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Vanni S, Nazerian P, Pecci R, Pepe G, Pavellini A, Casula C, de Curtis E, Ronchetti M, Vannucchi P, Bartolucci M, Vanni S, Casula C, Soldati V, Matteucci ML, Gargano U, Mirenda F, Nazerian P, Ottaviani M, Rocchetti M, Caviglioli C, Pavellini A, Vannucchi P, Pecci R, Pepe G, de Curtis E, Baldini A, Magazzini S, Sampieri A, Bartolucci M. Timing for nystagmus evaluation by STANDING or HINTS in patients with vertigo/dizziness in the emergency department. Acad Emerg Med 2022; 30:592-594. [PMID: 36448574 DOI: 10.1111/acem.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rudi Pecci
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Pepe
- Department of Emergency Medicine, Azienda USL Nord-Ovest, Viareggio, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Claudia Casula
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Ersilia de Curtis
- Department of Emergency Medicine, Azienda USL Toscana Centro, Prato, Italy
| | - Mattia Ronchetti
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Vannucchi
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Giannoni B, Pollastri F, Adembri C, Straticò D, Vannucchi P, Stival A, Checcucci C, Bruno C, Pecci R. Hearing outcomes and patient satisfaction after stapes surgery: local versus general anaesthesia. Acta Otorhinolaryngol Ital 2022; 42:471-480. [PMID: 36541385 PMCID: PMC9793144 DOI: 10.14639/0392-100x-n2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
Objective Otosclerosis is a frequent ear disorder causing a stapedo-ovalar ankylosis and conductive hearing loss. Stapedoplasty, performed under both general (GA) and local anaesthesia (LA), is the most advisable surgical solution. Auditory recovery relies on the patient's conditions and on the intervention itself. The aim of our work was to compare hearing outcomes with stapedoplasty performed under GA or LA and to investigate patients' compliance to both methods. Methods Fifty-five otosclerotic patients underwent stapedoplasty both under GA (32/55) and LA (23/55). Pre- and post-operative air and bone tone audiometry threshold values as well as the air-bone gap and its closure score, were analysed. All patients filled in a satisfaction questionnaire regarding their concern and level of appreciation of the type of anaesthesia. Results and conclusions Our data show that the auditory results with stapedoplasty are good and do not differ between LA and GA. Even considering the advantages and limits of the two methods, one cannot favour one or the other type of anaesthesia. Finally, the patient's satisfaction cannot be considered a criterion of choice, since this was found to be high in both cases.
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Affiliation(s)
- Beatrice Giannoni
- Unit of Audiology, Careggi University Hospital, Florence, Italy, Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Florence, Italy,Correspondence Beatrice Giannoni Unit of Audiology, Careggi University Hospital, Florence, Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, viale Gaetano Pieraccini 6, 50139 Florence, Italy Tel. +39 055 7948154 E-mail:
| | - Federica Pollastri
- Unit of Audiology, Careggi University Hospital, Florence, Italy, Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Florence, Italy
| | - Chiara Adembri
- Department of Experimental and Clinical Medicine, Unit of Anesthesiology, University of Florence, Italy
| | - Dina Straticò
- Unit of Audiology, Careggi University Hospital, Florence, Italy
| | - Paolo Vannucchi
- Unit of Audiology, Careggi University Hospital, Florence, Italy
| | - Alessia Stival
- Unit of Audiology, Careggi University Hospital, Florence, Italy
| | - Curzio Checcucci
- Department of Physycs and Astronomy, University of Florence, Italy
| | - Chiara Bruno
- Unit of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Rudi Pecci
- Unit of Audiology, Careggi University Hospital, Florence, Italy
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3
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Pecci R, Mandalà M, Marcari A, Bertolai R, Vannucchi P, Santimone R, Bentivegna L, Di Giustino F, Mengucci A, Vanni S, Pollastri F, Giannoni B. Vitamin D Insufficiency/Deficiency in Patients with Recurrent Benign Paroxysmal Positional Vertigo. J Int Adv Otol 2022; 18:158-166. [PMID: 35418365 PMCID: PMC9624169 DOI: 10.5152/iao.2022.21269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study is to verify if (1) there is a link between hypovitaminosis D and benign paroxysmal positional vertigo, (2) the number of benign paroxysmal positional vertigo relapses decreases after vitamin D supplementation; and (3) benign paroxysmal positional vertigo response to physical therapy improves after hypovitaminosis D correction. Methods: We enrolled 26 patients with benign paroxysmal positional vertigo and 24 subjects, who never suffered from vertigo, as a control group. All benign paroxysmal positional vertigo patients underwent physical therapy, once a week, until benign paroxysmal positional vertigo resolution. All participants were subjected to a dosage of serum 25(OH) vitamin D. In patients with hypovitaminosis D, we prescribed cholecalciferol. After 3 months of therapy, all patients were asked to undergo a second dosage of serum 25(OH) vitamin D. For each patient, we counted the number of maneuvers required to resolve each episode of benign paroxysmal positional vertigo before and after vitamin D supplementation. Results: At T0, both patients and controls had insufficient average vitamin D serum levels (23.18 and 23.73 ng/ml) without significant differences between groups (p 0.16). However, the percentage of patients who had a serum vitamin D deficiency before supplementation was higher than that of the control group (65.39% and 33.3%). The latter finding was statistically significant with a P = 0.002. Before integration 100% of patients had a recurrent BPPV (average number of recurrences/pt: 9.31) while after supplementation only 5/16 pts (31.25%) had just 1 recurrence (average number of relapses/pt 0.31, P = 0.0003). The average number of maneuvers before and after supplementation was 1.37 and 1.0 respectively (P = 0.6543). Conclusion: Our results suggest that (1) there is a relationship between vitamin D deficiency and the onset of BPPV, (2) hypovitaminosis correction is able to reduce both the number of patients relapsing and the number of relapses per patient, and (3) we have not found a significant effect of vitamin D supplementation as regards the responsivity of benign paroxysmal positional vertigo to physical therapy.
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Affiliation(s)
- Rudi Pecci
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
- Corresponding author: Rudi Pecci, e-mail:
| | - Marco Mandalà
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonella Marcari
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Roberto Bertolai
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Italy
| | - Paolo Vannucchi
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Rossana Santimone
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Lisa Bentivegna
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Fabio Di Giustino
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Arianna Mengucci
- Department of Oncology and Robotic Surgery, Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Federica Pollastri
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Italy
| | - Beatrice Giannoni
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Italy
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Pollastri F, Pecci R, Pellegrini E, Vannucchi P, Taverna C, Giannoni B. Late onset middle ear neuroendocrine tumor presenting with distant metastasis. Otolaryngology Case Reports 2021. [DOI: 10.1016/j.xocr.2021.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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Mandalà M, Califano L, Casani AP, Faralli M, Marcelli V, Neri G, Pecci R, Scasso F, Scotto di Santillo L, Vannucchi P, Giannoni B, Dasgupta S, Bindi I, Salerni L, Nuti D. Double-Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo. Laryngoscope 2020; 131:E1296-E1300. [PMID: 32822510 DOI: 10.1002/lary.28981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP). STUDY DESIGN Double-blind, randomized controlled trial. METHODS Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. RESULTS Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P < .0001) in the total sample, 76.9% versus 11.3% (P < .0001) in the geotropic variant group, and 60.5% versus 17.6% (P = .0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant. CONCLUSIONS FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC-BPPV into a strong one. LEVEL OF EVIDENCE 2 Laryngoscope, 131:E1296-E1300, 2021.
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Affiliation(s)
- Marco Mandalà
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luigi Califano
- Audiology and Phoniatrics Unit, Ospedale G. Rummo, Benevento, Italy
| | - Augusto Pietro Casani
- Department of Neuroscience, Otorhinolaryngology Unit, University of Pisa, Pisa, Italy
| | - Mario Faralli
- ENT Department, University of Perugia, Perugia, Italy
| | | | - Giampiero Neri
- Department of Neuroscience, Imaging and Clinical Sciences, Otorhinolaryngology Unit, University of Chieti, Chieti, Italy
| | - Rudi Pecci
- Department of Oto-Neuro-Ophthalmology, Audiology Unit, University of Florence, Florence, Italy
| | | | | | - Paolo Vannucchi
- Department of Oto-Neuro-Ophthalmology, Audiology Unit, University of Florence, Florence, Italy
| | - Beatrice Giannoni
- Department of Oto-Neuro-Ophthalmology, Audiology Unit, University of Florence, Florence, Italy
| | - Soumit Dasgupta
- Department of Audiovestibular Medicine and Neurotology, Alder Hey Children's Hospital NHS Trust, Liverpool, United Kingdom.,Sheffield Vertigo and Balance Centre, Sheffield, United Kingdom
| | - Ilaria Bindi
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Lorenzo Salerni
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Daniele Nuti
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani AP, Espinosa-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Corrigendum: Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects. Front Neurol 2020; 10:1374. [PMID: 32038457 PMCID: PMC6992644 DOI: 10.3389/fneur.2019.01374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roberto Teggi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Giacinto Asprella Libonati
- U. O. S. D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain.,Skull Base Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Augusto P Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Juan Manuel Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Nuti
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Russo
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
| | - Eduardo Martin-Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricardo Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre, University of Parma, Parma, Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Mario Bussi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
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7
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DI Giustino F, Vannucchi P, Pecci R, Mengucci A, Santimone R, Giannoni B. Bone-anchored hearing implant surgery: our experience with linear incision and punch techniques. ACTA ACUST UNITED AC 2019; 38:257-263. [PMID: 29984803 DOI: 10.14639/0392-100x-1694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 12/12/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY In recent years, bone-anchored hearing implants (BAHIs) have found wider application in the treatment of conductive and mixed hearing loss. Several surgical techniques have been developed to reduce complications, enhance healing and improve audiological and aesthetic results. We report our experience on the use of three BAHI surgery techniques: Group 1, linear incision with thinning of the subcutaneous tissue; Group 2, linear incision without thinning of the subcutaneous tissue; Group 3, punch technique (Minimally Invasive Ponto Surgery, MIPS). We retrospectively analysed patients undergoing BAHI surgery; results were evaluated on the basis of any intra-operative complication, duration of surgery and occurrence of adverse effects at the implantation site over 1 year of follow-up. We collected a total of 30 implantations (12 for Group 1, 8 for Group 2, 10 for Group 3) with an intra-operative complication rate of 25%, 0% and 10%, respectively. The average surgical time was 62.08 minutes, 34.37 minutes and 18.7 minutes respectively. During follow-up, we reported the occurrence of adverse effects in 10.63% of observations in Group 1, 3.12% in Group 2 and 2.5% in Group 3. This study confirms the low rate of intra and postoperative complications during BAHI surgery and documents the simplicity of execution of the novel MIPS technique, with a significant reduction in surgical time compared to the other two techniques, and positive effects in terms of health care costs.
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Affiliation(s)
- F DI Giustino
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - P Vannucchi
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - R Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Mengucci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - R Santimone
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - B Giannoni
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
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8
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani AP, Espinosa-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects. Front Neurol 2018; 9:395. [PMID: 29922214 PMCID: PMC5996089 DOI: 10.3389/fneur.2018.00395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 05/14/2018] [Indexed: 01/03/2023] Open
Abstract
Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.
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Affiliation(s)
- Roberto Teggi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Giacinto Asprella Libonati
- U. O. S. D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain.,Skull Base Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Augusto P Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Juan Manuel Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Nuti
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Russo
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
| | - Eduardo Martin-Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricardo Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre, University of Parma, Parma, Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Mario Bussi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
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9
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani A, Espinoza-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects. Headache 2017; 58:534-544. [DOI: 10.1111/head.13240] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/18/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Roberto Teggi
- ENT Department; San Raffaele Scientific Hospital; Milan Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology; San Raffaele Scientific Hospital; Milan Italy
| | - Roberto Albera
- Dipartimento di Scienze; Chirurgiche Università di Torino; Turin Italy
| | - Giacinto Asprella Libonati
- U.O.S.D. “Vestibologia e Otorinolaringoiatria” Presidio Ospedaliero “Giovanni Paolo II,”; Policoro MT Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili; University of Brescia; Brescia Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain; Skull Base Unit, Department of Otorhinolaryngology; University Hospital of Salamanca, IBSAL; Salamanca Spain
| | - Augusto Casani
- Department of Otorhinolaryngology-Pisa University Medical School Otorhinolaryngology; Pisa University Medical School; Pisa Italy
| | - Juan Manuel Espinoza-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO); Pfizer-University of Granada-Junta de Andalucia; Granada Spain
- Department of Otolaryngology; Hospital San Agustin; Linares Jaen Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery; Poliambulanza Foundation Hospital; Brescia Italy
| | - Jose A. Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research; Pfizer/University of Granada/Junta de Andalucia, PTS; Granada Spain
- Division of Otoneurology; Department of Otolaryngology, Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Sergio Lucisano
- Dipartimento di Scienze; Chirurgiche Università di Torino; Turin Italy
| | - Marco Mandalà
- Otology and Skull Base Unit; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences; University of Chieti-Pescara; Chieti Italy
| | - Daniele Nuti
- Otology and Skull Base Unit; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Rudy Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital; University of Florence; Florence Italy
| | - Antonio Russo
- University of Campania Luigi Vanvitelli; Naples Italy
| | | | - Ricardo Sanz
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre; University of Parma; Parma Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital; University of Florence; Florence Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology; San Raffaele Scientific Hospital; Milan Italy
| | - Mario Bussi
- ENT Department; San Raffaele Scientific Hospital; Milan Italy
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Berretti G, Colletti G, Parrinello G, Iavarone A, Vannucchi P, Deganello A. Pilot study on microvascular anastomosis: performance and future educational prospects. Acta Otorhinolaryngol Ital 2017; 38:304-309. [PMID: 29187756 PMCID: PMC6146574 DOI: 10.14639/0392-100x-1583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022]
Abstract
The introduction of microvascular free flaps has revolutionised modern reconstructive surgery. Unfortunately, access to training opportunities at standardised training courses is limited and expensive. We designed a pilot study on microvascular anastomoses with the aim of verifying if a short course, easily reproducible, could transmit microvascular skills to participants; if the chosen pre-test was predictive of final performance; and if age could influence the outcome. A total of 30 participants (10 students, 10 residents and 10 surgeons) without any previous microvascular experience were instructed and tested during a single 3 to 5 hour course. The two microanastomoses evaluated were the first ever performed by each participant. More than the half of the cohort was able to produce both patent microanastomoses in less than 2 hours; two-thirds of the attempted microanastomoses were patent. The pretest predicted decent scores from poor performances with a sensitivity of 61.5%, specificity of 100%, positive predictive value of 100% and negative predictive value of 40%. Students and residents obtained significantly higher scores than surgeons. Since our course model is short, cost-effective and highly reproducible, it could be introduced and implemented anywhere as an educational prospect for preselecting young residents showing talent and natural predisposition and having ambitions towards microvascular reconstructive surgery.
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Affiliation(s)
- G Berretti
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - G Colletti
- Maxillofacial Surgery, San Paolo Hospital, University of Milan, Italy
| | - G Parrinello
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Iavarone
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - P Vannucchi
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Deganello
- Department of Surgery and Translational Medicine, University of Florence, Italy
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Vanni S, Pecci R, Edlow JA, Nazerian P, Santimone R, Pepe G, Moretti M, Pavellini A, Caviglioli C, Casula C, Bigiarini S, Vannucchi P, Grifoni S. Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Front Neurol 2017; 8:590. [PMID: 29163350 PMCID: PMC5682038 DOI: 10.3389/fneur.2017.00590] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/23/2017] [Indexed: 12/05/2022] Open
Abstract
Objective We investigated the reliability and accuracy of a bedside diagnostic algorithm for patients presenting with vertigo/unsteadiness to the emergency department. Methods We enrolled consecutive adult patients presenting with vertigo/unsteadiness at a tertiary hospital. STANDING, the acronym for the four-step algorithm we have previously described, based on nystagmus observation and well-known diagnostic maneuvers includes (1) the discrimination between SponTAneous and positional nystagmus, (2) the evaluation of the Nystagmus Direction, (3) the head Impulse test, and (4) the evaluation of equilibrium (staNdinG). Reliability of each step was analyzed by Fleiss’ K calculation. The reference standard (central vertigo) was a composite of brain disease including stroke, demyelinating disease, neoplasm, or other brain disease diagnosed by initial imaging or during 3-month follow-up. Results Three hundred and fifty-two patients were included. The incidence of central vertigo was 11.4% [95% confidence interval (CI) 8.2–15.2%]. The leading cause was ischemic stroke (70%). The STANDING showed a good reliability (overall Fleiss K 0.83), the second step showing the highest (0.95), and the third step the lowest (0.74) agreement. The overall accuracy of the algorithm was 88% (95% CI 85–88%), showing high sensitivity (95%, 95% CI 83–99%) and specificity (87%, 95% CI 85–87%), very high-negative predictive value (99%, 95% CI 97–100%), and a positive predictive value of 48% (95% CI 41–50%) for central vertigo. Conclusion Using the STANDING algorithm, non-sub-specialists achieved good reliability and high accuracy in excluding stroke and other threatening causes of vertigo/unsteadiness.
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Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Rudi Pecci
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Jonathan A Edlow
- Department of Emergency Medicine, BIDMC, Boston, MA, United States
| | - Peiman Nazerian
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Rossana Santimone
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Giuseppe Pepe
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Marco Moretti
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Cosimo Caviglioli
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Claudia Casula
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Sofia Bigiarini
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Paolo Vannucchi
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
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Johansson ML, Stokroos RJ, Banga R, Hol MK, Mylanus EA, Savage Jones H, Tysome JR, Vannucchi P, Hof JR, Brunings JW, van Tongeren J, Lutgert RW, Banerjee A, Windfuhr JP, Caruso A, Giannuzzi AL, Bordin S, Hanif J, Schart-Morén N, Singam S, Jonhede S, Holmberg M, Cremers CW, Hultcrantz M. Short-term results from seventy-six patients receiving a bone-anchored hearing implant installed with a novel minimally invasive surgery technique. Clin Otolaryngol 2017; 42:1043-1048. [PMID: 27930877 DOI: 10.1111/coa.12803] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M L Johansson
- Oticon Medical AB, Askim, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R J Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - R Banga
- Queen Elizabeth Hospital, Birmingham, UK
| | - M K Hol
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A Mylanus
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J R Tysome
- Department of Skull Base Surgery, Addenbrookes Hospital, Cambridge University Teaching Hospitals NHS Trust, Cambridge, UK
| | - P Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - J R Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J W Brunings
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J van Tongeren
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - A Banerjee
- Department of Otolaryngology, James Cook University Hospital, Middlesbrough, UK
| | - J P Windfuhr
- Department of Otolaryngology, Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - A Caruso
- Gruppo Otologico, Piacenza, Italy
| | | | - S Bordin
- Venice International Otolaryngology Network, Venice, Italy
| | - J Hanif
- Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - N Schart-Morén
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - S Singam
- Department of ENT and Audiology, Torbay Hospital, Devon, UK
| | | | | | - C W Cremers
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Hultcrantz
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
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Di Giustino F, Pecci R, Vannucchi P. Vestibular schwannoma diagnosis: evaluation of a neuro-otological test battery. Hearing, Balance and Communication 2016. [DOI: 10.1080/21695717.2016.1239340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fabio Di Giustino
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Rudi Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Paolo Vannucchi
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Vanni S, Vannucchi P, Modesti PA. Vertigo: Dr Jekyll or Mr Hyde? A video tutorial for assessment of nystagmus in the emergency room. Intern Emerg Med 2016; 11:1041-1043. [PMID: 27650537 DOI: 10.1007/s11739-016-1544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Vanni
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Paolo Vannucchi
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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Dal Pozzo G, Mascalchi M, Fonda C, Olmastroni M, Pandolfo C, Vannucchi P, Pagnini P. Utilità del Gadolinio-DTPA nello studio RM dei neurinomi dell'acustico. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099200500203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sono stati esaminati con RM a media intensità di campo, prima e dopo somministrazione endovenosa di Gadolinio-DTPA, 18 pazienti con neurinoma del nervo acustico verificato chirurgicamente. In 14 pazienti con neurinoma a sviluppo intra ed extra-canalare l'esame RM diretto ha permesso di identificare la lesione e le sequenze Spin-Echo dipendenti dal tempo di rilassamento Tl si sono dimostrate le più utili a tal fine. In questi pazienti il Gadolinio-DTPA ha permesso una migliore delineazione dei rapporti topografici della lesione con le strutture troncoencefaliche e della fossa cranica posteriore. Nei rimanenti quattro pazienti, con neurinoma strettamente intracanalare, solo l'esame dopo somministrazione del mezzo di contrasto paramagnetico ha permesso di dimostrare inequivocabilmente il neurinoma sotto forma di una lesione ad elevata intensità di segnale all'interno del condotto uditivo interno. Questi risultati suggeriscono un ruolo fondamentale del Gadolinio-DTPA nella valutazione con RM di pazienti con sospetto neurinoma dell'acustico. Solo dopo la somministrazione del contrasto è infatti possibile ottenere un preciso bilancio spaziale della lesione e soprattutto concludere circa la presenza o meno di neurinomi esclusivamente intracanalari.
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Affiliation(s)
| | | | | | | | | | - P. Vannucchi
- Istituto di Audiologia, Università degli studi di Firenze
| | - P. Pagnini
- Istituto di Audiologia, Università degli studi di Firenze
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Vannucchi P, Pecci R, Giannoni B, Di Giustino F, Santimone R, Mengucci A. Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations. Audiol Res 2015; 5:130. [PMID: 26557364 PMCID: PMC4627115 DOI: 10.4081/audiores.2015.130] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 11/23/2022] Open
Abstract
We lately reported the cases of patients complaining positional vertigo whose nystagmic pattern was that of a peripheral torsional vertical positional down beating nystagmus originating from a lithiasis of the non-ampullary arm of the posterior semicircular canal (PSC). We considered this particular pathological picture the apogeotropic variant of PSC benign paroxysmal positional vertigo (BPPV). Since the description of the pilot cases we observed more than 150 patients showing the same clinical sign and course of symptoms. In this paper we describe, in detail, both nystagmus of apogeotropic PSC BPPV (A-PSC BPPV) and symptoms reported by patients trying to give a reasonable explanation for these clinical features. Moreover we developed two specific physical therapies directed to cure A-PSC BPPV. Preliminary results of these techniques are related.
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Affiliation(s)
- Paolo Vannucchi
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
| | - Rudi Pecci
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
| | - Beatrice Giannoni
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
| | - Fabio Di Giustino
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
| | - Rossana Santimone
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
| | - Arianna Mengucci
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Florence , Italy
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Vanni S, Nazerian P, Casati C, Moroni F, Risso M, Ottaviani M, Pecci R, Pepe G, Vannucchi P, Grifoni S. Can emergency physicians accurately and reliably assess acute vertigo in the emergency department? Emerg Med Australas 2015; 27:126-31. [PMID: 25756710 DOI: 10.1111/1742-6723.12372] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To validate a clinical diagnostic tool, used by emergency physicians (EPs), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool. METHODS A convenience sample of adult patients presenting to a single academic ED with isolated vertigo (i.e. vertigo without other neurological deficits) was prospectively evaluated with STANDING (SponTAneousNystagmus, Direction, head Impulse test, standiNG) by five trained EPs. The first step focused on the presence of spontaneous nystagmus, the second on the direction of nystagmus, the third on head impulse test and the fourth on gait. The local standard practice, senior audiologist evaluation corroborated by neuroimaging when deemed appropriate, was considered the reference standard. Sensitivity and specificity of STANDING were calculated. On the first 30 patients, inter-observer agreement among EPs was also assessed. RESULTS Five EPs with limited experience in nystagmus assessment volunteered to participate in the present study enrolling 98 patients. Their average evaluation time was 9.9 ± 2.8 min (range 6-17). Central acute vertigo was suspected in 16 (16.3%) patients. There were 13 true positives, three false positives, 81 true negatives and one false negative, with a high sensitivity (92.9%, 95% CI 70-100%) and specificity (96.4%, 95% CI 93-38%) for central acute vertigo according to senior audiologist evaluation. The Cohen's kappas of the first, second, third and fourth steps of the STANDING were 0.86, 0.93, 0.73 and 0.78, respectively. The whole test showed a good inter-observer agreement (k = 0.76, 95% CI 0.45-1). CONCLUSIONS In the hands of EPs, STANDING showed a good inter-observer agreement and accuracy validated against the local standard of care.
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Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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Harris R, Sakaguchi A, Petronotis K, Baxter A, Berg R, Burkett A, Charpentier D, Choi J, Diz Ferreiro P, Hamahashi M, Hashimoto Y, Heydolph K, Jovane L, Kastner M, Kurz W, Kutterolf S, Li Y, Malinverno A, Martin K, Millan C, Nascimento D, Saito S, Sandoval Gutierrez M, Screaton E, Smith-Duque C, Solomon E, Straub S, Tanikawa W, Torres M, Uchimura H, Vannucchi P, Yamamoto Y, Yan Q, Zhao X. Expedition 344 summary. Proceedings of the IODP 2013. [DOI: 10.2204/iodp.proc.344.101.2013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Harris R, Sakaguchi A, Petronotis K, Baxter A, Berg R, Burkett A, Charpentier D, Choi J, Diz Ferreiro P, Hamahashi M, Hashimoto Y, Heydolph K, Jovane L, Kastner M, Kurz W, Kutterolf S, Li Y, Malinverno A, Martin K, Millan C, Nascimento D, Saito S, Sandoval Gutierrez M, Screaton E, Smith-Duque C, Solomon E, Straub S, Tanikawa W, Torres M, Uchimura H, Vannucchi P, Yamamoto Y, Yan Q, Zhao X. Upper slope Site U1413. ACTA ACUST UNITED AC 2013. [DOI: 10.2204/iodp.proc.344.107.2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Harris R, Sakaguchi A, Petronotis K, Baxter A, Berg R, Burkett A, Charpentier D, Choi J, Diz Ferreiro P, Hamahashi M, Hashimoto Y, Heydolph K, Jovane L, Kastner M, Kurz W, Kutterolf S, Li Y, Malinverno A, Martin K, Millan C, Nascimento D, Saito S, Sandoval Gutierrez M, Screaton E, Smith-Duque C, Solomon E, Straub S, Tanikawa W, Torres M, Uchimura H, Vannucchi P, Yamamoto Y, Yan Q, Zhao X. Input Site U1381. Proceedings of the IODP 2013. [DOI: 10.2204/iodp.proc.344.103.2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Harris R, Sakaguchi A, Petronotis K, Baxter A, Berg R, Burkett A, Charpentier D, Choi J, Diz Ferreiro P, Hamahashi M, Hashimoto Y, Heydolph K, Jovane L, Kastner M, Kurz W, Kutterolf S, Li Y, Malinverno A, Martin K, Millan C, Nascimento D, Saito S, Sandoval Gutierrez M, Screaton E, Smith-Duque C, Solomon E, Straub S, Tanikawa W, Torres M, Uchimura H, Vannucchi P, Yamamoto Y, Yan Q, Zhao X. Input Site U1414. Proceedings of the IODP 2013. [DOI: 10.2204/iodp.proc.344.104.2013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mandalà M, Pepponi E, Santoro GP, Cambi J, Casani A, Faralli M, Giannoni B, Gufoni M, Marcelli V, Trabalzini F, Vannucchi P, Nuti D. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope 2013; 123:1782-6. [PMID: 23382081 DOI: 10.1002/lary.23918] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the Gufoni liberatory maneuver (GLM). STUDY DESIGN Double-blind randomized controlled trial. METHODS Seventy-two patients with unilateral LC-BPPV were recruited for a multicentric study. Patients were randomly assigned to treatment by GLM (n = 37) or sham treatment (n = 35). Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners. RESULTS At 1- and 24-hour follow-up, 75.7% and 83.8% of patients, respectively, undergoing GLM had recovered from vertigo, compared to around 10% of patients undergoing the sham maneuver (P < 0.0001). CONCLUSION To the best of our knowledge, this is the first class I study on the efficacy of the GLM in the treatment of LC-BPPV in both geotropic and apogeotropic forms. GLM proved highly effective compared to the sham maneuver (P < 0.0001). The present class I study of the efficacy of the GLM changes the level of recommendation of the method for treating LC-BPPV from level U to level B for the geotropic variant and from level B to level A for the apogeotropic variant of LC-BPPV.
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Affiliation(s)
- Marco Mandalà
- Dipartimento di Scienze neurologiche e sensoriali, Università di Siena, Siena.
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Mandalà M, Santoro GP, Asprella Libonati G, Casani AP, Faralli M, Giannoni B, Gufoni M, Marcelli V, Marchetti P, Pepponi E, Vannucchi P, Nuti D. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 2011; 259:882-5. [DOI: 10.1007/s00415-011-6272-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 09/29/2011] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To study the pathophysiology of lateral semicircular canal (LSC) paroxysmal positional vertigo (PPV). STUDY DESIGN Retrospective study. METHODS Between June 2004 and June 2005 we observed 471 patients with PPV. In the apogeotropic forms of LSC-PPV, we tried to transform the nystagmus into the geotropic form, either by diagnostic or therapeutic menoeuvres. If we failed, we advised barbecue rotations toward the healthy side and sleeping on the affected side. Patients were evaluated once a week until resolution. RESULTS 91 patients suffered LSC involvement, in 61 cases in the geotropic form and in 30 cases in the apogeotropic form. Out of these, five transformed into the geotropic form during the first examination; in 5 patients we observed geotropic nystagmus at the follow-up visit; the last 20 never showed geotropic nystagmus before resolution. CONCLUSION We hypothesize that in the geotropic form the debris is free floating in the posterior arm of the LSC (canalolithiasis). In the apogeotropic form the debris can be free floating in the anterior arm or attached to the cupula of the ampulla; if we observe transformation from the apogeotropic into the geotropic form this suggested a canalolithiasis, otherwise we have assumed a cupulolithiasis.
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Affiliation(s)
- Paolo Vannucchi
- Department of Surgical Sciences, Oto-Neuro-Ophthalmology - Service of Audiology, University of Florence, Italy.
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25
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26
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27
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28
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29
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Vannucchi P. [Vertical and/or horizontal subjective visual]. Acta Otorhinolaryngol Ital 2003; 23:74-9. [PMID: 15108505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- P Vannucchi
- Dipartimento di Scienze Chirurgiche Oto-Neuro-Oftalmologiche, Università di Firenze
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30
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Pagnini P, Verrecchia L, Giannoni B, Vannucchi P. [Migraine-related vertigo (MV)]. Acta Otorhinolaryngol Ital 2003; 23:19-27. [PMID: 15108496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- P Pagnini
- Dipartimento di Scienze Chirurgiche Otoneuroftalmologiche, Sezione di Audiologia, Università di Firenze
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31
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Abstract
Middle ear adenoma (MEA) is a rare tumor postulated to take origin from the lining epithelium of the middle ear cavity. The authors report on a case of MEA arising in a 53-year old woman suffering from a sensation of fullness in her left ear, otalgia, and light left-sided hearing loss. Histopathologically, the lesion was composed of cuboidal and polygonal cells displaying a trabecular, tubulo-glandular, and solid pattern of growth. Immunohistochemically, neoplastic cells diffusely stained with anti-vimentin antibodies and were focally positive for chromogranin A, neuron-specific enolase, lysozyme, and cytokeratins AE1/AE3. The majority of tumor cells showed weak and diffuse staining with both anti-PP and anti-ACTH antibodies and intense positivity with anti-glucagon and anti Leu-7 antibodies. Ultrastructural investigation revealed both mucinous-glandular and neuroendocrine differentiation. The authors suggest that the appropriate terminology would be adeno-carcinoid or amphicrine tumor of the middle ear rather than "adenoma," a term that does not reflect its dual nature.
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Affiliation(s)
- S Ketabchi
- Dipartimento di Patologia Umana ed Oncologia, Università degli Studi di Firenze, Italia
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32
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Giannoni B, Pagnini P, Vannucchi P. [Delayed endolymphatic hydrops]. Acta Otorhinolaryngol Ital 1998; 18:66-70. [PMID: 10205936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Delayed Endolymphatic Hydrops (DEH) is a disease entity that must be distinguished from idiopathic endolymphatic hydrops (Ménière's disease). Idiopathic hydrops is characterized by the following symptoms: 1) vertigo often accompanied by nausea and vomiting; 2) tinnitus; 3) hearing loss, usually fluctuating; and 4) sensation of pressure or fullness in the affected ear. Idiopathic hydrops most commonly occurs in middle-aged patients, usually between 30 and 50 years. It may involve one or both ears and usually exibits fluctuating hearing loss and episodic vertigo, although one symptom may precede the other by months or years. It is rare for Ménière's disease to present with a severe sensorineural hearing loss. Delayed Endolymphatic Hydrops was first described, under the name of "unilateral deafness with subsequent vertigo", by Wolfson and Lieberman and Nadol et al.; this was later confirmed by other authors. The disease is characterized by a profound sensorineural hearing loss in one ear, found to have been present in most cases from early childhood, due to an unknown cause, trauma or viral infections. After a prolonged period (usually many years) patients with DEH experience the onset of episodic vertigo from the deaf ear (Ipsilateral Delayed Endolymphatic Hydrops) or develop a fluctuating hearing loss and/or episodic vertigo in the opposite ear, previously with normal hearing (Controlateral Delayed Endolymphatic Hydrops). Vestibular symptoms are identical to those of Ménière's disease: in fact there is evidence that endolymphatic hydrops in the previously damaged ear or in the previously normal ear represents at least part of the labyrinthine pathology. Histopathology studies recently conducted on temporal bones of subjects affected with controlateral DEH show pathologic changes in the deaf ears similar to those found in viral labyrinthitis, whereas pathologic changes in the hearing ears resemble those known to occur in Ménière's disease. Medical treatment has not been found to be effective in patients with DEH, but it must be the first choice of treatment especially in controlateral forms of the disease. So far, surgical intervention has been demonstrated to give the best results; either conservative or more radical, depending on the type of DEH. Pharmacological labyrinthectomy with ototoxic drugs could be the therapy of choice in the future. In this paper we review the literature in order to summarize the clinical features and criteria for diagnosing DEH, we also report histopathologic findings and pathogenetic hypotheses formulated for this syndrome. Moreover, we discuss the best therapeutic approach for the ipsilateral and controlateral variants of DEH.
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Affiliation(s)
- B Giannoni
- Cattedra di Audiologia, Università degli Studi di Firenze
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33
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Abstract
We evaluated a new therapeutic maneuver-Prolonged Position on the healthy side, for Benign Paroxysmal Positional Vertigo (BPPV) of the horizontal semicircular canal. We devised this type of physical treatment in accordance with the “canalolithiasis” theory of BPPV, in order to try to free the horizontal semicircular canal of otoconial debris. We compared the results obtained by Prolonged Position with two other physical therapies by dividing our horizontal canal BPPV patients into three therapeutic groups: 1) 35 patients treated with Prolonged Position; 2) 24 patients treated with head shaking in a supine position; 3) 15 patients for whom therapy was omitted. More than 90% of the patients treated with Prolonged Position recovered within 3 days, although 6 patients out of 35 subsequently developed BPPV of the posterior semicircular canal, which then responded well to a particular repositioning maneuver. The results of Prolonged Position were significantly better than those obtained by performing head shaking or by omitting treatment. Prolonged Position can be applied to patients of all ages and general conditions and does not require hospitalization.
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Affiliation(s)
- P. Vannucchi
- Service of Audiology, University of Florence, Florence, Italy
| | - B. Giannoni
- Service of Audiology, University of Florence, Florence, Italy
| | - P. Pagnini
- Service of Audiology, University of Florence, Florence, Italy
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Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997; 7:1-6. [PMID: 9057155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated a new therapeutic maneuver-Prolonged Position on the healthy side, for Benign Paroxysmal Positional Vertigo (BPPV) of the horizontal semicircular canal. We devised this type of physical treatment in accordance with the "canalolithiasis" theory of BPPV, in order to try to free the horizontal semicircular canal of otoconial debris. We compared the results obtained by Prolonged Position with two other physical therapies by dividing our horizontal canal BPPV patients into three therapeutic groups: 1) 35 patients treated with Prolonged Position; 2) 24 patients treated with head shaking in a supine position; 3) 15 patients for whom therapy was omitted. More than 90% of the patients treated with Prolonged Position recovered within 3 days, although 6 patients out of 35 subsequently developed BPPV of the posterior semicircular canal, which then responded well to a particular repositioning maneuver. The results of Prolonged Position were significantly better than those obtained by performing head shaking or by omitting treatment. Prolonged Position can be applied to patients of all ages and general conditions and does not require hospitalization.
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Affiliation(s)
- P Vannucchi
- Service of Audiology, University of Florence, Italy
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35
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Nuti D, Vannucchi P, Pagnini P. Benign Paroxysmal Positional Vertigo of the Horizontal Canal: A Form of Canalolithiasis with Variable Clinical Features. ACTA ACUST UNITED AC 1996. [DOI: 10.3233/ves-1996-6303] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Benign paroxysmal positional vertigo of the horizontal semicircular canal (HC-BPPV) is a well-defined syndrome characterized by direction-changing horizontal positional nystagmus. We report the clinical features of 5 patients who illustrate the possible variables of the syndrome. In most cases, nystagmus is geotropic and more intense when the pathological ear is lowermost; less often the syndrome presents with apogeotropic nystagmus that is more intense when the affected ear is uppermost. The nystagmus pattern may vary in time in the same patient, changing from apogeotropic to geotropic even in observations at short intervals. In some patients, the features indicate involvement of more than one canal, either simultaneously or in succession. It is sustained that the clinical findings can be explained by movement of endolymph caused by displacement of otoconia in the semicircular canals and that variants are due to different positions of the otoconia within the canals.
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Affiliation(s)
- Daniele Nuti
- Department of Otolaryngology, University of Siena, Italy
| | | | - Paolo Pagnini
- Department of Audiology, University of Firenze, Italy
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Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features. J Vestib Res 1996; 6:173-84. [PMID: 8744525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Benign paroxysmal positional vertigo of the horizontal semicircular canal (HC-BPPV) is a well-defined syndrome characterized by direction-changing horizontal positional nystagmus. We report the clinical features of 5 patients who illustrate the possible variables of the syndrome. In most cases, nystagmus is geotropic and more intense when the pathological ear is lowermost; less often the syndrome presents with apogeotropic nystagmus that is more intense when the affected ear is uppermost. The nystagmus pattern may vary in time in the same patient, changing from apogeotropic to geotropic even in observations at short intervals. In some patients, the features indicate involvement of more than one canal, either simultaneously or in succession. It is sustained that the clinical findings can be explained by movement of endolymph caused by displacement of otoconia in the semicircular canals and that variants are due to different positions of the otoconia within the canals.
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Affiliation(s)
- D Nuti
- Department of Otolaryngology, University of Siena, Italy
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Vannucchi P. Retrograde intravenous pressure infusion technique in the treatment of cutaneous necrotizing vasculitis. J Eur Acad Dermatol Venereol 1995. [DOI: 10.1016/0926-9959(95)96442-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Vannucchi P, Pagnini P, Santoro R. [A comparison between the "bithermal caloric test" and the "hot monothermal with simultaneous cold test"]. Acta Otorhinolaryngol Ital 1993; 13:261-6. [PMID: 8304039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hot (44) and cold (30) caloric test are the most common tool to investigate canal activity. Many authors, otherwise, have pointed out that this method is very long needing about five minutes of interval among the irrigations and that it is often troublesome for the patient that is exposed four times to a vertigo. To investigate vestibular function some of these authors tried to use the hot monothermal test alone but results were poor. The aim of this study was to propose a shorter and a less troublesome method of investigation and to introduce a new diagnostic possibility not pointed out with traditional caloric test. We have tried to determine some new reliable diagnostic criteria modifying confidential value of the hot monothermal test and considering the eventual presence of the nystagmus and its direction during the cold simultaneous test; on the basis of this results we are able to distinguish a normal vestibular function from a labyrinthine preponderance or a directional preponderance or an aspecific disfunction. When the vestibular function is normal or when there is a labyrinthine preponderance our results are in total accord with those achieved with the traditional bithermal test. Therefore we suggest to use always the hot monothermal test associated with the cold simultaneous test, performing the two cold irrigations in additions, only in the case of a directional preponderance or an aspecific disfunction.
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Affiliation(s)
- P Vannucchi
- Cattedra di Audiologia, Università di Firenze
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Cipriani M, Vannucchi P, Bacalli S, Cencetti S, Lagi A. [Diagnosis of cardiocirculatory autonomic failure by the tilting method]. Recenti Prog Med 1992; 83:291-4. [PMID: 1439109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The variation of SBP, DBP and HR is evaluated on tilting in a group of 34 patients affected by orthostatic hypotension versus a group of 54 healthy subjects, age and sex cross-matched. The patients affected by cardiovascular autonomic failure showed: 1) a fall of SBP greater than -19 mmHg in the 1st min; 2) a fall of the SBP average value (for 10 minutes) greater than -22 mmHg. Contrarily, the healthy subjects showed: 1) no variations of SBP values during the 1st minute and 2) a growing of SBP between the 2nd and the 10th minute; 3) a SBP average value (for 10 minutes) with a positive trend. The DBP and HR showed not differences between the groups. We suggest that the measure of SBP on standing may be considered an easy and fast method to perform a diagnosis of autonomic cardiovascular failure.
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Affiliation(s)
- M Cipriani
- U.O. di Medicina interna, Ospedale S. Maria Nuova, Firenze
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40
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Vannucchi P. [Internal medicine, specialism, hospitals]. Recenti Prog Med 1990; 81:550. [PMID: 2247704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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41
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Abstract
Over a period of 4 years we observed 15 cases of benign positional vertigo (BPV) probably caused by deposition of otoliths in the horizontal semicircular canal. Rapid rolling onto one side in recumbent position provokes a paroxysmal, purely horizontal and geotropic nystagmus which nearly always spontaneously inverts direction. Rolling the patient onto the other side provokes a left intense geotropic nystagmus. BPV is more violent but resolves more rapidly than that of the better known posterior canal positional vertigo. Sometimes both syndromes are present together.
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Affiliation(s)
- P Pagnini
- Service of Audiology, University of Florence, Italy
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42
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Lagi A, Ciolli P, Grifoni S, Vannucchi P, Nozzoli C, Morettini A. [Valsalva's maneuver in vasodepressive syncope]. Recenti Prog Med 1988; 79:506-8. [PMID: 3241902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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43
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Lagi A, Ciolli P, Grifoni S, Lagi A, Morettini A, Nozzoli C, Vannucchi P, Berni G. [Stimulation of the carotid sinus in the diagnosis of vasodepressive syncope]. Recenti Prog Med 1988; 79:111-5. [PMID: 3393715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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44
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De Vito F, Pagnini P, Vannucchi P. [Treatment of cupulolithiasis: critical observations on the Semont maneuver]. Acta Otorhinolaryngol Ital 1987; 7:589-96. [PMID: 3455091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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45
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Lagi A, Vannucchi P, Nozzoli C, Borsotti M, Morettini A, Grifoni S, Berni G. [Metabolic acidosis as a prognostic indicator in acute cardiogenic pulmonary edema]. Recenti Prog Med 1987; 78:5-8. [PMID: 3589120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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46
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Vannucchi P, Lagi A, Nozzoli C, Grifoni S, Morettini A, Berni G. [The TRH test in the pathogenetic diagnosis of paroxysmal atrial fibrillation]. Recenti Prog Med 1986; 77:169-72. [PMID: 3086952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Marconi G, Pagnini P, Vannucchi P. Ophthalmoplegia plus, an electro-oculographic study. Ital J Neurol Sci 1985; 6:429-39. [PMID: 3878836 DOI: 10.1007/bf02331035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To find out whether the central structures governing conjugate eye movements are affected in ophthalmoplegia plus (OP), we conducted an electro-oculographic study in 6 patients suffering from OP with varying degrees of extraocular involvement and with mitochondrial changes in the skeletal musculature. All the patients presented alterations of the smooth pursuit and saccadic movements, of optokinetic nystagmus as well as of the vestibular reflexes and of visuovestibular interaction, thus confirming impairment of the central oculomotor structures and particularly of those of the archicerebellum and brainstem. These data suggest a supranuclear component in the pathogenesis of ophthalmoplegia and are in accord with the findings of brainstem spongiosis in OP, which in turn seem to express a multisystem pathological state of the mitochondria.
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