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10:14 AM
Scientific Sessions—Wednesday
10:06 AM Visuo-Vestibular Interaction in the Diagnosis of Vertigo Renzo Mora, MD (presenter); Massimo Dellepiane, MD; Angelo Salami, MD Genoa Italy OBJECTIVE: The aim of this work was to determine the diagnostic value of a visuo-vestibular interaction test in the diagnosis of central and peripheral vertigo. METHODS: In this study 108 patients affected with central (group A) and peripheral vertigo (group B) were enrolled. All the patients underwent electronystagmography (ENG) recording: the patients, head blocked, sat on a Tonnies rotatory chair Pro model, which was placed in the middle of a rotatory cylindrical chamber (2 metres in diameter and 1.9 metres in height). The rotatory cylinder was driven by a direct current engine that turned it clockwise and counterclockwise, up to 200 degrees/sec., and its internal area was covered with 32 black vertical contrast. All the subjects underwent the rotatory vestibular stimulation by Stop test, optokinetic stimulation, and contemporary rotatory vestibular and optokinetic stimulation (VVOR). RESULTS: For the analysis of the results we have considered nystagmus slow phase after each instrumental stimulation. In particular, after contemporary rotatory vestibular and optokinetic stimulation, in group A (85 patients), VVOR was homodirectional to vestibular ocular reflex in 54 patients, while it was homodirectional to optokinetic nystagmus (OKN) in 24 patients and hypokinetic in 7 patients. After the same test, in
MINISEMINARS 10:30 AM to 12:00 PM MTCC Room 801AB
䡲 Improving Outcomes in FESS: Tips from Revision Surgeons James N Palmer, MD (moderator); Rodney J Schlosser, MD; Aldo Cassol Stamm, MD PhD; Peter John Wormald, MD FRACS FRCS
group B (23 patients), VVOR was homodirectional to OKN in all the patients. CONCLUSIONS: Our visuo-vestibular interaction test shows an optokinetic inhibition and a vestibular prevalence in the central vertigo: these results highlight the role for ENG in determining the presence of peripheral or central vestibular diseases.
10:14 AM Bionic Hearing: From Round Window to Inferior Colliculus Vittorio Colletti, MD (presenter); Liliana Colletti; Marco Carner, MD Verona Italy OBJECTIVE: Hearing restoration in patients with middle ear defects from COM and NF2. COM patients with major defects of the ossicular chain failing to obtain hearing restoration even after repeated ossiculoplasties (OPL) may regain their hearing with an electromagnetic hearing aid placed on the RW. ABI results, constantly poor in NF2, may be surprisingly outstanding in nontumor patients (Colletti et al. 2005). To improve hearing performances in NF2 patients auditory nuclei distant to the damaged brainstem such as the inferior colliculus need to be explored. METHODS: Over the last 10 years the presenters fitted 412 patients with a bionic device: 321 with CI; 80 with ABI; 10 with COM and repeated OPL with a Vibrant Med-El Soundbridge (VSB) placing the floating mass transducer onto the round window (RW), and 1 NF2 patient previously operated on several times for recurrences and treated with gamma-knife with the application of an auditory implant (Med-El Pulsar 100) at the level of the IC. RESULTS: Dramatic improvements in PT threshold (AB gap closure in 70%, overclosure in 30%), and speech understanding (average SDS from 5.5 pre-op to 86.8 post-op at 65 dB HL) were obtained with the RWVSB. Electrical stimulation produced a full range of loudness and pitch sensations specific to each of the 12 electrodes (12/12) with no extra-auditory responses. CONCLUSIONS: Bionic restoration of hearing can now be applied for lesions of the auditory system that span from the middle ear to the brainstem.
Philadelphia PA; Charleston SC; Sao Paulo Brazil; Woodville Australia Functional Endoscopic Sinus Surgery (FESS) is a well-established technique for treatment of patients with Chronic Rhinosinusitis. Applied in properly selected patients, FESS is associated with an 80-90 percent success rate. However, the remaining 10-20 percent of patients often have recurrence of disease and will require subsequent surgery. This seminar will use a case-based approach to evaluate and discuss the common problems and difficulties that are seen by the revision surgeon. In the process of dissecting surgical situations that require revision, the panelists will discuss strategies to avoid
WEDNESDAY
0.01). Mucosal inflammation encountered during surgery was associated with a higher incidence of postoperative otorrhea (14% vs. 2%, P ⬍ 0.05). The incidence of moist debris was statistically higher in patients with canal wall down procedures (20% vs. 1%, P ⬍ 0.01). CONCLUSIONS: Overall, 17% of patient developed recurrence. Canal wall down procedures appear to have a lower incidence of recurrence but a higher rate of moist debris and myringitis. Middle ear inflammation is the only factor associated with an increased rate of postoperative otorrhea. Long-term follow-up should be the rule in cholesteatoma to detect recurrence.
P207
10:06 AM Visuo-Vestibular Interaction in the Diagnosis of Vertigo Renzo Mora, MD (presenter); Massimo Dellepiane, MD; Angelo Salami, MD Genoa Italy OBJECTIVE: The aim of this work was to determine the diagnostic value of a visuo-vestibular interaction test in the diagnosis of central and peripheral vertigo. METHODS: In this study 108 patients affected with central (group A) and peripheral vertigo (group B) were enrolled. All the patients underwent electronystagmography (ENG) recording: the patients, head blocked, sat on a Tonnies rotatory chair Pro model, which was placed in the middle of a rotatory cylindrical chamber (2 metres in diameter and 1.9 metres in height). The rotatory cylinder was driven by a direct current engine that turned it clockwise and counterclockwise, up to 200 degrees/sec., and its internal area was covered with 32 black vertical contrast. All the subjects underwent the rotatory vestibular stimulation by Stop test, optokinetic stimulation, and contemporary rotatory vestibular and optokinetic stimulation (VVOR). RESULTS: For the analysis of the results we have considered nystagmus slow phase after each instrumental stimulation. In particular, after contemporary rotatory vestibular and optokinetic stimulation, in group A (85 patients), VVOR was homodirectional to vestibular ocular reflex in 54 patients, while it was homodirectional to optokinetic nystagmus (OKN) in 24 patients and hypokinetic in 7 patients. After the same test, in
MINISEMINARS 10:30 AM to 12:00 PM MTCC Room 801AB
䡲 Improving Outcomes in FESS: Tips from Revision Surgeons James N Palmer, MD (moderator); Rodney J Schlosser, MD; Aldo Cassol Stamm, MD PhD; Peter John Wormald, MD FRACS FRCS
group B (23 patients), VVOR was homodirectional to OKN in all the patients. CONCLUSIONS: Our visuo-vestibular interaction test shows an optokinetic inhibition and a vestibular prevalence in the central vertigo: these results highlight the role for ENG in determining the presence of peripheral or central vestibular diseases.
10:14 AM Bionic Hearing: From Round Window to Inferior Colliculus Vittorio Colletti, MD (presenter); Liliana Colletti; Marco Carner, MD Verona Italy OBJECTIVE: Hearing restoration in patients with middle ear defects from COM and NF2. COM patients with major defects of the ossicular chain failing to obtain hearing restoration even after repeated ossiculoplasties (OPL) may regain their hearing with an electromagnetic hearing aid placed on the RW. ABI results, constantly poor in NF2, may be surprisingly outstanding in nontumor patients (Colletti et al. 2005). To improve hearing performances in NF2 patients auditory nuclei distant to the damaged brainstem such as the inferior colliculus need to be explored. METHODS: Over the last 10 years the presenters fitted 412 patients with a bionic device: 321 with CI; 80 with ABI; 10 with COM and repeated OPL with a Vibrant Med-El Soundbridge (VSB) placing the floating mass transducer onto the round window (RW), and 1 NF2 patient previously operated on several times for recurrences and treated with gamma-knife with the application of an auditory implant (Med-El Pulsar 100) at the level of the IC. RESULTS: Dramatic improvements in PT threshold (AB gap closure in 70%, overclosure in 30%), and speech understanding (average SDS from 5.5 pre-op to 86.8 post-op at 65 dB HL) were obtained with the RWVSB. Electrical stimulation produced a full range of loudness and pitch sensations specific to each of the 12 electrodes (12/12) with no extra-auditory responses. CONCLUSIONS: Bionic restoration of hearing can now be applied for lesions of the auditory system that span from the middle ear to the brainstem.
Philadelphia PA; Charleston SC; Sao Paulo Brazil; Woodville Australia Functional Endoscopic Sinus Surgery (FESS) is a well-established technique for treatment of patients with Chronic Rhinosinusitis. Applied in properly selected patients, FESS is associated with an 80-90 percent success rate. However, the remaining 10-20 percent of patients often have recurrence of disease and will require subsequent surgery. This seminar will use a case-based approach to evaluate and discuss the common problems and difficulties that are seen by the revision surgeon. In the process of dissecting surgical situations that require revision, the panelists will discuss strategies to avoid
WEDNESDAY
0.01). Mucosal inflammation encountered during surgery was associated with a higher incidence of postoperative otorrhea (14% vs. 2%, P ⬍ 0.05). The incidence of moist debris was statistically higher in patients with canal wall down procedures (20% vs. 1%, P ⬍ 0.01). CONCLUSIONS: Overall, 17% of patient developed recurrence. Canal wall down procedures appear to have a lower incidence of recurrence but a higher rate of moist debris and myringitis. Middle ear inflammation is the only factor associated with an increased rate of postoperative otorrhea. Long-term follow-up should be the rule in cholesteatoma to detect recurrence.
P207