Pneumolabyrinth and Recurrent Paroxysmal Positional Vertigo After Traumatic Stapes Fracture

2018 ◽  
Vol 128 (4) ◽  
pp. 352-356
Author(s):  
Francesco Comacchio ◽  
Giorgio Guidetti ◽  
Riccardo Guidetti ◽  
Marta Mion
Keyword(s):  
Middle Ear ◽  
Previous History ◽  
Rare Event ◽  
Middle Ear Surgery ◽  
High Resolution Computed Tomography ◽  
Perilymphatic Fistula ◽  
Positional Vertigo ◽  
History Of ◽  
Stapes Fracture ◽  
Paroxysmal Positional Vertigo

Objectives: The development of pneumolabyrinth without previous head trauma is a rare event; the associated symptoms may be nonspecific, and they can simulate various cochleo-vestibular pathological entities. The aim of the present study is to describe one of these rare occurrences, characterized by a peculiar onset. Methods: We report a case of stapes fracture secondary to ear pick penetration into the middle ear with a pneumolabyrinth that caused a recurrent paroxysmal positional vertigo (PPV) mimicking a canalolithiasis. Results: The patient developed a profound left sensorineural hearing loss and an intractable PPV with “migrant” features. A pneumolabyrinth was visualized with high-resolution computed tomography. A perilymphatic fistula (PLF) with stapes fracture was found while performing an explorative tympanotomy. After the surgical treatment of the PLF, the patient no longer complained of vestibular symptoms. Conclusions: To our knowledge, this is the fifth case of traumatic pneumolabyrinth simulating a canalolithiasis without previous history of temporal bone trauma and/or middle ear surgery. A pneumolabyrinth should be suspected in case of patients presenting recurrent intractable PPV after ear trauma.

scholarly journals Congenital Cholesteatoma in Adult: Is it Still Possible?

2021 ◽  
Vol 27 (1) ◽  
pp. 96-99
Author(s):  
Heng Yao Tan ◽  
Anuar Idwan Idris ◽  
Cheng Ai Ong ◽  
Asma A
Keyword(s):  
Tympanic Membrane ◽  
Previous History ◽  
Tympanic Membrane Perforation ◽  
High Resolution Computed Tomography ◽  
Congenital Cholesteatoma ◽  
Positional Vertigo ◽  
Modified Radical Mastoidectomy ◽  
Membrane Perforation ◽  
History Of ◽  
Intact Tympanic Membrane

Congenital cholesteatoma is a mass of squamous epithelium located medial to an intact tympanic membrane without previous history of tympanic membrane perforation, otorrhoea or otological surgery. We described a 24 year old gentleman with a left postauricular discharging fistula for 3 years with recent history of gradual hearing loss, tinnitus and recurrent episodes of positional vertigo. Clinical examination noted left postauricular fistula opening and otoscopy showed a whitish mass medial to a bulging intact tympanic membrane. High-resolution computed tomography of temporal bone was suggestive of cholesteatoma. Left modified radical mastoidectomy was done and he recovered with resolution of symptoms. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 96-99

Singular Neurectomy Update

1982 ◽  
Vol 91 (5) ◽  
pp. 469-473 ◽  
Author(s):  
Richard R. Gacek
Keyword(s):  
Middle Ear ◽  
Benign Paroxysmal Positional Vertigo ◽  
Anatomical Variation ◽  
Complete Relief ◽  
Average Hospital Stay ◽  
Ablation Procedure ◽  
Work Time ◽  
Average Hospital ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

The results of a poll revealed that 96 singular neurectomies have been performed by ten surgeons in this country. Eighty-eight of these (91.7%) resulted in complete relief of benign paroxysmal positional vertigo (BPPV). In seven patients (7.3%) there was a sensorineural hearing loss as a result of this procedure. The average hospital stay for patients having this procedure ranged from 2–6 days, and the return to work time ranged from 1 to 3 weeks. These results indicate that singular neurectomy is an effective selective vestibular ablation procedure for BPPV and that the risks and disability are comparable to other routine middle ear procedures. The causes for failure of this procedure to relieve positional vertigo are a) misdiagnosis of BPPV and b) failure to recognize the singular nerve in the middle ear. Knowledge of the pathophysiology of the disorder and of the anatomical variation in the location of the singular canal will reduce these causes of failure.

scholarly journals Cutting the chorda tympani: not just a matter of taste

2010 ◽  
Vol 124 (9) ◽  
pp. 999-1002 ◽  
Author(s):  
N Guinand ◽  
T Just ◽  
N W Stow ◽  
H Cao Van ◽  
B N Landis
Keyword(s):  
Middle Ear ◽  
Tertiary Care ◽  
Case Series ◽  
Salivary Flow ◽  
Middle Ear Surgery ◽  
Chorda Tympani ◽  
Tertiary Care Centre ◽  
Ear Surgery ◽  
Salivary Function ◽  
History Of

AbstractIntroduction:Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.Setting:Tertiary care centre.Material and methods:We report a case series of three patients with bilateral chorda tympani lesions. Chorda tympani function was assessed using ‘taste strips’ and unstimulated sialometry. A careful history of oral symptoms was taken.Results:All patients showed transient or permanent bilateral ageusia of the anterior two-thirds of the tongue, and a decreased resting salivary flow rate. In addition, all patients suffered from transient or persistent, distressing xerostomia.Conclusion:Taste disorders may occur after middle-ear surgery but they are mostly transient, even when the chorda tympani nerves are sectioned bilaterally. In contrast, bilateral chorda tympani lesions may lead to severe, persistent and distressing xerostomia. Based on this neglected aspect of chorda tympani function, we emphasise the importance of preserving the chorda tympani whenever possible.

Standard Anesthetic Technique for Middle Ear Surgical Procedures: A Comparison of Desflurane and Sevoflurane

2005 ◽  
Vol 133 (2) ◽  
pp. 269-274 ◽  
Author(s):  
W. Scott Jellish ◽  
Kevin Owen ◽  
Steven Edelstein ◽  
Elaine Fluder ◽  
John P. Leonetti
Keyword(s):  
Middle Ear ◽  
Operating Conditions ◽  
Anesthetic Technique ◽  
Middle Ear Surgery ◽  
Pain Scores ◽  
Significant Difference ◽  
Discharge Readiness ◽  
History Of ◽  
Blood Pressures ◽  
To Receive

Objective: This study was designed to compare desflurane and sevoflurane anesthesia for middle ear microsurgery. Study Design: One hundred healthy adults undergoing middle ear surgery were assigned to receive either desflurane or sevoflurane as their anesthetic. Intraoperative hemodynamics and BIS numbers were recorded. Hemodynamics, pain, nausea/vomiting, discharge readiness, and other parameters were compared postoperatively and 24 hours later. Results: No intraoperative differences were noted except in BIS scores which trended lower with desflurane. PACU blood pressures were higher after desflurane but pain scores, nausea/vomiting, rescue anti-emetics, recovery scores, and discharge times were similar. A significant difference was noted in anesthetic costs (desflurane > sevoflurane), and in patients with the lowest BIS scores associated with more nausea/vomiting. Conclusions: Both anesthetics may be used for ototic surgery but propofol anesthesia should still be considered in patients with a history of emetic sequelae. Significance: Short-acting inhalational anesthetics produce excellent operating conditions and reduce costs for otologic surgery.

Management of Bilateral Benign Paroxysmal Positional Vertigo

2005 ◽  
Vol 133 (5) ◽  
pp. 769-773 ◽  
Author(s):  
Daniel M. Kaplan ◽  
Michel Nash ◽  
Alexander Niv ◽  
Mordechai Kraus
Keyword(s):  
American Academy ◽  
Benign Paroxysmal Positional Vertigo ◽  
Neck Surgery ◽  
Positive History ◽  
Positional Vertigo ◽  
History Of ◽  
The Mean ◽  
Symptomatic Side ◽  
Paroxysmal Positional Vertigo

Objective To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. Methods All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Results Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. Conclusion BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. Ebm Rating: C © 2005 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.

Nature of spontaneous tympanic membrane perforation in acute otitis media in children

1989 ◽  
Vol 103 (12) ◽  
pp. 1150-1153 ◽  
Author(s):  
G. Berger
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Healing Process ◽  
Previous History ◽  
Acute Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Membrane Perforation ◽  
Free Drainage ◽  
History Of ◽  
Ear Effusion

AbstractThe study was undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media. Eighty (29.5 per cent) out of 271 children with acute otitis media had eardrums which perforated. An increased incidence of perforation was associated with a previous history of otitis media.All perforations were small and limited exclusively to the pars tensa. In 85 per cent of the patients, the perforation was located in the anterior-inferior quadrant. It had smooth margins enabling free drainage of pus and was associated with a favourable clinical course. In the remaining 15 per cent of the cases, the perforation was located in the posterior-superior quandrant. It had a nipple-like shape with a tiny opening that did not allow pus to drain sufficiently from the middle ear.The perforation closed in 94 per cent of the patients within one month. The healing process was gradual and following perforation closure, there was evidence of middle ear effusion for some time before normal aeration was regained.

scholarly journals A Young Patient with Horizontal Semicircular Cupulolithiasis with Immediate Response to the Therapeutic Head-Shaking Maneuver (HSM)

2021 ◽  
Author(s):  
Ajay Kumar Vats
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Treatment Options ◽  
Positional Nystagmus ◽  
Short Term ◽  
Horizontal Semicircular Canal ◽  
Positional Vertigo ◽  
History Of ◽  
The Right ◽  
Rotational Vertigo ◽  
Paroxysmal Positional Vertigo

AbstractThe apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo is attributed to either short anterior ampullary arm canalolithiasis or to the cupulolithiasis with the otoconial debris adhering to the cupula on utricular (Cup-U) or canal side (Cup-C), rendering it heavy and gravity sensitive. The treatment options for horizontal semicircular cupulolithiasis are not very well defined. A 25-year-old female patient with 8 days history of vertigo on rolling to either of the lateral recumbent position presented in the first week of November 2019. The supine roll test (SRT) on yawing head maximally to the right as well as to the left elicited an apogeotropic horizontal positional nystagmus lasting more than 1 minute, which was stronger on the right side and indicated a diagnosis of left horizontal semicircular cupulolithiasis. Two short-term follow-ups at 1 and 24 hours after head-shaking maneuver (HSM), with verifying SRT, were undertaken. During either of the two follow-ups, neither the previously elicited horizontal positional nystagmus was observed, nor did the patient have vertigo on rolling to lateral recumbent positions. She was telephonically questioned weekly regarding the recurrence of rotational vertigo for the next 4 weeks, and it was confirmed that she remained symptom free till then. The therapeutic HSM, owing to the inertial forces generated, can detach the otoconial debris from the cupula that renders it heavy and gravity sensitive. Successful offloading of cupula by HSM brings immediate cure in the Cup-U variant of the horizontal semicircular cupulolithiasis.

Hearing Screening in a School for the Severely-Profoundly Intellectually-Impaired and Multiply-Handicapped Students

1981 ◽  
Vol 12 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Linda Yaffe
Keyword(s):  
Public School ◽  
Middle Ear ◽  
School System ◽  
Screening Program ◽  
Previous History ◽  
School Personnel ◽  
Health Department ◽  
Hearing Screening ◽  
Baltimore City ◽  
History Of

A hearing screening program was organized, supervised, and followed up in a secondary public school for a population of severely-profoundly intellectually-impaired and multiply-handicapped students who had no previous history of an auditory screening by the school system. The program was implemented using public school personnel and equipment without incurring additional expenses. Results were considered significant in that 11% of the students screened were identified as potentially hearing-impaired as compared to 4% of the regular Baltimore City School student population who failed hearing screenings. This 4% was reduced because 35% of the students identified and tested by the Baltimore City Health Department had normal hearing and no evidence of middle ear dysfunction. In contrast, 95.8% of the 24 mentally retarded students identified exhibited evidence of at least some reduction in hearing or middle ear dysfunction. The hearing screening proved effective in identifying existing ear problems.

Hallpike Defines the Syndrome of Benign Paroxysmal Positional Vertigo

2016 ◽  
Author(s):  
Robert W. Baloh
Keyword(s):  
Clinical Features ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Positional Vertigo ◽  
Common Causes ◽  
History Of ◽  
Clinical Description ◽  
Vestibular Neuronitis ◽  
Temporal Bones ◽  
Paroxysmal Positional Vertigo

In 1952, Charles Hallpike and Margaret Dix published a paper in which they described the clinical profile of three of the most common causes of vertigo—Ménière’s disease, vestibular neuronitis, and benign paroxysmal positional vertigo (BPPV). Their strategy was simple: First, identify the symptoms and natural history of the disease, then document the physical signs associated with the disease, and finally, when possible, correlate the clinical features with histological studies of the temporal bones. They provided the first clear clinical description and the first pathology associated with the syndrome of BPPV. They described the clinical features of a large number of cases they had seen in the Queen Square clinic. They concluded that positional nystagmus of the benign paroxysmal type, first described by Robert Bárány in 1921, was due, as Bárány believed, to otolith disease.

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