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ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
Methods: Patients were identified from the hospital radiology
department’s database. All referrals to CT or MRI during the
study year were analyzed. The number of examinations done
due to vertigo was calculated and positive diagnostic findings are
reported. Possible clinical signs predicting deviant CT or MRI
finding were identified. The data was stored in the database and
the SPSS program applied for statistical analysis.
Results: Benign paroxysmal vertigo, migraine-associated dizziness,
vestibular neuronitis, and otitis media-related dizziness are major
causes for vertigo in children. Diagnosis in vertiginous children is
based on a careful history including family history and neurological
and otorhinolaryngologic evaluations. Imaging studies are often
done to exclude central causes for vertigo. The number of studies
done for vertigo in children is reported and related to the annual
number of vertiginous children visiting the hospital. The possible
predictors for deviant findings are listed and discussed.
Conclusions: There are seldom positive findings in CT or MRI in
vertiginous children.
Abstract no.: 043
Effect of visual and postural perturbation in VR-posturography
Toppila E1, Pyykkö I1, Forsman P:, Tossavainen T3, Starck J2
'Department of Otolaryngology, University of Tampere, 2Finnish Institute
of Occupational Health - Department of Physics, 3University of Tampere,
Department of computer science.
With virtual reality (VR) technique the balance can be tested with
unconventional visual and postural perturbations. The advantage
is that the testing situation becomes more realistic and capable of
revealing valuables information about the performance of postural
system. It is possible to use visual stimuluation, postural stimula-
tion or combined visual and postural stimulation. The combined
stimulus consists of 30 s period with visual and postural perturba-
tions are in phase and 30 s period when the perturbations are 180
degrees of phase. The transition from one phase to the second one
occurred at a zero crossing of stimuli. 45 healthy controls and 106
patients with Meniere’s disease were tested on the VR-platform.
For both groups the sway velocity during the off-phase perturba-
tion decreased in average by 10%. Among Meniere patients the
relative change distribution (skewness = 0.54) was different from
the distribution of controls (skewness = -0.94). This indicates
that the Meniere patients have a different tendency of changing
strategy than control when the perturbation changes. The visual
dependence varies in among Meniere patients that may explain the
periodic visual visual dominance that may lead to falls.
S-IX ALLEARS
Abstract no.: 044
Otitis Media -flexible approach based on pathogenesis
Michael M. Paparella, M.D. Director, Otology/Neurotology Fellowship,
Minnesota Ear, Head & Neck Clinic, Director, Otopathology Labora-
tory, Clinical Professor and Chairman Emeritus, Department of Otola-
ryngology, University of Minnesota, International Hearing Foundation
To a significant degree our surgical approach to the various
forms of otitis media is based on our understanding of pathogen-
esis. Pathogenesis includes etiology at the outset, which through
mechanisms and processes leads to a pathological state which,
when accompanied by symptoms, allows the patient to present
him or her self to the physicians for consideration of treatment.
The common fundamental of most forms of otitis media in terms
of individuals, has to be with genetic factors that can lead to eusta-
chian tubal dysfunction.
As we have published in numerous articles, the otitis medias
with effusion (OME) are represented by three types, acute
perilymph otitis media (POM), serous otitis media (SOM) and
mucoid otitis media (MOM). It is the mucoid form of otitis media
(MOM) which along with other factors, can lead to chronic otitis
media. The otitis medial with effusions are characterized by
intractable liquid pathology whereas once along the continuum
when mucoid otitis media becomes chronic otitis media the disease
is characterized by intractable tissue pathology characterized by
the presence of 1) cholesteatoma, 2) granulation tissue and/or 3)
cholesterol granulation tissue. In addition, we find genetic factors
leads to a variety of obstructive condition. In addition to the
well established and understood fact that most forms of chronic
otitis media, particularly those starting in childhood, have hypo
pneumatization of the mastoid air cell system, we have found that
most patients with chronic otitis media also have obstructive sites
in hypoplastic middle ear, in the external auditory canal as well as
in the mastoid, all of which play a role in developing and treating
chronic otitis media.
As part of this continuum we have published and also find
in many patients that chronic otitis media characterized by
intractable tissue pathology can often occur beneath an intact
tympanic membrane which belies the belief that chronic otitis
media as defined in all textbooks must have a perforation and a
history of ottorhea. Another important consideration in chronic
otitis media is the importance of middle ear/inner ear interaction.
Again, in numerous publication s from our laboratories and
others it is clear that otitis media in its various forms particularly
when silent otitis media is present, can lead to inner ear
manifestations including not only sensorineural hearing loss,
but in some instances dizziness and vertigo in the absence of a
classical cholesteatoma fistula. Techniques based on concepts of
pathogenesis will be discussed and presented.
Abstract no.: 045
Natural treatment of acute otitis media
Kristinsson KG. Magnúsdóttir AB, Petersen H, Landspítali University
Hospital, and Hermansson A, Lund University Hospital
With increasing resistance to antimicrobial agents, physicians and
the public are looking for alternative treatments for acute otitis
media. Such alternatives could significantly reduce antimicrobial
consumption, especially by children. Although homeopathy has
been used with some positive effects in the past, no studies have so
far demonstrated a statistically significant effect. Antimicrobials
cannot pass or diffuse through intact tympanic membranes, and
therefore treatment through the ear canal is not advised. A recent
study performed in Iceland may change this paradigm.
Essential oils are volatile and can have good antimicrobial
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