scholarly journals Pneumolabyrinth: Radiologic Evidence of Labyrinthine Injury

2008 ◽  
Vol 23 (2) ◽  
pp. 49-50
Author(s):  
Nathaniel W. Yang
Keyword(s):  
Soft Tissue ◽  
Inner Ear ◽  
Tympanic Membrane ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Round Window ◽  
Spontaneous Nystagmus ◽  
Head Impulse Test ◽  
Round Window Membrane ◽  
The Right

A U.S. serviceman presented with a three month history of unsteadiness on ambulation and increasing episodes of vertigo whenever he turned his head rapidly to the right. He had previously been injured in a bomb blast while stationed in Iraq four months prior to consultation. Aside from multiple soft tissue and bone trauma, he had also experienced vertigo and nearly complete deafness in the right ear immediately after the blast. Medical records indicated the presence of a traumatic perforation of the right tympanic membrane and spontaneous nystagmus on initial emergency medical assessment after the incident. Physical examination on consultation revealed bilaterally intact eardrums, a positive right head impulse test, and a normal Romberg test. Audiometry showed a severe right SNHL. A presumptive diagnosis of a persistent perilymph fistula secondary to inner ear barotrauma was entertained, and supported by findings on temporal bone CT imaging. Figure 1 is the axial CT image of the patient's inner ear at the level of the basal turn of the cochlea. Two linear lucencies are visible within the cochlea (arrowheads). These have the same signal characteristics as the normal external auditory canal and middle ear space. As such, they indicate the presence of air within the cochlea – a condition termed pneumolabyrinth. Figure 2 shows a normal cochlea at the same level for comparison. Note the uniform soft tissue density within the cochlear lumen, representing the endocochlear fluids. The lucency in the round window niche (thin arrow) also represents air, but this is a normal finding.   Barotrauma from blast injuries and traumatic tympanic membrane perforations may cause perilymph fistulas. This is probably due to a sudden pressure wave transmitted through the tympanic membrane that results in an inward rupture of the round window membrane or an inward displacement of the stapedial footplate.1 Pneumolabyrinth has been identified in patients suffering from perilymph fistulas due to barotraumas,2 and therefore can bolster the diagnosis when identified in the appropriate clinical setting. It has also been identified in patients with perilymph fistulas from other causes, including iatrogenic stapes fractures during mastoid surgery, temporal bone fractures, cholesteatoma, neoplasms of the temporal bone, stapedectomy, and after cochlear implantation.3

Temporal Bone Pathology in Scuba Diving Deaths

1993 ◽  
Vol 109 (3) ◽  
pp. 514-521 ◽  
Author(s):  
Patrick J. Antonelli ◽  
G. Joseph Parell ◽  
Gary D. Becker ◽  
Michael M. Paparella
Keyword(s):  
Inner Ear ◽  
Temporal Bone ◽  
Round Window ◽  
Scuba Diving ◽  
Round Window Membrane ◽  
Bone Pathology ◽  
Rapid Ascent ◽  
Temporal Bones ◽  
Inner Ear Damage ◽  
Air Cells

Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissner's membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable. (OTOLARYNGOL HEAD NECK SURG 1993;109:514-21.)

scholarly journals Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Yann Nguyen ◽  
Francesca Yoshie Russo ◽  
Isabelle Mosnier ◽  
Evelyne Ferrary ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Inner Ear ◽  
Round Window ◽  
Bone Conduction ◽  
Hearing Threshold ◽  
Round Window Membrane ◽  
Prospective Clinical Study ◽  
Local Skin ◽  
Local Skin Reaction ◽  
Bone Conduction Hearing

Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery.Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC) skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance.Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study.Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

Inner Ear Pathology and Otitis Media

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 249-253 ◽  
Author(s):  
Michael M. Paparella ◽  
Marcos V. Goycoolea ◽  
William L. Meyerhoff
Keyword(s):  
Inner Ear ◽  
Otitis Media ◽  
Round Window ◽  
Round Window Membrane

Insidious inner ear complications of otitis media have been and are being studied in our laboratory. The purpose of this paper is to review these studies, coordinate, capsulize and highlight the results with emphasis on the transport role of the round window membrane.

Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone

2018 ◽  
Vol 128 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Adam McCann ◽  
Sameer A. Alvi ◽  
Jessica Newman ◽  
Kiran Kakarala ◽  
Hinrich Staecker ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skull Base ◽  
Temporal Bone ◽  
Soft Tissues ◽  
Trauma Surgery ◽  
Oral Antibiotic ◽  
Facial Skeleton ◽  
Atypical Form ◽  
Unsuccessful Treatment ◽  
The Right

Background: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. Methods: Case report with literature review. Results: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. Conclusions: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.

scholarly journals Bilateral temporal bone fractures: a case report

2017 ◽  
Vol 4 (1) ◽  
pp. 271
Author(s):  
Kiran Natarajan ◽  
Koka Madhav ◽  
A. V. Saraswathi ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Csf Leak ◽  
The Right ◽  
Temporal Bones

<p>Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones &amp; MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. </p>

Common drugs used in ENT

2009 ◽  
pp. 347-350
Author(s):  
Rogan Corbridge ◽  
Nicholas Steventon
Keyword(s):  
Inner Ear ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Otitis Externa ◽  
Round Window ◽  
Acid Reflux ◽  
Tympanic Membrane Perforation ◽  
Active Infection ◽  
Middle Ear Mucosa ◽  
Membrane Perforation

Drugs used in the ear 348 Drugs used in the nose 349 Drugs used in the treatment of acid reflux 350 This group of drugs is widely used for the treatment of otitis externa. Otitis externa 2 drops tds for 10 days Presence of grommet or tympanic membrane perforation due to aminoglycoside ototoxicity in the inner ear. Risk thought to be low in the presence of active infection where the middle-ear mucosa is swollen and the antibiotic is unlikely to reach the inner ear via the round window...

Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation

2019 ◽  
Vol 24 (4) ◽  
pp. 183-190
Author(s):  
Ting-Hua Yang ◽  
Yi-Ho Young
Keyword(s):  
Clinical Practice ◽  
Inner Ear ◽  
Morphological Study ◽  
Antifungal Agents ◽  
Clinical Investigation ◽  
Round Window ◽  
Round Window Membrane ◽  
Potential Candidate ◽  
Potential Treatment ◽  
Total Dosage

Background: Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. Objectives: The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. Methods: Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. Results: All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. Conclusion: The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.

Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)

1996 ◽  
Vol 75 (8) ◽  
pp. 468-488 ◽  
Author(s):  
Herbert Silverstein ◽  
Daniel Choo ◽  
Seth I. Rosenberg ◽  
Jeffery Kuhn ◽  
Michael Seidman ◽  
...  
Keyword(s):  
Inner Ear ◽  
Round Window ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Round Window Membrane ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Inner Ear Disease ◽  
Ménière's Disease

Intratympanic instillation of Depo-Medrol® (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser-assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.

Vestibular Pathophysiologic Changes in Experimental Perilymphatic Fistula

1992 ◽  
Vol 101 (7) ◽  
pp. 612-616 ◽  
Author(s):  
Yasuya Nomura ◽  
Yi-Ho Young ◽  
Makoto Hara
Keyword(s):  
Round Window ◽  
Vestibular Function ◽  
Acute Stage ◽  
Spontaneous Nystagmus ◽  
Round Window Membrane ◽  
Caloric Test ◽  
Positional Nystagmus ◽  
Perilymphatic Fistula ◽  
Membrane Changes ◽  
Ice Water

An animal model of experimental perilymphatic fistula (EPLF) was developed in the guinea pig in order to study vestibular pathophysiology. In experimental animals, 4 μL of perilymph was suctioned from one cochlea via the round window membrane. Changes in vestibular function were as follows. 1) During the acute stage (5 hours postoperatively), spontaneous nystagmus directed toward the normal side was noted in 57.4% of the EPLF animals. This lasted less than 24 hours. 2) One week postoperatively, direction-fixed positional nystagmus toward the lesioned ear was present in 22.7% of the EPLF animals, especially when the lesioned ear was positioned inferiorly. 3) With the ice water caloric test, no response was present in 58.1% of the EPLF animals and an irregular response was found in 22.6% of them, 1 week postoperatively. These results tend to indicate that tests of vestibular function may differentiate between patients with Meniere's disease and those with perilymphatic fistula. Histologic findings indicate that a floating labyrinth is the cause of positional nystagmus and caloric irregularity. The absence of caloric responses was associated with collapse of the vestibular labyrinth.

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