1/9. Permanent sensorineural hearing loss following spinal anesthesia.A 25-year-old female developed permanent, fluctuating sensorineural hearing loss (SNHL), disabling vertigo, and tinnitus following an uneventful spinal anesthesia for cesarean section. At her first visit to the ear-nose-throat (ENT) department approximately 2 months postoperatively, pure-tone thresholds revealed profound SNHL on the right side whereas thresholds were within normal limits on the left side. The recruitment score (SISI) was 95% at 2000 Hz on the right side. Directional preponderance towards the right and the right canal paresis were evidenced by bithermal caloric testing. At follow ups the pure tone thresholds have shown some improvement, but fluctuating SNHL, disabling vertigo attacks, and tinnitus have remained. These findings imply a cochlear pathology causing endolymphatic hydrops possibly induced by lumbar puncture for spinal anesthesia.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
2/9. 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) |
3/9. Lesion site in idiopathic bilateral vestibulopathy: a galvanic vestibular-evoked myogenic potential study.CONCLUSION: The result suggests that patients with idiopathic bilateral vestibulopathy may have nerve lesions when the inferior nerve system is affected, while the inferior vestibular nerve system may be spared. OBJECTIVE: To clarify the lesion site in idiopathic bilateral vestibulopathy, an acquired bilateral vestibulopathy of unknown cause. MATERIAL AND methods: Two 75-year-old males diagnosed with idiopathic bilateral vestibulopathy were enrolled. Both showed absent or highly decreased responses on the caloric test on both sides. They underwent vestibular-evoked myogenic potential (VEMP) testing by means of acoustical and electrical stimulation. As acoustic stimulation, 95 dB nHL clicks and short tone bursts (500 Hz) were presented, while 3 mA (1 ms) short-duration galvanic stimuli were presented as electrical stimulation. Responses were recorded on the sternocleidomastoid muscles. RESULTS: Both patients showed unilateral absence of VEMPs with both acoustic and short-duration galvanic stimuli.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
4/9. Distal renal tubular acidosis associated with large vestibular aqueduct and sensorineural hearing loss.CONCLUSIONS: hearing loss and equilibrium dysfunction have different etiologies in patients with large vestibular aqueduct syndrome. We suggest that all children with distal renal tubular acidosis (dRTA) should be subjected to an equilibrium study and audiological evaluation, as well as to a CT or MRI scan. OBJECTIVE: dRTA has been described in association with sensorineural hearing loss, but there are no reported cases that have been examined in detail using audiological and equilibrium studies. We report here a case of progressive sensorineural hearing loss with a large vestibular aqueduct and dRTA, and the results of audiological and equilibrium studies. MATERIAL AND methods: A 31-year-old female presented with hearing loss, tinnitus and vertigo. She had been treated with oral sodium citrate, potassium citrate and potassium chloride supplementation because of dRTA since the age of 1 month. RESULTS: The pure-tone audiogram of the patient was off the scale for the right ear and showed progressive sensorineural hearing loss for the left ear. ice-water caloric testing showed canal paresis on the left side. temporal bone CT and inner ear MRI revealed a large vestibular aqueduct and a large endolymphatic sac on both sides.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
5/9. 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) |
6/9. Acoustic tumor with hearing loss of sudden onset and recovery.In many cases of acoustic tumor the hearing loss is gradually progressive, but some cases of acoustic tumor show a sudden onset of hearing loss. In this paper we report two interesting cases of acoustic tumors which were diagnosed as sudden deafness at the first examination. Being treated with steroid hormones, their hearing was partially recovered. But the hearing loss recurred in both cases. At the second examination, CT showed the cerebellopontine angle tumors. So it was emphasized that careful questioning as well as the caloric test and the auditory brainstem response (ABR) was important. If one of these tests shows abnormality, the patient should be examined by the CT scan. The same may be said of patients who show recovery due to steroid hormone therapy.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
7/9. An algorithm for neurotologic disorders.In the evaluation of patients with complaints of dizziness, hearing loss, and/or tinnitus, the primary objective is to determine the site of the lesion. An accurate localization of the lesion is important for selecting the most appropriate radiologic study. The information obtained from the vestibular and audiometeric evaluations identifies the site of the lesion accurately. For the vestibular evaluation we use photoelectric nystagmography (PENG) and the Torok monothermal differential caloric test. The initial audiometeric evaluation consists of a pure-tone audiogram and speech discrimination scores. Additional audiometric site-of-lesion tests and ABR are used selectively as the diagnostic yield of these tests does not significantly add to the information already obtained from the vestibular evaluation. If the lesion is suspected to lie in the middle ear or internal auditory canals, we use pluridirectional tomography. For further delineation of lesions confined to the internal auditory canal we use pneumo-CT. For suspected morphologic lesions of the posterior fossa we use thin-section CT with enhancement. review has proved useful in defining petrous apex and skull base lesions. CT-rBBC studies have proved valuable in objectively demonstrating a deficient perfusion of the brain. The vascularity of certain lesions such as glomus tumors can be satisfactorily confirmed by this technique.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
8/9. Pitfalls in the diagnosis of acoustic neuroma.The patient with an acoustic neuroma may present to the otologist with a variety of clinical features. Classically these include a retrocochlear pattern of sensorineural hearing loss, reduced vestibular response on caloric testing and radiological asymmetry of the internal auditory canals (IAC). The absence of any or all of these features, however, does not exclude the presence of tumour. Five cases are presented to illustrate the potential for diagnostic delay unless a routine battery of investigations is undertaken in patients with neuro-otological disorders. All patterns of subjective audiometry are encountered, auditory brain stem response testing may be unreliable where hearing loss is profound, vestibular testing is normal in half of small tumours and the intracanalicular tumour may be radiologically undetectable unless IAC meatography is employed.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
9/9. Neurotological findings in patients with acute mumps deafness.We report the neurotological findings in 4 cases of acute stage hearing loss due to mumps. In 2 of the cases, the less severe hearing loss which occurred in the opposite ear was shown to have improved after therapy. If patients with mumps suffer from a mild hearing loss which recovers quickly, the temporary auditory problem might go undiagnosed; thus the incidence of mumps deafness might well be higher than that reported in the literature. Two of our patients complained of dizziness. In the caloric test, a reduced response of the ear with poorer hearing was found in 3 cases, and a normal caloric response was revealed in the fourth. In the galvanic body sway test (GBST), 3 cases showed a normal response bilaterally and one case presented a normal response bilaterally in the first test, no response in the right side in the second test, and recovery of response in the third test. These findings suggest that an inner ear disorder might occur in combination with a retrolabyrinthine disorder in mumps deafness, with the former lasting longer and the latter improving earlier.- - - - - - - - - - ranking = 2keywords = caloric (Clic here for more details about this article) |