The Journal of International Advanced Otology (J Int Adv Otol) is an international, peer reviewed, open access publication that is fully sponsored and owned by the European Academy of Otology and Neurotology and the Politzer Society. The journal is published triannually in April, August, and December and its publication language is English.The scope of the Journal is limited with otology, neurotology, audiology (excluding linguistics) and skull base medicine.The Journal of International Advanced Otology aims to publish manuscripts at the highest clinical and scientific level. J Int Adv Otol publishes original articles in the form of clinical and basic research, review articles, short reports and a limited number of case reports. Controversial patient discussions, communications on emerging technology, and historical issues will also be considered for publication.Target audience of J Int Adv Otol includes physicians and academics who work in the fields of otology, neurotology, audiology and skull base medicine.

PURPOSE: Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers. METHODS: Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically. RESULTS: In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95-0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications. CONCLUSIONS: A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation. (2019). Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians. European Archives of Oto-Rhino-Laryngology, 276(4):985-991. Funding:The study received no funding. Conflict of Interest:The authors declare that they have no conflict of interests.Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists and ENT physicians Abstract Purpose Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ENT (ear, nose and throat) physicians, and GPs (general practitioners), and to explore potential reasons for the underuse of the maneuvers. MethodsNeurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically. ResultsIn total, 97 neurologists, 85 ENT physic...

Background: The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease. Methods: 105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function tests, videonystagmography, and computer posturography were performed before MRI. The 3T MRI with gadolinium contrast was performed to evaluate the endolymphatic hydrops. Imaging protocol consisted of 3D-FLAIR and 3D T2DRIVE sequences. Vestibular endolymphatic sac was interpreted as enlarged if occupied more than 50% of the vestibular area. Results: 78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease. Conclusions: Temporal bone 3T MRI with gadolinium contrast is clinically superior to confirm the diagnosis of Menière's disease. Grade II endolymphatic hydrops on MRI, directional preponderance, and unilateral weakness on caloric test were independent predictors for the definite Menière's disease.

Darbo tikslas. Įvertinti diagnostinių tyrimų patikimumą norint diferencijuoti Menjero ligą į tipus: tikėtina ir neabejotina Menjero ilga. Darbo metodika. 2017m. Vilniaus universitetinėje ligoninėjė, Santaros klinikose (VUL SK), Ausų, nosies ir gerklės ligų centre buvo atliktas prospektyvinis tyrimas, jame dalyvavo 50 tiriamųjų, kuriems buvo nustatyta Menjero liga (ML). Tiriamieji, remiantis 2015 m. Barany draugijos priimtais kriterijais, buvo suskirstyti į dvi grupes – tikėtiną ir neabejotiną ML. Visiems tiriamiesiems buvo vertinta klinika, ligos trukmė, audiometrija, videonistagmometrija (VNG) kalorinis testas, posturometrija, 3T smilkinkaulių MRT su gadolinio (Gd) kontrastu vertinti endolimfos vandenę. Rezultatai. 26 tiriamiesiems nustatyta tikėtina ir 24 tiriamiesiems neabejotina Menjero liga. Vertindami simptomų intensyvumą, ligos trukmę neradome statistinio patikimumo tarp ligos tipų p>0,05. Vidutinis rizikos nukristi indeksas (RFI) statistiškai reikšmingai nesiskiria tarp tikėtinos ir neabejotinos ML (p>0,05). Videonistagmometrija (VNG) kalorinis mėginys (vienpusis susilpnėjimas (UW%) ir/ar krypties vyravimas (DP%) yra statistiškai reikšmingas norint diferencijuoti ML į tipus p<0,05. 3T smilkinkaulių MRT su Gd kontrastu vertintant endolimfos vandenę statistiškai reikšmingas p<0,05 norint diferencijuoti Menjero ligą į tipus. Audiometrijos tyrimo rezultatų pakenktos ausies decibelų (dB) vidurkis statistiškai reikšmingai nesiskyrė tarp grupių (p>0,05). Išvados. Diferencijuojant Menjero ligą į tipus gauta, kad statistiškai reikšmingi instrumentiniai tyrimai yra: VNG kalorinis mėginys ir 3T smilkinkaulių MRT su Gd kontrastu.

Reikšminiai žodžiai: posturografija, pusiausvyra, svaigimas, vestibulinis neuronitas. Pusiausvyros sistemos kontrolės disbalansas sukelia simptomus, kurie sutrikdo aktyvią žmogaus veiklą, o diagnostika neretai yra sudėtinga dėl galimų priežasčių įvairovės, todėl tai kelia rimtą galvosūkį įvairių specialybių gydytojams, į kuriuos kreipiasi pacientai. Dauguma plačiai naudojamų pusiausvyros funkcijos tyrimo metodų yra gana riboti, nes tiria tik vieną ar kelias pusiausvyrą išlaikančias sistemas, išskyrus posturografiją. Ji ypač vertinga diferencijuojant periferinės vestibulinės sistemos sutrikimus nuo kitų sistemų (centrinės, somatosensorinės, psichiatrinės, ortopedinės), kas ir yra kol kas pirmiausia ir svarbiausia renkantis tolesnę gydymo taktiką. Sistema įgalina objektyviai, greitai ir dažnai vertintini ligos dinamiką, vaistų ir reabilitacijos efektyvumą, kas iki šiol buvo subjektyvu. Straipsnio tikslas yra apžvelgti šiuo metu pasaulyje ir Lietuvoje naudojamus posturografijos metodus, jų veikimo principus, pritaikymą klinikinėje praktikoje ir esminius vertinimo parametrus. Taip pat pristatome klinikinį atvejį paciento, kuriam posturografija buvo naudinga diagnozuojant vestibulinį neuronitą ir vertinant gydymo eigą.