Caracterización de complicaciones por otitis media aguda en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Characterization of complications of acute otitis media at the Clinical Hospital of Pontificia Universidad Católica de Chile

Introducción: las complicaciones por otitis media aguda tienen una incidencia menor a un 1%. Aun así, se describe en literatura una mortalidad de un 5%. Actualmente existe escasa evidencia sobre estas complicaciones en nuestra realidad local. Objetivo: describir las de complicaciones de otitis media aguda según tipo, sexo, síntomas de ingreso, exámenes solicitados y tratamiento. Material y Métodos: estudio descriptivo retrospectivo de revisión de fichas clínicas que incluyó pacientes que ingresaron al Hospital Clínico de la Pontificia Universidad Católica de Chile con diagnóstico de otitis media aguda entre el 1 enero de 2000 hasta el 30 de julio de 2022. Resultados: se obtuvieron 71 pacientes ingresados por complicación de otitis media aguda. La edad media fue de 26,79 años, con 46 mujeres y 25 hombres. Se observaron complicaciones extracraneales, intracraneales y complicaciones simultáneas. Las complicaciones más frecuentes fueron la laberintitis y mastoiditis sin reportar casos de mortalidad. Discusión: actualmente existe escasa información sobre complicaciones de otitis media aguda y su epidemiología a nivel local. Las complicaciones extracraneales fueron más frecuentes: de ellas, la laberintitis y la mastoiditis agudas. El diagnóstico es clínico con apoyo de exámenes tanto de laboratorio, audiovestibulares e imágenes. Con respecto al tratamiento quirúrgico, se debe evaluar caso a caso y debe incluir miringotomía con o sin instalación de tubo de ventilación y mastoidectomía en casos refractarios. Es importante la sospecha y la derivación precoz

Introduction: Complications due to acute otitis media have an incidence of less than 1%. Nevertheless, it is described in the literature as having a 5% mortality rate. Currently, there is little evidence of these complications in our local reality. Objective: Describe the complications of acute otitis media based on its type, patient gender, admission symptoms, requested exams, and treatment. Material and Methods: Retrospective and descriptive study of patients' medical records admitted at the "Hospital Clínico de la Pontificia Universidad Católica de Chile" who were diagnosed with acute otitis media from January 1st, 2000, to July 30th, 2022. Results: There were 71 patients admitted due to complications of acute otitis media. On average, they were 26.29 years old; 46 were women, and 25 were men. Extracranial, intracranial, and simultaneous complications were observed. The most frequent ones were labyrinthitis and mastoiditis, without any mortality cases reported. Discussion: Currently, there is scarce information about the complications of acute otitis media and its local epidemiology. Extracranial complications were the most frequent: acute labyrinthitis and mastoiditis. The clinical diagnosis is supported by laboratory, audiovestibular, and image tests. Regarding surgical treatment, each patient must be evaluated independently. It should include myringotomy with or without a ventilation tube and mastoidectomy in refractory cases. It is crucial to detect it early and proceed with a medical referral.

Resonancia magnética de alta definición para la evaluación de trastornos laberínticos / High definition magnetic resonance imaging for the evaluation of labyrinthic disorders

Resumen Objetivo: Describir los hallazgos en resonancia magnética (RM) en lesiones intralaberínticas. Methods: Se incluyeron pacientes evaluados entre enero de 2012 y marzo de 2019 que se sometieron a una RM del oído interno. Se recogieron datos demográficos y de imagen. Las RM incluyeron secuencias ponderadas en T2 de alta resolución (T2 AR), secuencias ponderadas en T1 sin contraste (T1 SC) y secuencias ponderadas en T1 con contraste (T1 CC). Resultados: Se analizaron las imágenes de RM de 23 pacientes con una mediana de edad de 60 años (rango: 43-73). Encontramos 8 (34,8%) pacientes con neurinoma intralaberíntico, 7 (30,4%) con laberintitis inflamatoria, 5 (21,7%) con laberintitis osificante y 3 (13%) con hemorragia intralaberíntica. Todos los pacientes con neurinoma intralaberíntico tenían una baja señal en la secuencias T2 AR, ligera hiperseñal en las secuencias T1 SC y realce poscontraste. Tres pacientes (42,5%) con laberintitis inflamatoria tenían baja señal en las secuencias T2 AR y 5 (71%) tenían realce en las secuencias T1 CC. Los pacientes con laberintitis osificante tenían una baja señal en las secuencias T2 AR y los pacientes con hemorragia tenían una señal alta en las secuencias T1 SC. Los pacientes con neurinoma intralaberíntico tenían señal más baja en T2 AR que los pacientes con laberintitis inflamatoria (p = 0,026). Conclusiones: Existen diferentes condiciones que pueden alterar la señal del laberinto en la RM. El patrón radiológico permite establecer su diagnóstico. La investigación proporciona información relevante para la interpretación de las alteraciones de la señal del laberinto membranoso en la RM.

Abstract Objective: The objective of this investigation is to describe the findings in magnetic resonance imaging (MRI) in intralabyrinthine lesions. Method: We included patients evaluated between January 2012 and March 2019 who underwent an MRI of the inner ear. Demographic and image data were collected. MRI included high-resolution T2 (HR-T2), non-contrast T1 (NC-T1) and contrast-enhanced T1 (CE-T1). Results: MRI images of 23 patients were analyzed. The median age was 60 years (range: 43-73). We found 8 (34.8%) patients with intra-labyrinthine neurinoma, 7 (30.4%) patients with inflammatory labyrinthitis, 5 (21.7%) with ossifying labyrinthitis and 3 (13%) with intra-labyrinthine hemorrhage. All patients with intra-labyrinthine neurinoma had a low signal in HR-T2, a slight high signal in NC- T1 and post-contrast enhancement. Three patients with inflammatory labyrinthitis (42.5%) had low signal in HR-T2 and 5 patients (71%) had enhancement with CE-T1. Patients with ossifying labyrinthitis had a low signal in HR-T2 and patients with hemorrhage had high signal in NC-T1. Patients with intra-labyrinthine neurinoma had a lower signal in HR-T2 than patients with inflammatory labyrinthitis (p = 0.026). Conclusions: There are multiple entities that can alter the labyrinth signal in MRI. The radiological pattern allows establishing their diagnosis. The research provides relevant information for the interpretation of the alterations of the membranous labyrinth signal in MRI.

Swellings on Forehead – An Enigma: A Case Report

Acute viral labyrinthitis occurs seasonally in one in 600 patients and may last for up to 2 weeks or more. There is no demonstrablecause and etiology for the disease and it remains speculative. The most common virus associated with labyrinthitis is influenza,whereas some cases may even be associated with unidentifiable viruses. This is a rare case report where an 11-year-old girlwith viral labyrinthitis mysteriously presented with tender swellings on the forehead which puzzled the pediatrician and the ENTconsult in arriving at a diagnosis. This child presented only with mild-to-moderate grade fever and headache initially. Noneof her presenting illness was contributory toward labyrinthitis. Her blood count was normal and there were no inflammatorymarkers present. After culture sensitivity testing and a 10-day initial therapy with norfloxacin, her symptoms improved. However,2 weeks later, she again presented with severe dizziness and fainting episodes and mild ear pain which favored diagnosis towardviral labyrinthitis. The swellings and fever disappeared after prompt treatment. Here, the forehead swellings were very muchmisleading and kept the pediatrician and the ENT surgeon in confusion. This case report could be an eye-opener in this area

A Case of Scala Vestibuli Cochlear Implantation in Tympanogenic Labyrinthitis Ossificans / 대한이비인후과학회지

Labyrinthitis ossificans (LO) is a pathologic formation of fibrosis and new bone within the lumen of the otic capsule. The LO is a challenging issue in cochlear implantation since obliteration and obstruction of the cochlea make electrode insertion through scala tympani (classic route) difficult. Moreover, tympanomastoidectomy for resolution of chronic otitis media is also simultaneously considered for tympanogenic LO with severe to profound hearing loss because ossification could progress in case of staged or delayed implantation after initial tympanomastoidectomy. We report a patient with tympanogenic LO, who received subtotal petrosectomy with simultaneous cochlear implantation via scala vestibuli instead of the scala tympani for hearing rehabilitation.

A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo / 대한평형의학회지

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is easily cured with canal repositioning maneuvers, but some patients are resistant to the repositioning maneuver and require surgical intervention. Labyrinthitis ossificans is the pathologic condition that fibrous tissue and new bone occupy the membranous labyrinthine space. It occurs as a sequela of inner ear inflammation resulting from diverse causes, mostly bacterial meningitis and otitis media. We describe here a 42-year-old female patient with refractory posterior semicircular canal (PSCC) BPPV and adhesive otitis media in same ear. Otoscopic examination revealed adhesive tympanic membrane without middle ear space and temporal bone computed tomography showed complete ossification of the labyrinth at the same side. We performed a canal wall down mastoidectomy and PSCC occlusion. The patient had complete resolution of paroxysmal vertigo and positional nystagmus, postoperatively.

Bacterial Meningitis Initially Presenting as Labyrinthitis / 대한평형의학회지

Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

Kawasaki Disease and Labyrinthitis: An Underdiagnosed Complication

Sensorineural hearing loss (SNHL) that is seldom cited as a Kawasaki disease (KD) complication is known as an additional, potentially severe, and frequently irreversible sequel. Furthermore the vestibular functions of KD have been underestimated and it could be an important complication combined with SNHL in KD. We described a case that a 4 year-old boy who developed vestibular loss with SNHL has recovered successfully with a combined treatment.

Suppurative labyrinthitis associated with otitis media: 26 years' experience / Labirintite associada à otite média: experiência de 26 anos

ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.

A Case of Bacterial Meningoencephalitis Following Sudden Sensorineural Hearing Loss with Vertigo / 대한이비인후과학회지

We report a case of sudden sensorineural hearing loss with vertigo in a 68-year-old woman, who developed bacterial meningoencephalitis during steroid treatment. The patient initially showed severe degree of sensorineural hearing loss on the left side with spontaneous nystagmus beating toward the contralateral side. Brain magnetic resonance imaging demonstrated no abnormal finding other than high signal intensity in parts of mastoid air cells and mild mucosal hypertrophy of the paranasal sinuses. During the course of steroid treatment, the hearing worsened to profound hearing loss, and on the 6th day of steroid treatment, the patient demonstrated dysarthria and disorientation with subsequent development of high fever. The patient was diagnosed with bacterial meningoencephalitis and treated with antibiotics. The patient recovered without any neurologic deficit but unilateral profound hearing loss persisted. The case is presented here along with a possible pathogenic mechanism of bacterial meningoencephalitis following sudden sensorineural hearing loss in this patient.

Tontura de origem labiríntica / Labyrinthine dizziness

A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente relaciona-se a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura, considerando as necessidades dos médicos clínicos.

Dizziness is a symptom associated with numerous medical conditions and it recruits detailed diagnostic investigation and individualized therapeutic approach. It is often associated with tinnitus and related to disorders of peripheral vestibular system. It is present in a significant number of diseases and its occurrence in various medical specialties became essential the real need for extensive knowledge of the conditions associated with it. This study presents the viewpoint of expert opinion, an approach related to the diagnosis and treatment of dizziness, considering the necessities of physicians.

Benign Paroxysmal Positional Vertigo with Simultaneous Involvement of Multiple Semicircular Canals

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.

Risk Factors for Treatment Failure in Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Particular repositioning maneuver (PRM) have been recommended as a treatment of benign paroxysmal positional vertigo (BPPV). Some patients require multiple treatments for remission, although most of the patients are treated at the first trial of single maneuver. The purpose of this study was to evaluate risk factors for the treatment failure in patients with posterior canal BPPV (p-BPPV) and horizontal canal BPPV (h-BPPV). SUBJECTS AND METHOD: Retrospective review was performed for the 287 patients diagnosed as BPPV visiting the dizziness clinic between February 2011 and August 2012. The diagnostic criteria for BPPV were met by following the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery. Patients were classified into two groups: Group 1 (treatment success) that requires only 1 PRM and Group 2 (treatment failure) that requires more than 2 PRMs. We analyzed the relationship between treatment failure and the clinical characteristics, and studied the etiology of BPPV. RESULTS: The study included 183 patients with p-BPPV, 54 patients with h-BPPV (geotropic type), and 50 patients with h-BPPV (apogeotropic type). The type of BPPV and average numbers of PRM required for remission were significantly related with treatment failure by statistical analysis (p<0.05, respectively). Statistically significant correlation was demonstrated between the history of ipsilateral inner ear viral infection (acute vestibular neuritis, sudden sensorineural hearing loss) and treatment failure (p<0.05). CONCLUSION: Multiple PRMs may be required in patients with h-BPPV (apogeotropic type) or with secondary BPPV caused by ipsilateral inner ear viral disease. Clinically, this information may be used to provide helpful information for clinicians performing PRM to treat BPPV.

Tuberculous Otitis Media with Facial Paralysis Combined with Labyrinthitis

Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications.

Trombose de artéria basilar: relato de caso / Basilar artery thrombosis: case report

JUSTIFICATIVA E OBJETIVOS: O acidente vascular encefálico vértebro-basilar é uma entidade difícil de ser reconhecida através de dados semiológicos, pois pode se apresentar clinicamente semelhante a uma labirintopatia. O objetivo deste estudo foi alertar sobre os sintomas apresentados pelo paciente com vertigem central para se fazer um diagnóstico precoce. A justificativa baseia-se no quadro de um paciente com vertigem e vômitos, avaliado como uma labirintopatia, chamando atenção de dados semiológicos úteis na distinção entre a vertigem central e a periférica. RELATO DO CASO: Paciente do sexo masculino, 69 anos, hipertenso foi atendido em pronto-atendimento com vertigem, vômitos e mal estar. Medicado com metoclopramida, dimenidrinato, clonazepam. Alta com melhora parcial do quadro, suspeitando labirintite. Orientado consulta com otorrinolaringologia. No dia seguinte evoluiu com incapacidade de marcha, vertigem, vômitos, rebaixamento do nível de consciência e descerebração bilateral. Submetido à intubação orotraqueal. Tomografia computadorizada de crânio (TCC) revelou sinal de hiperdensidade da artéria basilar sugerindo trombose,confirmada pela angiografia. Tendo-se em vista quadro neurológico e tempo de evolução impreciso, optou-se por não utilizar trombolítico. No dia seguinte, o paciente apresentava-se em coma (Glasgow = 3),TCC revelando acidente vascular encefálico isquêmico (AVEI) agudo vértebro-basilar extenso evoluindo para óbito 72 horas após. CONCLUSÃO: A distinção entre vertigem central ou periférica é um desafio semiológico. O diagnóstico precoce do AVEI por TCC é limitado. O conhecimento de dados semiológicos é uma ferramenta indispensável para o reconhecimento do AVE vértebro-basilar em unidades de PA.

BACKGROUND AND OBJECTIVES: Vertebrobasilar strokeis a difficult entity to be recognized through semiological data, because it can be clinically similar to a labyrinthopathy. This study aims at alerting about the symptoms of patients with central vertigo to make an early diagnosis, as the clinical picture of vertigo and vomiting can be diagnosed as a labyrinthopathy; it also aims at drawing attention to semiological data useful for distinguishing between the peripheral and central vertigo. CASE REPORT: Male patient, 69 years, hypertensive, was seen in an emergency service with dizziness, vomiting, malaise. He was given metoclopramide, dimenhydrinate, and clonazepam. He was discharged with partial improvement of his condition and suspicion of labyrinthitis. He was referred to an otorhinolaryngologist. The next day he progressed with inability to walk, dizziness, vomiting, decreased level of consciousness and bilateral decerebration. He underwent orotracheal intubation. Computed tomography (CT) revealed hyperdensity sign of basilar artery suggestive of thrombosis, confirmed by angiography. Due to the neurological symptoms and inaccurate time course, we chose not to use thrombolytic therapy. The next day, the patient was in coma (Glasgow= 3), with CT revealing extensive acute vertebrobasilar ischemic stroke (AIS) that progressed to death in 72 hours. CONCLUSION: The distinction between central or peripheral vertigo is a semiological challenge. Early diagnosis of AIS by brain TC is limited. The knowledge of semiological data is an indispensable tool for the recognition of vertebrobasilar stroke in emergency care.

Labirintopatias / Labyrinthitis

A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente se relaciona a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura.

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. MATERIALS AND METHODS: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. RESULTS: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. CONCLUSION: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

A Case of Acute Serous Labyrinthitis Complicated by Chronic Otitis Media Showing Atypical Nystagmus Pattern / 대한평형의학회지

Serous or suppurative labyrinthitis is one of the intratemporal complications of acute or chronic otitis media. Labyrinthitis can occur by meningogenic or hematogenous infection. Major symptoms of labyrinthitis are vertigo and hearing loss. The disease progresses in two phases; serous labyrinthitis, so called toxic labyrinthitis, and suppurative labyrinthitis. If labyrinthitis treated at serous phase, hearing could be saved. But, if the disease progressed to suppurative phase, hearing loss is difficult to recover. Therefore it is very important to distinguish these two phases of labyrinthitis when treating the patient. In general, the direction of nystagmus during labyrinthitis is helpful sign to distinguish these two phases. We report here on an unusual case of acute serous labyrinthitis complicated with chronic otitis media showing atypical pattern with a review of the related literatures.

Sudden Sensorineural Hearing Loss Occurring after Blunt Head Trauma

Sudden sensorineural hearing loss (SNHL) due to blunt head trauma is a rare condition. Possible causes of SNHL by head trauma include cellular injury, perilymphatic fistula, labyrinthine concussion due to microfracture in inner ear and blunt trauma with simultaneous acute labyrithitis. We report here on two unusual cases in which cochleovestibular functions were totally damaged in patients with sudden SNHL due to blunt head trauma. Both cases presented with vertigo, tinnitus and a sudden onset of hearing impairment in the unilateral ear after blunt trauma. Audiograms revealed a profound to severe unilateral SNHL. Caloric testing revealed a decreased caloric response of 100% in the ipsilateral side compared to the contralateral side. Vestibular evoked myogenic potential testing revealed no response in the ipsilateral ear. Neither patient recovered hearing despite oral and/or intratympanic steroid therapy.

Sudden Sensorineural Hearing Loss Occurring after Blunt Head Trauma

Sudden sensorineural hearing loss (SNHL) due to blunt head trauma is a rare condition. Possible causes of SNHL by head trauma include cellular injury, perilymphatic fistula, labyrinthine concussion due to microfracture in inner ear and blunt trauma with simultaneous acute labyrithitis. We report here on two unusual cases in which cochleovestibular functions were totally damaged in patients with sudden SNHL due to blunt head trauma. Both cases presented with vertigo, tinnitus and a sudden onset of hearing impairment in the unilateral ear after blunt trauma. Audiograms revealed a profound to severe unilateral SNHL. Caloric testing revealed a decreased caloric response of 100% in the ipsilateral side compared to the contralateral side. Vestibular evoked myogenic potential testing revealed no response in the ipsilateral ear. Neither patient recovered hearing despite oral and/or intratympanic steroid therapy.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis / 대한평형의학회지

Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.