Publications by authors named "Gerard Gianoli"

This review aims to draw attention to the multiple ipsilateral otic capsule dehiscences (OCDs), which may cause therapeutic failure in operated patients. A series of six severely disabled patients with symptoms and signs consistent with a superior semicircular canal dehiscence (SSCD) diagnosis, confirmed by a high-resolution CT scan, is presented here. Five of the patients underwent surgery, and in four of the cases, the postoperative results were poor and/or disappointing.

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Mildly elevated intracranial pressure appears to be a distinct pathology separate from idiopathic increased intracranial pressure and migraine. Many patients present with head fullness-pressure and dizziness, which is often suggestive of a clinical diagnosis of vestibular migraine. These patients may additionally have episodic vertigo as seen in endolymphatic hydrops and positional vertigo in addition to feeling dizzy.

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Identifying a vestibular source of pathology in patients complaining of post-traumatic brain injury (TBI) dizziness can be difficult. We describe a possible new method utilizing a reduction in post-TBI symptoms (including dizziness) with the use of a noise cancellation device (NCD). This retrospective case series included patients with TBI and dizziness presenting to a binocular vision specialty clinic, who were diagnosed with a vertical heterophoria (VH).

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Article Synopsis
  • The report discusses a case series of 16 patients with findings suggestive of a new type of labyrinthine dehiscence syndrome, specifically involving the horizontal semicircular canal and the facial nerve.
  • The study was conducted at a neurotology vestibular referral center in 2019, analyzing high-resolution CT scans and various patient symptoms and tests.
  • Results showed that over half of the patients had additional dehiscent sites beyond the initially suspected horizontal semicircular canal dehiscence.
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Article Synopsis
  • - Dizziness is a common symptom following head trauma, especially in concussion cases, where it is only less frequent than headaches.
  • - Post-concussive dizziness (PCD) can have multiple causes which fall into non-vestibular, central vestibular, and peripheral vestibular categories; recognizing both central and peripheral issues is crucial for proper diagnosis.
  • - Timely evaluation of vestibular disorders is often lacking, but identifying and treating peripheral vestibular dysfunction can significantly improve patient outcomes compared to addressing central issues.
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Objective: Patients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors.

Study Design: Observational analytic case-control study in a tertiary referral center.

Methods: Twelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms.

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By the nature of their origin, acoustic neuromas always result in some degree of vestibular dysfunction. The implications of this are typically more notable postoperatively, rather than preoperatively or intraoperatively. However, preoperative vestibular assessment can have implications on operative approach and postoperative rehabilitation.

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Evaluation of dizziness in patients who are involved in litigation can deviate significantly from the evaluation of patients who have no ongoing litigation. This article presents the basic principles of the physician's role in the evaluation of litigating patients. Considerations for physical examination, diagnostic testing, and review of medical records are discussed.

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Objective: To analyze if patients whose vestibular symptoms are associated with nonorganic sway patterns show more evidence of somatization and/or malingering than patients whose vestibular symptoms are associated with normal or physiologically abnormal sway patterns observed in people with documented vestibular pathologic findings.

Patients: One hundred fifteen patients with complaints of vestibular dysfunction and hearing impairment.

Interventions: Computerized dynamic posturography (CDP) and completion of the Modified Somatic Perception Questionnaire (MSPQ)--a validated test for the detection of malingering.

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Objective: To determine the incidence of caloric and rotational chair testing (ROT) abnormalities in a group of patients with chronic suppurative otitis media (CSOM) and to correlate caloric test results with ROT.

Patients: Twenty-five patients with CSOM with or without cholesteatoma who were to undergo tympanomastoid surgery.

Interventions: Caloric and ROT.

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Hypothesis: Anatomic differences may render the superior division of the vestibular nerve more susceptible to injury during vestibular neuritis.

Background: Neural degeneration has been identified in temporal bone studies of vestibular neuritis. Previous anatomic and physiologic studies of vestibular neuritis have demonstrated that the superior division of the vestibular nerve is preferentially affected, with sparing of the inferior division.

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Objective: Delayed facial palsy (DFP) after acoustic neuroma surgery has been reported to occur in up to one third of cases. Reactivation of latent virus has been proposed as an etiology for DFP. However, only retrospective case reports and case series have offered data to support this theory.

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