[Sudden hearing loss in a patient with a 3-mm acoustic tumor]. / Uç milimetrelik akustik tümörü olan bir hastada ani isitme kaybi.

Sudden sensorineural hearing loss (SNHL) accounts for 1% of all SNHL cases. It has been reported that acoustic neuroma may be present up to 47.5% of patients with sudden SNHL. A 55-year-old man presented with sudden hearing loss in his left ear of 45-day history. Audiologic and transient evoked otoacoustic emission tests showed near-total hearing loss and absence of emissions in the left ear, respectively. Electronystagmography showed left canal paralysis and lack of response to the Kobrak test. The interpeak interval I-V latency and interaural amplitude differences in wave V latency were prolonged in auditory brainstem response. Computed tomography showed an increase in the diameter of the left internal acoustic canal, and magnetic resonance imaging (MRI) revealed an intracanalicular mass, 3 mm in size, originating from the left cochlear nerve. Another mass (18x17 mm) was detected that filled the right pontocerebellar cistern, suggesting a meningioma, but this was not thought to exert an obvious shift effect contributing to the development of left-sided hearing loss. Despite treatment with a tapered course of fluocortolone for 18 days the patient's hearing level did not change. He was included in a follow-up with MRI at six-month intervals.

Anxiety sensitivity as predictor of pain in patients undergoing restorative dental procedures.

OBJECTIVES: The personality disposition to anxiety sensitivity refers to beliefs about negative consequences of bodily arousal. The concept has recently been successfully applied in research on chronic pain conditions. The present study investigated whether anxiety sensitivity interacts with dental fear to increase expected and experienced pain during routine dental treatment. METHODS: Subjects were 97 patients undergoing dental procedures of excavation and filling. Anxiety dispositions were measured by the Anxiety Sensitivity Index and the Dental Anxiety Scale. Expected and experienced pain were assessed by affective and sensory verbal descriptor scales and a numerical rating scale measuring pain intensity. RESULTS: Dentally fearful patients scoring high in anxiety sensitivity both expected and experienced more pain than low scorers did. Significant interactions were found predicting expected affective and intense pain and experienced pain intensity. CONCLUSION: The results lend support to the assumption that dentally fearful patients with a disposition to high anxiety sensitivity amplify pain anticipations when exposed to the critical situation. When dentally fearful patients are under treatment, their beliefs about negative consequences of bodily arousal may negatively influence their evaluation of treatment related pain.

Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures.

A prevailing hypothesis suggests that exaggerated pain expectations in dentally anxious and pain-sensitive patients might usually be disconfirmed by a lower level of pain experienced during treatment. The present study was conducted to investigate whether this contention also holds during stressful dental procedures. Patients reporting high and low levels of dental fear and of pain sensitivity were compared in their expected and experienced pain and in the concordance between the two measures. Participants were 97 patients undergoing extraction and root canal treatment. The measuring instruments used were the Dental Anxiety Scale (DAS), the Pain Sensitivity Index (PSI), affective and sensory pain descriptor scales, and a numerical pain-intensity scale. The results demonstrated that patients, in general, expected more pain than they subsequently experienced. Subjects with a high DAS score both expected and experienced more pain than those with a low DAS score. Within the group of subjects with a high DAS score, those indicating high pain sensitivity expected and experienced more pain than their counterparts; additionally, only those reporting low pain sensitivity disconfirmed their high pain expectancies. The results suggest that during stressful dental procedures, patients indicating dental anxiety and pain sensitivity above median levels are especially at risk of stabilizing exaggerated pain expectations and dental fear.