Tinnitus: an underreported condition following microvascular decompression for hemifacial spasm.

PURPOSE: While hearing loss is a well-known condition following microvascular decompression (MVD) for hemifacial spasm (HFS), tinnitus is an underreported one. This study aims to identify prevalence, characteristics, severity, and predictors of tinnitus following MVD for HFS. METHODS: A single-center cohort of 55 HFS patients completed a questionnaire approximately 5 years following MVD. Data encompassed tinnitus presence, side, type, onset, and severity measured by a 10-point Visual Analogue Scale (VAS). Descriptive, correlation, and logistic regression analyses were conducted. RESULTS  : At surgery, participants' median age was 58 years (IQR 52-65). The median duration of HFS symptoms before surgery was 5 years (IQR 3-8), slightly predominant on the left (60%). Postoperative tinnitus was reported by 20 patients (36%), versus nine (16%) that reported preoperative tinnitus. Postoperative tinnitus was ipsilateral on the surgical side in 13 patients (65%), bilateral in six (30%), and contralateral in one (5%). Among patients with bilateral postoperative tinnitus, 33% did not have this preoperatively. Tinnitus was continuous in 70% of cases and pulsatile in 30%. Onset of new tinnitus was in 58% immediately or within days, in 25% within three months, and in 17% between three months and one year after surgery. The mean severity of postoperative tinnitus was 5.1 points on the VAS. Preoperative tinnitus and presence of arachnoid adhesions had suggestive associations with postoperative tinnitus in initial analyses (p = 0.005 and p = 0.065). However, preoperative tinnitus was the only significant predictor of postoperative tinnitus (p = 0.011). CONCLUSION: Tinnitus is a common condition following MVD for HFS, with a moderate overall severity. Causes behind postoperative tinnitus remain obscure but could be related to those of postoperative hearing loss in this patient population. Clinicians should be aware of tinnitus following MVD and vigilantly monitor its occurrence, to facilitate prevention efforts and optimize outcome for HFS patients undergoing MVD.

Challenges in the use of Venous Sinus Stenting in the Treatment of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus.

Although numerous case series and meta-analyses have shown the efficacy of venous sinus stenting (VSS) in the treatment of idiopathic intracranial hypertension and idiopathic intracranial hypertension-associated pulsatile tinnitus, there remain numerous challenges to be resolved. There is no widespread agreement on candidacy; pressure gradient and failed medical treatment are common indications, but not all clinicians require medical refractoriness as a criterion. Venous manometry, venography, and cerebral angiography are essential tools for patient assessment, but again disagreements exist regarding the best, or most appropriate, diagnostic imaging choice. Challenges with the VSS technique also exist, such as stent choice and deployment. There are considerations regarding postprocedural balloon angioplasty and pharmacologic treatment, but there is insufficient evidence to formalize postoperative decision making. Although complications of VSS are relatively rare, they include in-stent stenosis, hemorrhage, and subdural hematoma, and the learning curve for VSS presents specific challenges in navigating venous anatomy, emphasizing the need for wider availability of high-quality training. Recurrence of symptoms, particularly stent-adjacent stenosis, poses challenges, and although restenting and cerebrospinal fluid-diverting procedures are options, there is a need for clearer criteria for retreatment strategies. Despite these challenges, when comparing VSS with traditional cerebrospinal fluid-diverting procedures, VSS emerges as a favorable option, with strong clinical outcomes, lower complication rates, and cost-effectiveness. Further research is necessary to refine techniques and indications and address specific aspects of VSS to overcome these challenges.

Foundations of the Diagnosis and Management of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus.

Venous sinus stenosis has garnered increasing academic attention as a potential etiology of idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The complex anatomy of the cerebral venous sinuses and veins plays a crucial role in the pathophysiology of these conditions. Venous sinus stenosis, often found in the superior sagittal or transverse sinus, can lead to elevated intracranial pressure (ICP) and characteristic IIH symptoms. Stenosis, variations in dural venous anatomy, and flow dominance patterns contribute to aberrant flow and subsequent PT. Accurate imaging plays a vital role in diagnosis, and magnetic resonance (MR) venography is particularly useful for detecting stenosis. Management strategies for IIH and PT focus on treating the underlying disease, weight management, medical interventions, and, in severe cases, surgical or endovascular procedures. Recently, venous sinus stenting has gained interest as a minimally invasive treatment option for IIH and PT. Stenting addresses venous sinus stenosis, breaking the feedback loop between elevated ICP and stenosis, thus reducing ICP and promoting cerebrospinal fluid outflow. The correction and resolution of flow aberrances can also mitigate or resolve PT symptoms. While venous sinus stenting remains an emerging field, initial results are promising. Further research is needed to refine patient selection criteria and evaluate the long-term efficacy of stenting as compared to traditional treatments.

Hearing loss in Takayasu's arteritis.

OBJECTIVES: Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC). METHODS: Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests. RESULTS: The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke. CONCLUSIONS: Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

Noise-Induced Hearing Loss and Use of Hearing Protection Awareness among Medical Students in Saudi Arabia: Mixed Qualitative and Quantitative Study.

BACKGROUND: Noise-Induced Hearing Loss (NIHL) is a prevalent occupational hazard among healthcare professionals, including medical students. Despite its detrimental effects, the awareness and utilization of hearing protection measures among medical students in Saudi Arabia remain understudied. OBJECTIVE: Is to determine the level of awareness and understanding of NIHL among medical students in Saudi Arabia, as well as their knowledge and usage of hearing protection measures and to identify potential barriers and facilitators for hearing protection utilization. METHODS: A mixed-methods approach was employed, involving a questionnaire survey and semi-structured interviews. The survey collected data on demographics, knowledge of NIHL, and hearing protection practices among medical students. Subsequently, a semi-structured interview was conducted to obtain in-depth insights into the students' experiences, attitudes, and beliefs regarding NIHL and the use of hearing protection. RESULTS: The level about NIHL was 59.32%. Better access to information is associated with increased odds of awareness (odds ratio=3.07, p=0.012). Having relatives with hearing loss increases the odds of awareness (odds ratio =2.49, p=0.034). Individuals with hearing loss or impairment have higher odds of awareness (odds ratio =2.27, p=0.046). Ear Pain, temporary hearing loss, tinnitus, or ringing in the ear: These factors are not significantly associated with awareness of noise-induced hearing loss (p>0.05). Using hearing aids is strongly associated with increased odds of awareness (odds ratio =3.94, p=0.006).The quantitative analysis provided statistical information on the prevalence rates and factors influencing hearing protection usage, while the qualitative analysis uncover nuanced perspectives and experiences. CONCLUSION: This research will contribute to the understanding of NIHL and hearing protection practices among medical students in Saudi Arabia. Improving hearing protection awareness and practices among medical students can ultimately reduce the incidence of NIHL and promote a healthier work environment within the healthcare sector.

COVID-19 Vaccination Effects on Tinnitus and Hyperacusis: Longitudinal Case study.

The case study explores COVID-19 vaccination connection to tinnitus and hyperacusis, considering its onset and exacerbation post vaccination. The subject is a 47-year-old woman with a history of bilateral tinnitus, and her hearing history was tracked from 2014 to 2023. An intense episode of tinnitus occurred in 2021, distinct from previous experiences post COVID-19 vaccination, second dose. Symptoms manifested as sudden onset of hyperacusis, pronounced "roar" type tinnitus, and a sudden decline in hearing. Audiometric results showed reduce thresholds in low frequencies and lower speech scores in the left ear. This escalation significantly affects speech understanding in group conditions and noisy environments. There was a gradual improvement in tinnitus and hyperacusis severity, but the subject has a greater problem with speech understanding. The subject's journey involved visits to specialists, multiple testing including neuroimaging, naturopath consultations, and anxiety medication. It emphasizes the importance of healthcare practitioners recognizing and documenting these issues and need for timely multidisciplinary intervention and support. Further research is necessary to better understand the relationship between COVID-19, vaccination, and auditory symptoms.

Patient-reported measures of tinnitus for individuals with neurofibromatosis type 2-related schwannomatosis: Recommendations for clinical trials.

BACKGROUND: Neurofibromatosis type 2-related schwannomatosis is a genetic disease characterized by the development of bilateral vestibular schwannomas, ependymomas, meningiomas, and cataracts. Mild to profound hearing loss and tinnitus are common symptoms reported by individuals with neurofibromatosis type 2. While tinnitus is known to have a significant and negative impact on the quality of life of individuals from the general population, the impact on individuals with neurofibromatosis type 2 is unknown. Consensus regarding the selection of suitable patient-reported outcome measures for assessment could advance further research into tinnitus in neurofibromatosis type 2 patients. The purpose of this work is to achieve a consensus recommendation by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration for patient-reported outcome measures used to evaluate quality of life in the domain of tinnitus for neurofibromatosis type 2 clinical trials. METHODS: The Response Evaluation in Neurofibromatosis and Schwannomatosis Patient-Reported Outcomes Communication Subgroup systematically evaluated patient-reported outcome measures of quality of life in the domain of tinnitus for individuals with neurofibromatosis type 2 using previously published Response Evaluation in Neurofibromatosis and Schwannomatosis rating procedures. Of the 19 identified patient-reported outcome measures, 3 measures were excluded because they were not validated as an outcome measure or could not have been used as a single outcome measure for a clinical trial. Sixteen published patient-reported outcome measures for the domain of tinnitus were scored and compared on their participant characteristics, item content, psychometric properties, and feasibility for use in clinical trials. RESULTS: The Tinnitus Functional Index was identified as the most highly rated measure for the assessment of tinnitus in populations with neurofibromatosis type 2, due to strengths in the areas of item content, psychometric properties, feasibility, and available scores. DISCUSSION: Response Evaluation in Neurofibromatosis and Schwannomatosis currently recommends the Tinnitus Functional Index for the assessment of tinnitus in neurofibromatosis type 2 clinical trials.

New-Onset Tinnitus After Dorsal Root Ganglion Stimulator Implantation: A Case Report.

Dorsal column (dcSCS) and dorsal root ganglion stimulation (DRG-S) complications are similar, typically related to placement and device failure. We present the first case of tinnitus after DRG-S implantation. The patient presented with complex regional pain syndrome (CRPS) type 2. After previous failed treatments, she had a lumbosacral DRG-S trial, which provided relief; however, she briefly noted ringing in her ears. After permanent implantation, she reported persistent, intolerable left-sided tinnitus. Tinnitus can be modulated by secondary somatosensory inputs to the cochlear nucleus from the dcSCS. Therefore, lumbosacral DRG-S stimulating distal sensory neurons leading to tinnitus is a feasible complication.

Analysis of characteristics of and risk factors for otological symptoms after COVID-19 infection.

The purpose of this study was to explore the characteristics of and risk factors for otological symptoms after contracting COVID-19. We invited 468 participants who had been infected with COVID-19 to participate in a survey. 310 (66.2%) were women and 158 (33.8%) were men. The mean age is 38.73 (12.21) years. The questionnaire included their basic information, symptoms and symptom duration after SARS-CoV-2 infection, number of vaccine doses received, and details regarding otological symptoms. In total, 106/468 (22.6%) participants experienced tinnitus, 66/468 (14.1%) hearing loss, 103/468 (22.0%) aural fullness, and 71/468 (15.2%) dizziness. Women were more prone to experience tinnitus (P = 0.022) and dizziness (P = 0.001) than men. The group with hearing loss were older (P = 0.025), and their initial COVID-19 symptoms lasted longer (P = 0.028) than those of patients without. Patients with aural fullness were more likely to experience fatigue than patients without (P = 0.002). Patients experiencing dizziness were more likely to experience pharyngalgia (P = 0.040) and fatigue (P = 0.005) than those without. The number of vaccine doses was positively associated with the resolution of otological symptoms (P = 0.035). Multiple logistic regression analysis revealed that sex was an independent risk factor for tinnitus (odds ratio [OR], 1.802; 95% confidence interval [CI], 1.099-2.953; P = 0.020), the duration of initial COVID-19 symptoms for hearing loss (OR, 1.055; 95% CI, 1.008-1.105; P = 0.023), and sex for dizziness (OR, 2.870; 95% CI, 1.489-5.535; P = 0.002). Sex, age, COVID-19-related fatigue, and the duration of initial COVID-19 symptoms may affect the occurrence of otological symptoms, and vaccines may aid their resolution.

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study.

OBJECTIVE: The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss. METHODS: A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis. RESULTS: Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers. CONCLUSION: The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.

Transmastoid Surgery for Superior Canal Dehiscence: Prospective Longitudinal Objective and Patient-Reported Audiovestibular Outcomes.

OBJECTIVE: We assess symptom control, reversal and stability of objective third-window indicators, and hearing and balance function after transmastoid superior canal dehiscence plugging. To do this, we combine patient self-assessment questionnaires with auditory and vestibular test data collected at a preoperative and multiple postoperative visits. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients who underwent transmastoid plugging for superior canal dehiscence from 2012 to 2020. INTERVENTIONS: Plugging of the superior semicircular canal using the transmastoid approach. MAIN OUTCOME MEASURES: Patients were evaluated preoperatively, 3-month postoperative, and at yearly follow-ups (up to 8 yr postoperative). Self-assessment questionnaires included Autophony Index, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and Hearing Handicap Inventory. Objective tests included audiometry, cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, and video head impulse test. RESULTS: There was a statistically significant improvement in Autophony Index and Hearing Handicap Inventory total scores from the preoperative evaluation to 1 year postoperative. Dizziness Handicap Inventory and Tinnitus Handicap Inventory total scores also improved but statistically insignificant. Cervical and ocular vestibular evoked myogenic potential amplitudes and low-frequency air-bone gap showed statically significant reversal of the third-window effect preoperative versus 1 year postoperative. Video head impulse test of the superior semicircular canal revealed cases of pathological function preoperative with postoperative recovery. Results were stable over time. CONCLUSIONS: Superior canal dehiscence repair resolves symptoms of autophony and improves hearing disability. Objective third-window indicators reverse and show long-term stability. Auditory and vestibular function is preserved postoperative, even superior semicircular canal function may be normal. Data suggest that surgical outcomes should not be evaluated until 1 year postoperative.

Time-dependent effects of acoustic trauma and tinnitus on extracellular levels of amino acids in the inferior colliculus of rats.

Chronic tinnitus is a debilitating condition with very few management options. Acoustic trauma that causes tinnitus has been shown to induce neuronal hyperactivity in multiple brain areas in the auditory pathway, including the inferior colliculus. This neuronal hyperactivity could be attributed to an imbalance between excitatory and inhibitory neurotransmission. However, it is not clear how the levels of neurotransmitters, especially neurotransmitters in the extracellular space, change over time following acoustic trauma and the development of tinnitus. In the present study, a range of amino acids were measured in the inferior colliculus of rats during acoustic trauma as well as at 1 week and 5 months post-trauma using in vivo microdialysis and high-performance liquid chromatography. Amino acid levels in response to sound stimulation were also measured at 1 week and 5 months post-trauma. It was found that unilateral exposure to a 16 kHz pure tone at 115 dB SPL for 1 h caused immediate hearing loss in all the animals and chronic tinnitus in 58 % of the animals. Comparing to the sham condition, extracellular levels of GABA were significantly increased at both the acute and 1 week time points after acoustic trauma. However, there was no significant difference in any of the amino acid levels measured between sham, tinnitus positive and tinnitus negative animals at 5 months post-trauma. There was also no clear pattern in the relationship between neurochemical changes and sound frequency/acoustic trauma/tinnitus status, which might be due to the relatively poorer temporal resolution of the microdialysis compared to electrophysiological responses.

Increased prevalence of hearing loss, tinnitus and sudden deafness among patients with Sjögren's syndrome.

BACKGROUND: This study aimed to provide an updated prevalence of hearing loss, tinnitus, vertigo and sudden deafness on patients with Sjögren's syndrome and matched comparison patients. METHODS: Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database and Taiwan's registered catastrophic illness dataset. This study included 20 266 patients with Sjögren's syndrome as the study group and 60 798 propensity score-matched comparison patients as the comparison group. We used multivariable logistic regressions to estimate the ORs and 95% CI for tinnitus, hearing loss, vertigo and sudden deafness among Sjögren's syndrome patients versus comparison patients. RESULTS: χ2 tests showed there were statistically significant differences between the study group and comparison group in the prevalence of tinnitus (10.1% vs 6.3%, p<0.001), hearing loss (5.6% vs 3.3%, p<0.001), vertigo (4.6% vs 3.2%, p<0.001) and sudden deafness (0.8% vs 0.6%, p<0.001). Multiple logistic regression revealed that patients with Sjögren's syndrome had a greater tendency to have tinnitus (OR=1.690, 95% CI 1.596-1.788), sudden deafness (OR=1.368, 95% CI 1.137-1.647), hearing loss (OR=1.724, 95% CI 1.598-1.859) and vertigo (OR=1.473, 95% CI 1.360-1.597) relative to comparison patients after adjusting for age, income, geographic location, residential urbanisation level, diabetes, hypertension, hyperlipidaemia and rheumatoid arthritis. CONCLUSIONS: We found higher prevalence of hearing loss, vertigo, tinnitus and sudden deafness among patients with Sjögren's syndrome relative to comparison patients. Findings may provide guidance to physicians in counselling patients with Sjögren's syndrome regarding a higher risk of hearing loss, tinnitus, sudden deafness and vertigo.

Isolated bilateral tinnitus after spinal anesthesia: A case report.

Rarely, endolymphatic hydrops may occur after spinal anesthesia due to the perforation of the dural membrane and a decrease in cerebrospinal fluid pressure. Consequently, auditory complications such as tinnitus and hearing loss may arise. Tinnitus can be accompanied by headache and hearing loss. In this case report, isolated bilateral tinnitus, which occurred in the early intraoperative period and spontaneously regressed in a patient who underwent bilateral tubal ligation under spinal anesthesia, is presented.

The effects of acute and chronic noise trauma on stimulus-evoked activity across primary auditory cortex layers.

Exposure to intense noise environments is a major cause of sensorineural hearing loss and auditory perception disorders, such as tinnitus and hyperacusis, which may have a central origin. The effects of noise-induced hearing loss on the auditory cortex have been documented in many studies. One limitation of these studies, however, is that the effects of noise trauma have been mostly studied at the granular layer (i.e, the main cortical recipient of thalamic input), while the cortex is a very complex structure, with six different layers each having its own pattern of connectivity and role in sensory processing. The present study aims to investigate the effects of acute and chronic noise trauma on the laminar pattern of stimulus-evoked activity in the primary auditory cortex of the anesthetized guinea pig. We show that acute and chronic noise trauma are both followed by an increase in stimulus-evoked cortical responses, mostly in the granular and supragranular layers. The cortical responses are more monotonic as a function of the intensity level after noise trauma. There was minimal change, if any, in local field potential (LFP) amplitude after acute noise trauma, while LFP amplitude was enhanced after chronic noise trauma. Finally, LFP and the current source density analysis suggest that acute but more specifically chronic noise trauma is associated with the emergence of a new sink in the supragranular layer. This result suggests that supragranular layers become a major input recipient. We discuss the possible mechanisms and functional implications of these changes.NEW & NOTEWORTHY Our study shows that cortical activity is enhanced after trauma and that the sequence of cortical column activation during stimulus-evoked response is altered, i.e. the supragranular layer becomes a major input recipient. We speculate that these large cortical changes may play a key role in the auditory hypersensitivity (hyperacusis) that can be triggered after noise trauma in human subjects.

Reporting of auditory symptoms over time: (in)consistencies, expectations and the nocebo effect.

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points.Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis.Study sample: 6881 members of the UK general public aged 18+ years.Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively.Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing.

Essential Palatal Myoclonus and Clicking Tinnitus in a Nine-Year-Old Boy-A Case Report.

The work describes a case of palatal myoclonus with distressing tinnitus in a 9-year-old boy and its successful treatment with injections of botulinum toxin. This case report discusses common questions about myoclonic-induced clicking tinnitus and provides answers. Laryngoscope, 134:397-399, 2024.

Temporomandibular joint herniation into the external auditory canal presenting as clicking tinnitus: A case report.

BACKGROUND: Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation. CLINICAL PRESENTATION: A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery. CONCLUSION: This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.

Blast-Induced Central Auditory Neurodegeneration Affects Tinnitus Development Regardless of Peripheral Cochlear Damage.

Blast exposure causes serious complications, the most common of which are ear-related symptoms such as hearing loss and tinnitus. The blast shock waves can cause neurodegeneration of the auditory pathway in the brainstem, as well as the cochlea, which is the primary receptor for hearing, leading to blast-induced tinnitus. However, it is still unclear which lesion is more dominant in triggering tinnitus, the peripheral cochlea or the brainstem lesion owing to the complex pathophysiology and the difficulty in objectively measuring tinnitus. Recently, gap detection tests have been developed and are potentially well-suited for determining the presence of tinnitus. In this study, we investigated whether the peripheral cochlea or the central nervous system has a dominant effect on the generation of tinnitus using a blast-exposed mouse model with or without earplugs, which prevent cochlear damage from a blast transmitted via the external auditory canal. The results showed that the earplug (+) group, in which the cochlea was neither physiologically nor histologically damaged, showed a similar extent of tinnitus behavior in a gap prepulse inhibition of acoustic startle reflex test as the earplug (-) group, in which the explosion caused a cochlear synaptic loss in the inner hair cells and demyelination of auditory neurons. In contrast, both excitatory synapses labeled with VGLUT-1 and inhibitory synapses labeled with GAD65 were reduced in the ventral cochlear nucleus, and demyelination in the medial nucleus of the trapezoid body was observed in both groups. These disruptions significantly correlated with the presence of tinnitus behavior regardless of cochlear damage. These results indicate that the lesion in the brainstem could be dominant to the cochlear lesion in the development of tinnitus following blast exposure.

Surgical labyrinthectomy in the treatment of unilateral Meniere disease: a Belgian retrospective study.

PURPOSE: Meniere's disease (MD) is a disabling condition with symptoms, such as hearing loss, dizziness, and tinnitus. Surgery is the last resort option for managing MD when other treatments are not effective. Surgical labyrinthectomy (SL) is less commonly performed than vestibular neurectomy or chemical labyrinthectomy. We sought to assess the efficacy and safety of the SL procedure. METHODS: A retrospective study was carried out involving a cohort of 25 patients with disabling and drug-resistant MD, who underwent SL performed by the same surgeon at University Hospital UCL Namur between 2009 and 2019. All patients considered their hearing non-functional and requested a radical therapeutic option. We compared subjective and objective measures before and after surgery, retrieved from patient medical records. RESULTS: The difference between the Dizziness Handicap Inventory scores before and after surgery was statistically significant (p < 0.01). 81% of patients being satisfied with surgery. No post-operative complications occurred. Following SL, 14 patients evolved well, both subjectively and clinically, without any further vestibular workup required, which was offered to the other patients. All had a total deafness on the operated side, as expected, while four benefited from multidisciplinary rehabilitation because of persistent tinnitus. The scientific literature on this topic was reviewed, compared, and discussed. CONCLUSIONS: Based on our results, SL represents an efficient and safe approach to achieve vestibular deafferentation in patients with unilateral, disabling, and treatment-resistant MD, with non-functional hearing.