Occult middle ear and mastoid fluid in acute otitis externa.

OBJECTIVES/HYPOTHESIS: Presence of fluid in the middle ear (ME) or mastoid air cells in acute otitis externa (OE) has not been reported. We hypothesize that in patients with OE there is often otitis media (occult middle ear and mastoid fluid) and secondary fluid in the mastoid air cell system, which is not seen during a clinical examination because of edema in the external canal skin. STUDY DESIGN: Retrospective chart review. METHODS: We reviewed the medical records of 209 patients who presented to our ear, nose, and throat (ENT) clinic with acute OE that was resolved with oral and/or topical antibiotics. RESULTS: Twenty-seven of the 209 patients presented with unilateral or bilateral acute OE (29 ears) and received a computed tomography (CT) scan of their temporal bones, which was ordered by the Emergency Department or ENT services. Twenty-three of 29 ears (79%) showed fluid in the ME, mastoid, or both. Nine of the 10 patients (82%), who obtained their CT scan within 1 week of symptom onset, were found to have fluid. CONCLUSIONS: These findings support our hypothesis and serve to inform the medical community (both ENT and primary care) that fluid is often present in the ME or mastoid in patients with acute OE whose symptoms will resolve with oral and/or topical antibiotics.

Pseudo-sudden deafness.

OBJECTIVES: We describe the symptom complex and management of a clinical entity we refer to as "pseudo-sudden deafness," which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination. METHODS: We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component. RESULTS: Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients. CONCLUSIONS: Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.

Long-term effects of hearing aids on word recognition scores.

OBJECTIVES: The purpose of this study was to retrospectively examine how monaurally fitted hearing aids affected word recognition scores in patients with bilateral symmetric sensorineural hearing loss. METHODS: Sixty-six patients from 2 separate institutions were included in this study. In addition to having bilateral symmetric sensorineural hearing loss due to presbycusis, each patient had to have worn a single hearing aid for at least 5 months and have valid pre-aid and post-aid audiograms. Word recognition scores were analyzed with a table of confidence levels generated by Thornton and Raffin that determined the probability of differences between word recognition scores. RESULTS: Hearing aids did not improve or preserve word recognition scores to the degree that has been previously reported in the literature. The unaided (control) ear demonstrated a decrease in word recognition scores over time, as was expected from previous studies. The aided ears demonstrated a similar decline in word recognition scores when compared to the unaided ears. When the conventional confidence level of 0.05 was used, the aided ears showed no advantage over the unaided (control) ears. CONCLUSIONS: These findings are not consistent with the acclimatization first reported by Silman et al in 1993. Such a discrepancy in the results calls for further studies to evaluate just how effective unilateral hearing aids are in patients with bilateral symmetric sensorineural hearing loss.

Primary lymphoma of the temporal bone presenting as XIIth cranial nerve weakness.

Primary lymphoma of the temporal bone is an extremely rare finding in clinical practice. Although it is treated as a type of non-Hodgkin lymphoma, the absence of systemic signs and symptoms makes detection dependent on the tumor's local mass effect. In this article, we report a case of temporal bone lymphoma that caused XIIth nerve palsy. We also discuss the clinical manifestations of temporal bone lymphoma and the importance of imaging the head and neck when any idiopathic cranial nerve palsy develops.

Amyloidosis of the external auditory canal.

We present a case of bilateral otitis externa that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal lesions may be the only manifestation of treatable systemic disease and should be biopsied, even though their bilaterality argues against malignancy.