1/14. A small vestibular schwannoma arising from the inferior vestibular nerve.The investigation of a complaint of unilateral right sensorineural hearing loss led to the identification of a right 3 mm vestibular schwannoma arising from the inferior division of the right vestibular nerve. On investigation the patient was found to have normal caloric function, this being mediated by the superior vestibular nerve. Both transient and distortion product otoacoustic emissions were absent in the right ear, and ABR was abnormal on this side. These findings are of interest as they indicate that this small lesion produced a hearing loss that was both cochlear and retrocochlear. The anatomical finding that the medial auditory efferents run within the inferior vestibular nerve is considered. This patient did not experience tinnitus or hyperacusis despite the site of the lesion arising from the inferior vestibular nerve.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
2/14. Familial early-onset progressive vestibulopathy without hearing impairment.A family with early-onset vestibulopathy is presented. The 34-year-old father had experienced brief attacks of vertigo and currently suffers from unsteadiness and oscillopsia during head movements. His two young sons also experience brief attacks of spontaneous vertigo. In vestibular testing all three subjects showed reduced caloric responses. However, only the father showed reduced otolith function (as reflected by the vestibular-evoked myogenic potentials). Further, all three subjects had walked before the age of 1 year and none of them had had any auditory symptoms. It is suggested that they have familial early-onset progressive vestibulopathy affecting the canals before the otoliths but sparing cochlear function.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
3/14. Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction.OBJECTIVES: To investigate the clinical and radiological features of patients presenting with an acute auditory syndrome as a prodromal symptom of anterior inferior cerebellar artery (AICA) infarction. methods: 16 consecutive cases of AICA infarction diagnosed by brain magnetic resonance imaging completed a standardised audiovestibular questionnaire and underwent a neuro-otological evaluation by an experienced neuro-otologist. RESULTS: Five patients (31%) had an acute auditory syndrome as a prodrome of AICA infarction one to 10 days before onset of other brain stem or cerebellar symptoms. Two types of acute auditory syndrome were found: recurrent transient hearing loss with or without tinnitus (n = 3), and a single episode of prolonged hearing loss with or without tinnitus (n = 2). The episodic symptoms were brief, lasting only minutes. The tinnitus preceding the infarction was identical to the tinnitus experienced at the time of infarction. At the time of infarction, all patients developed hearing loss, tinnitus, vertigo, and ipsilateral hemiataxia. The most commonly affected site was the middle cerebellar peduncle (n = 5). Four of the five patients had incomplete hearing loss and all had absence of vestibular function to caloric stimulation on the affected side. CONCLUSIONS: Acute auditory syndrome may be a warning sign of impending pontocerebellar infarction in the distribution of the AICA. The acute auditory syndrome preceding an AICA infarct may result from ischaemia of the inner ear or the vestibulocochlear nerve.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
4/14. Neuro-otologic findings in unilateral isolated narrow internal auditory meatus.OBJECTIVE: To report neuro-otologic findings concerning the four nerves in the internal auditory meatus (IAM) in patients with isolated congenitally narrow IAM and explore the implications regarding ontogeny of the nerves in the IAM. DESIGN: Retrospective case series study. SETTING: University hospital. SUBJECTS: Five consecutive patients between 1997 and 2002 with unilateral isolated narrow IAM demonstrated by high-resolution computed tomography whose chief complaint was hearing loss (1 male and 4 females, 4 right sides and 1 left; age range 5-37 years, mean 20 years; IAM diameter at the porus: 26-33% of that on the normal side). MAIN OUTCOME MEASURES: Functional studies concerning the VIIth cranial nerve and the three branches of the VIIIth cranial nerve. RESULTS: In all ears, auditory brain stem responses were absent, the speech discrimination score was 0%, and otoacoustic emissions were absent or markedly reduced compared with those on the normal side. Caloric responses were absent in two ears, reduced in two ears, and normal in one ear. Galvanic body sway tests showed no responses in the two ears in which caloric responses were absent. Inferior vestibular nerve function was estimated as normal in all ears on the basis of vestibular evoked myogenic potential recordings. facial nerve functions were normal in all patients. CONCLUSIONS: In isolated congenital stenosis of IAM, dysfunction of each nerve in the IAM can occur independently. In the ontogeny of the VIIIth cranial nerve, the cochlear and superior vestibular nerves tended to be involved together, whereas the cochlear and inferior vestibular nerves appeared independent of each other.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
5/14. Audiological, vestibular and radiological abnormalities in Kallman's syndrome.Kallman's syndrome is a multifaceted congenital disorder with predominantly endocrine abnormalities. We have characterized the associated mixed hearing loss and identified consistent radiological evidence of abnormal temporal bone anatomy. Abnormal labyrinthine morphology is accompanied by a complete absence of response to vestibular stimulation with caloric or rotational chair testing. The endocrine abnormalities are correctable and Kallman's syndrome is a diagnosis worthy of consideration when assessing children with congenital hearing loss.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
6/14. Embolic internal auditory artery infarction from vertebral artery dissection.A 51-year-old man developed sudden vertigo, right hearing loss and dysphagia. Examination revealed right horner syndrome, spontaneous torsional-horizontal nystagmus, right central type facial palsy, dysarthria, reduced soft palate elevation without gag reflex, left hypesthesia, right dysmetria and imbalance. audiometry and bithermal caloric tests documented right sensorineural hearing loss and canal paresis. Brain MRI and cerebral angiography documented right lateral medullary infarction from vertebral artery dissection, without involvement of other parts of the brainstem supplied by the anterior inferior cerebellar artery (AICA). This case suggests artery-to-artery embolism as a possible mechanism of isolated vertigo or hearing loss from labyrinthine infarction.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
7/14. temporal bone pathology of a patient without hearing and caloric reaction, and with counter-rolling after chronic myelocytic leukemia.The temporal bone pathology of a 36-year-old man who suffered from chronic myelocytic leukemia and sudden hearing loss of both ears, was studied from the viewpoint of neurotology. Neurotological examination showed bilaterally profound hearing loss and no caloric reaction but good counter-rolling reaction to the right and the left head tilt and no other abnormal neurological findings. He died of intracranial hemorrhage. A study of histopathology of the temporal bones revealed extensive destruction of the organ of corti, dilatation of Reissner's membrane, leukemic infiltration in the cochlea but good preservation of sensory hair cells in the vestibular endorgans. Leukemic cell infiltration in perilymphatic and endolymphatic spaces, and leukemic hemorrhage in the perilymphatic spaces were observed. And also in the left internal auditory canal, obvious leukemic infiltration and marked hemorrhage were observed, but in the right internal auditory canal, no abnormal change was found. We discuss the correlation between neurotological findings and histopathological findings.- - - - - - - - - - ranking = 5keywords = caloric (Clic here for more details about this article) |
8/14. Audiologic and other clinical findings in a case of basilar artery aneurysm.A patient with a large, right-sided basilar artery aneurysm was evaluated. Major symptoms included progressive hearing loss, facial numbness, occipital headaches, dizziness, and diplopia of less than a year's duration. Audiologic results indicated a low-frequency sensorineural hearing loss with marked discrepancies between ascending and descending pure-tone thresholds for the ear ipsilateral to the lesion. Auditory brain-stem response demonstrated bilateral abnormalities, but the early waves were normal. Contralateral acoustic reflexes were absent on the right and elevated on the left. electronystagmography results showed bilaterally absent caloric responses as well as gaze nystagmus and abnormal pursuit movements. Additional audiologic results as well as radiologic and medical findings are also presented.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
9/14. Pendred's syndrome with episodic vertigo, tinnitus and vomiting and normal bithermal caloric responses.A case of early-onset bilateral sensori-neural deafness with episodic objective vertigo, tinnitus and vomiting, suggestive of Meniere's syndrome, was found to have a diffuse goitre. A Perchlorate discharge test was positive, indicating an organification defect diagnostic of Pendred's syndrome. The case was found to be euthyroid both clinically and on investigations. Tone decay was absent and recruitment was found, thus indicating a cochlear site of lesion. Bithermal caloric tests and clinical tests of vestibular function were within normal limits. x-rays, including petrous tomography, did not show any abnormalities.- - - - - - - - - - ranking = 5keywords = caloric (Clic here for more details about this article) |
10/14. Auditory brainstem response artefact caused by caloric testing.In the external ear canal, residual water from caloric testing or any other irrigation may act to simulate a conductive hearing loss and interfere with subsequent auditory brainstem response recording leading to increased latencies and reduced amplitudes. This artefact in the ABR may be mistaken for a retrocochlear lesion.- - - - - - - - - - ranking = 5keywords = caloric (Clic here for more details about this article) |
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