Congenital cholesteatoma of the middle ear - uncommon clinical presentation

Introduction. Congenital cholesteatoma of the middle ear is un uncommon and yet not well-defined disease. Only few cases of cholesteatoma in the fossa ovalis with unusual clinical presentation have been reported in medical literature. Case report. We reported a 16-year-old girl with congenital cholesteatoma in the fossa ovalis with minimal clinical presentation. A small mass was found occluding the fossa ovalis and mimicking otosclerotic process within tympanic cavity. The operation started as stapedotomy, and when the process was confirmed it converted to mastoidectomy via the retroauricular approach. Conclusion. The diagnosis of congenital cholesteatoma in children should always be considered, even if the clinical symptoms imitate other ear disorders, in our case otosclerosis. [Projekat Ministarstva nauke Republike Srbije, br. 179055: Cochlear implantation impact on education of deaf and hearing-impaired

Kliničko ispitivanje vestibularne kompenzacije

Cilj istraživanja učenja i memorije je razumeti kako dešavanja na celularnom i molekularnom nivou proizvode određene promene u ponašanju. Dovođenje u vezu neuralne aktivnosti sa jedne strane i percepcije ili akcije životinje (i čoveka) je težak zadatak jer velika kompleksnost većine nervnih mreža veoma otežava dovođenje u direktnu vezu celularnu aktivnost sa posledičnim ponašanjem. Te prepreke su nešto manje u vestibularnom sistemu jer VOR (vestibulookularni refleks) predstavlja relativno „jednostavan“ model za izučavanje celularnih mehanizama učenja. Zato vestibularni sistem (njegov centralni aparat) predstavlja primamljiv model ispitivanja plastičnosti CNSa – mogućnosti prilagođavanja nakon promena ili oštećenja. Relativno jednostavno beleženje i kvantifikacija pokreta oka kao posledice refleksnih odgovora VORa je razlog za ispitivanje funkcije vestibularnih čula, vestibularnog sistema i vestibularne kompenzacije upravo putem VORa, a time i sticanje opštih uvida u mehanizme učenja, plasticiteta i kompenzacije u CNSu. Ispitivanja vestibularne kompenzacije skoro isključivo su bila fokusirana na stanja nakon jednostranog perifernog vestibularnog otećenja zbog neravnoteže dve strane koja tada nastane i odgovarajuće dramatične kliničke slike. Nakon naglo nastalog jednostranog vestibularnog oštećenja pojave se statički i dinamički znaci i simptomi. Statički postoje kada glava miruje i najuočljiviji su: spontani nistagmus prema zdravoj strani, torzija oba oka ka oštećenoj strani, vertigo – osećaj okretanja sebe ili okoline i tendencija pada uglavnom na stranu oštećenja pogotovo sa zatvorenim očima. Dinamički znaci se jave kada se glava kreće i najznačajniji su: veoma oslabljen VOR pri okretima glave na stranu oštećenja, oscilopsia – osećaj trešenja ili igranja slike i ataksia – zanošenje i nesigurnost prilikom hodanja. Nakon jednostranog trajnog oštećenja svi ovi znaci i simptomi traju duže ili kraće, postepeno se manje ili više povuku, neki od njih u potpunosti, a drugi ne. Nalazi su ukazivali da je statička vestibularna kompenzacija uglavnom veoma uspešna, dok je kod procene uspešnosti dinamičke vestibularne kompenzacije bilo mnogo nejasnoća i lutanja. Postoji razlika i u načinu ispitivanja statičke i dinamičke vestibularne kompenzacije: kod statičke vestibularne kompenzacije beleži se......

Relevance of vestibulospinal tests after unilateral neurolabyrinthitis

In this paper we wanted to assess clinical relevance of two vestibulospinal tests: standing test (derived from Romberg test) and past pointing test. In retrospective and prospective study 42 patients have been tested with standing test and 50 patients with past pointing test. All patients suffered from unilateral neurolabyrinthitis that had started from one day to two years prior to examination. All patients had unilateral areflexion, or hyporeflexion on caloric test using 10°C water. Control group consisted of 32 healthy individuals for both tests. Results show that both tests correctly indicate side of the lesion but only during first week of illness. Moreover, even during that first week sensitivity of both tests was below 50 %, which means that more then half results from patients fall within normal findings. We conclude that vestibulospinal tests do not deserve prominent place in assessing patients with vestibular syndrom. Conclusions must be made according to findings obtained from much more precise vestibuloocular tests

Assessment of senses of hearing and balance in chronic suppurative otitis media

Chronic suppurative otitis media is among the most frequent illnesses treated in ENT wards. To establish the diagnosis, otomicroscopy alone usually suffice. Assessing the sense of hearing, often the sense of balance, too, is mandatory. Assessment of hearing will show the extent of conductive and sensorineural hearing loss. Apart from this, sometimes, when the finding is not obvious, it is necessary to conduct audiological investigation in more detail in order to establish whether the diagnosis of chronic suppurative otitis media is correct. Existence and extent of conductive hearing loss or confIrmation of tympanic membrane perforation by tympanometry can help a great deal. Also, some new results about the site of perforation and the middle ear volume influence on conductive hearing loss may help have a better insight into chronic suppurative otitis media. Assessing the sense of balance may show dysfunctions with not yet necessarily permanent damage: perilymphatic fistula and benign paroxysmal positional vertigo (BPPV). Unilateral or bilateral damage may be diagnosed with appropriate tests of vestibuloocular reflex (VOR): spontaneous nystagmus, head impulse test, head shaking test. These bedside tests do not require bulky, expensive equipment for stimulus delivery or special equipment for recording nystagmus. In addition, their significance is their ability to provide enough information without performing caloric testing which is contraindicated in chronic suppurative otitis media