Ocular Causes for Headache.

Ocular causes of headaches include headaches associated with refractive error (HARE), convergence insufficiency (CI), and accommodative spasm (AS). HARE is more severe in patients with a high amount of refractive error. CI or AS patients can have diplopia and strabismus. Both CI and AS can be associated with head trauma or other systemic disorders. Headaches due to ocular causes are frontally localized occurring near the end of the day and are associated with increased amount of near work. HARE is treated with glasses while CI or AS may need other therapies such as prism, eye drops, surgery, or orthoptic exercises.

Subepithelial Corneal Deposits Associated with Exemestane.

This is a case report of corneal deposits noted in a 69-year-old female patient taking the aromatase inhibitor, exemestane, after undergoing a mastectomy and chemotherapy for breast cancer. The patient presented to our eye clinic for a new-onset floater in one eye, and bilateral subepithelial opacities were found incidentally on exam. The patient completed a 5-year course of the medication shortly after her initial visit with us and was noted to have a slight improvement in the density of the opacities on a follow-up visit 3 months later. We believe these corneal changes were most likely secondary to exemestane. The effect of aromatase inhibitors on the eye deserves further exploration as an increasing number of patients are prescribed these medications.

Hearing outcomes after surgical plugging of the superior semicircular canal by a middle cranial fossa approach.

OBJECTIVE: To determine postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for superior semicircular canal dehiscence syndrome (SCDS). STUDY DESIGN: Clinical review. SETTING: Tertiary care medical center. PATIENTS: Forty-three cases of SCDS based on history, physical examination, vestibular function testing, and computed tomography imaging confirming the presence of a dehiscence. All patients underwent surgical plugging of the superior semicircular canal via middle cranial fossa approach. INTERVENTION: Pure tone audiometry was performed preoperatively and at 7 days and at least 1 month postoperatively. MAIN OUTCOME MEASURES: Change in air-bone gap (ABG) and pure tone average (PTA). RESULTS: Preoperative average ABG across 0.25, 0.5, 1, and 2 kHz was 16.0 dB (standard deviation [SD], 7.5 dB). At 7 days postoperatively, average ABG was 16.5 dB (SD, 11.1; p = 0.42), and at greater than 1 month was 8.1 dB (SD, 8.4; p < 0.001). 53% (95% confidence interval, 33-69) of affected ears had greater than 10 dB increase in their 4-frequency (0.5, 1, 2, and 4 kHz) PTA measured by bone-conduction (BC) threshold 7 days postoperatively and 25% (95% confidence interval, 8-39) at greater than 1 month postoperatively. Mean BC PTA of affected ears was 8.4 dB hearing loss (HL) (SD, 10.4) preoperatively. Compared with baseline, this declined to 19.2 dB HL (SD, 12.6; p < 0.001) at 7 days postoperatively and 16.4 dB HL (SD, 18.8; p = 0.01) at greater than 1 month. No significant differences in speech discrimination score were noted (F = 0.17). CONCLUSION: Low-frequency air-bone gap decreases after surgical plugging and seems to be due to both increased BC thresholds and decreased AC thresholds. Surgical plugging via a middle cranial fossa approach in SCDS is associated with mild high-frequency sensorineural hearing loss that persists in 25% but no change in speech discrimination.