Anatomical Variations in Patients with Ménière Disease: A Tomography Study

Abstract Introduction The etiology of Ménière disease (MD), a difficult-to-treat condition with great morbidity, remains controversial in the literature. The possible clinical and diagnostic impact of anatomical variations of the temporal bone among patients with MD has been recently studied. Objective To identify anatomical variations of the temporal bone associated with the diagnosis of MD. Methods Thirty-seven patients were included, although each ear was considered separately (n = 74). A case group (nA = 33) was composed of the affected ears of patients with definiteMDand a control group (nB = 41) was used consisting of the ears of individuals who did not meet the criteria for MD and of the contralateral ears from patients with unilateral disease. Tomographic images from the individuals included in the study were submitted to a blinded and systematic evaluation regarding a broad variety of anatomical variations of the temporal bone. Obtained data were compared statistically between the groups and after stratifying the study sample. Significance level was set at 0.05. Results Among the affected ears, it was observed an increased number of tomographic scans in which the vestibular aqueduct could not be identified (p = 0.01, Fisher exact test). No statistically significant differences were observed when comparing the affected and contralateral ears frompatients with unilateral MD, between affected ears from patients with unilateral and bilateral disease or between contralateral ears of patients with unilateral affection and patients without the disease. Conclusion Some anatomical variations might be more frequent in the affected ears of patients with MD, such as the lower rates of individualization of the vestibular aqueduct.

Unilateral horizontal semicircular canal malformation causing recurrent vertigo

@#A 62-year-old man consulted for recurrent episodes of vertigo lasting from seconds to several minutes. The vertigo was variably described as spinning, lateral swaying, and a feeling of being “unsure of his position in space.” These episodes were noted to have begun when the patient was still in his 20’s. Standard pure tone audiometry revealed a mild-to-moderate downsloping mixed hearing loss in the left ear. Bithermal caloric testing indicated the presence of a significant left-sided peripheral vestibular loss. Due to the fact that the vertigo episodes presented relatively early in life, the possibility of a congenital inner ear malformation was considered as a cause for his symptoms. Computerized tomographic (CT) imaging of the temporal bone was performed. This clearly showed the left horizontal semicircular canal lacking a central bony island. (Figure 1 and 2) The cochlea, superior and posterior semicircular canals, vestibular and cochlear aqueducts, and ossicular chain were grossly normal. A malformation of the horizontal or lateral semicircular canal is one of the most common inner ear malformations, as it is the last vestibular structure to be formed during inner ear embryogenesis. As such, it may occur in isolation or may be associated with other vestibular, cochlear, or middle ear malformations.1,2 Although vertigo and dizziness are symptoms to be expected in such a condition, existing data indicates that it may be totally asymptomatic, or it may also present as a sensorineural, conductive, or mixed type of hearing loss.1,3 Radiologic imaging is of prime importance in diagnosing such conditions, especially when auditory and/or vestibular symptoms manifest early in life. This case perfectly illustrates the need for such studies, as the patient went undiagnosed for more than forty years! No definitive statements can be gleaned from existing medical literature with respect to treatment. However, in patients with debilitating vestibular symptoms, management with modalities that selectively target the vestibular system, but spare the auditory system, such as vestibular neurectomy and trans-tympanic aminoglycoside therapy appear to be reasonable options.

A Case of Bilateral Hearing Loss Following External Ventricular Drainage / 대한이비인후과학회지

The sensorineural hearing loss following extraventricular drainage (EVD) is perhaps an underestimated complication rather than an uncommon event. Changes in the cerebrospinal fluid (CSF) pressure may lead to endolymphatic hydrops through the patent cochlear aqueduct resulting in sensorineural hearing loss. We describe the case of a 9-year-old child suffering from meduloblastoma. Bilateral hearing loss, especially at low frequency was found after emergent extraventricular drainage. At 2 months of treatment, hearing loss improved a little, but not restored to a serviceable hearing. Our experience and a review of articles indicate that early detection and awareness of hearing loss after EVD are important for treatment strategy.

A Case of Labyrinthine Hydrops Caused by Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) is a rare cause of labyrinthine hydrops. The otologic symptoms of SIH include ear fullness, tinnitus, and hearing loss which can result from labyrinthine hydrops. We report a case of labyrinthine hydrops caused by SIH, confirmed by an audiometric impairment that occurred only when in an upright posture.

Imágenes en anatomía coclear TC y RM / Cochlear anatomy CT and MR imaging

Los autores ofrecen un breve repaso de anatomía normal de la cóclea con imágenes de TC y RM a fin de posibilitar una más acabada identificación de hallazgos patológicos en pacientes con hipoacusia perceptiva

Tratamiento quirúrgico del vértigo: revisión bibliográfica / Surgical treatment of vertigo: a review

Se hace una revisión bibliográfica crítica de los procedimientos quirúrgicos usados para curar el síntoma vértigo, con objeto de aclarar sus indicaciones en función de resultados y de efectos nocivos. Las conclusiones a que se llegó fueron las siguientes: 1. En el vértigo producto de fístula perilinfática, se debe intervenir quirúrgicamente tan pronto sea diagnosticada y aún en casos de que solo exista una razonable sospecha. 2. En el vértigo postural paroxístico benigno incapacitante y resistente a tratamiento médico y rehabilitación física, se puede intervenir con obliteración del conducto semicircular posterior, informando al paciente, de preferencia por escrito, que existe riesgo, aunque poco probable, de que aparezca hipoacusia y acúfeno. 3. El vértigo ocasionado por la enfermedad de Meniére o por otros padecimientos, en caso de ser incapacitante y no susceptible a tratamiento médico, debe intervenirse siguiendo dos criterios: Cuando la audición ha disminuido hasta el punto de ya no ser útil, se puede emplear la gentamicina intratimpánica o la derivación del saco endolinfático; si estas fracasan, debe efectuarse laberintectomía. Cuando hay buena audición, o audición recuperable con auxiliar auditivo se puede hacer derivación del saco endolinfático; si ésta fracasa, neurectomía vestibular. 4. Hay razones para ser escéptico sobre la existencia y sobre la posibilidad diagnóstica del vértigo como producto de compresión vascular al tronco del nervio octavo, por lo que la descompresión microvascular del nervio debe considerarse como en fase experimental, y no efectuarse en ambiente clínico.

Perilymphatic hydrops: a human temporal bone study

The study included 17 temporal bones with non artifactually bulging round window membrane that indicated increased perilymphatic pressure. The specimens had been routinely processed and prepared for light microscopy. Pathological finding in the inner and middle ear reported. They are correlated with pathological changes in the internal auditory meatus and to details of the medical history. A correlation has been shown between perilymphatic hypertension, on the one hand, and potential cases of increased intracranial tension and a patent cochlear aqueduct, on the other hand