Hearing Loss

Complicated coexisting pyogenic and tuberculous otitis media affecting the temporozygomatic, infratemporal, and parotid areas: Report of a rare entity

January 24, 2013     Tripti Brar, MBBS, MS, DNB; Sumit Mrig, MBBS, MS, DNB; J.C. Passey, MS; A.K. Agarwal, MS; Shayma Jain, MD
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Abstract

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.

Hearing loss secondary to a nasopharyngeal retention cyst

October 31, 2012     Enrique Palacios, MD, FACR; Michael Ellis, MD; Harold Neitzschman, MD, FACR
article

Resection is generally not indicated for small, asymptomatic pharyngeal cysts. Symptomatic cysts, on the other hand, can be treated with aspiration or a complete transoral resection, particularly if the lesion is large.

Cholesterol granuloma

October 8, 2012     Joseph A. Ursick, MD; Derald E. Brackmann, MD
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 Cholesterol granulomas can cause bony expansion and typically become symptomatic when they encroach upon adjacent cranial nerves.

Bilateral posterior semicircular canal dehiscence in the setting of Hallermann-Streiff syndrome

September 7, 2012     John C. Goddard, MD; Eric R. Oliver, MD; Ted A. Meyer, MD, PhD
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Abstract

Hallermann-Streiff syndrome, also known as oculomandibulofacial syndrome, is a rare congenital disorder affecting growth and cranial, dental, ocular, pilocutaneous, and mental development. In addition to routine audiologic testing in patients with this syndrome, high-resolution computed tomography of the temporal bones should be performed in those with documented or suspected sensorineural hearing loss. Cochlear implantation may be considered, as in other children with syndromic hearing loss and certain inner ear abnormalities, if the appropriate audiologic, psychosocial, and medical criteria are met. The current case report radiographically and clinically characterizes inner ear dysplasia in an 8-year-old patient with Hallermann-Streiff syndrome. High-resolution computed tomography of the temporal bones revealed a hypoplastic bony island between the vestibule and horizontal semicircular canals, as well as incomplete bony coverage of the posterior semicircular canal crura bilaterally. To our knowledge, this is the first report of a pediatric patient demonstrating bilateral posterior semicircular canal dehiscence.

Bilateral hemotympanum secondary to septoplasty

September 7, 2012     Jae Hoon Lee, MD
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Hemotympanum can be caused by temporal bone fractures, barotrauma, administration of anticoagulants, hematologic disorders, and chronic otitis media secondary to the formation of granulation tissue or a cholesterol granuloma. It can also occur secondary to nasal packing or spontaneous epistaxis, as well as eustachian tube dysfunction.

Intradermal melanocytic nevus of the external auditory canal

August 10, 2012     Kai-Chieh Chan, MD; Chi-Ju Yeh, MD; Wan-Ling Ho, MD
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Intradermal melanocytic nevi are usually asymptomatic, but a patient with such a lesion in the external auditory canal can present with aural obstruction and conductive deafness.

Prediction of stapes footplate thickness based on the level of hearing loss in otosclerosis

August 10, 2012     Hadi Samimi-Ardestani, MD; Mohammadtaghi Khorsandi-Ashtiani, MD; Elmira Ghoujeghi, MD; Mohsen Rajati, MD; Mahtab Rabbani-Anari, MD; Aman Ghoujeghi, MD
article

Abstract

During surgical treatment of a patient with otosclerosis, the probability of success depends in large part on the extent of the surgeon’s experience. Therefore, predicting the preoperative severity of disease may help determine the choice of surgeon based on how experienced the surgeon should be. We conducted a study to evaluate the relationship between hearing thresholds and footplate thickness in otosclerosis patients who underwent stapes surgery. We used a qualitative method for measuring footplate thickness that was based on the simplicity or difficulty of opening the footplate. Our study population was divided into two groups; group 1 was made up of 66 patients whose footplates were easily opened with low pressure or with repeated motions by hand, and group 2 was made up of 14 patients whose footplate was either opened by drilling or not opened because it had been obliterated. We found that the patients in group 2, who had more severe disease, had significantly higher air- and bone-conduction thresholds than did the patients in group 1. According to our findings, otosclerotic patients with high air- and bone-conduction thresholds generally have more severe disease and thus require a more experienced surgeon.

Primary acquired cholesteatoma

April 30, 2012     Joseph A. Ursick, MD; Jose N. Fayad, MD
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Cholesteatomas are believed to form as the result of poor eustachian tube function with resultant tympanic membrane retraction and a lack of normal epithelial migration.

The burden of hearing loss in Kaduna, Nigeria: A 4-year study at the National Ear Care Centre

March 31, 2012     Aliyu M. Kodiya, FWACS, Olushola A. Afolabi, FWACS, and Babagana M. Ahmad, FWACS, FICS
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Abstract

Hearing loss among people in developing countries has been recognized as a major source of disability. Many of its causes are preventable, and others are curable. We reviewed the records of 5,485 patients who had presented during a 4-year period to the National Ear Care Centre in Kaduna, Nigeria. Of these, we identified 1,435 patients-812 males and 623 females, aged 9 months to 90 years (mean: 29.2 yr)-who had been diagnosed with hearing loss (26.2%). In addition to demographic data, we compiled information on each patient's type and degree of hearing loss, the affected side, and the predisposing factors. Sex and age cross-tabulations revealed that the greatest proportion of hearing loss according to sex occurred between the ages of 11 and 20 years for males and 21 and 30 years for females. The most common type of hearing loss was sensorineural, which was seen in 78.9% of patients; conductive hearing loss was seen in 17.7% and mixed in 3.4%. More than three-quarters of hearing losses were either moderate, moderately severe, or severe. Bilateral losses were far more common than unilateral losses; among the latter, the left side was affected slightly more often than the right. Predisposing factors were not documented in the vast majority of cases (87.6%), but when they were, the most common were chronic suppurative otitis media, meningitis, febrile convulsion, measles, and trauma. We present these findings to highlight the burden of hearing loss in our part of the world.

Idiopathic bilateral auricular petrification

March 31, 2012     Karl J. Alsey, MbChB, MRCS, Simon R. Freeman, MBChB, FRCS, and Ajay Nigam, MBBS, FRCS
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Abstract

Auricular petrification is a rare diagnosis and presents an interesting therapeutic challenge. Fewer than 160 cases have been reported in the literature since the first description by Bochdalek in 1866. The most common etiology is ectopic calcification. It may also result from injurious processes including frostbite, physical trauma, inflammatory conditions, and various endocrinopathies. We report an incidental finding of idiopathic bilateral auricular petrification in a 40-year-old man presenting with idiopathic unilateral sensorineural deafness.

Otoscopic findings in otosclerosis

March 31, 2012     John C. Goddard, MD and Jose N. Fayad, MD
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Only 10% of patients with otosclerosis exhibit the reddish hue of the Schwartze sign. It is believed to appear because of increased vascularity over the promontory in the middle ear.

Is there a need for audiologic evaluation in patients with Behçet disease?

March 1, 2012     Saniye Cinar, MD, Fikret Cinar, MD, and Sibel Kiran, MD, PhD
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Abstract. Behçet disease is known to be a multisystem condition. We conducted a study to determine the prevalence of hearing loss in patients with Behçet disease and to identify any associations between audiologic findings and other clinical manifestations and treatment. Our study group was made up of 41 adults with Behçet disease and 41 healthy sex- and age-matched controls. All patients and controls underwent a complete clinical otolaryngologic examination, which included pure-tone audiometry, acoustic impedance testing, and otoacoustic emissions testing. Audiology revealed that the prevalence of sensorineural hearing loss (SNHL) was significantly higher in the Behçet patients than in the controls-68.3 vs. 22.0% (p < 0.002). The duration of Behçet disease had no significant impact on whether patients did or did not experience hearing loss. Hearing loss was the fourth most common clinical finding in the Behçet group, after oral ulcers, genital ulcers, and skin lesions. We conclude that SNHL is present in a significant number of Behçet patients, and we suggest the need for an adequate investigation of hearing in the routine follow-up of these patients.

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