Tone burst electrocochleography disproves a diagnosis of Meniere's disease treated aggressively.

Reliable confirmation of the presence or absence of endolymphatic hydrops is essential to avoid confusing vestibular migraine with Meniere's disease. MRI inner ear imaging is a promising new method to confirm hydrops, avoiding both unnecessary invasive or destructive inner ear treatments, but it is not universally available. Tone burst electrocochleography is an older simple, quick, safe, and sensitive test that is potentially available, with existing (or minorly upgraded) equipment at most tertiary medical centers. In Meniere's disease hydrops remains after intratympanic treatments. A case is presented of a 45 year-old man with a long history of recurrent vertigo attacks who, due to an erroneous diagnosis of Meniere's disease, was given five intratympanic treatments with no effect. He was subsequently found by tone burst electrocochleography to have no hydrops and was differentially diagnosed with probable vestibular migraine. Response to treatment confirms this diagnosis. This patient's electrocochleographic findings are compared with two other patients with definite Meniere's disease, one of whom had demonstrable hydrops despite intratympanic gentamycin treatments.

Saccular otoconia as a cause of Ménière's disease: hypothesis based on two theories.

BACKGROUND: The cause of Ménière's disease remains enigmatic after 156 years. Schuknecht's rupture and potassium intoxication theory of attacks was based on histological studies. OBJECTIVES: This paper aimed to: present the most contemporary evidence indicating that ruptures do not usually occur, and discuss the possibility that detached saccular otoconia are the main cause of Ménière's disease; and to establish an unequivocal definition of the age of Ménière's disease onset. METHOD: The paper reviews the electrophysiological basis of the Gibson-Arenberg drainage theory used to explain vertigo attacks. The current, limited knowledge of the likely fate of detached saccular otoconia is discussed. RESULTS: Electrophysiological studies during attacks do not support endolymph ruptures, but rather endolymph flowing in one direction and then in the opposite direction. Age of onset for Ménière's disease parallels that for benign paroxysmal positional vertigo. CONCLUSION: The similarity of age of onset spectrum for Ménière's disease and benign paroxysmal positional vertigo raises the possibility that the two conditions have the same fundamental cause.

On the classification of hydropic ear disease (Menière's disease).

More than 150 years after its initial description by Prosper Menière, the disease named after him is still at the center of scientific debates. Two recent developments have specifically created a breeding ground for controversy: (1) Since its first description 10 years ago, magnetic resonance imaging diagnosis of endolymphatic hydrops in living patients has seen an increasing and worldwide application. (2) The Bárány Society Classification Committee published diagnostic criteria for Menière's disease in 2015 and proposed a concept of the disease that has elicited widespread criticism. In order to promote the understanding of the underlying controversies and arguments, this article gives an overview of and discusses relevant classification proposals for Menière's disease, including the new classification system of hydropic ear disease.

An FPGA-based instrumentation platform for use at deep cryogenic temperatures.

We describe the operation of a cryogenic instrumentation platform incorporating commercially available field-programmable gate arrays (FPGAs). The functionality of the FPGAs at temperatures approaching 4 K enables signal routing, multiplexing, and complex digital signal processing in close proximity to cooled devices or detectors within the cryostat. The performance of the FPGAs in a cryogenic environment is evaluated, including clock speed, error rates, and power consumption. Although constructed for the purpose of controlling and reading out quantum computing devices with low latency, the instrument is generic enough to be of broad use in a range of cryogenic applications.

Dispersive readout of a few-electron double quantum dot with fast RF gate sensors.

We report the dispersive charge-state readout of a double quantum dot in the few-electron regime using the in situ gate electrodes as sensitive detectors. We benchmark this gate sensing technique against the well established quantum point contact charge detector and find comparable performance with a bandwidth of ∼ 10 MHz and an equivalent charge sensitivity of ∼ 6.3 × 10(-3) e/sqrt[Hz]. Dispersive gate sensing alleviates the burden of separate charge detectors for quantum dot systems and promises to enable readout of qubits in scaled-up arrays.

Magnetic resonance imaging for Ménière's disease: correlation with tone burst electrocochleography.

The newly developed use of magnetic resonance imaging of the human inner ear, on a 3 Tesla scanner with intratympanically administered gadolinium, can now reliably distinguish perilymph from endolymph and visually confirm the presence or absence of endolymphatic hydrops. Transtympanic tone burst electrocochleography is an established, and under-utilised evoked response electrophysiological test for hydrops, but it relies on a symptom score to indicate the likelihood of hydrops being present. The current diagnostic criteria for Ménière's disease make no allowance for any in vivo test, making diagnostic errors likely. In this small pilot study of three patients undergoing tone burst electrocochleography, subsequent magnetic resonance imaging confirmed or excluded the hydrops that the electrocochleography predicted. Magnetic resonance imaging of the inner ear is a safe technique that can be performed in conjunction with imaging of the VIIIth cranial nerves. As this report comprised only three patients in a pilot study, rigorous clinical studies are required to define the possible role of magnetic resonance imaging in the diagnosis of Ménière's disease.

When not to syringe an ear.

This article reviews the potential hazards of ear syringing and the Accident Compensation Corporation Medical Misadventure Unit's experience of alleged iatrogenic injury over a 17-month period. Syringing claims account for about 25% of the total claims received by the ACC ENT Medical Misadventure Committee. Forty-seven claims were accepted as either mishap or error, and 63 claims were declined. Perforation of the drum was by far the commonest injury resulting in significant disability. Severe iatrogenic otitis externa accounted for most of the remainder. Practice nurses had syringed the ears of approximately two-thirds of the claimants with significant disability. The contraindications to ear syringing are listed and discussed. The correct technique, with a few "do and don't" pointers, is briefly reviewed. Management of the unintentional injury is discussed.

Prospective, randomized, controlled study comparing two dosing regimens of gentamicin/oral ciprofloxacin switch therapy for acute pyelonephritis.

Aminoglycosides are drugs of choice for severe gram-negative urinary tract sepsis. Recent evidence suggests that they are just as efficacious, but less nephrotoxic and ototoxic, if given as a single daily dose rather than in divided doses. We considered that a single, large dose of an aminoglycoside followed by oral therapy with a different antibiotic might be equally effective and possibly less toxic. This randomized, controlled study compared a single large i.v. dose (10 mg/kg) of gentamicin (S) with a standard multiple dose regimen (M) of gentamicin (2.5 mg/kg i.v. stat and then computer generated divided doses aiming for peak and trough concentrations of 8 and 1.5 mg/l respectively) for the treatment of patients with suspected acute pyelonephritis requiring hospitalization for parenteral antibiotic treatment. All patients were switched to oral ciprofloxacin either four hours after the S dose or when clinically appropriate in the M regimen. For all patients the total duration of treatment was five days. Fifty-three patients (48 women; mean age 32 yr) were enrolled. Clinical and bacteriological efficacy could be assessed in 41 patients. Thirteen of 16 in the S arm and 24 of 25 in the M arm were clinically cured and the other four clinically improved. Fifteen of 16 in the S arm and 23 of 25 in the M arm were cured bacteriologically (sterile urine 7-10 days after treatment). In 41 patients high tone audiometry was carried out before or very soon after the start of treatment, and again at the end of treatment. Ototoxicity (> or = 10 dB loss in > or = 2 frequencies in both ears) was observed in 3 of 18 in the S group (17%) and 7 of 23 in the M group (30%) (NS). Other side-effects and toxicity were mild and not different between groups. Substantial cost savings occurred in the S group. In summary, a large single dose of gentamicin was comparable in efficacy and toxicity to a standard regimen, but cheaper and more convenient to use.

The management of preauricular sinus.

Preauricular sinus is a common congenital condition which does not always cause symptoms. It is often misdiagnosed, can be difficult to treat surgically, and recurrences are common. The results of treatment in twelve Christchurch patients are discussed and a surgical technique is described.

Chondrosarcoma arising in the nasal septum.

A case is presented of a chondrosarcoma arising in the nasal septum and extending into the maxillary sinuses. This tumour is unusual in the head and neck and rarely arises in the nasal septum. Diagnostic difficulties are discussed. The treatment was radical surgery with removal of a major portion of the upper jaw, necessitating reconstruction with a maxillo-facial prothesis.

Abnormally patent eustachian tube syndrome.

Seven new cases of abnormally patent eustachian tube syndrome are presented. It is an uncommon disorder in which the voice and breathing are heard loudly in the affected ear. In mild cases blocked ear sensation may be the only symptom. The common predisposing causes are rapid weight loss and pregnancy. It usually resolves without surgical intervention. An occasional patient is extremely distressed by the symptoms.

The presenting symptoms of head and neck cancer.

The late presentation of head and neck malignancies is often attributable to failure by the patient and the doctors to appreciate the significance of early symptoms. The presenting features of 522 cases are summarised. They emphasize that the following clinical features are significant, especially in a patient who smokes or drinks: local pain, pain referred to the ear, hoarseness, dysphagia, dyspnoea and stridor, persistent sore throat, nasal obstruction, bleeding, problems fitting dentures and a neck lump. An adequate history and ability to examine the head and neck region are prerequisites to early diagnosis. A knowledge of the presenting features of head and neck malignancies could be stressed more adequately by public health authorities.

Fatal epistaxis from an aneurysm of the intracranial internal carotid artery.

An instance of fatal epistaxis is reported in a patient with an unsuspected aneurysm of the infraclinoid portion of the internal carotid artery. There was no known history of trauma. The aneurysm was subsequently detected on an old X-ray film. Epistaxis from an aneurysm at this site is nearly always preceded by significant head trauma and is associated with cranial nerve palsies, a syndrome with a high mortality. Epistaxis from rupture of a non-traumatic aneurysm is very rare.

Carcinoma of the ureter.

A case of primary carcinoma of the ureter is presented. The features of 12 previous cases are summarised and discussed with reference to the literature. The tumour occurs most commonly in the sixth and seventh decades and is often diagnosed late. Subsequent bladder tumours are common, so vigilant follow-up is necessary.

Histocompatibility antigens and immune responsiveness; their relevance to rheumatic diseases.

Associations between histocompatibility antigens and human diseases have been found. Some of the highest correlations are with the so-called "rheumatoid variant" disorders. Data gained from ummunogenetic studies in laboratory animals has been invoked in speculation on the significance of the high antigen associations in disease pathogenesis. While much of this data better supports theories on the aetiology of other conditions with less significant antigen associations, it is discussed here with reference to the rheumatic diseases.