Review

Authors: J M Zakrzewska

The diagnosis and management of facial pain below the eye can be very different dependant on whether the patient visits a dentist or medical practitioner. A structure for accurate diagnosis is proposed beginning with a very careful history. The commonest acute causes of pain are dental and these are well managed by dentists. Chronic facial pain can be unilateral or bilateral and continuous or episodic. The commonest non-dental pains are temporomandibular disorders (TMDs), especially musculoskeletal involving the muscles of mastication either unilaterally or bilaterally; they may be associated with other chronic pains. A very wide range of treatments are used but early diagnosis, reassurance and some simple physiotherapy is often effective in those with good coping strategies. Dentists will often make splints to wear at night. Neuropathic pain is usually unilateral and of the episodic type; the most easily recognized is trigeminal neuralgia. This severe electric shock like pain, provoked by light touch, responds best to carbamazepine, and neurosurgery in poorly controlled patients. Trauma, either major or because of dental procedures, results in neuropathic pain and these are then managed as for any other neuropathic pain. Red flags include giant cell arteritis which much be distinguished from temporomandibular disorders (TMD), especially in >50 yr olds, and cancer which can present as a progressive neuropathic pain. Burning mouth syndrome is rarely recognized as a neuropathic pain as it occurs principally in peri-menopausal women and is thought to be psychological. Chronic facial pain patients are best managed by a multidisciplinary team.

Topics: Diagnosis, Differential; Facial Pain; Humans; Neuralgia; Pain Management; Pain Measurement; Temporomandibular Joint Disorders; Trigeminal Neuralgia

PubMed: 23794651
DOI: 10.1093/bja/aet125

Authors: Michael Strupp, Alexandre Bisdorff, Joseph Furman...

This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), a synonym for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. "Acute Unilateral Vestibulopathy", 2. "Acute Unilateral Vestibulopathy in Evolution", 3. "Probable Acute Unilateral Vestibulopathy" and 4. "History of Acute Unilateral Vestibulopathy". The specific diagnostic criteria for these are as follows:"Acute Unilateral Vestibulopathy": A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder."Acute Unilateral Vestibulopathy in Evolution": A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies."Probable Acute Unilateral Vestibulopathy": Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented."History of acute unilateral vestibulopathy": A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase.It is important to note that there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria.

Topics: Humans; Vestibular Neuronitis; Vertigo; Vestibular Diseases; Vestibule, Labyrinth; Nystagmus, Pathologic

PubMed: 35723133
DOI: 10.3233/VES-220201

Review

Authors: Tal Dalal, Nitin Gupta, Rafi Haddad...

Imagine smelling a novel perfume with only one nostril and then smelling it again with the other nostril. Clearly, you can tell that it is the same perfume both times. This simple experiment demonstrates that odor information is shared across both hemispheres to enable perceptual unity. In many sensory systems, perceptual unity is believed to be mediated by inter-hemispheric connections between iso-functional cortical regions. However, in the olfactory system, the underlying neural mechanisms that enable this coordination are unclear because the two olfactory cortices are not topographically organized and do not seem to have homotypic inter-hemispheric mapping. This review presents recent advances in determining which aspects of odor information are processed unilaterally or bilaterally, and how odor information is shared across the two hemispheres. We argue that understanding the mechanisms of inter-hemispheric coordination can provide valuable insights that are hard to achieve when focusing on one hemisphere alone.

Topics: Animals; Discrimination, Psychological; Functional Laterality; Humans; Memory; Odorants; Olfactory Bulb; Olfactory Cortex; Olfactory Mucosa; Olfactory Pathways; Olfactory Perception; Olfactory Receptor Neurons; Receptors, Odorant; Smell

PubMed: 32238904
DOI: 10.1038/s42003-020-0876-6

Authors: Alejandro Escobar Hincapié, Carlos Alberto Agudelo Velásquez, Mariluz Ortiz Uribe...

This study aimed to compare the effects of the post-activation performance enhancement (PAPE) of two different types of warm-ups, unilateral and bilateral, on the performance in vertical jumping and agility of healthy subjects with strength training experience. In the study, 17 subjects (12 men and 5 women) performed two different PAPE protocols: unilateral squat (UT) and bilateral squat (BT). The height of the subjects' countermovement jump (CMJ) and the subjects' time to perform the T-agility test (TAT) were measured before and after executing the PAPE warm-up. The squats were performed at a velocity of 0.59 m·s with three sets of three repetitions, with a 3-min rest between sets and a 5-min rest after both uni- and bilateral PAPE warm-ups before taking the tests again. For statistical analysis, we applied ANOVA and calculated the effect size. The results showed that the PAPE for each case decreased the CMJ height but generated significant improvements in the total time taken for the T-agility test ( < 0.01); however, in both cases, the effect sizes were trivial. In conclusion, it is possible to observe that the PAPE, performed both unilaterally and bilaterally, negatively affects the performance in the vertical jump, showing moderate effect sizes. However, both PAPE protocols show performance benefits in agility tests, with a large effect size for the unilateral protocol and moderate for the bilateral protocol.

Topics: Female; Humans; Male; Posture; Resistance Training; Rest; Warm-Up Exercise

PubMed: 34639455
DOI: 10.3390/ijerph181910154

Authors: Kanta Matsuzawa, Tomoyuki Matsui, Yoshikazu Azuma...

OBJECTIVES

Spondylolysis occurs bilaterally or unilaterally and bilateral spondylolysis increases the risk of developing isthmic spondylolisthesis. The characteristics of the lumbar lordosis angle (LLA), sacral slope angle (SSA), and spondylolysis fracture angle (SFA) in bilateral spondylolysis compared with those in unilateral spondylolysis have not been clarified. The purpose of this study was to compare the LLA, SSA, and SFA of bilateral and unilateral spondylolysis.

MATERIALS AND METHODS

Thirty-eight patients with lumbar spondylolysis who visited our clinic for an initial visit and 15 age-matched patients with a chief complaint of low back pain were included as controls. Computed tomography films were used to classify all spondylolysis patients into two groups: those with bilateral fractures (bilateral) and those with unilateral fractures (unilateral). The LLA and SSA were measured using lateral X-ray films and the SFA was measured using computed tomography films.

RESULTS

The LLA was significantly higher in all spondylolysis patients than in the control group (p = .026). There was no significant difference in SSA between the spondylolysis and control groups (p = .28). The LLA was significantly higher in the bilateral group than in the unilateral group (p = .018). There was no significant difference in SSA between the bilateral and unilateral groups (p = .15). The SFA was significantly lower in the bilateral group than in the unilateral group (p = .024).

CONCLUSIONS

This study suggests that physical therapy for spondylolysis may be considered bilaterally and unilaterally.

Topics: Humans; Lumbar Vertebrae; Spondylolysis; Spondylolisthesis; Lumbosacral Region; Lordosis; Fractures, Bone

PubMed: 36256612
DOI: 10.1371/journal.pone.0276337

Review

Authors: Hillary A Snapp, Sebastian A Ausili

There is an increasing global recognition of the negative impact of hearing loss, and its association to many chronic health conditions. The deficits and disabilities associated with profound unilateral hearing loss, however, continue to be under-recognized and lack public awareness. Profound unilateral hearing loss significantly impairs spatial hearing abilities, which is reliant on the complex interaction of monaural and binaural hearing cues. Unilaterally deafened listeners lose access to critical binaural hearing cues. Consequently, this leads to a reduced ability to understand speech in competing noise and to localize sounds. The functional deficits of profound unilateral hearing loss have a substantial impact on socialization, learning and work productivity. In recognition of this, rehabilitative solutions such as the rerouting of signal and hearing implants are on the rise. This review focuses on the latest insights into the deficits of profound unilateral hearing impairment, and current treatment approaches.

PubMed: 32260087
DOI: 10.3390/jcm9041010

Review

Authors: John R Craig

Odontogenic sinusitis (ODS) is more common than historically reported, and is underrepresented in the sinusitis literature. ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures, and most commonly presents unilaterally. ODS clinical features, microbiology, and diagnostic and treatment paradigms are also distinct from rhinosinusitis. ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers, and clinicians must be able to suspect and confirm the condition. ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography, overt maxillary dental pathology on computed tomography, unilateral middle meatal purulence on nasal endoscopy, foul smell, and odontogenic bacteria in sinus cultures. Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence, edema, or polyps. Dental providers should confirm dental pathology through appropriate examinations and imaging. Once ODS is confirmed, a multidisciplinary shared decision-making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions. Oral antibiotics are generally ineffective at resolving ODS, especially when there is treatable dental pathology. When both the dental pathology and sinusitis are addressed, resolution can be expected in 90%-100% of cases. For treatable dental pathology, while primary dental treatment may resolve the sinusitis, a significant percentage of patients still require endoscopic sinus surgery. For patients with significant sinusitis symptom burdens, primary endoscopic sinus surgery is an option to resolve symptoms faster, followed by appropriate dental management. More well-designed studies are necessary across all areas of ODS.

PubMed: 35619928
DOI: 10.1002/wjo2.9