Video-oculography in detecting refixation saccades

OtolaryngologyHead and Neck Surgery Volume 121 Number 2

demanded surgical correction (decreasing) of the level of the inferior turbinate bone until the airflow at inspiration shifted to the median nasal passage, with corresponding recovery of the protective function of the nose. The low position of the fundus of the nasal vestibule detected in 36 patients and also causing the "down-fall" of the airflow into the inferior nasal passage also resulted in its overload with seasonal rhinitis. It was necessary to perform surgical correction and raise the fundus of the nasal vestibule until the shift of the airflow into the median nasal passage was level, which also repaired the protective function of the nose with disappearance of seasonal rhinitis in these patients. Conclusion: (1) Appearance of regular seasonal rhinitis, despite the presence of the "physiological bridge," is indicative of impaired protective function of nasal aerodynamics. (2) Exposure of the inferior nasal passage to inspiration raises its sensitivity to overloads in the fall and winter, thus programming its role of the trigger of acute seasonal rhinitis. (3) The even distribution of airflows between the inferior and median nasal passages is a sufficient overload for the inferior nasal passage in the fall and winter. (4) The excessively high situation of the physiological bridge causes the "down-fall" of the airflow at inspiration into the inferior nasal passage, which results in its overload and seasonal rhinitis. In such cases, tO protect the inferior nasal passage from overloads, it is necessary to surgically shift the inferior turbinate bone downwards with supplementary correction (when appropriate) of the physiological bridge until the airflow at inspiration is shifted to the median nasal passage. (5) The extremely low situation of the fundus of the nasal vestibule, even when the physiological bridge is present, causes the "down-fall" Of the airflow at inspiration into the inferior nasal passage, which results in its overload and seasonal rhinitis. In such cases, to protect the inferior nasal passage from overloads, surgical raising of the fundus of the nasal vestibule is indicated until the main airflow is shifted into the median nasal passage. (6) The inferior nasal passage needs protection from the main airflow at inspiration (ie, protection from inspiration). 13 Video-Oculography in Detecting Refixation Saccades T~MO P HIRVONEN MD; HEIKK)AALTO PHD; ERNA KENTALA MD; Helsinki Finland

Objectives: The vestibulo-ocular reflex (VOR) produces compensatory eye movements during head movements. If the VOR is deficient, gaze stability can be preserved by other mechanisms. Refixation saccades have been found in patients with unilateral vestibular loss during head movements toward the lesioned side. The purpose of the study was to evaluate the occurrence of refixation saccades by using video-oculography (VOG) during head impulse test. Methods: Six patients with unilateral vestibular lesions

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were measured with a commercial VOG. Manual head impulses of moderate acceleration up to 1000 degrees/second 2, a velocity up to 100 degrees/second, and an amplitude of 10 degrees were delivered horizontally approximately 8 times toward each side. The head impulse recording was visually inspected to find out refixation saccades. At least 3 impulses containing refixation saccades were required for a positive test. Results: Refixation saccades were found in 3 of 6 patients. One had acute vestibular neuronitis, the other had Meniere's disease (MD) and was treated with gentamicin 3 weeks earlier, and the third had been operated on for a vestibular schwannoma. Negative test results were found in 2 patients with MD and in 1 patient with unilateral caloric weakness. Conclusion: By using low-acceleration, manual, and nonstandardized head impulses, we were able to find re fixation saccades in half of our patients. This warrants further study with standardized, higher acceleration, machine-driven impulses and an automatic identification of saccades. 14 Persistent Tinnitus after Sudden Deafness: A Rationale for Treatment TANIT GANZ SANCHEZ MD; FABIO AJIMURA MD; RICARDO FERREIRA BENTO MD PHD; ROSELI SARAIVA MOREtRA BII-[AR MD; Sao Paulo Brazil

Objectives: The early treatment for sudden deafness aims to reestablish the auditory thresholds. Tinnitus is usually a secondary concern, but sometimes it may remain as the main complaint. The objective of the study was to evaluate the effect of intravenous lidocaine in patient s with persistent tinnitus after the treatment of sudden deafness andthe efficacy of its substitution for oral carbamazepine as a long-term treatment. Methods: Twenty-four patients with previous sudden deafness who remained with persistent tinnitus were evaluated (15 females and 9 males; mean age = 44.95 years) and classified as having mild, moderate, or severe tinnitus. All patients first underwent a test with an intravenous injection of 2% lidocaine (1 mg/kg in 3 minutes) in a quite chamber for easy perception of tinnitus changes. Results were classified into abolition, improvement, unchanged, and worsened. Patients with favorable results (abolition + improvement) started oral carbamazepine for 2 months (100 to 600 mg/day), and the new results were classified as for lidocaine. Results: Tinnitus was mild in 2 cases, moderate in 8, and severe in 14. Intravenous lidocaine presented favorable results in 83.3% of cases of persistent tinnitus due to sudden deafness (6 cases with abolition and 14 with improvement). Among the 14 cases with severe tinnitus, 12 had favorable results (85.7%), as well as 7 of 8 with moderate tinnitus (88.8%). With carbamazepine, 5 of 6 patients with tinnitus abolition after lidocaine used oral carbamazepine, and 4 presented