Visual vertigo, commonly associated with persistent postural-perceptual dizziness (PPPD), is characterised by dizziness and imbalance provoked by visually complex environments. Vestibular rehabilitation often includes vestibulo-ocular reflex (VOR) exercises; however, the added value of structured balance training in routine clinical practice remains less well described. This retrospective service evaluation was conducted in a specialist vestibular physiotherapy service at a tertiary NHS trust hospital in the United Kingdom. Eighty-five adults with clinically diagnosed visual vertigo/PPPD underwent physiotherapy-led vestibular rehabilitation. Patients completed either VOR exercises alone (n=36) or VOR combined with progressive balance training (n=49), reflecting individual tolerance and rehabilitation progression in routine care. Outcomes were assessed using the Dizziness Handicap Inventory (DHI) before and after treatment. Within-group and between-group changes were analysed using paired and independent-samples t-tests. Both groups demonstrated significant improvement in DHI scores following rehabilitation (p<0.001). The VOR-only group improved from a mean DHI score of 70.6 to 56.6 (mean reduction 14.0), whereas the VOR plus balance group improved from 73.4 to 24.4 (mean reduction 49.0). Between-group comparison showed significantly greater improvement in the combined rehabilitation group (p<0.001). In routine clinical practice, vestibular rehabilitation incorporating both VOR exercises and structured balance training was associated with substantially greater reduction in dizziness-related handicap than VOR exercises alone in patients with visual vertigo/PPPD. These findings support progression to balance-challenging rehabilitation tasks when tolerated.
Radioiodine whole-body scintigraphy plays a pivotal role in the surveillance of differentiated thyroid carcinoma. However, false-positive radioiodine uptake may occur in various benign and malignant conditions, potentially leading to diagnostic confusion. Parotid oncocytoma is a rare benign salivary gland neoplasm accounting for less than 1
Chondroid syringoma (mixed tumor of the skin) is a rare, benign cutaneous adnexal neoplasm composed of epithelial and mesenchymal elements. Occurrence in the facial region, particularly adjacent to the nasal ala, is uncommon and often clinically misdiagnosed as an epidermal cyst or adnexal mass. A 66-year-old male presented with a firm, non-tender, slow-growing nodule measuring approximately 2.3 CM at the left nasolabial fold above the nasal ala. 128-slice helical computed tomography (CT) demonstrated a well-defined 23 × 20 × 19 mm hypodense lesion with internal calcifications abutting the nasal bone, alongside a secondary asymptomatic 3.5 × 5.0 mm lesion in the left inferior cheek. Fine-needle aspiration cytology suggested a benign adnexal lesion. The primary mass was managed via complete surgical excision with an elliptical skin incision, yielding negative surgical margins. Histopathology confirmed a benign biphasic tumor with chondroid stroma without adverse features such as atypia, necrosis, or perineural invasion. The secondary cheek lesion was managed conservatively and remained stable over a 6-month follow-up, during which no recurrence of the primary tumor was observed. Complete surgical excision with clear margins remains the treatment of choice for chondroid syringoma. Accurate histopathological evaluation and structured follow-up are critical to confirm benign etiology and prevent recurrence.
Primary spindle cell sarcomas of the palatine tonsil are exceedingly rare malignant neoplasms. Due to their overlapping histopathological features with spindle cell variants of epithelial and other mesenchymal tumours, diagnosis is challenging and requires careful clinicopathological correlation with immunohistochemistry. Furthermore, the rarity of head and neck sarcomas results in poorly defined management protocols. A 65-year-old man presented with a foreign body sensation in the throat and odynophagia lasting for two months. An examination revealed a 4 cm × 3 cm lobulated, firm mass occupying the left tonsillar fossa and crossing the midline. Contrast-enhanced CT scans demonstrated a well-defined enhancing lesion confined to the left lateral oropharyngeal wall, with no involvement of the base of the tongue or the epiglottis. No cervical lymphadenopathy or distant metastasis was identified on staging evaluation. Fine needle aspiration indicated malignant spindle cells. The patient underwent coblation-assisted transoral excision with adequate margins. Histopathology revealed spindle cells arranged in short fascicles, exhibiting moderate eosinophilic cytoplasm, nuclear hyperchromasia, and occasional mitotic figures. No squamous differentiation was identified. Immunohistochemistry demonstrated vimentin positivity and negativity for pan-cytokeratin, p63, EMA, S100, desmin, CD99, and CD34, supporting the diagnosis of spindle cell sarcoma. The postoperative recovery was uneventful. The patient remains disease-free after three years of follow-up. Primary tonsillar spindle cell sarcoma is a rare diagnostic entity that requires a broad immunohistochemical panel and careful histopathological evaluation. Complete surgical excision remains the cornerstone of management for localised disease, and long term follow up is essential. Reporting such rare presentations aids in improving the understanding of disease behaviour and guiding future treatment strategies.
Minimizing tissue injury and postoperative morbidity is essential for enhancing recovery in rhinoplasty. This study aimed to evaluate the efficacy and safety of percutaneous perforated piezo-osteotomy versus the conventional osteotome technique in reducing postoperative morbidity. This randomized, single-blind, split-mouth trial, registered under code “IRCT20220104053618N1,” enrolled 24 patients (mean age 23 ± 2.1 years; 70.8
