Inner ear

Endaural labyrinthectomy

March 31, 2008     Michael M. Paparella, MD

Sudden onset of sensorineural hearing loss secondary to intralabyrinthine hemorrhage: MRI findings

March 1, 2008     William M. Rosado Jr., MD and Enrique Palacios, MD, FACR

Noise-induced perilymph fistula

April 1, 2006     Brian Kung, MD; Robert T. Sataloff, MD, DMA
Perilymph fistulae are difficult to diagnose because they present with a wide variety of signs and symptoms, they are associated with many etiologies, and they often mimic other conditions. In this article, we describe a case of perilymph fistula that featured one of its more rare causes: acoustic trauma-specifically, damage from a loud blast from the siren of a fire engine. We also review the literature and discuss the difficulties of diagnosis and treatment and the possible mechanisms by which acoustic trauma and other etiologies cause perilymph fistulae.

Preoperative computed tomography may fail to detect patients at risk for perilymph gusher

December 1, 2005     Michael D. McFadden, MD; Jason G. Wilmoth, MD; Anthony A. Mancuso, MD; Patrick J. Antonelli, MD
Perilymph gusher (PG) is a very rare occurrence that can lead to an adverse outcome during inner ear surgery. In the absence of a family history of X-linked mixed deafness syndrome, surgeons may have difficulty determining if a patient is at risk preoperatively. Radiographic imaging is often performed in an attempt to identify such a possibility, but there are few data to support the value of negative studies. We conducted a retrospective study of 3 cases of PG in which findings on preoperative high-resolution computed tomography (CT) of the temporal bone had been interpreted as normal. We reviewed these CTs to discern if they did in fact demonstrate any abnormalities that might have indicated a risk of PG, and we found that the original radiologist had missed a dilated internal auditory canal and a deformity of the cochlear modiolus in the affected ear of 1 of these patients. No abnormality was detected on review of the CTs of the other 2 patients. Therefore, we conclude that negative CT findings do not necessarily rule out a risk of PG.

Efficacy of the Epley maneuver for posterior canal BPPV: A long-term, controlled study of 81 patients

January 1, 2005     Wietske Richard, MD; Tjasse D. Bruintjes, MD, PhD; Peter Oostenbrink; Roeland B. van Leeuwen, MD, PhD
We assessed the efficacy of the Epley maneuver (canalith repositioning) in a study of 81 patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV). A group of 61 patients underwent the maneuver, while a control group of 20 patients received no therapy. All patients were evaluated at 1 and 6 months. The percentage of patients who experienced subjective improvement was significantly higher in the treatment group at both 1 month (89% vs. 10%) and 6 months (92% vs. 50%). Three patients in the treatment group who did not improve after treatment underwent a second maneuver, and all achieved a positive result. In addition, 4 successfully treated patients experienced a recurrence between 1 and 6 months following treatment; 3 were retreated, and 2 of them responded well. We conclude that the Epley maneuver provides effective and long-term control of symptoms in patients with BPPV.

Migraine and benign paroxysmal positional vertigo: An outcome study of 476 patients

December 1, 2004     Alev Uneri, MD
To investigate whether migraine is more common in patients with benign paroxysmal positional vertigo (BPPV) than in the general population, the author conducted a retrospective study of 476 patients with BPPV seen over 12 years at a tertiary referral center. Records of patients with a confirmed diagnosis of BPPV followed for 1 to 7 years were reviewed. The typical history of BPPV and the characteristic torsional positional nystagmus were identified in all patients. A modified Epley maneuver was performed for all patients with posterior semicircular canal BPPV, with a 98% success rate. The survey consisted of detailed patient questionnaires and vestibular tests. Migraine and motion sickness were three times more common in patients with BPPV than in the general population. A family history of migraine (58.4%) and vertigo (44.9%) was also more common in patients than in a control group.
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