Inner Ear Disease and Benign Paroxysmal Positional Vertigo: A Critical Review of Incidence, Clinical Characteristics, and Management

Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients

Polymorphisms of CD16A and CD32 Fcγ receptors and circulating immune complexes in Ménière's disease: a case-control study

<p>Abstract</p> <p>Background</p> <p>Autoimmune diseases with elevated circulating autoantibodies drive tissue damage and the onset of disease. The Fcγ receptors bind IgG subtypes modulating the clearance of circulating immune complexes (CIC). The inner ear damage in Ménière's disease (MD) could be mediated by an immune response driven by CIC. We examined single-nucleotide polymorphism (SNPs) in the CD16A and CD32 genes in patients with MD which may determine a Fcγ receptor with lower binding to CIC.</p> <p>Methods</p> <p>The functional CD16A (FcγRIIIa*559A > C, rs396991) and CD32A (FcγRIIa*519A > G, rs1801274) SNPs were analyzed using PCR-based TaqMan Genotyping Assay in two cohorts of 156 mediterranean and 112 Galicia patients in a case-control study. Data were analyzed by χ²with Fisher's exact test and Cochran-Armitage trend test (CATT). CIC were measured by ELISA for C1q-binding CIC.</p> <p>Results</p> <p>Elevated CIC were found in 7% of patients with MD during the intercrisis period. No differences were found in the allelic frequency for rs396991 or rs1801274 in controls subjects when they were compared with patients with MD from the same geographic area. However, the frequency of AA and AC genotypes of CD16A (rs396991) differed among mediterranean and Galicia controls (Fisher's test, corrected p = 6.9 × 10^-4for AA; corrected p = 0.02 for AC). Although genotype AC of the CD16A receptor was significantly more frequent in mediterranean controls than in patients, [Fisher's test corrected p = 0.02; OR = 0.63 (0.44-0.91)], a genetic additive effect for the allele C was not observed (CATT, p = 0.23). Moreover, no differences were found in genotype frequencies for rs396991 between patients with MD and controls from Galicia (CATT, p = 0.14). The allelic frequency of CD32 (rs1801274) was not different between patients and controls either in mediterranean (p = 0.51) or Galicia population (p = 0.11).</p> <p>Conclusions</p> <p>Elevated CIC are not found in most of patients with MD. Functional polymorphisms of CD16A and CD32 genes are not associated with onset of MD.</p

Bilateral carcinoma of the temporal bone: Case report and literature review

Introduction: Squamous cell carcinoma of the temporal bone is a rare entity. Only a few cases have been reported in the literature and even fewer describe bilateral tumours. Because its clinical presentation resembles chronic otitis media or otitis externa, diagnosis could be delayed. Case Report: A case is presented of bilateral squamous cell carcinoma of the temporal bone in a 66 year old woman. The patient underwent a left subtotal petrosectomy followed by a right subtotal petrosectomy a month later. Conclusions: Early diagnosis is directly related to patient prognosis. However, prognosis remains poor and the surgical treatment is a challenge for the experienced skull base surgeon. © 2009 European Association for Cranio-Maxillo-Facial Surgery

Pulsatile tinnitus: A review of the literature and an unusual case of iatrogenic pneumocephalus causing pulsatile tinnitus

Background: Pulsatile tinnitus is frequently attributed to identifiable and treatable causes, in contrast to the more common subjective non-pulsatile tinnitus. It usually originates from vascular structures as a result of either increased blood flow or lumen stenosis; atherosclerotic carotid or subclavian artery disease; arterial, venous, or arteriovenous malformations, fistulas, or dissection; and paragangliomas. Other causes have also been reported, with often unclear pathophysiology. Objective: The aim of this paper is to present a case of pulsatile tinnitus secondary to iatrogenic pneumocephalus and to review the literature on pulsatile tinnitus. Subject: A 48-year-old white woman had a roaring, very disturbing, pulsatile tinnitus after the removal of a cerebellar lobe meningioma. When the patient experienced the symptom of tinnitus, a pulsatile movement of the tympanic membrane could be clearly seen, and this was synchronous with the patient&apos;s heartbeat. Computed tomography revealed an epidural pneumocephalus in the left posterior fossa communicating freely with the air cell system of the left mastoid cavity without any sign of residual tumor. A simple mastoidectomy was performed. The whole air cell system was removed and the mastoid cavity was filled with abdominal fat. After the operation, the pulsatile tinnitus ceased completely and the pneumocephalus disappeared gradually. The patient is free of symptoms 11 months after surgery. Conclusion: Otologists, neurosurgeons, and skull base surgeons should be aware of this surgical complication and be careful to identify any accidental opening to the air cell system of the temporal bone and meticulously close it when it happens. The review of the literature leads to the conclusion that pulsatile tinnitus should be thoroughly investigated, as it may be related to diseases that may have serious complications. © 2005, Otology &amp; Neurotology, Inc

Screening for hearing loss and middle-ear effusion in school-age children, using transient evoked otoacoustic emissions: a feasibility study

Introduction: The characteristics of otoacoustic emissions that make them ideally suited for universal newborn hearing loss screening could potentially be useful for the screening of older children. This study was performed in order to assess the role of otoacoustic emissions in a screening programme for middle-ear disorders and hearing loss in school-age children. Methods: Cross-sectional, preliminary screening study. Setting: Primary schools of Argolida municipality, south-east Greece, between December 2004 and March 2005. Patient selection and recruitment: All the primary school students of Argolida were invited, by press releases and individually by their teachers, to attend a session of otological and audiological screening. Results: One hundred and ninety-six children were evaluated using transient evoked otoacoustic emissions. Twenty per cent failed in both ears, while in 32 per cent otoacoustic emissions could not be produced in at least one ear. Younger children had higher rates of absent transient evoked otoacoustic emissions. The absence of otoacoustic emissions was highly correlated with tympanic membrane changes seen on otoscopy and the presence of a type B tympanogram. As a single screening modality, otoacoustic emissions had a 100 per cent sensitivity in diagnosing hearing loss worse than 30 dB, and a 90 per cent sensitivity and 64 per cent specificity in diagnosing hearing loss worse than 25 dB, which did not improve by adding tympanometry to the screening protocol. Conclusion: These results strongly suggest the potential usefulness of otoacoustic emission testing in screening school-age children for hearing loss. Further studies, taking into account cost-effectiveness issues, are indicate

Treatment of the horizontal semicircular canal canalithiasis: Pros and cons of the repositioning maneuvers in a clinical study and critical review of the literature

OBJECTIVE: Several repositioning maneuvers have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV) due to canalithiasis of the horizontal semicircular canal (HSC). However, comparisons between these canalith repositioning procedures as well as a generally accepted algorithm for the management of HSC canalithiasis are currently lacking. The aim of this study was to compare the efficacy of 3 different treatment proposals and review the relevant literature. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary neurotology department. PATIENTS: Sixty patients diagnosed with HSC canalithiasis. INTERVENTIONS: A single application of Baloh&apos;s maneuver (n = 13), Vannucchi&apos;s forced prolonged position (n = 29), or Asprella-Gufoni maneuver (n = 18). MAIN OUTCOME MEASURES: Bilateral geotropic nystagmus. RESULTS: The first application of the Baloh&apos;s maneuver seemed to be significantly less effective than both Vannucchi&apos;s forced prolonged position (p = 0.035) and the Asprella-Gufoni maneuver (p = 0.006). No significant difference was detected in the efficiency of Vannucchi&apos;s forced prolonged position and the Asprella-Gufoni maneuver for this population (p = 0.4). CONCLUSION: The Asprella-Gufoni maneuver and Vannucchi&apos;s forced prolonged position both seem to be significantly more effective than the Baloh&apos;s maneuver in the treatment of HSC canalithiasis. The important pros of the Asprella-Gufoni maneuver versus Vannucchi&apos;s forced prolonged position are patient&apos;s convenience and maximal use of gravitational and angular acceleration forces. Controlled clinical studies are needed to conclude to an evidence-based proposal for the therapeutical steps that should be followed after the diagnosis of HSC canalithiasis. © 2011, Otology &amp;Neurotology, Inc

Pituitary apoplexy: A pathologic entity from an otolaryngologist&apos;s view

A case of pituitary apoplexy, which was initially misdiagnosed as ‘acute frontal sinusitis’, is reported. The presenting symptoms and signs of the patient were headache, moderate fever, left periorbital edema, marked tenderness over the left frontal sinus and purulent secretion over the left middle turbinate and nasopharynx. These clinical symptoms were wrongly perceived as complicated frontal sinusitis. The CT scan and the elective right carotid angiography showed a pituitary adenoma. Therefore pituitary apoplexy of a preexisting pituitary adenoma was diagnosed. The patient underwent surgical removal of the adenoma and his postoperative course was uneventful. Thus otolaryngologists should consider pituitary apoplexy in the differential diagnosis of pathologies concerning the anatomic area of the anterior cranial fossa

Monostotic fibrous dysplasia of the temporal bone

Fibrous dysplasia is a slowly progressive bony disorder where normal bone is replaced by abnormal fibro-osseous tissue. Its monostotic variety in the temporal bone is very rare and such a case is presented here. Computed tomography (CT) may be adequate for the diagnosis and follow-up of these patients. Limited surgery should only be considered in cases of symptomatic disease

Aural symptoms in patients with temporomandibular joint disorders: Multiple frequency tympanometry provides objective evidence of changes in middle ear impedance

OBJECTIVE: The association of temporomandibular joint (TMJ) disorders with aural symptoms, such as tinnitus, otic fullness, and subjective decrease of hearing acuity, is a well-established clinical observation. Although several hypotheses have been made about the otic-conductive origin of these complaints, conventional 226-Hz tympanometry has failed to demonstrate any middle ear abnormalities. The aim of this study was to evaluate patients with TMJ disorders with multiple frequency tympanometry (MFT). STUDY DESIGN: Prospective clinical study. SETTING: Outpatient clinic. PATIENTS: The population of this study consisted of 40 patients with unilateral TMJ disorders diagnosed for longer than 1 month. INTERVENTIONS: After verifying that there were no abnormal otoscopic findings, 226-Hz tympanometry, conventional pure-tone audiometry, brainstem auditory evoked potentials, and MFT were performed. MAIN OUTCOME MEASURE: Resonant frequency (RF) values. RESULTS: With the exception of MFT, no abnormal audiologic findings were revealed. The ear ipsilateral to the lesion demonstrated significantly higher (p = 0.002) RF values in comparison to the contralateral ear. The difference in RF values was more obvious in patients aged 45 years or younger. CONCLUSION: The results of this study imply an increase in the stiffness of the middle ear, which has not been detected by conventional tympanometry. This represents the first concrete documentation of minor alterations in the conductive properties of the middle ear and seems to support the various hypotheses on the middle-ear origin of aural complaints in patients with TMJ disorders. Further studies are needed before a clear insight on the presumably multifactorial pathophysiology of these complaints can finally be reached. © 2010, Otology &amp; Neurotology, Inc

Semicircular canal versus otolithic involvement in idiopathic sudden hearing loss

Objective: To evaluate the results of vestibular evoked myogenic potential testing in patients with idiopathic sudden hearing loss, and to correlate these results with the findings of caloric testing, the clinical appearance of vertigo and the influence of age.Materials and methods: Eighty-six patients with unilateral idiopathic sudden hearing loss and 35 healthy controls underwent a standard protocol of neurotological evaluation. Vestibular evoked myogenic potential responses were measured and compared with caloric responses.Results: On the affected side, 30.2 per cent of patients showed abnormal vestibular evoked myogenic potential responses, while 52.3 per cent had abnormal caloric responses. A statistically significant relationship was found between the results of these two tests. A statistically significant relationship was also found between the type of vestibular lesion and the occurrence of vertigo. Advancing age correlated statistically with more extensive labyrinthic lesions.Conclusions: A combination of vestibular evoked myogenic potential and electronystagmography testing indicated the existence of vestibular involvement in many patients with idiopathic sudden hearing loss. Both tests are necessary in order to obtain a more thorough and in-depth knowledge of the pathophysiology of idiopathic sudden hearing loss. © 2009 JLO (1984) Limited