News from Dr Julian Ahmed MBBS MRCPS BSc MSc, Specialty Trainee Audio-Vestibular Medicine, London, UK
The 11th biennial British Society of Neuro-otology meeting took place on 6 October 2017 at the St Thomas’ site of Guy’s and St Thomas’ NHS Foundation Trust. It was attended by 95 delegates from around the world. The programme featured a range of presentations by speakers from across Europe and the USA, with topics ranging from basic clinical sciences to practical clinical neuro-otology.
Proceedings started at full pace with a keynote lecture on ‘Spatial representation and navigation in relation to the vestibular system’ by Prof Neil Burgess of UCL’s Cognitive and Computational Neurosciences unit. This was a fascinating exploration of the different neuronal populations that integrate sensory information to provide a mapping system for spatial orientation and memory. An informative discussion followed analysing how neural mechanisms can be directly linked to clinical features seen in day to day practice.
The bulk of the day was split into free paper presentations with further discussion around topics. The prize for the best overall presentation was awarded to Dr Kheradmand, John’s Hopkins University, for his work on errors of upright perception in patients with vestibular migraine. His elegantly designed study used the Subjective Visual Vertical test paradigm to look at perception scores in migraineurs in comparison to the standard population. Results indicated a larger effect representing an overcompensation error. Other highlights included reports by members of the Imperial College Neuro-otology research unit detailing aspects of neural modulation following vestibular stimulation. Key learning points were that dominance plays a role, there is bi-directional modulation of the motor cortex, and that poorly compensated patients may benefit from rehabilitation stimulating the visual cortex.
Additionally, Joel Goebel, Washington University School of Medicine, St Louis Missouri, USA, presented his work on the optimal size of target in dynamic visual testing, with results indicating a 0.3 logMAR target size is preferential to improve specificity. Diego Kaski, UCL/Queen’s Square, presented a case report on visual deafferentation following prolonged self-induced
light deprivation related to vertiginous migraine, highlighting the pitfalls of psychological aspects being insufficiently addressed.
In between free paper sessions, there was a wide range of posters on display. Notable topics included aspects of vestibular rehabilitation, a significant association of hypovitaminosis D
with BPPV, effectiveness of group CBT in reducing psychological measures of dizzy patients and how dopaminergic activation enhances visual area signal to noise ratio opening a possible aid to rehabilitation. Winner of the poster presentation was Dr van Esch from the Netherlands for work on 'Video-head impulse test results in patients with Menière's disease' showing that no
relationship could be demonstrated with duration or stage of disease. Commendation was also given to Jas Sandhu for his poster on 'Treatment of tinnitus using theta burst based repetitive
transcranial magnetic stimulation', and H J Marcus for a poster on 'The spectrum of vestibular dysfunction in acute traumatic brain injury'.
Ending the day was a keynote lecture by Jonny Harcourt, Consultant in ENT, Charing Cross Hospital on 'Advances in intratympanic therapies for Ménière’s disease'. This was a highly relevant tour of all the work that has had a major impact on management of such a debilitating condition. This is particularly noteworthy in the current climate where other treatment options are ultimately being found to be ineffective and encouragingly it turned out the germ of the idea stemmed from discussion at the BSNO some 10 years earlier!
"The BSNO is held every two years with the next event scheduled for October 2019 to take place at Charing Cross Hospital, London. It is contributed to by health professionals working in the field of neuro-otology. It is more than just a conference to disseminate information: it is a forum to meet and push forward ideas, with a real potential impact on clinical practice and thus highly recommended. Special mention goes to current Chairman Prof Peter Rea, Natasha Harrington-Benton from the Ménière’s Society, and Louisa Murdin from the host institution GST for their efforts in organising the event."
For more information visit www.bsno.org.uk