Tinnitus

Tympanic membrane perforation with squamous epithelial ingrowth

August 27, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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The squamous epithelium of the tympanic membrane and external auditory canal exhibits an inherent migration pattern to facilitate the exfoliation of keratinizing squamous cells as part of a natural cleansing mechanism.

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
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Patients classically present with pulsatile tinnitus and a red mass medial to the tympanic membrane. Some patients may have findings of a red mass that blanches with pneumatic otoscopy, called Brown's sign.

How to approach a bilobed petrous apex granuloma: A case report

January 21, 2014     Aaron G. Benson, MD
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Abstract

Cholesterol granulomas are the most common lesions involving the petrous apex. However, they are still an uncommon finding overall, and they often remain undiagnosed until they have become extremely large and symptomatic. Many surgical approaches to the petrous apex exist. Factors that often influence the surgical approach include the surgeon's experience, the patient's anatomy, and the patient's hearing status. The purpose of this case report--which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left-sided pulsatile tinnitus--is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.

Dehiscence of the high jugular bulb

October 23, 2013     Min-Tsan Shu, MD; Yu-Chun Chen, MD; Cheng-Chien Yang, MD; Kang-Chao Wu, MD
article

The conservative treatment for a high jugular bulb is regular follow-up with serial imaging studies to detect possible progression, even in asymptomatic cases.

Paraganglioma presenting as cholesterol granuloma of the petrous apex

September 18, 2013     Selena E. Heman-Ackah, MD, MBA; Tina C. Huang, MD
article

Abstract

We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.

An unusual cause of vertigo, tinnitus, and hyperacusis: Vogt-Koyanagi-Harada syndrome

December 31, 2012     LT Philip Gaudreau, MD; LCDR Justin Moy, MD; Fred Lindsay, DO
article

Abstract

We describe the case of a 36-year-old woman with a history of vitiligo who presented with an insidious onset of neurologic, vestibular, ocular, and auditory symptoms. She had recently noted the onset of vertigo, tinnitus, and hypersensitivity to sound. Findings on audiometry were within normal limits, although the patient reported some auditory discomfort during the testing. The patient had a history of bilateral uveitis and peripheral neurologic symptoms. She was diagnosed with Vogt-Koyanagi-Harada (VKH) syndrome and started on corticosteroid therapy. Her neurologic, vestibular, ocular, and auditory symptoms resolved. VKH syndrome is an uncommon cause of vertigo and hearing loss, but it should be considered in the differential diagnosis of patients with autoimmunity-related inner ear symptoms.

Intraoperative view of a glomus tympanicum

December 31, 2012     Waitsz T. Chang, MRCS; Willis S.S. Tsang, FRCSEd(ORL)
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For the treatment of a small glomus tympanicum, surgical excision via an anterior tympanotomy approach is possible.

Efficacy of gabapentin on subjective idiopathic tinnitus: A randomized, double-blind, placebo-controlled trial

March 31, 2011     Mahboobeh Adami Dehkordi, MD, Samaneh Abolbashari, MD, Reza Taheri, MD, and Sasan Einolghozati, MD
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Abstract

Tinnitus can cause extreme morbidity. Despite many attempts to find a treatment for idiopathic cases, they remain difficult to manage. Because nerve injury is one of the suspected etiologies of tinnitus and because gabapentin has been found to be effective in treating nerve injuries, some authors have attempted to determine if gabapentin has a role in treating tinnitus. Although gabapentin was found to be ineffective for tinnitus in these previous studies, to the best of our knowledge no studies have been performed that took into consideration the presence of various accompanying factors and concomitant diseases that might influence its effect. We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial of gabapentin for idiopathic tinnitus. We treated 40 patients with gabapentin and measured its effectiveness by comparing differences between pre- and post-treatment Tinnitus Severity Index (TSI) values and tinnitus loudness scores. We also compared these outcomes with those of a group of 40 matched placebo controls. At study's end, we found no significant differences between the gabapentin and control groups in mean decreases in TSI value and loudness score (p = 0.85 and p = 0.12, respectively). However, we did find that patients with hypertension, diabetes, and/or dyslipidemia showed a better response to gabapentin than did those with tinnitus alone (p = 0.01). We conclude that although there was no statistically significant difference between gabapentin and placebo in treating isolated tinnitus or tinnitus overall, patients with concomitant hypertension, diabetes, and/or dyslipidemia may benefit from gabapentin.

Glomus jugulare

January 1, 2011     Jeffrey D. Suh, MD, Ashley E. Balaker, MD, Brian D. Suh, MD, and Keith E. Blackwell, MD
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A critical evaluation of Web sites offering patient information on tinnitus

January 1, 2010     Stephen M. Kieran, AFRCSI, Liam J. Skinner, FRCS (ORL-HNS), Martin Donnelly, FRCS (ORL-HNS), and David A. Smyth, FRCS (ORL-HNS)
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Abstract

The Internet is a vast information resource for both patients and healthcare professionals. However, the quality and content often lack formal scrutiny, so we examined the quality of patient information regarding tinnitus on the Internet. Using the three most popular search engines (google.com, yahoo.com, and msn.com), we found pertinent Web sites using the search term tinnitus. Web sites' accountability and authorship were evaluated using previously published criteria. The quality of patient information about tinnitus was assessed using a new 10-point scale, the Tinnitus Information Value (TIV). Statistical analysis was performed using the independent sample t-test (p ≤ 0.05). An electronic database of 90 Web sites was constructed using the first 30 English-language Web sites identified by each search engine. After duplicates and sites only containing links to other Web sites were eliminated, 39 remained. The mean score for accountability was 2.13 on scale of 0 to 7. The mean TIV was 5.0 on a scale of 0 to 10. Only 12 sites (30.8%) had their authors clearly identified. Twenty-two (56.4%) sites were sponsored by commercial interests or represented private practices. The mean TIV was significantly higher (p = 0.037) for noncommercial (personal, academic institution, or charity) sites (5.88 ± 2.39 SD) than those representing commercial interests (4.32 ± 2.10 SD). Tinnitus information available on the Internet is indeed variable, and care should be taken in recommending tinnitus Web sites to patients.

Monaural diplacusis with tinnitus, aural fullness, hyperacusis, and sensorineural hearing loss

February 1, 2009     Kenneth H. Brookler, MD, MS, FRCSC
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An approach to tinnitus management

October 31, 2008     Kenneth H. Brookler, MD, MS, FRCSC and Mohamed A. Hamid, MD, PhD
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