Evaluation of vestibular system in septorhinoplasty cases

Benign Paroximal Positional Vertigo (BPPV) is one of the most common reasons of peripheral vertigoes and about 25-30 % of all patients resorting to the clinic of neurootology with the complaint of vertigo are diagnosed with BPPV. Cases are often unilateral. It is argued that the bilateral involvement can often occur following the head trauma. The argument that BPPV is more frequently observed in head trauma has been supported by many studies in the literature. Particularly, the surgical interventions including osteotomy lead to the loss of otolithes in the utricle. Thus, particles floating freely gain access to the posterior semicircular channel.Vestibular Evoked Myogenic Potentials (VEMP) test can provide useful information concerning BPPV as a test used in controlling the functions of saccule which is one of the otolith organs. In the literature, potential saccular dysfunction in BPPV patients was detected with VEMP.Horizontal variant of BPPV is examined with the positionel head test. Dix-Hallpike manoeuvre is a proactive manoeuvre and supports the clinical diagnose of BPPV with nystagmus assessment. This test is performed to observe the typical nystagmus of BPPV observed in posterior semicircular channel.Hypothesis of our study is to determine whether a relationship can be established between vestibular disorders such as BPPV and the septorhinoplasty surgery causing potential head trauma in terms of the influence of the vestibular functions. To this end, rhinoplasty cases undergoing the osteotomy process dyring surgery and the septoplasty cases that were not subjected to this trauma were compared by conducting VEMP, Dix-Hallpike and Positional tests in the preoperative and postoperative periods.To this end, 65 patients who filled in the Patient Assessment Form and were found acceptable out of the patients who resorted to the ENT clinic of Ankara Hospital of Medicine Faculty of Başkent University to have a nose surgery between July 2011 and January 2012 and would undergo a septorhinoplasty operation were included in the study. After the preoperative tests were evaluated, 25 patients who required such traumatic interventions as osteotomy and rasping during the nasal surgery were taken in the test group. As to the control group, 25 septoplasty patients who did not undergo an osteotomy process during the surgery and were coherent with the study criteria were selected. In this study, clinical findings that could lead to BPPV were encountered only one rhinoplasty patient having an osteotomy process.As a consequence, the present study is the first prospective research examining the role of the operation trauma associated with the rhinoplasty on the etiology of BPPV with the help of the most objective tests available such as VNG and VEMP. Besides, there is a need for prospective studies to be conducted on larger samples in order to reveal whether BPPV whose physiopatological mechanism has been properly understood is a complication that can still be caused by maxillofacial interventions due to the surgery-related case reports in the literature.