Otology

Laterality of sudden sensorineural hearing loss

August 27, 2014     Michael Reiss, MD; Gilfe Reiss, MD
article

Abstract

It is known that sudden sensorineural hearing loss and other otoneurologic diseases, such as tinnitus or Ménière disease, occur more frequently in the left ear than in the right. We studied lateralization of sudden deafness in 489 patients treated at Radebeul Hospital from January 2004 to December 2009. The male-to-female ratio was 1:1.24; we found a predominance of the left side only in female patients. The cause for this predominance is unclear. The slight asymmetry might indicate a greater vulnerability of the left inner ear in women, suggesting hormonal factors in the genesis of sudden deafness.

Vertigo in elderly patients: A review of 164 cases in Brazil

August 27, 2014     Pedro Luiz Mangabeira Albernaz, MD, PhD
article

Abstract

The author conducted a study to identify and categorize those vestibular disorders that were the most common among elderly patients at his private clinic over a 20-year period. He reviewed the records of 735 patients aged 65 to 90 years. The most common diagnosis was vertigo and/or disequilibrium, which occurred in 164 patients (22.3%). Of this group, 121 patients (73.8%) had a peripheral vestibular disorder and 43 (26.2%) had a central vestibular disorder. The characteristics of these cases are discussed.

Angiolipoleiomyoma located in the earlobe

July 13, 2014     Sirin Yasar, MD; Zehra Asiran Serdar, MD; Fatih Goktay, MD; Burcu Barutcugil, MD; Selvinaz Ozkara, MD; Pelin Demirturk, MD
article

Abstract

Angiolipoleiomyoma (ALLM) is a solid tumor that is mostly derived from muscle tissue. It is often located in the kidneys of patients with tuberous sclerosis; ALLMs located outside the kidneys are very rare. Among the rare presentations are cutaneous ALLMs, which manifest as 1- to 4-cm asymptomatic, acquired, solitary, subcutaneous nodules that have a strong predilection for males. To the best of our knowledge, only 22 cases of ALLM of the skin have been previously reported in the literature; in 5 of these cases, the tumor was located on the ear. Histologically, tumoral proliferation is observed with smooth muscle, fat tissue, and vascular channels surrounded by a fibrous capsule; cellular atypia is not observed. We report the case of a 67-year-old man who presented for evaluation of a purplish nodular lesion that had been present on his right earlobe for 10 years. Analysis of an excisional biopsy specimen revealed a nodular formation that consisted mostly of thick-walled veins within a fibromyxoid stroma; smooth-muscle tissue and fat globules were observed in places. The lesion was diagnosed as a cutaneous ALLM.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
article

It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Ototoxicity in Nigeria: Why it persists

July 13, 2014     Daniel D. Kokong, MBBS, FWACS; Aminu Bakari, MBBS, FWACS, FICS; Babagana M. Ahmad, MBBS, FWACS, FICS
article

Abstract

No therapy is currently available to reverse the serious damage that can be caused by ototoxic drugs, such as permanent hearing loss and balance disorders. Otolaryngologists in various regions of the world have developed strategies aimed at curtailing drug-induced ototoxicity, but similar efforts in most developing nations have yet to be well established. We conducted a study to document our experience in Nigeria. Our study population was made up of 156 patients-66 males and 90 females, aged 5 to 85 years (mean: 32.1 ± 30.7)-who were diagnosed with drug-induced ototoxicity over a 3-year period. Tinnitus was the first and the predominant symptom in 140 patients (89.7%). The most common cause of drug-induced ototoxicity among the 156 patients was injection of an unknown agent (n = 55 [35.3%]); among the known agents, the most common were chloramphenicol (n = 25 [16.0%]), chloroquine (n = 22 [14.1%]), and gentamicin (n = 20 [12.8%]). One pregnant woman experienced a miscarriage at 4 months after receiving intramuscular chloroquine, and another woman fell into a coma after receiving intramuscular streptomycin. Two agents that have not been linked to ototoxicity-oxytocin and thiopentone sodium-were found to be ototoxic in our study (1 case each). Of the 312 ears, 31 (9.9%) showed normal audiometric patterns; on the other end of the spectrum, 155 ears (49.7%) had profound sensorineural hearing loss (SNHL). Mixed hearing loss was seen in 90 ears (28.8%). Hearing loss was bilaterally symmetrical in 127 patients (81.4%), bilaterally asymmetrical in 15 patients (9.6%), and unilateral in 14 patients (9.0%). Treatment was primarily medical; hearing aids were fitted for 7 patients (4.5%). Only 41 patients (26.3%) kept as many as 3 scheduled follow-up appointments. Ototoxicity remains prevalent in the developing countries of Africa. Numerous drugs and other agents are responsible, and management outcomes are difficult to ascertain. Thus, our emphasis must be placed on prevention if we are to minimize the potentially devastating effects of ototoxicity.

Automastoidectomy

June 8, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
article

Treatment of automastoidectomy depends on the nature of the patient's symptoms, the presence or absence of pathologic tissue, the presence of complications, and the shape and degree of epithelialization of the resulting mastoid cavity.

An abnormal sigmoid sinus with a dire clinical implication

June 8, 2014     Perianan Puraviappan, MS(ORL); Naryanan Prepageran, FRCS Ed; Cheng Ai Ong, MS(ORL); Raffique Abd Karim, MS(ORL); Omkara Rubini Lingham, MS(ORL); Rajagopalan Raman, MS(ORL)
article

In reviewing CT scans before surgery, the location of the sigmoid sinus should always be noted.

Bacteriology and antimicrobial susceptibility of ENT infections in a tropical hospital

June 8, 2014     Yok Kuan Chew, MBBS; Jack Pein Cheong, MBBS; Nambiar Ramesh, MBBS; Mohamad Din Noorafidah, MPath; Sushil Brito-Mutunayagam, MS; Abdullah Khir, MS; Narayanan Prepageran, FRCS
article

Abstract

We conducted a retrospective observational study to determine the spectrum and antibiotic sensitivity pattern of organisms isolated in otorhinolaryngologic (ORL) infections. We reviewed the laboratory culture and sensitivity records of 4,909 patients-2,773 males (56.5%) and 2,136 females (43.5%), aged 2 to 90 years (mean: 45.3 ± 12.6)-who had been seen at two government hospitals in Malaysia. Of this group, 4,332 patients had a respiratory tract infection (88.2%), 206 had an ear infection (4.2%), 188 had a deep neck infection (3.8%), and 183 had an oropharyngeal infection (3.7%). The most common isolated organisms were Klebsiella spp, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S aureus, coagulase-negative S aureus, and Acinetobacter baumannii. We also identified the antimicrobial susceptibility of these organisms. We conclude that since the spectrum of causative pathogens in some infections differs between tropical and nontropical areas of the world, tropical hospitals should not completely adopt the antibiotic guidelines for ORL infections that have been recommended for hospitals in nontropical regions. We hope that our review and analysis of local data will help practitioners in Malaysia develop an appropriate prescribing policy with respect to ORL pathogens and antimicrobial susceptibility. The goal is to reduce the morbidity and mortality associated with these infections.

Evaluating occupational hearing loss: The value of the AMA's Guides to the Evaluation of Permanent Impairment

May 7, 2014     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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As scientific knowledge and methodology expand and our knowledge base grows, it is essential for physicians and scientists to incorporate new knowledge and allow our practices to evolve.

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

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.

Chondroid syringoma of the ear lobule: A unique case

May 7, 2014     Yasser Al Omran, BSc (Hons); Rawia Mohamed, MBBS, FRCPA; Mohammed-Kamal Al-Omran, MBBS, FRCS Ed, FRCS (Glasg)
article

Because of the inconspicuous clinical presentation of chondroid syringomas, they are often disregarded; other, more common, differential diagnoses are usually considered.

Ceruminous adenocarcinoma of the ear

May 7, 2014     Jagdeep Singh Virk, MA (Cantab), MRCS, DOHNS; Gaurav Kumar, FRCS(ORL-HNS); Sherif Khalil, MS, FRCS(ORL-HNS), MD
article

Ceruminous carcinomas are extremely rare and tend to present as a mass or with otalgia. They are difficult to diagnose histopathologically (in part due to varied and nonstandardized nomenclature).

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