1/11. Cutaneous-evoked tinnitus. I. Phenomenology, psychophysics and functional imaging.DC00166e and acute unilateral deafferentation of the auditory periphery (auditory and vestibular afferents) can induce changes in the central nervous system that may result in unique forms of tinnitus. These tinnitus perceptions can be controlled (turned on and off) or modulated (changed in pitch or loudness) by performing certain overt behaviors in other sensory/motor systems. Clinical reports from our laboratory and several other independent sources indicate that static change in eye gaze, from a neutral head-referenced position, is one such behavior that can evoke, modulate and/or suppress these phantom auditory events. This report deals with a new clinical entity and a form of tinnitus that can be evoked directly by cutaneous stimulation of the upper hand and fingertip regions. In 2 adults, cutaneous-evoked tinnitus was reported following neurosurgery for space-occupying lesions at the base of the skull and posterior craniofossa, where hearing and vestibular functions were lost completely and acutely in one ear (unilateral deafferentation) and facial nerve paralysis (unilateral deefferentation) was present either immediately following neurosurgery or had occurred as a delayed-onset event. Herein, we focus on the phenomenology of this discovery, provide perceptual correlates using contemporary psychophysical methods and document in one individual cutaneous-evoked tinnitus-related neural activity using functional magnetic resonance imaging. In a companion paper, neuroanatomical and physiological interactions between auditory and somatosensory systems, possible mechanistic accounts and relevant functional neuroimaging studies are reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Cochlear and vestibular dysfunction resulting from physical exertion or environmental pressure changes.Inner ear damage due to physical exertion or environmental pressure changes has been described only recently. According to Goodhill there are two possible mechanisms of injury: the explosive and the implosive. The former is triggered by increased C.S.F. pressure transmitted to the perilymph space; the latter by increased pressure in the middle ear transmitted to the perilymph space through the two windows. Sudden hearing loss or dizziness, or both, are the main symptoms. The diagnosis will be established by the history, the audiogram, and the electronystagmogram (ENG). The treatment is still controversial. As the formation of a fistula is a real possibility, an exploratory tympanotomy is suggestive on suspected cases. Due to the variety of symptoms every case has to be assessed individually. A detailed history is of utmost importance.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
3/11. Sonographic findings in glomus tympanicum tumor.A glomus tympanicum tumor that is associated with a visible retrotympanic mass is the most frequent cause of pulsatile tinnitus. The preoperative diagnostic approach to this lesion includes a meticulous physical examination as well as high-resolution CT, magnetic resonance angiography, and digital angiography, which can also be used for preoperative embolization. We report the use of color transcranial Doppler sonography in the evaluation of glomus tympanicum tumor in a 67-year-old woman with a 3-year history of left tinnitus. An otoscopic examination revealed a reddish pulsatile mass behind an intact tympanic membrane. No lesions were visualized on gray-scale sonography. Contrast-enhanced color transcranial Doppler sonography showed a vascular ovoid mass that measured 2 x 1 x 1 cm; spectral analysis of the lesion revealed arterial flow with a low resistance index. color transcranial Doppler sonography helped define the dimensions and vascular characteristics of the lesion.- - - - - - - - - - ranking = 10.364595148391keywords = physical examination, physical (Clic here for more details about this article) |
4/11. Inverted papilloma of the sphenoid sinus presenting with auditory symptoms: a report of two cases.OBJECTIVES: The report aims to inform the reader of cases of inverted papilloma involving the sphenoid sinus presenting with auditory symptoms. STUDY DESIGN: Case series. methods: A retrospective medical record analysis was carried out to identify patients with inverted papilloma involving the sphenoid sinus that presented with a primary complaint of hearing loss or tinnitus, or both. Clinical records, including initial history and physical examination, audiologic and radiologic studies, and operative and histopathologic reports, were carefully examined. A complete literature review for relevant studies was performed to explore possible pathophysiologic factors and similar cases. RESULTS: Two patients with inverted papilloma presenting with primary auditory complaints were identified. One patient had roaring tinnitus and sensorineural hearing loss demonstrated with audiologic assessment, whereas the other had pulsatile tinnitus. Both patients had biopsy-proven inverted papilloma involving the sphenoid sinus, and both patients underwent endoscopic resection of the disease. No other cause or origin of their auditory symptoms was confirmed. The auditory symptoms of both patients improved markedly after excision of their inverted papillomas. CONCLUSIONS: tinnitus with or without hearing loss is an unusual presentation of inverted papilloma of the sphenoid sinus. Sphenoid tumors should be considered in the workup of these symptoms.- - - - - - - - - - ranking = 10.364595148391keywords = physical examination, physical (Clic here for more details about this article) |
5/11. headache with unilateral pulsatile tinnitus in women can signal dural sinus thrombosis.OBJECTIVES: Dural sinus thrombosis commonly presents with headache, and rarely with tinnitus. These thromboses can progress to neurologic impairment and death. We are sharing recent clinical experiences with these thromboses as they present to the otologist. methods: We report the presentation, physical examination, and imaging studies of 4 patients. RESULTS: Four women had thrombotic occlusion of the sigmoid sinus. Their only symptoms were focal headache in all 4 patients, and unilateral pulsatile tinnitus in 2 of them. Imaging studies had to be repeated or alternative testing performed in order to conclusively identify the problem. CONCLUSIONS: It is important to be vigilant for the possibility of sigmoid sinus thrombosis in women who complain of unilateral head pain or unilateral pulsatile tinnitus. Appropriate imaging must be performed.- - - - - - - - - - ranking = 10.364595148391keywords = physical examination, physical (Clic here for more details about this article) |
6/11. Acoustic neuromas with normal pure tone hearing levels.From 1966 through 1983, 408 patients underwent primary removal of an acoustic neuroma at the Mayo Clinic. Of these, 21 had preoperative pure tone hearing levels of 25 dB hearing loss or better at 500, 1000, and 2000 Hz, which for this study was defined as normal pure tone hearing. Fourteen patients (67%) had dysequilibrium and 13 (62%) had subjective hearing impairment. Nystagmus was the most common physical finding. Five patients (23%) had completely symmetric pure tone hearing levels through all frequencies tested. The mean speech discrimination score was 90%. Mean tumor size was 2.4 cm. brain stem evoked response audiometry was the most helpful of the special tests in the evaluation of these patients with normal pure tone hearing levels. Our results suggest that 5% of patients with acoustic neuromas have normal pure tone hearing levels. A careful history, a thorough physical examination, and an appropriate selection of tests will identify these patients.- - - - - - - - - - ranking = 11.364595148391keywords = physical examination, physical (Clic here for more details about this article) |
7/11. tinnitus: diagnosis and treatment.Few conditions are seen as commonly by the otologist and are more poorly understood than subjective tinnitus. tinnitus has been reported in as high as 80% of patients seen in an otolaryngology practice. This symptom is especially marked in patients with a hearing problem and can be so severe that it becomes incapacitating. Careful diagnosis and classification of tinnitus is important for understanding of the problem. Identification of the frequency and intensity of masking, using a tinnitus analyzer, is useful in selecting the form of treatment. Analysis of the history, physical findings and the use of special electrocochleography and brain stem evoked response audiometry help to identify the site of lesion, which may be within the cochlea, cochlear nerve, cochlear nucleus, brain stem, midbrain or auditory cortex. Specific disease entities should be identified and treated. Lesions of the end-organ or cochlear nerve can be treated when necessary by translabyrinthine or middle cranial fossa section of the cochlear nerve. tinnitus from cervical nerve lesions can be treated by rhizotomy. The use of a hearing aid or introduction of a sound with a tinnitus masker has been found to be 82% effective in suppressing tinnitus. Maskers can be combined with a hearing aid in some cases. The pathogenesis of tinnitus is discussed, but the method of action of tinnitus relief by auditory stimulation is still unclear. A thoughtful and complete examination with our new diagnostic tools and the judicious selection of therapy now makes it possible to give relief to the majority of patients suffering with disturbing tinnitus.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. ataxia and hearing loss secondary to perilymphatic fistula.ataxia is rarely attributed to lesions of the peripheral vestibular system. In 1973, the first case of ataxia and hearing loss secondary to a labyrinthine fistula was reported. Until now, this syndrome has not been reported in patients under the age of 10 years. A case is presented of a 5-year-old boy with symptoms of ataxia and hearing loss as well as vertigo and tinnitus after head trauma. Three physical findings appear to be most characteristic of patients with perilymphatic fistulas: a positive fistula response, positive positional testing with the involved ear down, and evidence of vestibular ataxia when testing station and gait. The absolute diagnosis of perilymphatic fistula can only be established by exploration of the middle ear space. If a fistula is found, it may be sealed with soft tissue and, if this fails, actual stapedectomy may be required.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Pure-tone masking of tinnitus.Experiments were initiated to determine the frequency most closely associated with a continuous atonal tinnitus reported by a listener with a sloping sensorineural hearing loss in his left ear. The procedure was modeled after that used to obtain a psychophysical tuning curve. Pure tones presented binaurally and monaurally between 521 and 3629 Hz were adjusted in level by the listener to just mask his tinnitus, which functioned as a signal. Masking curves for binaural and monaural masker presentation were found to be of similar shape but they varied in terms of absolute level, variability of estimates, and with regard to fine detail of the curves. The magnitude of the tinnitus as also estimated by a loudness match with a pure tone to the opposite ear. The masking levels required to mask the tinnitus were found to be consistent with those reported necessary to mask the equally loud pure tone. These findings are consistent with Langenbeck's [1953, 1965] hypothesis that tinnitus arising from the inner ear should be masked in a manner similar to an externally presented tone at the same effective level. Information derived from the masking of tinnitus by pure tones may be useful in fitting tinnitus-masking devices and also for diagnosing the site of lesion associated with tinnitus.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/11. Auditory perceptual and visual-spatial characteristics of gaze-evoked tinnitus.Auditory perceptual and visual-spatial characteristics of subjective tinnitus evoked by eye gaze were studied in two adult human subjects. This uncommon form of tinnitus occurred approximately 4-6 weeks following neurosurgery for gross total excision of space-occupying lesions of the cerebellopontine angle and hearing was lost in the operated ear. In both cases, the gaze-evoked tinnitus was characterized as being tonal in nature, with pitch and loudness percepts remaining constant as long as the same horizontal or vertical eye directions were maintained. tinnitus was absent when the eyes were in a neutral head-referenced position with subjects looking straight ahead. The results and implications of ophthalmological, standard and modified visual-field assessment, pure-tone audiometric assessment, spontaneous otoacoustic emission testing and detailed psychophysical assessment of pitch and loudness are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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