RESUMEN
PURPOSE: To assess the effectiveness of a variation of the Epley maneuver, which we have titled "Chair-based Abbreviated Repositioning maneuver (ChARM)", in solving cases of benign positional paroxysmal vertigo (BPPV) of the posterior canal. ChARM addresses multiple issues of highly overloaded medical centers that delay its due and timely resolution. For example it does not necessitate an examination bed/table and requires only a backed chair, and less than 3 min to be performed. In combination with a recently published abbreviated diagnostic maneuver it can solve BPPV cases within few minutes of single medical visit. METHODS: Patients being diagnosed with posterior BPPV by means of an abbreviated diagnostic maneuver were recruited. Immediately after diagnosis, a single attempt of ChARM was conducted. The patient was followed for 48 h and at 1 month after these procedures to assess the persistence of symptomatology. RESULTS: 124 patients were treated with ChARM immediately after diagnosis during their very first medical visit. 92 patients (74.2%) solved their symptomatology completely after a single attempt of ChARM. The absence of symptoms persisted during the 30 days of follow-up. DISCUSSION: ChARM showed high success rates in solving posterior BPPV. The entire diagnostic-treatment procedure takes less than 5 min to perform and may allow direct treatment of patients, thereby avoiding unnecessary referrals or full vestibular testing. These abbreviated tools may be particularly useful in primary care settings or heavily overloaded otolaryngology or neurology departments.
Asunto(s)
Vértigo Posicional Paroxístico Benigno , Posicionamiento del Paciente/métodos , Vértigo Posicional Paroxístico Benigno/diagnóstico , Vértigo Posicional Paroxístico Benigno/fisiopatología , Vértigo Posicional Paroxístico Benigno/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nistagmo Fisiológico , Factores de Tiempo , Resultado del TratamientoRESUMEN
HYPOTHESIS: Based on a three-dimensional analysis, the orientation of the basal turn of the cochlea, the disposition of the basilar membrane, and the characteristics of the hook region--all of which determine the ideal electrode insertion vector during cochlear implantation--might vary among individuals to a greater degree than previously considered. The aim of this study is to assess the variability of an ideal insertion vector among a sample of surgical candidates from a purely anatomical perspective as well as from a more intraoperative-surgical perspective. BACKGROUND: During cochlear implantation through a cochleostomy or round window approach, the angle or vector of insertion after the first entry point seems to be related to intracochlear damage, which might correlate with anatomical and functional features. METHODS: Three-dimensional reconstructions of the temporal bones of 50 cochlear implant candidates (a total of 100 ears) were assessed. The spatial orientation of an ideal insertion vector for a cochleostomy and a round window approach were estimated. RESULTS: A difference as great as 60 degrees was observed for an ideal insertion vector among the subjects. From an intraoperative perspective, this variability involves pushing the electrodes "as near to the buttress" or "as near to the emergence of the corda tympani" as possible, depending on the case. CONCLUSION: The orientation of the basal turn and the corresponding ideal electrode insertion vector vary widely among subjects. A proper preoperative estimation on a case-to-case scenario for this feature might lead to technique adaptation during insertion, possibly contributing to minimizing electrode insertion trauma and thus optimizing the anatomical and functional results.