Sudden Otovestibular Dysfunction in 3 Metastatic Melanoma Patients Treated With Immune Checkpoint Inhibitors

Immune-related adverse events have been described in 86%-96% of high-risk melanoma patients treated with immune checkpoint inhibitors (ICI), while in 17%-59% of cases these are classified as severe or even life-threatening. The most common immune-related adverse events include diarrhea, fatigue, hypothyroidism, and hepatitis. Bilateral uveitis and unspecific vertigo have been described in 1% of cases, respectively, in the pivotal studies of ICIs, but the affection of the vestibule-cochlear system has not been reported before. In this case series, we present 3-stage IV melanoma patients with sudden onset of otovestibular dysfunction (hearing loss and vestibulopathy), partly combined with uveitis because of ICIs. We describe detailed diagnostic work-up and therapeutic interventions and discuss possible pathogenic mechanisms of this rare and disabling event.

Hidden hearing deficits in military service members with persistent post concussive symptoms

INTRODUCTION

Individuals with persistent symptoms after mild traumatic brain injury (mTBI) often have auditory complaints. In this study, we used the auditory brainstem response (ABR) to determine whether cochlear synaptopathy could explain auditory symptoms.

METHODS

69 adult military service members with mTBI and 25 adults without brain injury (NCT01611194 and NCT01925963) completed pure-tone audiometry, ABR, and central auditory processing tests. All participants were male, ages 21-50.

RESULTS

37/69 mTBI participants had measurable hearing loss, while another 20%-30% had hearing complaints or tinnitus. While mTBI participants with measurable hearing loss had reduced wave I and III amplitude and decreased III-V interpeak latency, those with no measurable hearing loss did not significantly differ from controls on any ABR parameter. Those with measurable hearing loss were also more likely to have abnormal central auditory processing. mTBI participants with no measurable hearing loss but who reported hearing concerns had some ABR findings (III-V interpeak latency, I and V amplitudes, V/I amplitude ratio) more like the measurable hearing loss mTBI group than normative controls.

CONCLUSION

Cochlear synaptopathy may have contributed to some of the auditory impairment in service members with mTBI with measurable hearing loss. However, these results are likely confounded by cochlear hair cell damage.

[The results of bilateral cochlear implantation in the children who survived meningitis]

The objective of the present study was the prospective analysis of the results of bilateral cochlear implantation (CI) in the children presenting with bilateral ossification of the cochlea after they had survived meningitis. A total of 15 patients underwent the surgical intervention. In those exhibiting bilateral ossification of the basal cochlear helix over the 5 mm segment (up to first bend of the cochlear turn) and partial ossification of the second helix (in 6 children), the affected portions were removed with the placement of two choleostomies, the lower one (from the ossified membrane of the cochlear window) and the upper one (toward the second helix). Activation of the speech processors of the CI systems was carried out within 4-6 weeks after surgery. The hearing abilities of the children were evaluated in accordance with the 'Estimation of the auditory perception categories', 'Estimation of the child's apprehension capacity', and 'Analysis of speech intelligibility rating' guidelines. In all the children with ossification over less than 5 mm of the basal cochlear helix, it proved possible to introduce the whole intracochlear electrode grid whereas only half of the electrode array was implanted in the cases of overall ossification of the basal helix. The first results obtained by telemetry and surdopedagogical testing gave evidence of the possibility of identifying various sources of non-verbal and speech stimuli in all the treated children at a small (up to 3 meters) distance.

Perilymphatic fistula after underwater diving: a series of 11 cases

INTRODUCTION

Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula.

METHODS

We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment.

RESULTS

Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12).

CONCLUSION

The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early.

Surgical methods and postoperative results of cochlear implantation in 79 cases of ossified cochlea

CONCLUSION

A man-made bone tunnel of 1.5 turns around the modiolus can be created in cases of total cochlear ossification. Patients with ossified cochlea types I and II achieved satisfactory hearing results after cochlear implantation (CI). Patients with ossified cochlea type III, in which the modiolus is damaged by the ossification, showed poor hearing results after CI.

OBJECTIVES

To introduce a new CI surgical technique for ossified cochlea and to summarize postoperative hearing results.

METHODS

A total of 79 patients with ossified cochlea who underwent CI were analyzed. Cases were divided into three types: type I, round window ossification; type II, partial cochlear ossification; and type III, complete cochlear ossification. Four surgical methods were used: method A, applicable to type I; methods B and C, applicable to type II; and method D, applicable to type III. Sound field audiometric and speech tests were performed 6 months postoperatively.

RESULTS

All surgeries were successful. The average hearing thresholds for warble tone were 35 dB hearing level (HL) in types I and II and 75 dB HL in type III. The average recognition rates of Mandarin speech were 100% (single finals) and 91% (single initials) in types I and II and 20% (single finals) and 0% (single initials) in type III.

Cochlear-facial dehiscence--a newly described entity

Dehiscence of the cochlear otic capsule has recently been described as a pathologic entity. We describe two cases of cochlear-facial dehiscence, which are the first reported: a 69-year-old male who complained of hearing loss, autophony, and pulsatile tinnitus and a 41-year-old female who complained of left-sided hearing loss, pulsatile tinnitus, and vertigo. In both, computed tomography (CT) showed bony dehiscence between the facial nerve and cochlea. Cochlear-facial dehiscence is another example of otic capsule dehiscence that produces symptoms of third-window lesions. When patients present with symptoms of third-window lesions and CT does not show superior canal dehiscence, cochlear-facial dehiscence should be considered.

Late pneumolabyrinth after undiagnosed post-traumatic perilymphatic fistula. Case report illustrating the importance of systematic emergency management

INTRODUCTION

Temporal bone fracture is a common complication of high-energy cranial trauma. Labyrinth involvement is rare, but there is a risk of perilymphatic rupture that is often underestimated on initial clinical examination due to the predominance of neurological and/or somatic symptoms.

CASE REPORT

A patient presented with overlooked perilymphatic fistula, decompensated by hyperpressure effort due to poorly adapted management.

DISCUSSION

Following a review of the literature on post-traumatic pneumolabyrinth, overall management (from diagnosis to treatment, via prevention advice) was analyzed. A constructive critique of the patient's treatment was thus made.

CONCLUSION

We argue for a systematic management protocol in cranial trauma with temporal bone fracture, comprising ENT examination, millimetric-scale cross-sectional imaging of the fracture site, and standardized counseling to prevent late complications.

[The estimation of the efficacy of manual therapy included in the combined treatment of cochlear-vestibular disorders based on the results of computed stabilography]

The objective of the present study was to estimate the efficacy of the combined treatment of spondylogenic cochlear-vestibular disorders with the use of both medicamental and non-medicamental modalities. Computed static stabilometry was applied for diagnostics of postural disbalance and evaluation of the treatment outcomes. It was shown that the application of manual therapy for the management of 56 patients presenting with spondylogenic cochlear-vestibular disorders resulted in the decrease of tinnitus and the improvement of vestibular and cochlear functions.

Deterioration of hearing in a cochlear implantee with relapsing polychondritis

We report on a rare case of cochlear implantation in a patient affected by relapsing polychondritis (RP), which over time induced cochlear fibrosis/ossification and deterioration of previously excellent hearing performance. The clinical course was determined by CT scan, electrophysiology, and speech perception data. We conclude that RP is a severe autoimmune connective disorder that can cause profound sensorineural hearing loss. Cochlear implantation in these patients can provide excellent performance. Continuation of therapy may improve prognosis, but relapses involving inner ear structures can determine fibrosis/ossification of the modiolus and interfere with cochlear implant use.

[Cochleovestibular disorders: approaches to diagnostics and treatment]

The aim of this work was to evaluate the efficacy of introduction of milgamma and milgamma compositum in the treatment of 52 patients with cochleovestibular disorders of different etiology. Thirteen patients enrolled in the study received standard therapy and 39 others were given its combination with milgamma preparations. Combined therapy with milgamma and milgamma compositum ensured faster vestibular compensation including posturographic characteristics than the standard treatment (within 3-4 weeks compared with 5 weeks in controls). The results of the study give reason to recommend milgamma and milgamma compositum as neurotropic medicines in addition to standard therapy for the management of the patients presenting with cochleovestibular disorders for the acceleration of the vestibular compensation.

[Hirudotherapy in the treatment of peripheral cochleovestibular disorders of vascular origin]

Basic therapy of peripheral cochleovestibular disorders of vascular origin consists of the rational combination of medicamentous and non-medicamentous treatments that collectively ensure positive clinical results. The use of hirudotherapy for the management of peripheral cochleovestibular disorders resulted in the substantial decrease of ear noise and the maintenance of the tendency toward further improvement of cochlear and vestibular functions.

Congenital cholesteatoma extending into the internal auditory canal and cochlea: a case report

We report here on a case of congenital cholesteatoma that extended into the internal auditory meatus and cochlea. A 17-year-old boy underwent surgery for a very large cholesteatoma, which was discovered behind an intact tympanic membrane. Pure tone audiometry revealed an unresponsive ear. High resolution temporal bone computed tomography showed perilabyrinthine extension with its absence in the vestibular area, and destruction of the bony cochlea at the basal turn, the tegmen and the posterior cranial fossa. Magnetic resonance imaging revealed no intracranial extension. Surgical exploration of the middle ear and the mastoid cavity revealed that both the vestibule and the basal turn of the cochlea were filled with a noninfected cholesteatoma. The cholesteatoma extended into the internal auditory meatus through translabyrinthine destruction; it extended into the basal turn of the cochlea through the infralabyrinthine route. The bony segment of the facial nerve canal demonstrated near total dehiscence. The cholesteatoma was removed by the transotic approach. Congenital cholesteatoma is characterized by no specific history. Therefore, early detection of this malady can be challenging, but it is important to prevent such complications as were observed in this reported case.

[Otoacoustic emissions in clinical and surgical practice]

OBJECTIVES

Otoacoustic emissions (OAEs), discovered in 1978, have a well-established cochlear origin. They strongly depend on the outer hair cells and are widely used in experimental research as a means for testing cochlear function. However, outside screening, OAEs are only rarely used in clinical practice. The objective of this paper was to show their vast clinical utility.

MATERIAL AND METHODS

First, a review of the biophysical and physiological knowledge on OAEs is provided, concerning transient OAEs as well as distortion-product OAEs, recalling the origin and the meanings of these acoustic signals. Several clinical situations are then presented, and the corresponding OAE alterations are explained, such as hearing screening in neonates, diagnosis of hearing impairment with particularities related to the age of the patient, situations critical to the cochlea such as ototoxic treatments, and surgical procedures to the cerebellopontine angle.

RESULTS

OAEs appear to be a powerful tool in clinical practice, particularly in hearing screening and diagnosis of deafness. They can also be used to monitor hearing function during cerebellopontine angle tumor resection.

CONCLUSION

OAEs are still rarely used as a diagnostic tool by clinicians despite their clinical value, which should make them a primary choice.

Improved cryosections and specific immunohistochemical methods for detecting hypoxia in mouse and rat cochleae

The present study was undertaken to develop an improved cryoembedding method for analysis of mice and rat cochleae, which permits high-quality cryosections and preserves overall structure and cellular resolution as shown by hematoxylin/eosin staining. The preservation of morphology and antigenicity is mandatory to achieve optimal results. A total of 20 male cd/1 mice and 14 male Sprague-Dawley rats were used in experiments for optimization of preservation, fixative, decalcification, embedding and cryosectioning of cochleae from adult and aged rodents. In addition, a novel immunohistochemical procedure (using Hydroxyprobe-1 kit) was developed for detecting regions of hypoxia in mice and rat cochlea. This method employs a primary fluorescent-conjugated monoclonal antibody directed against pimonidazole protein adducts that are created in hypoxic tissues. Subsequent studies of hypoxia inducible factor-1alpha (HIF-1alpha) by immunofluorescence in the cochlea of these animals were performed in order to confirm that immunochemical detection of pimonidazole protein is representative of a hypoxic environment. We conclude that the present method results in high-quality cryosections of cochlear tissues presenting good anatomical and histological preservation. Furthermore, our optimized procedures provide novel tools for the investigation of neuro-sensory-epithelium in physio-pathological situations associated with hypoxia and/or ischemia, such as inner ear development, plasticity, regeneration and senescence.

Recurrent meningitis and cerebrospinal fluid leak-two sides of the same vestibulocochlear defect: report of three cases

Cochlear dysplasia is a rare congenital anomaly. However, early detection of this anomaly can prevent serious consequences. We describe three cases of cochlear dysplasia that presented with recurrent meningitis and cerebro-spinal fluid (CSF) leak in children in which early diagnosis prevented further complications.

SUSAC SYNDROME IN FOUR MALE PATIENTS

PURPOSE

To report the clinical and imaging features in four male patients presenting with Susac syndrome, a microangiopathy affecting the brain, the retina, and the cochlea.

METHODS

Retrospective review of clinical data, fluorescein angiograms, and magnetic resonance imaging findings in these four cases.

RESULTS

All four patients were young men (range, 20-35 years). The axiomatic triad of ocular, cochlear, and neurologic involvement was present in three patients. Neurologic symptoms were absent in the fourth one. Fluorescein angiography showed arteriolar wall hyperfluorescence in all four patients. Magnetic resonance images showed in three patients multifocal hyperintense lesions in the white matter and the corpus callosum with typical involvement of the central fibers. Therapeutic modalities and clinical course are described. Three patients had a follow-up of 3, 5, and 13 years with complete remission of the disease within 1 year in all three cases. One patient had severe neuropsychological sequelae.

CONCLUSION

Susac syndrome seems to be less unusual in men than previously reported. Though presenting as a self-limited monophasic course disease in most cases, it may result in severe neuropsychological sequelae. Early diagnosis of the syndrome is enabled by the combination of the ophthalmologic, audiometric, and brain magnetic resonance features.

Diagnostics of the Cochlear Amplifier by Means of Distortion Product Otoacoustic Emissions

Distortion product otoacoustic emission (DPOAE) growth functions reflect the active nonlinear cochlear sound processing when using a primary-tone setting which accounts for the different compressions of the two primaries at the DPOAE generation site and hence provide a measure for objectively assessing cochlear sensitivity and compression. DPOAE thresholds can be derived from extrapolated DPOAE input/output (I/O) functions independently of the noise floor and consequently can serve as a unique measure for reading DPOAE measurements. The thus-estimated DPOAE thresholds exhibit a close correspondence to behavior audiometric thresholds and thus can be used for reconstructing an audiogram, i.e., a DPOAE audiogram. The DPOAE I/O functions' slope increases with cochlear hearing loss and thus provides a measure for assessing recruitment. Hence, DPOAE I/O functions can give more information for diagnostic purposes than those of DP grams, transiently evoked OAEs (TEOAEs), or auditory brain stem responses (ABRs). DPOAE audiograms can be applied in pediatric audiology to assess cochlear dysfunction in a couple of minutes. In newborn hearing screening, they are able to detect transitory sound-conductive hearing loss and thus can help to reduce the rate of false-positive TEOAE responses in the early postnatal period. Since DPOAE I/O functions are correlated with loudness functions, DPOAEs offer the possibility of basic hearing aid adjustments, especially in infants and children. Extrapolated DPOAE I/O functions provide a tool for a fast automated frequency-specific and quantitative evaluation of hearing loss.

Summating Potential-Action Potential Waveform Amplitude and Width in the Diagnosis of Meni??re???s Disease

OBJECTIVES

It has been suggested that analyzing the width and amplitude of the summating potential-action potential (SP-AP) waveforms can increase the sensitivity of electrocochleography. The objective of this study was to evaluate the ratio of SP to AP amplitude (SP/AP) and SP-AP waveform width, as well as the AP latency difference to condensation and rarefaction clicks, for the diagnosis of Menière's disease.

STUDY DESIGN

This was a prospective, controlled study.

METHODS

We used transtympanic electrocochleography to evaluate 21 patients with definite Menière's disease and 19 normal-hearing patients with other cochleovestibular disorders, comparing SP/AP, AP latency difference, and SP-AP waveform widths as well as calculating the diagnostic sensitivity of these parameters.

RESULTS

Mean SP-AP waveform width was 1.89 ms in the study group and 1.58 ms in the control group. Mean SP/AP was 0.37 in the study group and 0.22 in the control group. The mean product of SP-AP waveform width and SP/AP was 75.26 ms% in the study group and 34.60 ms% in the control group. Mean AP latency difference was 0.13 ms in the study group and 0.07 ms in the control group. For the parameters evaluated, the differences between the groups were statistically significant. In the study group, the sensitivities for the width of the SP-AP waveform, the SP/AP, and the AP latency difference were 33.3%, 52.4%, and 23.8%, respectively.

CONCLUSIONS

The use of the parameters evaluated did not increase the sensitivity of the electrocochleography, whether used in isolation or in conjunction with the SP/AP. Determining SP/AP presented the greatest sensitivity.

Intrakochleäres Schwannom als Ursache für eine Surditas

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Noise-induced perilymph fistula

Perilymph fistulae are difficult to diagnose because they present with a wide variety of signs and symptoms, they are associated with many etiologies, and they often mimic other conditions. In this article, we describe a case of perilymph fistula that featured one of its more rare causes: acoustic trauma--specifically, damage from a loud blast from the siren of a fire engine. We also review the literature and discuss the difficulties of diagnosis and treatment and the possible mechanisms by which acoustic trauma and other etiologies cause perilymph fistulae.

Could vestibular evoked myogenic potentials (VEMPs) also be useful in the diagnosis of perilymphatic fistula?

The role of vestibular evoked myogenic potentials (VEMPs) is at this time indisputable in the study of vestibular disorders. Furthermore, VEMPs are widely accepted as a diagnostic tool when a superior semicircular canal dehiscence (SCD) is suspected, presenting in such cases a lowering of threshold values able to raise a recordable response due to increased inner ear immittance. According to the same principle, the possibility of another kind of alteration having the same effect on the inner ear might be considered when high-resolution computed tomography has excluded the presence of an SCD. In this paper four cases are described in which high-resolution computed tomography showed normal features without any labyrinthine dehiscence and VEMP threshold values were lowered; the appropriateness of suspecting a perilymphatic fistula in such cases and resorting to VEMPs in detecting a perilymphatic fistula is discussed.

Hyperacusis in Williams syndrome: Characteristics and associated neuroaudiologic abnormalities

BACKGROUND

Hyperacusis and phonophobia are common, debilitating symptoms in Williams syndrome (WS), yet little is known about their underlying audiologic and neurologic processes.

METHODS

The mothers of 49 subjects with WS were asked to complete the Hyperacusis Screening Questionnaire. Subjects with reported hyperacusis and sufficient developmental capacity underwent comprehensive audiological and brain auditory evoked response (BAER) testing. Findings were compared with those from pair-matched typically developing control subjects.

RESULTS

Forty-one of the 49 children with WS (84%) had hyperacusis of moderate to severe degree, which began in infancy. Of these, 21 (mean age 15.8 +/- 5.5 years) were quantitatively tested. Subjects with WS reported discomfort at sound intensities on average 20 dB lower than control subjects. Pure-tone audiometry and distortion products otoacoustic emission test revealed a high-frequency cochlear hearing loss. An absence of ipsilateral acoustic reflex responses to maximum stimulation was significantly more common in the subjects with WS than controls. On BAER testing, the WS group had a significant prolongation in wave I latency.

CONCLUSIONS

Hyperacusis in Williams syndrome (WS) is associated with a high-frequency hearing loss resembling the configuration of noise-induced hearing loss. The hyperacusis and hearing loss in WS may stem from a deficiency in the acoustic reflex resulting from auditory nerve dysfunction. Additional mechanisms that may mediate hyperacusis in WS and should be evaluated in future studies include recruitment, malformation of the facial canal, and haploinsufficiency of the elastin gene.

Cochlear Preservation After Meningitis: An Animal Model Confirmation of Adjunctive Steroid Therapy

OBJECTIVE/HYPOTHESIS

The objective of the present study was to determine whether treating pneumococcal meningitis with a combined antibiotic and steroid regime will prevent cochlear damage, a common pneumococcal meningitis side effect.

STUDY DESIGN

This was a prospective animal study.

METHODS

Gerbils were randomly assigned to three experimental groups. Animals in group 1, the control animals, received intrathecal saline injections. Animals in groups 2 and 3 received intrathecal injections of Streptococcus pneumoniae to induce meningitis. Although group 2 solely was treated for 7 days with intraperitoneal penicillin injections (48,0000 units), group 3 received, in addition to the antibiotic for 4 days, 0.5 mg/kg intraperitoneal dexamethasone injections. Three months after the meningitis was induced, the animals' cochlear function was determined using auditory brainstem responses (ABRs). Fifteen frequencies were tested, five octaves at three steps per octave between 2 and 50 kHz.

RESULTS

ABR thresholds were significantly elevated only in group 2. When compared with group 1, ABR thresholds were 19 dB higher (P<.05). Frequencies at the low-frequency end of the hearing range were affected more than the midfrequencies. Animals that received dexamethasone had 2-dB higher thresholds than the control group (P>.05).

CONCLUSIONS

Dexamethasone therapy in conjunction with antibiotic therapy preserves cochlear function in cases of S. pneumoniae meningitis in the Mongolian gerbil model.

A Diagnostic Test for Ménière's Disease and Cochlear Hydrops: Impaired High-Pass Noise Masking of Auditory Brainstem Responses

HYPOTHESIS

Endolymphatic hydrops in patients diagnosed with Ménière's disease causes changes in the response properties of the basilar membrane that lead to impaired high-pass noise masking of auditory brainstem responses to clicks.

BACKGROUND

Ménière's disease is defined as the idiopathic syndrome of endolymphatic (cochlear) hydrops, which is an abnormal increase in the volume of cochlear fluid (endolymph) in the inner ear. Accurate detection and diagnosis are important but difficult because of the lack of sufficiently sensitive tests.

METHODS

Two populations were compared: (1) 38 non-Ménière's normal-hearing subjects; and (2) 23 patients who, at the time of testing, continued to have at least three of the four hallmark symptoms (i.e., tinnitus, vertigo, fluctuating hearing loss, and fullness) used in the diagnosis of Ménière's disease. Auditory brainstem responses to clicks presented ipsilaterally with masking noise that was high-pass filtered at various frequencies were recorded.

RESULTS

In the Ménière's patients, the masking noise is insufficient such that an undermasked Wave V is still present at a latency similar to that of Wave V in the response to the clicks alone. In the control non-Ménière's normal-hearing subjects, this undermasked component was either absent or significantly delayed because of the masking noise. The difference in the delays between these populations is such that the distributions do not overlap, resulting in 100% sensitivity and 100% specificity.

CONCLUSION

This test is able to distinguish objectively active Ménière's disease in individuals and may show promise for tracking changes in the severity of the disease caused by progression or treatment.

Distribution of neurotological findings in patients with cochleovestibular dysfunction

The relationship between spatial body positioning and environment comes from perfect corporal balance. The three most important systems responsible for this relationship are: the optic system (sight), the proprioceptive system, and the labyrinthine system. Study design: retrospective clinical. We carried out a retrospective study in 3,701 patients of a private otolaryngologic clinic in Jundiai – Sao Paulo, Brazil, who underwent vestibular and cochlear labyrinthine function testing, from 1979 to 2004. Aim: To determinate the syndromic distribution of the population and to correlate its relationship with sex, age, symptomatology, as well as otological, clinical and electronystagmographic findings, and which were the most frequent medical specialties who asked for this investigation. Results: We found higher prevalence in females (1.75:1). Seventy-nine percent of the patients were aged 20 to 59 years old, therefore including people in productive age, with a major prevalence of peripheral syndromes, but there was no preference for age or sex among different syndromes. This study also demonstrated that some otoneurological symptoms were common to all kinds of otoneurological syndromes, in opposition to the data found in the world literature. Tinnitus, hearing loss, nausea and vomiting as well as harmonic alterations in clinical examination were found with more frequency on peripheral syndromes, whereas non-harmonic was found in central syndromes, according to the reviewed literature. The conclusions showed that the majority of the patients started their investigation with either otolaryngologists or neurologists and 36% of the patients had peripheral syndrome and almost 25% had normal evaluation.

Computed tomography findings of labyrinthitis ossificans secondary to meningitis: a case report

A 26-year-old man was admitted to our hospital with chronic left ear drainage. He had a history of meningitis when he was a child. Computed tomography (CT) of the temporal bone showed complete obliteration of the otic labyrinth by sclerotic tissue. Based on CT findings, the patient was diagnosed as labyrinthitis ossificans. Computed tomography is an appropriate method of examination for the identification of labyrinthitis ossificans and is of particular importance for the evaluation of patients before cochlear implantation.

An unusual disease presenting at an unusual age: Susac’s syndrome

Susac's syndrome is a rare disease of unknown aetiology affecting the small vessels of the retina, brain, and cochlea. We present the case of a 55-year-old female, the oldest patient yet described with the condition, and highlight the syndrome's clinical features.

[Audiological diagnosis of cochleovestibular disorders caused by internal ear hydrops]

A total of 75 patients with clinical signs of internal ear hydrops (IEH) were examined using dehydration tests and electrocochleography. The patients were divided into groups by the results of pure tone threshold audiometry according to the international classification. Both methods proved highly informative. Positive dehydration tests were obtained in 57% cases, positive electrocochleography evidence was observed in 73% cases. An increased SP/AP amplitude was seen in 65% cases. Both methods allowed IEH detection in 82% cases. In normal hearing and hypoacusis of the first degree electrocochleography is more effective than dehydration tests in detection of IEH, but with hearing loss deterioration this advantage lessens. It is shown that patients can suffer from IEH in normal values of pure tone threshold audiometry. This should be taken into consideration in examination of patients who do not complain of hypoacusis.

Obliteration der Cochlea beim Cogan-Syndrom - Bedeutung für die Cochlear-Implant-Chirurgie

BACKGROUND

Acute, often bilateral deafness in Cogan's syndrome or other autoimmune diseases is caused by autoimmune mediated inflammatory attack on the membranous labyrinth. Auditory rehabilitation in case of bilateral deafness can be achieved by cochlear implant surgery.

METHODS

A retrospective analysis of all patients suffering from Cogan's syndrome that had received a cochlear implant, was carried out.

RESULTS

6 of 295 adult patients (2.6 %) that had received a cochlear implant, had become deaf due to Cogan's syndrome. Partial obliteration or ossifikation was encountered in all cases and influenced surgical procedure. In one case a fibrous obliteration of the scala tympani was found 8 weeks after acute onset of complete deafness.

CONCLUSIONS

The course of obliteration is unknown. With regard to our results a fibrous obliteration may occur as early as 8 weeks after complete deafness. This has to be considered in counseling of patients. Only early cochlear implant surgery facilitates best possible rehabilitation results.

Middle ear and cochlear disorders result in different DPOAE growth behaviour: implications for the differentiation of sound conductive and cochlear hearing loss

Input/output functions of distortion product otoacoustic emissions (DPOAE I/O-functions) give an insight into the compressive, non-linear sound processing of the cochlea. With an inner ear dysfunction a steeper I/O-function is observed. Due to the linear sound processing of the middle ear, one can assume that the DPOAE growth behaviour remains unaltered with a sound conduction dysfunction. If that is true, a differentiation between middle and inner ear dysfunction will be possible by using the slope of DPOAE I/O-functions as a means for assessing cochlear compression. In order to test that hypothesis, DPOAE I/O-functions were recorded in a wide primary tone level range at up to 8 f2 frequencies between 2.0 and 8.0 kHz (15 dB SPL < L2< 60 dB SPL; L1=0.46 L2 + 41 dB SPL; f2/f1=1.2) in guinea pigs in which middle (saline solution in the bulla) and inner ear (exposure to loud broadband noise) disorders were induced. Middle ear dysfunction resulted in a reduction of the DPOAE amplitude independent of the primary tone level. Consequently, DPOAE growth behaviour was not affected. In contrast to that, during cochlear impairment, steepened DPOAE I/O-functions were observed reflecting loss of compression of the cochlear amplifier. Accordingly, DPOAE I/O-functions allow a differentiation between middle and inner ear dysfunction. Further studies will have to show the usability of this method for clinical diagnostics, e.g. for detecting sound conduction disturbances in newborn hearing screening due to amniotic fluid or Eustachian tube dysfunctions during the early postnatal period.

[Susac syndrome: a report of two cases]

OBJECTIVE

To investigate the clinic characters and diagnosis of Susac syndrome.

METHODS

Two cases were systematically studied by the authors.

RESULTS

All the two cases were young women. The clinical manifestations include acute and subacute multifocal and diffuse encephalopathic symptoms, hearing loss, and visual loss. Diagnosis is facilitated by demonstration of retinal arteriolar occlusions without uveitis or keratoconjunctivitis, mid-to-low frequency unilateral or bilateral sensorineural hearing loss, and numerous small foci of increased signal in the white and gray matter on T2-weighted brain magnetic resonance imaging.

CONCLUSIONS

This rare syndrome often can be identified at an early stage with a careful history and physical examination. MRI, SPECT, retinal fluorescein angiography and audiometry will contribute to diagnosis.

[Effects of Cisplatin on Auditory Function in Children with cancer. Otoacoustic Emission Evaluation]

This study was done to ascertain prospectively whether distortion product-evoked otoacoustic emissions (DP-EOAE) might detect changes in specific frequencies damaged in inner ear function earlier, before they become permanent after cisplatinum exposure for cancer treatment in children. Sixteen children treated with cisplatinum for various types of cancer were repeatedly evaluated after each chemotherapy session; results were compared to 44 controls. We observed a progressive damage in auditory function. In second assessment 50% of DP-EOAE studies were abnormal; in the third study, 66% were abnormal, and in the fourth test 71% were abnormal. Our results suggest that DP-EOAE are useful tests for earlier auditory changes induced by cisplatinum therapy; higher frequencies are the most affected, and we propose that DP-EOAE be a mandatory test before treatment and during cisplatinum therapy to detect or diagnose early hearing loss.

Preoperative high resolution CT and MR imaging in cochlear implantation

INTRODUCTION

Accurate preoperative imaging of the temporal bone in patients receiving cochlear implants is important. High resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are the 2 preoperative imaging modalities that provide critical information on abnormalities of the otic capsule, pneumatisation of the mastoid, middle ear abnormalities, cochlear ducts patency and presence of cochlear nerve.

MATERIALS AND METHODS

The HRCT and MR imaging in 46 cochlear implant patients in our department were reviewed.

RESULTS

Majority of our patients [34 patients (73.9%)] showed normal HRCT of the temporal bone; 5 (10.9%) patients had labyrinthitis ossificans, 2 (4.3%) had Mondini's abnormality and 2 (4.3%) had middle ear effusion. One patient each had high jugular bulb, hypoplasia of the internal auditory canal and single cochlear cavity, respectively.

CONCLUSION

The above findings contribute significantly to our surgical decisions regarding candidacy for surgery, side selection and surgical technique in cochlear implantation.

[Prognostic factors in hearing recovery following sudden unilateral deafness]

A perilymph fistula is a possible cause for sudden unilateral sensory deafness. In this retrospective study the data of 73 patients with unilateral sudden deafness were analyzed. All of them underwent an exploratory tympanotomy during which both windows were packed with soft tissue. Postoperatively all patients received rheological therapy with pentoxifyllin and steroids. The following possible prognostic indicators were analyzed: age, sex, tinnitus, vertigo, vomiting, spontaneous nystagmus, positive fistula test, time between onset of symptoms and therapy, intraoperative proof of a perilymph fistula, and signs of barotrauma in the patient's history. A significant postoperative recovery of the hearing loss (>20%) was found in 29 patients (39.7%) (group 1), and 44 patients (60.3%) showed only an increase of <20% (group 2). The statistical analyses showed the following significant difference: The symptoms vertigo (p=0.002) and spontaneous nystagmus (p=0.014) occurred more frequently in group 2 (patients with a poor hearing recovery) than in group 1. Patients with a barotrauma,however, had an overproportionally good outcome (50-100% hearing recovery). A perilymph fistula was seen intraoperatively equally often in both groups. In summary, the symptoms vertigo and spontaneous nystagmus are indicators of complex damage in cases of sudden deafness and are associated with a worse prognosis concerning hearing recovery. Exploratory tympanotomy in combination with drug treatment is a reasonable therapy as an ultima ratio in every case of unilateral sudden deafness.

Prediction of progression from atypical to definite Ménière's disease using electrocochleography and glycerol and furosemide tests

OBJECTIVE

To investigate whether electrocochleography (ECochG) and glycerol and furosemide tests could predict progression from atypical to definite Ménière's disease (MD).

MATERIAL AND METHODS

ECochG and glycerol and furosemide tests were performed in 1569 patients with various cochleovestibular diseases, including definite MD, atypical MD, syphilitic labyrinthitis, delayed endolymphatic hydrops, sudden hearing loss, cochleovestibulopathy and sensorineural hearing loss. Patients with atypical MD were divided into five categories based on their symptoms.

RESULTS

A total of 115/118 patients (97%) with definite MD who underwent all 3 tests showed a positive result in at least 1 test. Ninety-nine patients who did not satisfy the diagnostic criteria of definite MD but had vertigo and/or hearing loss at the first visit subsequently progressed to definite MD. It was retrospectively found that 92% of patients showed at least 1 positive finding in these 3 tests at the initial stage. In those patients who showed a negative test result in either ECochG or the glycerol test, the possibility of progression to definite MD was low.

CONCLUSION

The combination of ECochG and the glycerol and furosemide tests was helpful in diagnosing endolymphatic hydrops (ELH). ECochG and the glycerol test were effective tools for predicting the progression to definite MD in patients with atypical MD, sudden hearing loss and other cochleovestibular diseases. Our test results also indicated that the pathological state of atypical MD included both non-ELH and ELH.

Cross-sectional analysis of hearing threshold in relation to age in a large family with cochleovestibular impairment thoroughly genotyped for DFNA9/COCH

Hearing threshold was analyzed for each frequency in relation to age in 88 members of a large Dutch family with cochleovestibular impairment caused by a P51S mutation in the COCH gene within the DFNA9 locus (chromosome 14q12-13). The participants in this study were 34 mutation carriers and 54 relatives without the mutation (control subjects). A sigmoidal dose-response curve with a variable slope was used to fit the mutation carriers' threshold-on-age data. Progression started at about 40 years of age and only lasted for some 20 to 25 years; the associated average progression was 2.9 dB/y for all frequencies. However, some hearing impairment was already present before, predominantly at the high frequencies. The mean thresholds in the young mutation carriers (< 33 years of age) were significantly higher (by 4 to 13 dB) than those in age-matched controls at 2 to 8 kHz. Presumably, mutation carriers have a congenital, stable offset threshold (10 to 29 dB) at these frequencies, and develop progression later in life.