-intervention QOL scores: 41.1 versus 66.9 (P ⬍ 0.001, signed rank test) and 60.0 versus 72.2 (P ⬍ 0.001, paired t test), respectively. All subdomains, except the advanced speech perception domain among HA patients, showed statistically significant increases (P ⬍ 0.01, paired t test). After controlling for confounding variables, the improvement in QOL in CI users showed a trend toward significance (P ⫽ 0.098, multiple linear regression) as compared to the HA users. Conclusions: Cochlear implants provide at least comparable benefit for those with profound hearing loss as hearing aids bring for those with less severe hearing loss. 11:08
AM
Management of Posttraumatic Vertigo Arne Ernst MD PhD; Rainer Seidl MD; Frank Zamani MD (presenter); Ingo Todt MD Berlin Germany; Berlin Germany; Berlin Germany; Berlin Germany
Objectives: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction with vertigo and to report the results of treatment after extensive diagnostics. Methods: 63 patients (2000-2002) treated at the department after blunt head and neck trauma (no fractures were included) who complained of vertigo immediately after the trauma (primary disorder) or after a delay of 3 weeks to 3 months (secondary disorder) were investigated by a neuroto-
logical follow-up before and after therapy. It included caloric, rotatory testing, dynamic posturography, and—if necessary— otolith testing and EcoG. Audiometric tests (PTA, OAE recordings) were included. Results: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorder (5), delayed endolymphatic hydrops (12), and canalolithiasis (reoccurring) (9). The patients (except those with cervicogenic vertigo) were free of vertigo after treatment which consisted of habituation training, medical, and surgical therapy options. Conclusions: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery is the most important prerequisite for a therapeutic success. Surgical measures (eg, saccotomy, canal occlusion, neurectomy) should be an integral part if conservative treatment is not effective. 11:16
AM
Intracranial Complications of Otitis Media: 15 Years of Experience with 33 Patients Norma Penido MD (presenter); Andrei Borin MD; Luiz C N Iha MD; Vinicius M Suguri MD; Ektor Onishi MD; Yotaka Fukuda MD; Oswaldo Laercio M Cruz MD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Moema Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: Central nervous system (CNS) complications of acute (AOM) and chronic otitis media (COM) are decreasing in number but still represent a challenger in early recognition, adequate treatment, and satisfactory results. This retrospective study analyzes the main factors for diagnosis and therapy efficiency based on our experience during the last 15 years. Methods: Charts of 6 patients with AOM and 26 with COM associated with CNS complications were analyzed regarding clinical aspects, image studies, and therapeutic approach. Results: Age ranged from 6 to 79 years old, with no gender preference. Persistent fever, headache, and purulent ear discharge were the main symptoms. Proteus mirabillis, enterococcus, and Pseudomonas aeruginosa were the most common agents in COM and pneumococo and haemophilus in AOM. 19 patients (58%) presented more than one complication in a total of 56 CNS complications: 26 encephalic abscesses, 21 meningitis, 5 lateral sinus thrombosis, 2 subdural empiema, 1 epidural empiema, and 1 meningocele. The first surgical intervention was craniotomy and drainage of abscess (n ⫽ 17), open mastoidectomy with abscess drainage through the mastoid (n ⫽ 10), open mastoidectomy without abscess drainage (n ⫽ 8), and closed mastoidectomy (n ⫽ 2).
MONDAY
P92
Otolaryngology– Head and Neck Surgery August 2003