Tinnitus

Metastatic breast carcinoma presenting as unilateral pulsatile tinnitus: A case report

February 2, 2015     Andrew Moore, MRCS, DOHNS; Max Cunnane, BMBS, BMedSci; Jason C. Fleming, MRCS, DOHNS, MEd
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Abstract

Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.

Spontaneous bilateral dural arteriovenous fistulas with pulsatile tinnitus

January 19, 2015     Tzu-Chieh Lin, MD; Hsiung-Kwang Chung, MD; Jeng-Nan Hsu, MD
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Abstract

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to otolaryngologists and can be attributed to serious vascular malformations such as dural arteriovenous fistulas (DAVFs). Spontaneous DAVFs are relatively rare. A 65-year-old woman presented with sudden-onset subjective/objective pulsatile tinnitus on the right side that had persisted for 2 months. Angiography and magnetic resonance angiography revealed DAVF formation. Stereotactic radiosurgery was performed, and total remission of the DAVFs was achieved.

Effect of low-level laser therapy in the treatment of cochlear tinnitus: A double-blind, placebo-controlled study

January 19, 2015     Mahboobeh Adami Dehkordi, MD; Sasan Einolghozati, MD; Seyyed Mohsen Ghasemi, PhD; Samaneh Abolbashari, MD; Mojtaba Meshkat, MSc; Hadi Behzad, MSc
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Abstract

Many treatments for chronic tinnitus have been attempted, but the condition remains difficult to cure, especially in the case of cochlear tinnitus. We conducted a prospective, double-blind, placebo-controlled study to assess the effect of low-dose laser therapy on chronic cochlear tinnitus. Our study population was made up of 66 patients-33 who received active laser treatment (case group) and 33 who received inactive dummy treatment (control group). Patients in the laser group received 5 mV with a wavelength of 650 nm for 20 minutes a day, 5 days a week, for 4 weeks. The controls followed the same schedule, but they were “treated” with an inactive device. The degree of tinnitus was evaluated before and after treatment in each group in three ways: (1) the Tinnitus Severity Index (TSI), (2) a subjective 10-point self-assessment scale for tinnitus loudness, and (3) the Tinnitus Evaluation Test (TET). At study's end, we found no statistically significant differences between the case and control groups in the number of patients who experienced a reduction in TSI values (p = 0.589) or a reduction in subjective self-assessment scores (p = 0.475). Nor did we find any significant reductions in the loudness (p = 0.665) and frequency (p = 0.396) of tinnitus as determined by the TET. We conclude that 5-mV laser therapy with a wavelength of 650 nm is no better than placebo for improving hearing thresholds overall or for treating tinnitus with regard to age, sex, environmental noise level, and the duration of 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
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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
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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.

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.

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
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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.

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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