This document summarizes benign paroxysmal positional vertigo (BPPV), a common cause of positional vertigo. It describes the pathophysiology of BPPV, involving debris accumulating in the posterior or horizontal semicircular canals, causing vertigo when the head is moved into certain positions. It outlines diagnostic tests like the Dix-Hallpike maneuver and treatments including the Epley maneuver and particle repositioning maneuvers, which aim to move the debris out of the affected canal.
1) A feasibility study was conducted to assess the potential effectiveness of music training for patients with tinnitus. 92 subjects with tinnitus were recruited and instructed to listen to digitally modified music.
2) Patients' tinnitus was matched and their severity was assessed using the Tinnitus Handicap Inventory (THI) questionnaire before and after the study. 35 subjects completed the 3 month music therapy training.
3) Preliminary results found the average THI score improved after therapy, indicating reduced tinnitus severity. Subjects with different tinnitus characteristics saw varying levels of improvement. Further studies are still needed to evaluate outcomes.
1) This case report describes a 65-year-old female patient who presented with sudden deafness in the right ear as well as persistent direction-changing positional nystagmus.
2) Initial tests found benign paroxysmal positional vertigo (BPPV) involving the right horizontal semicircular canal, but forced prolonged positioning maneuvers failed to resolve her symptoms.
3) The persisting geotrophic nystagmus is proposed to be caused by a phenomenon called a "light cupula" rather than free-floating particles in the canal.
This document summarizes benign paroxysmal positional vertigo (BPPV), a common cause of positional vertigo. It describes the pathophysiology of BPPV, involving debris accumulating in the posterior or horizontal semicircular canals, causing vertigo when the head is moved into certain positions. It outlines diagnostic tests like the Dix-Hallpike maneuver and treatments including the Epley maneuver and particle repositioning maneuvers, which aim to move the debris out of the affected canal.
1) A feasibility study was conducted to assess the potential effectiveness of music training for patients with tinnitus. 92 subjects with tinnitus were recruited and instructed to listen to digitally modified music.
2) Patients' tinnitus was matched and their severity was assessed using the Tinnitus Handicap Inventory (THI) questionnaire before and after the study. 35 subjects completed the 3 month music therapy training.
3) Preliminary results found the average THI score improved after therapy, indicating reduced tinnitus severity. Subjects with different tinnitus characteristics saw varying levels of improvement. Further studies are still needed to evaluate outcomes.
1) This case report describes a 65-year-old female patient who presented with sudden deafness in the right ear as well as persistent direction-changing positional nystagmus.
2) Initial tests found benign paroxysmal positional vertigo (BPPV) involving the right horizontal semicircular canal, but forced prolonged positioning maneuvers failed to resolve her symptoms.
3) The persisting geotrophic nystagmus is proposed to be caused by a phenomenon called a "light cupula" rather than free-floating particles in the canal.
Functional endoscopic sinus surgery complicated with orbital hemorrhageDavid Yeh
This document describes a case of orbital hemorrhage that occurred during functional endoscopic sinus surgery (FESS). Key details:
- A patient underwent uneventful FESS surgery but later developed swelling and ecchymosis of the right eye.
- An orbital hematoma was discovered, which can occur due to injury of orbital veins during surgery. The patient recovered fully after 2 weeks.
- The document then discusses risks of orbital and surrounding structures during FESS, including the lamina papyracea, optic nerve, and arteries. Preventing and managing complications of FESS is important.
The document discusses the career experiences of Dr. Ye Dawei, an ear, nose, and throat specialist at Zhiliu Hospital in Hsinchu. It shares his memories from attending Hsinchu Middle School, experiences studying medicine, and insights from his medical career. It also questions what personality traits are suitable for studying medicine and includes the Hippocratic Oath pledging to serve patients with purity, holiness and prioritizing their health above all else.
A Single Therapy for All Subtypes of Horizontal Canal Positional VertigoDavid Yeh
This document describes a study that evaluated a single therapy approach for treating all subtypes of horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The study included 89 patients diagnosed with HC-BPPV who were treated with forced prolonged position (FPP), lying on the side of weaker nystagmus for 12 hours. All subtypes, including canalolithiasis (Can), cupulolithiasis with otoliths on the utricle side (Cup-U), and cupulolithiasis with otoliths on the canal side (Cup-C), were effectively treated with FPP in less than four sessions. The results support using FPP as a
1) The document discusses the management of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) using rapid head rotation.
2) 132 BPPV patients were diagnosed and treated, with 41 cases of HC-BPPV. Most HC-BPPV cases were treated with barbecue maneuver and/or forced prolonged position with good results.
3) Intractable HC-BPPV cases were treated with rapid head rotation, which was effective in resolving vertigo in most cases, especially for HC-Cupulolithiasis.
1) The document reports on a study of 132 patients with horizontal canal benign paroxysmal positional vertigo (HC-BPPV) treated with barbecue maneuver, forced prolonged position (FPP), and/or rapid head rotation.
2) Results found that barbecue maneuver and/or FPP resolved HC-BPPV in 22 patients, while rapid head rotation resolved HC-BPPV in 7 patients, inducing different nystagmus responses.
3) The document concludes that FPP and barbecue maneuver remain first choice treatments for HC-BPPV, while rapid head rotation can be used for intractable cases, especially cupulolithiasis cases. Nystagmus direction depends on
Functional endoscopic sinus surgery complicated with orbital hemorrhageDavid Yeh
This document describes a case of orbital hemorrhage that occurred during functional endoscopic sinus surgery (FESS). Key details:
- A patient underwent uneventful FESS surgery but later developed swelling and ecchymosis of the right eye.
- An orbital hematoma was discovered, which can occur due to injury of orbital veins during surgery. The patient recovered fully after 2 weeks.
- The document then discusses risks of orbital and surrounding structures during FESS, including the lamina papyracea, optic nerve, and arteries. Preventing and managing complications of FESS is important.
The document discusses the career experiences of Dr. Ye Dawei, an ear, nose, and throat specialist at Zhiliu Hospital in Hsinchu. It shares his memories from attending Hsinchu Middle School, experiences studying medicine, and insights from his medical career. It also questions what personality traits are suitable for studying medicine and includes the Hippocratic Oath pledging to serve patients with purity, holiness and prioritizing their health above all else.
A Single Therapy for All Subtypes of Horizontal Canal Positional VertigoDavid Yeh
This document describes a study that evaluated a single therapy approach for treating all subtypes of horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The study included 89 patients diagnosed with HC-BPPV who were treated with forced prolonged position (FPP), lying on the side of weaker nystagmus for 12 hours. All subtypes, including canalolithiasis (Can), cupulolithiasis with otoliths on the utricle side (Cup-U), and cupulolithiasis with otoliths on the canal side (Cup-C), were effectively treated with FPP in less than four sessions. The results support using FPP as a
1) The document discusses the management of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) using rapid head rotation.
2) 132 BPPV patients were diagnosed and treated, with 41 cases of HC-BPPV. Most HC-BPPV cases were treated with barbecue maneuver and/or forced prolonged position with good results.
3) Intractable HC-BPPV cases were treated with rapid head rotation, which was effective in resolving vertigo in most cases, especially for HC-Cupulolithiasis.
1) The document reports on a study of 132 patients with horizontal canal benign paroxysmal positional vertigo (HC-BPPV) treated with barbecue maneuver, forced prolonged position (FPP), and/or rapid head rotation.
2) Results found that barbecue maneuver and/or FPP resolved HC-BPPV in 22 patients, while rapid head rotation resolved HC-BPPV in 7 patients, inducing different nystagmus responses.
3) The document concludes that FPP and barbecue maneuver remain first choice treatments for HC-BPPV, while rapid head rotation can be used for intractable cases, especially cupulolithiasis cases. Nystagmus direction depends on
12. <SCRIPT Language="JavaScript">
var msg="竹苗地區唯一 Homepage‥‥";
var interval = 200;
var space10=" ";
var seq=0;
function Scroll() {
document.tmForm.tmText.value = msg.sub☆
string(seq, msg.length) + space10 + ms☆
g.substring(0, msg.length);
seq++;seq++;
if ( seq > msg.length ) { seq = 0 };
window.setTimeout("Scroll();", interval);
}
</SCRIPT>
---------------------↑
13. 只要修改 var msg=" 竹苗地區唯一神經耳科專科醫師,1999 年最炫的選擇… "
中的內容即可用在自已的網頁上。再看另一個「每日小秘訣」也是同樣的道
理。
---------------------↓
<SCRIPT Language="JavaScript">
tips=new Array(6);
tips[0]="竹苗地區唯一國際網路 Home Page 諮詢醫師";
tips[1]="竹苗地區首創神經耳科眩暈特別門診";
tips[2]="Life is too short to be little。";
tips[3]="所有事物終必過去。 George Harrison";
tips[4]="技術進展到一定程度就成為魔術。 ";
tips[5]="沒有震驚於量子物理的人,就是不了解它。Niels Bohr";
index=Math.floor(Math.random() * tips.length);
document.write("<CENTER>" + tips[index] + "</CENTER><P>");
</SCRIPT>
---------------------↑
14. 只要修放 tips 陣列裡的文字內容,就可顯示出你自已的小秘訣。「訪客計數
器」的工作原理其實和待會提到的「留言版」、「聊天室」一樣,都是由瀏覽
器向伺服器主機索求資料,而訪客計數器它剛好是程式執行的結果也是圖片。
所以只要在插入圖片的屬性交談窗中填入計數器程式的 URL 即可,這個 URL 網
址可向你申請的 ISP 公司網路管理員連絡索取。至於還有其它的選擇參數,則
是方便你設定成自已喜歡的顯示圖形。
【耳鼻喉科講座】單元裡的「耳鼻喉科講義」計劃收錄學生時代的耳鼻喉上課
講義和市面上所能看到的相關衛教或專業書籍,「國內耳鼻喉網站」是在國內
幾個熱門的搜尋引擎能找到的相關網站,也歡迎同好來信連結。「國外耳鼻喉
網站」是以 Otolaryngology– Head and Neck Surgery October 1996 標題為 A
guide to otolaryngology resources on the internet 為範本所收集的網址,
「民眾衛教篇」則是一些門診常見疾病的介紹。
【我的電腦】分別介紹我的桌上型和筆記型電腦硬體設備、常用的電腦軟體、
DOS 時代寫的資料庫程式、Windows 時代寫的 Visual Basic 程式、啟蒙書藉、
閱讀雜誌和常逛的軟硬體相關網站,其實就是刊登在 88 年 4 月份那篇文章中
的「你應該知道的軟體工具」和本篇上頭介紹的「我的電腦」單元。你可能注
15. 意到上頭的【耳鼻喉講座】和【我的電腦】分別有嵌入圖片,這有點像是交通
圖誌讓訪客一目瞭然。按下「設計師」功能列上的插入圖片鈕後就會出現一個
交談窗,在「Image file name」欄位中輸入圖檔名即可,另外可以選擇圖繞
文、文繞圖和其它對齊功能。或許你會輸入一個*.bmp 這個 Windows 環境下
最常見的點陣圖,卻發現它不被接受。原來 Home Page 所能接受的只有.gif
及.jpg(.jpeg)兩種格式,須另外使用圖片轉換工具如 Paint Shop Pro 等軟
體。就拿 Windows 95/98 開機時會看到藍天雲朵畫面來說,它就是
c:windows 目錄下的 clound.bmp 檔案,一張 640*480 24 bit 全彩的點陣圖。
所謂 24 bit 是紅色、藍色、綠色各 8bit 可產生 2^8=256 色,組合起來可產生
256*256*256=16,777,216 色謂之全彩。這已遠遠超過了人類視覺對顏色辨識的
範圍,於是有了壓縮圖檔.gif 和.jpg 的想法。一張全彩的點陣圖約佔 900KB 的
磁碟空間,經過壓縮後在網路流通時大大縮小了傳輸時間。至於要採.gif 或.jpg
須考量透空效果、交錯格式及失真等因素,這邊不擬多談。
【流行話題】原則上以我個人感興趣的醫療科普和電腦資訊為主題,點選其中
的「重審 AIDS」這個標題看看有啥內容。自華裔何大一博士當選為時代風雲
人物後,AIDS 一時又成為熱門話題。對於愛滋病病毒的致病機轉,即所謂這類
反轉錄病毒如何侵入人體 T 細胞,我有一股說不出的沉迷與愛戀。有一天晚上
16. 電視又在轉播女子花式撞球比賽了,Fisher 表演了一記母球 kiss 技巧,nine
ball in 又取得一局。多麼熟悉的感覺,想像一下從前在打司諾克撞球時代,所
謂的 kiss ball 大概就是以母球撞擊紅色子球 A 再由子球 A 撞擊另一紅色子球 B
入袋;而在花式撞球興起後選手常有機會表演另一種母球的 kiss 技巧,即母球
撞擊子球 A 後再由母球彈撞九號球入袋結束一局,這種 kiss 技巧讓人產生莫明
的心動。如果說根深蒂固的 DNA → RNA → protein 流程圖就像傳統的司諾克
kiss ball,那麼反轉錄病毒的 RNA → DNA → RNA 總會讓我聯想起美艷的花式
撞球的母球 kiss 技巧。RNA 就好比是母球,而 reverse transcriptase 恰恰扮演
了那顆子球 A 的撞牆角色。黃世聰醫師、陳炳憲醫師你們一定聽得懂我在說些
什麼,對不對?
「Documented AIDS」顧名思義收錄了我看過的專業書藉和市面一般醫普書
藉。「認識愛滋病 吳銅坤主編 婦幼家庭出版社」和「世紀疫疾 AIDS 劉正義
譯 華杏出版社」是兩本可以快速入門的中文小書,當然莊哲彥教授主編的「愛
滋病全貌」更是必備經典,最新的收錄文章則是結集成「愛滋病新知 1998 台
灣醫學會」。「Otolaryngological Manifestations of The Acquired
Immunodeficiency Syndrome」總算有一本完全以耳鼻喉科臨床為角度描述
AIDS 的小專集了,很多愛滋病患是以耳鼻喉頸部症狀來表現的,另外如耳廓的
17. Kaposi's Sarcoma、鼻前庭的的 Giant Herpetic ulcers、Pseudomonas
sinusitis…等,難怪有人說事實上第一線上最有可能接觸到愛滋病患的不是內科
仙仔而是耳鼻喉醫師。「Pediatric AIDS edited by Philip A. Pizzo,Catherine
M. Wiflert」全書分 6 個部份,從 HIV 的 epidermiology、biology、
pathogenesis、diagnosis、manifestations 和 treatment 等題目以小兒科的觀
點再表達一次。本書尤重 mechanism 的陳述而不僅只於臨床描述,有些部份
甚至可當生理醫學字典來用。如 ELISA 的定義來龍去脈、AZT 還有疫苗的想法
來由等,非常詳實。「Clinical Obsterics and Gynecology September 1989
volume 32 Number 3」裡頭有 AIDS in Women、AIDS in Obsterics、HIV in
pregnancy、perinatal HIV-1 infection,從婦兒科的角度再審視一次愛滋病感
覺非常棒。最有趣的是這本「愛滋病的常識與預防 武陵出版社」,副標題是
『愛滋病「生物武器」論的可能性』,我在考完專科醫師的一個午後無意間在
書店發現這本小書。作者永井明應該是一名日本臨床醫師,他好像對愛滋病的
中非起源論無啥好感,文中對 Gallo 較多負面的評價。事實上早在 1980 更早期
有關 HTLV-Ⅰ的發表事件中 Gallo 就和日本學者有過爭執了,這是題外話。文
中甚至根據愛滋病最初發生的時間、地點和人物等特性,駭俗地大膽提出愛滋
病毒本是美國實驗室的生化戰產物卻意外地造成流行。比起一般嚴謹的醫學文
章或衛教資料,這些內容可真像是偵探科幻小說。「Undocumented AIDS」
則是收錄了一些「反 AIDS/HIV 論」的網站文章,也就是以我曾在 88 年 4 月介
22. ●
一些 PC 的小技巧
雖說現在是視窗的世界,但有很多時候我仍然是在 DOS 的環境下工作。不儘診
所的 Novell 區域網路如此、給小姪子玩 DOS game 時如此;查詢 Medline 醫
學光碟和平常寫稿更是在 Windows 下開個 DOS Box 來工作。 平常我使用無
蝦米中文輸入法,它除了字根比倉頡更容易背頌之外,最大的利器是可自造詞
庫,對於寫稿常用到專用名詞的人士更是方便。在 Windows 95/98 下開個倚天
全螢幕的好處是以前自建的詞庫可繼續使用,但就不能邊跑其它 Windows 程
式了;倚天視窗則可以邊在 DOS 環境作業,還可以邊用 mail、邊開 news 或其
它視窗繪圖程式。但唯一缺點是無蝦米輸入法自建的詞庫在視窗下只能使用 4
個字母,以前建立的超過 5 個字母以上的詞庫就不能用了。我通常在 PE2 或漢
書等文書處理器下完成初稿後可直接 post 到 BBS,若是要作些標題放大字型、
插入圖片或分頁等美工編輯則再用一個「PE2 to Word Translator」程式轉換成
Word 檔案處理。查詢 Medline 我常將某一主題或某一作者的文章依所以年度
查詢後存在硬碟,它們的格式有 TI、AU、SO 和 AB 等項目。參考過 abstract
後可決定須要 copy 那些全文期刊,但委託別人代為影印全文的期刊清單上並
不須要含 abstract 的內容,若要再一年一片地重新設定所要內容非常不便。在
漢書下按 F1 鍵到巨集處可發現「記錄按鍵」、「按鍵重放」和「多次執行」