Infections of the Ear.

Infections of the ear are a common presentation to an acute care environment. In this article, the authors aim to summarize the most common presentations, and diagnostic and treatment options for typical infections of the ear. This article is geared toward the emergency physician, urgent care provider, and primary care provider who will likely be the initial evaluating and treating provider to assist them in determining what treatment modalities can be managed in a clinic and what needs to be referred for admission or specialty consultation.

Clinical examination and management of the dizzy patient.

Dizziness is the commonest reason for a GP appointment over the age of 75 years and many dizzy patients will end up in hospital. This article introduces the range of vestibular disorders commonly seen in hospital practice with a symptom-based approach and discusses the range of treatments that might be considered.

Lyme disease: sudden hearing loss as the sole presentation.

BACKGROUND: Lyme disease is an uncommon tick-borne multisystemic infection caused by Borrelia burgdorferi. The most common clinical manifestation is erythema migrans. In this report, a very unusual presentation of this condition is described, in which sudden onset sensorineural hearing loss was the sole presenting symptom. METHODS: Case report and review of English-language literature. RESULTS: A patient presented with sensorineural hearing loss, with no other symptoms or signs. Acute Lyme infection was detected by laboratory tests. Magnetic resonance imaging showed signs of labyrinthitis of the same inner ear. After hyperbaric oxygen and systemic antibiotic treatment, the patient showed total hearing recovery, and magnetic resonance imaging showed complete resolution of the labyrinthitis. CONCLUSION: To our knowledge, this is the first reported case of Lyme disease presenting only with sensorineural hearing loss. Borreliosis should be considered as an aetiological factor in sensorineural hearing loss. Adequate treatment may provide total recovery and prevent more severe forms of Lyme disease.

Vestibular neurolabyrinthitis: a follow-up study with cervical and ocular vestibular evoked myogenic potentials and the video head impulse test.

OBJECTIVES: The aim of this study was to evaluate prospectively, in a group of patients affected by vestibular neurolabyrinthitis (VN), a diagnostic protocol including cervical vestibular evoked myogenic potentials (C-VEMPs), ocular vestibular evoked myogenic potentials (O-VEMPs), and the video head impulse test (vHIT). METHODS: The diagnosis of VN was based on the patient's clinical history, an absence of associated auditory or neurologic symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function by use of the Fitzgerald-Hallpike caloric vestibular test and the ice test. RESULTS: In our series, 55% of the cases were superior and inferior VN, 40% were superior VN, and 5% were inferior VN. These cases, however, comprised different degrees of vestibular involvement, as the individual vestibular end organs have different prognoses. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. CONCLUSIONS: The implementation of C-VEMPs, O-VEMPs, and the vHIT in a vestibular diagnostic protocol has made it possible to observe patients with ampullary VN in a way that has not been feasible with other types of vestibular examinations. The age of the patient seems to have some impact on recovery from VN. When recovery occurs in the utricular and saccular nerves first and in the ampullary nerves subsequently, it may be reasonable to expect a more favorable outcome.

Dizziness and vertigo.

Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease.

Superior semicircular canal dehiscence: a possible pathway for intracranial spread of infection.

Otogenic brain abscesses account for 31.4% of all cerebral abscesses: bone erosion due to coalescent otomastoiditis or cholesteatomas, osteothrombophlebitis, and hematogenous spreading are the most frequent pathways of infection. We briefly reported and discussed the first case of otogenic brain abscess due to infectious labyrinthitis that (likely) spread intracranially through a dehiscence of the superior semicircular canal.

Análise comparativa do equilíbrio postural de indivíduos com e sem histórico de labirintite: estudo preliminar / Comparative analysis of postural balance between individuals with and without labyrinthitis: preliminary study

O objetivo deste estudo foi comparar o equilíbrio postural entre indivíduos com e sem histórico de labirintite por meio de um estudo transversal controlado, cuja amostra foi composta por um grupo de 12 participantes jovens, sem labirintite, do sexo feminino com média de idade de 22 ± 2,23 anos e índice de massa corporal 21,12 ± 2,09 e outro grupo composto por 12 indivíduos do sexo feminino com histórico de labirintite, porém fora de crise e com média de idade de 22 ± 1,46 anos e índice de massa corporal de 23,42 ± 3,52. O registro do deslocamento do centro de pressão foi realizado por uma plataforma de pressão F-Mat modelo 3100 do sistema F-Scan com software versão 4.2 (Tekscan, Inc., South Boston, MA), sendo avaliado o comprimento total da trajetória (CT), o deslocamento ântero-posterior (AP), médio-lateral (ML) e a velocidade máxima (VM). O teste t para amostras independentes encontrou diferenças estatisticamente significativas no parâmetro comprimento total da trajetória (CT) entre as medidas dos grupos, demonstrando que os indivíduos com histórico de labirintite estudados, mesmo fora da crise, mostraram equilibro postural deficitário quando comparado aos indivíduos do grupo sem histórico de labirintite.

The purpose of this study was to compare postural balance between individuals with and without history of labyrinthitis through a cross-controlled study, whose sample was composed by a group of 12 young participants females, without labyrinthitis, 22 ± 2.23 years old and body mass index of 21.12 ± 2.09, and another group composed of 12 individuals female with history of labyrinthitis beyond crisis, 22 ± 1.46 years old and body mass index 23.42 ± 3.52. The record of the displacement of the center of pressure was conducted by a platform of pressure F-Mat model 3100 of the F-Scan system with software version 4.2 (Tekscan, Inc., South Boston, MA), being measured total length path, anterior-posterior and medial-lateral displacement and maximum speed. The t-test for independent samples found significant differences statistical in the parameter total length path between the actions of groups demonstrating that individuals with a history of labyrinthitis studied showed postural balance deficit when compared to individuals in the group without history of labyrinthitis.

Neurologic diseases in llamas and alpacas.

Llamas and alpacas are affected by a wide range of neurologic diseases, including listeriosis, polioencephalomalacia, encephalitis caused by West Nile virus and equine herpesvirus, and meningeal worm. Cervical luxations and subluxations appear to be more common in camelids than in other species. Camelids that have otitis or discospondylitis may not present with clinical signs until the underlying pathology is severe. Meningitis and brain abscesses are an important complication of failure of passive transfer of immunity in crias. The cerebrospinal fluid tap is especially useful for diagnosing meningeal worm and ruling out other diseases. CT and MRI are particularly useful when intracranial disease is suspected or for spinal lesions that show only subtle lesions on plain radiography.

[Innovations in pathogenetic therapy for peripheral affection of the cranial nerves in otorhinolaryngology].

A total of 150 patients with peripheral affection of the facialnerve, 100 patients with acute neurosensory hypoacusis, 50 patients with affection of the reciprocal nerve were treated by the method using reciprocal interaction between M- and H-cholinergic mechanisms. Treatment outcomes showed that anticholinesterase therapy raises the efficacy of rehabilitation in patients with peripheral affection of the cranial nerves.

Inner ear and facial nerve complications of acute otitis media, including vertigo.

Acute otitis media is one of the most common diagnoses made in children in the United States. Intracranial and extracranial (intratemporal) complications have greatly decreased in the antibiotic era, but still remain a challenge when they arise. This article addresses two intratemporal complications with significant associated morbidity: facial nerve paralysis/paresis, and labyrinthitis. Epidemiology, pathology, clinical diagnosis, and treatment options are discussed, focusing on an evidence-based approach to diagnosis and management. In addition, the future of treatment and current questions regarding otitis media are briefly discussed.

Otogenic cerebellar abscess due to purulent labyrinthitis and defect of the superior semicircular canal and its propagation through the endolymphatic sac.

The otogenic cerebellar abscess still is one of the most dangerous complications of otitis media and implicates a high risk of mortality. Early diagnosis and therapy are decisive factors for the chances of rehabilitation. Radiologic imaging (CT/MRI) plays an important role. A broad-spectrum antibiotic according to antibiogram is indispensable. The type of surgical intervention depends on the cause and localization of the abscess. In this case the cerebellar abscess was a complication resulting from labyrinthitis, which was propagated through the endolymphatic duct and sac to the posterior fossa dura. Consequently, it could be cured ultimately only after petrosectomy and abscess drainage toward the mastoid cavity. It is mandatory to completely sanitize the infection surgically in order to avoid lethal complication especially in case of a delayed clinical course or recurrent symptoms of labyrinth involvement. Close interdisciplinary collaboration between ORL, neurosurgery and neuroradiology is desirable for successful therapy.

A case of tympanogenic labyrinthitis complicated by acute otitis media.

Widespread use of antimicrobial drugs in the management of otitis media has significantly reduced the incidence of labyrinthitis nowadays. Cases of tympanogenic labyrinthitis following acute otitis media have rarely been reported in recent literature on otolaryngology. We report an unusual case of tympanogenic labyrinthitis that presented with sudden sensorineural hearing loss (SNHL) following acute otitis media in an adult who had no previous otological complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the left ear. MRI was helpful to identify the inflammatory change of the membranous labyrinth. The patient's hearing returned to normal after treatment. The definite diagnosis of serous labyrinthitis was established retrospectively.

Cochlear microperfusion: experimental evaluation of a potential new therapy for severe hearing loss caused by inflammation.

HYPOTHESIS: Cochlear microperfusion will be a useful treatment of severe sensorineural hearing loss caused by inflammation. BACKGROUND: Viruses, bacteria, and autoimmunity can initiate inflammation in the inner ear. The acute phase is associated with elevations in cytokines, nitrous oxide, and cellular infiltrates and the breakdown of the blood-labyrinthine barrier. The chronic phase leads to irreversible ossification of the labyrinth. METHODS: The authors developed cochlear microperfusion to facilitate removal of inflammatory cells and their byproducts during the acute phase of inflammation. Using a ventral approach to the guinea pig cochlea, the authors displaced resident perilymph by delivering perfusate into the scala vestibuli and collecting the effluent from the scala tympani. The authors evaluated the benefit of the procedure in an animal model of severe hearing loss caused by inflammation. RESULTS: Healthy controls undergoing cochlear microperfusion with phosphate-buffered saline incurred a mean hearing loss of 16 dB (n=4). This hearing loss was associated with the creation of two cochleostomies and not the perfusion itself. Sterile labyrinthitis (n=5) generated by perfusion of the cochlea with antigen consistently produced severe hearing loss over the initial 48 hours, and this hearing loss persisted for the subsequent 7 days. Therapeutic cochlear microperfusion, performed within the first 24 hours of developing severe hearing loss (n=9), immediately restored on average 24 dB (p <0.007) of hearing. CONCLUSION: Cochlear microperfusion is a promising new technique for treating severe deafness caused by inflammation. The benefit may be sustained when combined with local delivery of immunosuppressive agents to the inner ear.

[Correction of vestibular disorders in patients with otitis media purulenta chronica complicated by labyrinthitis].

A vestibulogic examination was made in 66 patients with otitis media purulenta chronica complicated with labyrinthitis. The patients were divided into two groups: group 1 received surgical treatment in an acute period of labyrinthitis, group 2 was treated conservatively with delayed operation. The patients were examined at admission, 2 weeks, 1, 3, 6 and 12 months after the treatment. It was found that compensation of the vestibular function in group 1 took place 6 months after temporal bone surgery, in group 2-9 months after delayed operation, i.e. 1 years after hospitalization.

[Concomitant labyrinthitis]. / Sodruzhestvennyi labirintit.

The principal pathogenetic mechanism of labyrinthopaty development after traumas and operations lies in autoimmune inflammation of the contralateral ear similar to sympathetic inflammation of the eye. By analogy with sympathetic ophthalmitis, a term <> is proposed. Due to selective permeability of selective membranes, immune system has no connection with <> organs. These organs and tissues are isolated from the key sourse of immunity -- blood. Autotolerance to them is absent and their proteins are autoantigens. In destruction of hemato-labyrinthine barrier these autoantigens can reach lymphoid organs and provoke immune response inducing a cytotoxic action in relation to both the affected and the contralateral labyrinth. Besides pathology of the affected labyrinth, clinical picture of labyrinthopathy is caused by autoimmune labyrinthitis of the contralateral ear whereas in <> labyrinthitis of the affected ear - slow-progressive autoimmune concomitant labyrinthitis. Case reports are presented.

Cochlear implant candidacy and surgical considerations.

Numerous changes continue to occur in regard to cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound rather the prior requirement of a bilateral profound loss. In addition, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. New hardware, such as the behind-the-ear speech processors, require modification of existing implant surgery. Similarly, the new perimodiolar electrodes require special insertion techniques. Bilateral implantation clearly requires modification of the surgical techniques used for unilateral implantation. The surgery remains mostly the same, but takes almost twice as long, and requires some modification since at a certain point, when the first device is in contact with the body, the monopolar cautery may no longer be used. Research has already begun on the development of the totally implantable cochlear implant (TICI). This will clearly require a modification of the surgical technique currently used for the present semi-implantable devices. In addition to surgically burying the components of the present cochlear implant, we will also have to develop techniques for implanting a rechargeable power supply and a microphone for the TICI. The latter will be a challenge, since it must be placed where it is capable of great sensitivity, yet not exposed to interference or the risk of extrusion. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. We anticipate further changes in the foreseeable future, for which there will likely be surgical problems to solve.

Labyrinthitis in chronic otitis media.

Labyrinthitis is the most frequent complication of chronic otitis media (COM). Retrospective analysis of 1,210 patients operated due to COM was carried out. Circumscribed labyrinthitis was found in 17.2% and deafness in 1.2% of patients. To evaluate the effect of labyrinthitis on bone conduction (BC) we measured BC threshold in a group of 140 patients with unilateral COM without labyrinthitis and in a group of 42 patients with unilateral COM with labyrinthitis. BC threshold of the healthy ear was subtracted from the BC threshold of the affected ear in the same patient to eliminate presbyacusis. There was no significant difference in bone conduction threshold between the patients with circumscribed labyrinthitis and patients with COM without labyrinthitis. The incidence of labyrinthitis was higher in patients with cholesteatoma than in patients without cholesteatoma. Management of labyrinthine fistula is presented.