Bilateral clicking tinnitus due to myoclonus of middle ear muscles.

Isolated middle ear myoclonus can be a cause of objective tinnitus. We present an acoustically documented case of irregular bilateral middle ear myoclonus with loud clicking, and roaring tinnitus associated with essential palatal tremor. A palatal botulinum toxin injection did not eliminate the tinnitus. Division of both middle ear tendons in both ears abolished the clicking tinnitus with no effect on hearing.

Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans.

OBJECTIVE: This study was designed to compare the incidence of anatomical variations displayed on computerized tomography scans of individuals that identify as Polynesian or New Zealand Europeans. STUDY DESIGN: A retrospective analysis of computerized tomography of the paranasal sinuses. All scans were examined for a number of anatomical variations and the prevalence directly compared according to ethnic group. SETTING: All scans were performed at a tertiary referral center (Dunedin Public Hospital). SUBJECTS: Participants underwent computerized tomography of the paranasal sinuses for various indications. Ethnicity was determined from the electronic hospital record. RESULTS: There was no significant difference in the prevalence of anatomical variations between Polynesians and New Zealand Europeans. Our study results are comparable with other studies of Caucasian paranasal sinus anatomy. CONCLUSIONS: When performing endoscopic sinus surgery on those with Polynesian ethnicity, there are no specific anatomical variations to take into account.

Intratympanic versus intravenous delivery of methylprednisolone to cochlear perilymph.

OBJECTIVE: To compare methylprednisolone concentrations in the perilymph of the human ear and in plasma after intratympanic (IT) or intravenous (IV) administration. METHODS: Methylprednisolone concentrations in the perilymph of patients during cochlear implantation were compared after 3 dosing strategies of methylprednisolone solution for injection (40 mg/ml): 1) IT administration of up to 40 mg was injected into the middle ear through the external auditory canal via a 27-gauge needle passed through a small anterosuperior myringotomy; 2) IV administration of 1 mg/kg was given as a single injection over 30 seconds; 3) IV administration of 10 mg/kg was infused over 30 minutes. Perilymph (single sample, approximately 20 microL) was sampled using a needle passed through the round window membrane, from 0.5 to 3 hours after dosing. In most patients, simultaneous blood sampling was performed. Methylprednisolone concentrations were measured by high-performance liquid chromatography with a limit of quantification of 0.001 mg/L. RESULTS: In 39 patients studied, 33 perilymph samples were suitable for measurement, along with 26 plasma samples. Median perilymph concentrations were 6.7 mg/L (n = 18; range, 0.2-89.4 mg/L) after IT administration, 0.053 mg/L (n = 8; range, 0-0.47 mg/L) after IV injection of 1 mg/kg, and 0.2 mg/L (n = 7; range, 0.067-3.1 mg/L) after IV infusion of 10 mg/kg. The median perilymph concentrations were 126-fold higher after the IT administration than after 1 mg/kg IV (p = 0.0003) and 33-fold higher than after 10 mg/kg IV infusion (p = 0.0045). Plasma concentrations after IT administration were 16-fold lower than after IV administration of 1 mg/kg (p = 0.0006), and 136-fold lower than after IV infusion of 10 mg/kg (p = 0.0006). CONCLUSION: IT administration of methylprednisolone in humans results in much higher perilymph concentrations and much lower systemic concentrations than IV administration.