Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Jun 1995
Randomized Controlled Trial Clinical TrialMastoid oscillation: a critical factor for success in canalith repositioning procedure.
The canalith repositioning procedure has recently gained controversial recognition as a treatment for benign paroxysmal positional vertigo. Some authors contend that the canalith repositioning maneuver is no more effective than no treatment at all. Unfortunately, its technique has not been uniformly applied and its outcomes have not been uniformly assessed. ⋯ An overwhelming 92% of those who received the canalith repositioning maneuver with mastoid vibration felt improved, and 70% were free of rotatory nystagmus after only one treatment. A review of all patients diagnosed with benign paroxysmal positional vertigo and treated with the canalith repositioning maneuver with mastoid vibration was also undertaken. In a series of 67 patients with a minimum of four weeks of follow-up, only two have not responded to the canalith repositioning maneuver, yielding a 97% rate of symptom control.
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Otolaryngol Head Neck Surg · Feb 1995
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-based anesthesia as compared with standard anesthetic techniques for middle ear surgery.
To determine whether a totally intravenous technique with propofol and fentanyl is superior to isoflurane anesthesia in patients undergoing middle ear surgery. ⋯ Surgical duration, induction, maintenance, and total anesthesia times were recorded together with eye opening and extubation. Intergroup comparisons of postoperative nausea, vomiting, and pain, and recovery scores, we made by use of the Steward system. Patients receiving propofol, compared with the isoflurane-only group, had significantly less nausea (4/34 vs 12/34 patients, respectively; p < 0.05) and as vomiting (2/34 vs 8/34 patients, respectively; p < 0.05). Immediate recovery scores were significantly better for propofol compared with the isoflurane-droperidol group. Recovery scores at 30 minutes were also faster with propofol compared with isoflurane or isoflurane-droperidol (5.7 +/- 0.1 vs 5.1 +/- 0.2 and 5.2 +/- 0.2; p < 0.05).
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Acute postobstructive pulmonary edema may occur after airway obstruction. A decrease in intrathoracic and intraalveolar pressures causes an increased blood flow into the pulmonary vasculature and favors the development of pulmonary edema. Two mechanisms for the development of acute postobstructive pulmonary edema are proposed: type 1 follows acute airway obstruction, and type 2 follows relief of chronic airway obstruction.
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Vertigo is the most common symptom of transient ischemia within the vertebrobasilar system. Episodes typically come on abruptly and last minutes. ⋯ Isolated cerebellar infarction can mimic peripheral vestibular disorders because vertigo and imbalance are the main symptoms with both disorders. Modern neuroimaging techniques have markedly improved diagnostic capabilities.