[Evaluation of the Torok technic in the topolesional diagnosis of vestibular syndromes].
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We recently reviewed the records of 1024 operations for aural cholesteatoma. One hundred and eighty one of these were on children. Complications of the disease occurred more frequently in those whose disease had existed 20 years or more. As such, complications of the disease were less common in children. Our surgical management of cholesteatoma in children is the same as in adults. We are more likely, however, to perform the operation in two stages in children, and more likely to find residual cholesteatoma at the second-stage operation. There were no differences in the functional results in children and adults.
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beta 2-transferrin is a specific protein found in the cerebrospinal fluid and in the perilymph. Detecting beta 2-transferrin in the middle ear is of great interest when a fistula of the perilymph is suspected. This protein can be detected on microsamples with an immunofixation technique. We searched for beta 2-transferrin in pure perilymph, cerebrospinal fluid and serum in 8 patients operated by translabyrinthine approach for acoustic tumor removal. Search for beta 2-transferrin was performed in liquid from the inner ear in 3 labyrinthectomies. Samples were taken on collagen sponges or with micro syringes. beta 2-transferrin was detected in the perilymph of patients operated for neurinoma and in 2 of the 3 labyrinthectomies. This protein was found in only one of the patients for which the diagnosis of perilymphatic fistula had been retained. Detection of beta 2-transferrin in the middle ear can be proposed as a specific diagnostic test for perilymphatic fistula when the clinical situation does not suggest a fistula involving cerebrospinal fluid.
A professional mountain guide experienced an attack of vertigo at high altitude (4,000 m). Clinical data and the results of functional tests, were consistent with an attack of Meniere's disease. The physiopathological changes noted at high altitudes, and known as acute mountain sickness, are described. A hypothesis is suggested concerning the mechanism triggering this attack of Meniere's disease at high altitude.
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In 100 patients showing different lesions of the peripheral vestibular system and of the CNS, the influence of spontaneous vestibular nystagmus on optokinetic nystagmus was investigated. Considering the large interindividual differences in the results of vestibulo-visual interaction, the actual values of OKN slow-phase velocity obtained by visual stimulation are only of limited diagnostic value in a single case. However, by averaging the results obtained from various nosologic groups of patients very different but distinct patterns of vestibulo-visual interaction can be demonstrated: The diagnostic importance of quantitative assessment of optokinetic nystagmus is demonstrated by a statistical evaluation of test results obtained in normal subjects as well as in patients with peripheral and central vestibular disorders. The most important diagnostic parameters of a pathologic foveo-retinal optokinetic response are directional preponderance of slow phase velocity and gain of OKN. Increasing target velocity with decreasing gain clearly indicate the presence of a severe brainstem lesion involving the entire oculomotor control system which provides the coordination of head and eye movements.
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