Hearing Outcome of Low-tone Compared to High-tone Sudden Sensorineural Hearing Loss

Abstract Introduction Low-tone sudden sensorineural hearing loss (SSHL) is a well-recognized disease, in which the hearing loss is restricted to low frequencies. In contrast to lowtone SSHL, high-tone SSHL is characterized by high-frequency (4,000, 8,000 Hz) hearing loss and preservation of low-, middle-frequency hearing. Objective The objective of this study is to compare the hearing recovery and longterm outcome of low-tone SSHL with those of patients affected by high-tone SSHL in a follow-up of ~ 3 years. Methods The low-tone SSHL and high-tone SSHL groups included 27 and 20 patients, respectively; the patients of both groups were treated with intravenous steroids. Predictive factors (gender, affected side, delay of treatment, follow-up time) were also examined. Results Overall, complete hearing recovery was observed in 77.7% of the patients in the low-tone SSHL group and in 15% of the patients in the high-tone SSHL group. In the high-tone SSHL group, a higher proportion of patients reported tinnitus compared with the low-tone SSHL group (13 cases [65%] versus 3 cases [11%]); however, recurrences were more common in the low-tone SSHL (22%, 6 patients) compared with the hightone SSHL (2 cases [10%]) group. No predictive factor was found to statistically impact on hearing outcome. Conclusion After initial therapy, the low-tone SSHL patients have more favorable hearing outcome than high-tone SSHL patients. However, recurrences occurred more frequently in the low-tone SSHL group, while the high-tone SSHL group was more often accompanied by residual symptoms, such as tinnitus. (AU)

Bilateral supernumerary sternocleidomastoid heads with critical narrowing of the minor and major supraclavicular fossae: clinical and surgical implications / Cabezas supernumerarias bilaterales del músculo esternocleidomastoídeo con estrechamiento crítico de las fosas supraclavicular menor y mayor: implicancias clínicas y quirúrgicas

Anatomical variations of the sternocleidomastoid muscle are rare and concern its origin, insertion, and the number of heads. We report on a rare bilateral variant of the sternocleidomastoid muscle with aberrant and supernumerary muscular heads, observed in a cadaveric subject. On the right side of the neck, a typical sternomastoid head of the sternocleidomastoid muscle, and three aberrant clavicular heads of variable thickness, origin, and termination were noticed. On the left side, two sternomastoid heads were present; the medial one was of typical pattern, while the lateral was supernumerary. The cleidomastoid portion of the left sternocleidomastoid muscle was fused with the double sternomastoid segment. A strap-like muscle originating from the middle third of the clavicle and inserting onto the transverse process of the C3 vertebra was noticed. This is known as the cleidocervical muscle. On the right side of the neck, the posterior cervical triangle was diminished, the minor supraclavicular fossa was considerably narrow, whereas on the left, it was diminished in addition to a bilateral shortening of the major supraclavicular fossa minimizing space needed for potential surgical access. These findings are of prominent significance for anesthetists in ultrasound guided needle positioning in brachial plexus block, as well as in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoid muscle...

Las variaciones anatómicas del músculo esternocleidomastoideo son poco frecuentes y se refieren a su origen, inserción, y número de cabezas. Se presenta una rara variante del músculo esternocleidomastoideo con cabezas musculares aberrantes y supernumerarias bilateralmente en un cadáver. En el lado derecho del cuello, se observaron la cabeza esternomastoidea típica del músculo esternocleidomastoideo, y tres cabezas claviculares aberrantes de origen, espesor y terminación variable. En el lado izquierdo, se observaron dos cabezas esternomastoídeas, la medial con su patrón típico, mientras que el lateral fue supernumeraria. La porción cleidomastoídea del músculo esternocleidomastoideo izquierdo se fusionó con el segmento esternocleidomastoideo doble. Un músculo acintado similar procedentes del tercio medio de la clavícula e inserción en el proceso transverso de la vértebra C3 fue observado. Éste se conoce como el músculo cleidocervical. En el lado derecho del cuello, el triángulo cervical posterior fue disminuido, la fosa supraclavicular menor fue considerablemente estrecha, mientras que en el lado izquierdo, se disminuyó además a un acortamiento bilateral del espacio fosa supraclavicular importante reducir al mínimo necesario para el acceso quirúrgico potencial. Estos hallazgos tienen una importancia destacada para los anestesistas en el posicionamiento de aguja guiada por ecografía en el bloqueo del plexo braquial, así como en la cateterización de la vena subclavia o yugular externa, y en las intervenciones quirúrgicas que afecta las estructuras situadas debajo del músculo esternocleidomastoideo...