Bilateral sudden sensorineural hearing loss and chronic venous cerebrospinal insufficiency : a case report

OBJECTIVES: We report a case of bilateral sudden sensorineural hearing loss (SSHL) in a patient suffering from chronic venous cerebrospinal insufficiency (CCSVI). METHODS: Audiometric testing confirmed bilateral sensorineural hearing loss with hypoexcitability to caloric stimulation on the left side and echo-colour Doppler examination showed abnormal cerebral venous deficiency. RESULTS: The patient's condition improved after 15 days following medical treatment. CONCLUSIONS: CCSVI may explain the anatomical background which provides a predisposing factor for SSHL although further studies are needed to verify whether this observation is casual or coincidental

Characteristics of multiple sclerosis patient stance control disorders, measured by means of posturography and related to brainstem lesions

Balance disorders are commonly observed during the course of multiple sclerosis (MS). The aim of this study is to report characteristics of MS patient stance control disorders, measured by means of posturography and related to the brainstem lesions. Thirty-eight patients affected by MS, mildly to moderately disable according to Kurtzke\u2019s Expanded Disability Status Scale, underwent a complete clinical neurological and vestibular evaluation and brain MRI scanning. All patients were then tested on a static posturography platform (Tetrax, Israel) in four conditions: eyes open and eyes closed standing on a firm surface and on a foam pad. Clinical and/or magnetic resonance imaging evidence of brainstem involvement was observed in 55.3% of patients. When brainstem lesion was detected, Fourier analysis showed a typical pattern characterized by inversion of the 0- 0.1 Hz and 0.1-0.25 Hz frequency bands. In conclusion, MS leads to pervasive postural disturbances in the majority of subjects, including the visuo-vestibular loops and proprioception involving vestibulospinal pathways in at least 55.3% of patients. Our results may also suggest the presence of Fourier inversion in patients with brainstem lesions

Bridging the gap between chronic cerebrospinal venous insufficiency and Ménière disease

M\ue9ni\ue8re disease (MD) is a chronic illness of the inner ear that affects a substantial number of patients every year worldwide. Because of a dearth of well-controlled studies, the medical and surgical management of MD remains quite empirical. The main reason is that it is very difficult to investigate patients affected with \u201cCertain MD\u201d due to the post-mortem criterion necessary for this diagnostic grade. The aim of this paper is an attempt to approach MD into the context of the more recent findings about the global brain waste clearance system, to which inner ear is anatomically and functionally connected, in order to build a reasonable model of MD pathogenesis. it seems nowadays reasonable to state that CCSVI may be the anatomical background to develop endolymphatic hydrops in MD, the worldwide accepted pathogenetic mechanism of the disease. The mechanism leading from CCSVI to MD is still debated. Since MD has been correlated mostly to a wide and different diseases and treatments, CCSVI may be considered more than a cause of MD per se, rather the anatomical predisposition to develop the disease. CCSVI may lead to endolymphatic hydrops through a pure \u201chydraulic\u201d mechanism but in the model proposed in this paper CCSVI interplays with the Glymphatic (GS) and Brain Lymphatic System (LS) and MD development is due to a failure of the congenital venous abnormalities: MD develops when vascular and/or glymphatic and/or lymphatic compensation fails

Tinnitus as an alarm bell : stress reaction tinnitus model

Stress is a significant factor influencing the clinical course of tinnitus. Auditory system is particularly sensitive to the effects of different stress factors ( chemical, oxidative, emotional, etc.). Different stages of reaction ( alarm, resistance, exhaustion) lead to different characteristics of tinnitus and different therapeutic approaches. Individual characteristics of stress reaction may explain different aspects of tinnitus in various patients with different responses to treatment, despite similar audiological and ethiological factors. A model based on individual reactions to stress factors ( stress reaction tinnitus model) could explain tinnitus as an alarm signal, just like an 'alarm bell', informing the patient that something potentially dangerous for subject homeostasis is happening. Tinnitus could become a disabling symptom when the subject is chronically exposed to a stress factor and is unable to switch off the alarm. Stress signals, specific for each patient, have to be identified during the 'alarm' phase in order to prevent an evolution toward the 'resistance' and 'exhaustion' phases. In these phases, identification of stressor is no more sufficient, due to the organization of a 'paradoxical auditory memory' and a 'pathologically shifted attention to tinnitus'. Identification of stress reaction phase requires accurate otolaryngology and anamnesis combined with audiological matching tests (Feldman Masking Test, for example) and psychometric questionnaires ( Tinnitus Reaction and Tinnitus Cognitive Questionnaires). Copyright (C) 2006 S. Karger AG, Basel