Paciente con enfermedad descompresiva del oído interno / Patient with inner ear decompression sickness

Introducción: La enfermedad descompresiva es un síndrome clínico complejo causado por la sobresaturación de gases respiratorios en la sangre y los tejidos, después de una reducción abrupta de la presión ambiental, que puede presentarse como parte de los accidentes de buceo. Dada su baja prevalencia se da a conocer una de sus formas de presentación en los servicios de urgencias, que requiere rapidez en el diagnóstico y conducta terapéutica inmediata. Objetivo: Presentar un caso grave de enfermedad descompresiva del oído interno. Caso clínico: Paciente masculino de 71 años de edad, buzo aficionado y antecedente de un accidente vascular encefálico isquémico hace aproximadamente 1 año. Realizó inmersiones, luego de las cuales comenzó a presentar síntomas como mareos, náuseas, vómitos copiosos, inestabilidad para la marcha y manifestaciones sensitivas en la cara. Horas después de ser evaluado en centro médico de urgencia, sin diagnóstico específico, se trasladó al cuerpo de guardia del hospital, para su valoración por el especialista en medicina subacuática. Conclusiones: La orientación diagnóstica de un paciente con enfermedad descompresiva requiere derivación urgente a un centro de tratamiento de enfermedades disbáricas(AU)

Introduction: Decompression illness is a complex clinical syndrome caused by supersaturation of respiratory gases in the blood and tissues, after an abrupt reduction in environmental pressure, which can occur as part of diving accidents. Given its low prevalence, one of its forms of presentation is revealed in emergency services, which requires speed in diagnosis and immediate therapeutic conduct. Objective: To present a severe case of decompressive disease of the inner ear. Clinical case: 71-year-old male patient, amateur diver, with a history of an ischemic stroke approximately 1 year ago. He performed dives, after which he began to present symptoms such as dizziness, nausea, copious vomiting, unsteadiness in walking, and sensitive manifestations on the face. Hours after being evaluated at the emergency medical center, without a specific diagnosis, he was transferred to the hospital's emergency room, for evaluation by the underwater medicine specialist. Conclusions: The diagnostic orientation of a patient with decompression illness requires urgent referral to a center for the treatment of dysbaric diseases(AU)

Comparação do nível de confiança para realização de atividades diárias pré e pós reabilitação vestibular em pacientes com disfunção vestibular / Comparison of the level of confidence to perform daily activities before and after vestibular rehabilitation in patients with vestibular dysfunction / Comparación del nivel de confianza para la realización de actividades diarias antes y después de la rehabilitación vestibular en pacientes con disfunción vestibular

Introdução: A reabilitação vestibular (RV) surge como uma opção terapêutica em casos de tontura e desequilíbrio postural. O The Activities-specific Balance Confidence Scale (ABC Scale) é um questionário utilizado para avaliar a interferência destes sintomas vestibulares por meio do nível de confiança dos indivíduos em realizar atividades diárias que envolvem o equilíbrio postural. Objetivo: comparar o nível de confiança na realização de atividades diárias relacionadas ao equilíbrio corporal, pré e pós reabilitação vestibular (RV) em pacientes com disfunção vestibular. Método: Estudo primário, intervencional, clínico, longitudinal, prospectivo, analítico, não controlado. Participaram 14 indivíduos, do sexo feminino e masculino, portadores de vestibulopatia periférica. Foi aplicado o Activities-specific Balance Confidance Scale (ABC Scale) nas condições pré e pós RV. Os dados foram analisados de forma descritiva e inferencial, pelos testes Exato de Fisher, t-Sudent e o modelo linear de efeitos mistos. Resultados: A amostra se caracterizou por 78.57% do sexo feminino e 21.43% do sexo masculino, com média de idade de 59.21 anos. Observou-se diferença estatística quando comparados os resultados do ABC Scale nas condições pré e pós RV (p<0.0001). Não foi verificada diferença estatística entre os escores deste instrumento com as variáveis sexo, idade e número de sessões terapêuticas. Conclusão: Foi possível concluir que o nível de confiança dos pacientes dessa amostra modificou de baixo, na fase pré reabilitação, para alto, na fase final da intervenção, o que consolida a ocorrência do aumento no nível de confiança que acarretou melhoria na qualidade de vida. (AU)

Introduction: Vestibular rehabilitation (VR) appears as a therapeutic option in cases of dizziness and postural imbalance. The Activities-specific Balance Confidence Scale (ABC Scale) is a questionnaire used to assess the interference of these vestibular symptoms with the individuals' level of confidence to carry out daily activities involving postural balance. Objective: to compare the level of confidence to carry out daily activities related to body balance, before and after VR, in patients with vestibular dysfunction. Method: Primary, interventional, clinical, longitudinal, prospective, analytical, and noncontrolled study. The sample comprised 14 male and female individuals with peripheral vestibulopathy. The ABC Scale was applied before and after VR. Descriptive and inferential data analysis were performed, using Fisher's Exact test, Student's t-test, and the linear mixed-effects model. Results: The sample had 78.57% females and 21.43% males, with a mean age of 59.21 years. There was a statistical difference in ABC Scale results before and after VR (p < 0.0001). There was no statistical difference between its scores and sex, age, or the number of therapy sessions. Conclusion: It was concluded that this study patients' confidence level changed from low in the pre-rehabilitation phase, to high in the final phase of the intervention, which consolidates the increase in confidence level that led to an improvement of quality of life. (AU)

Introducción: La rehabilitación vestibular (RV) aparece como una opción terapéutica en casos de mareos y desequilibrio postural. La Escala de Confianza en el Equilibrio Específica de Actividades (Escala ABC) es un cuestionario utilizado para evaluar la interferencia de estos síntomas vestibulares a través del nivel de confianza de los individuos en la realización de actividades diarias que involucran el equilibrio postural. Objetivo: comparar el nivel de confianza en la realización de actividades cotidianas relacionadas con el equilibrio corporal, pre y post rehabilitación vestibular (RV) en pacientes con disfunción vestibular. Método: Estudio primario, intervencionista, clínico, longitudinal, prospectivo, analítico, no controlado. Participaron 14 individuos, hombres y mujeres y con vestibulopatía periférica. La Escala de Confianza del Equilibrio Específica de Actividades (Escala ABC) se aplicó en condiciones previas y posteriores a la RV. Los datos fueron sometidos a análisis descriptivo e inferencial mediante la prueba exacta de Fisher, t-Sudent y el modelo lineal de efectos mixtos. Resultados: La muestra se caracterizó por 78,57% del sexo femenino y 21,43% del masculino, con una edad media de 59,21 años. Hubo diferencia estadística al comparar los resultados de la Escala ABC en condiciones pre y post RV (p<0,0001). No hubo diferencia estadística entre los puntajes de este instrumento con las variables sexo, edad y número de sesiones terapéuticas. Conclusión: Fue posible concluir que el nivel de confianza de los pacientes de esta muestra pasó de bajo, en la fase de pre-rehabilitación, a alto, en la fase final de la intervención, lo que consolida la ocurrencia del aumento en el nivel de confianza que llevó a una mejora en la calidad de vida. (AU)

Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report / 临床耳鼻咽喉头颈外科杂志

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops / 临床耳鼻咽喉头颈外科杂志

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.

Application of Cervical Vestibular-Evoked Myogenic Potentials in Adults with Moderate to Profound Sensorineural Hearing Loss: A Preliminary Study

Abstract Introduction The cochlea and the vestibular receptors are closely related in terms of anatomy and phylogeny. Patients with moderate to profound sensorineural hearing loss (MPSHL) should have their vestibular organ functions tested. Objective To evaluate the incidence of vestibular abnormalities in patients with MPSHL and to study the correlation between the etiology of hearing loss (HL) and a possible damage to the labyrinth. Methods A case-control retrospective study was performed. In the case group, 20 adults with MPSHL of known etiology were included. The control group was composed of 15 adults with normal hearing. The case group was divided into 4 subgroups based on the etiology (bacterial meningitis, virus, vascular disease, congenital). Cervical vestibular-evoked myogenic potentials (cVEMPs) were used to rate the saccular function and lower vestibular nerve. Results The study was performed in 70 ears, and it highlighted the presence of early biphasic P1-N1 complex in 29 (71.5%) out of 40 ears in the study group, and in all of the 30 ears in the control group (p = 0.001). Regarding the presence or absence of cVEMPs among the four subgroups of patients with MPSHL, the data were statistically significant (p < 0.001). The comparison between the latencies and amplitude of P1-N1 in case and control groups from other studies and in the four subgroups of cases in the present study did not detect statistically significant differences. Conclusion The present study demonstrates that patients with MPSHL have a high incidence of damage to the labyrinthine organs, and it increases the current knowledge about the etiopathogenesis of sensorineural HL, which is often of unknown nature.

Application value of magnetic resonance hydrography of the inner ear in cochlear implantation

SUMMARY OBJECTIVE This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.

RESUMO OBJETIVO Este estudo visa investigar o valor da aplicação da hidrografia por ressonância magnética (RM) do ouvido interno no implante coclear. MÉTODOS Cento e quarenta e seis pacientes foram inscritos. Os exames da hidrografia por RM e do CT espiral para o canal auditivo intracraniano foram executados antes da cirurgia, e todos os resultados da imagem foram analisados estatisticamente, a fim de explorar o valor da aplicação da hidrografia por RM do ouvido interno no implante coclear. RESULTADOS Centro e quarenta e seis pacientes (292 ouvidos) foram examinados. Dentre esses pacientes, 13 foram diagnosticados com aquedutos vestibulares anormais (20 ouvidos) pela hidrografia por RM, enquanto cinco pacientes foram diagnosticados com esta doença pelo CT; 15 pacientes foram diagnosticados com malformação do ouvido interno (19 ouvidos) pela hidrografia por RM, enquanto 11 pacientes foram diagnosticados por CT (quatro foram diagnosticados erroneamente); cinco pacientes foram diagnosticados com estenose de canal acústico interno (oito ouvidos) pela hidrografia por RM, enquanto dois pacientes foram diagnosticados por CT (três foram diagnosticados erroneamente); e quatro pacientes foram diagnosticados com fibrose coclear (cinco ouvidos) pela hidrografia por RM, enquanto quatro foram diagnosticados por CT (quatro ouvidos). A taxa correta de diagnóstico foi de 77,40% (113/146) com base no CT, enquanto a taxa foi de 93,84% (137/146) com base na hidrografia por RM. CONCLUSÕES A técnica de imagem da hidrografia por RM pode ser aplicada à avaliação pré-operatória do implante coclear, que pode fornecer informações anatômicas precisas e confiáveis sobre o labirinto membranoso interno e os nervos no canal acústico interno, além de uma base exata para o diagnóstico da fibrose coclear e do desenvolvimento do nervo. Isso tem um significado orientador para a seleção de esquemas de tratamento.

Video head impulse test (v-hit) em indivíduos com diabetes mellitus tipo 1 / Video head impulse test (v-hit) in individuals with type 1 diabetes mellitus

RESUMO Objetivo Verificar a função dos canais semicirculares do labirinto de indivíduos com diabetes tipo 1, submetidos ao Video Head Impulse Test (v-HIT), e compará-los com indivíduos sem diabetes. Métodos Estudo transversal, observacional, analítico, realizado com uma amostra de conveniência, formada por 35 indivíduos diabéticos e 100 não diabéticos. Todos os participantes foram submetidos à avaliação vestibular por meio do v-HIT. Resultados A casuística foi composta por 135 participantes, divididos em dois grupos. O grupo de estudo foi composto por indivíduos com diabetes tipo 1, totalizando 21 mulheres e 14 homens. A idade variou entre 18 e 71 anos, com média de 35,37 anos e desvio padrão de 10,98. O grupo sem diabetes foi composto por 77 mulheres e 23 homens. A idade variou entre 20 e 83 anos, com média de 46,44 e desvio padrão de 19,82. Os grupos foram pareados entre si, com relação à idade (p=0,098) e sexo (p=0,052). Os pacientes diabéticos apresentaram ganho diminuído nos canais semicirculares posteriores e anterior esquerdo. A velocidade apresentou diferença significativa nos canais lateral esquerdo, anterior direito e posterior esquerdo no grupo com diabetes mellitus tipo 1, porém não apresentou correlação com o ganho dos canais semicirculares. Conclusão Os participantes com diabetes mellitus tipo 1 apresentaram um ganho diminuído nos canais semicirculares posteriores e no canal anterior esquerdo quando comparados com indivíduos não diabéticos.

ABSTRACT Purpose To verify the function of the labyrinth semicircular channels of type 1 diabetes individuals submitted to the Video Head Impulse Test (v-HIT) and to compare them with individuals without diabetes. Methods Cross-sectional, observational, analytical study conducted with a convenience sample of 35 diabetic and 100 non-diabetic individuals. All participants were submitted to vestibular evaluation using v-HIT. Results The sample consisted of 135 participants divided into two groups. The study group was composed of individuals with type 1 diabetes, totaling 21 women and 14 men. The age range was between 18 and 71 years, with a mean of 35.37 years and standard deviation of 10.98. The group without diabetes was composed of 77 women and 23 men. The age range was between 20 to 83 years, with a mean of 46.44 and standard deviation of 19.82. The groups were matched for age (p=0.098) and gender (p=0.052). Diabetic patients showed decreased gain in the posterior and left anterior semicircular canals. Velocity showed a significant difference in the left lateral, anterior right and posterior left canals in the group with DM1, however velocity did not show correlation with the gain of the semicircular canals. Conclusion participants with type 1 diabetes mellitus showed a decreased gain in the posterior semicircular canals and in the left anterior canal when compared to non-diabetic individuals.

Cholesteatoma labyrinthine fistula: prevalence and impact / Fístula labiríntica por colesteatoma: prevalência e impacto

Abstract Introduction: Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood. Objective: Evaluate patients with cholesteatoma, in order to identify possible risk factors or clinical findings associated with labyrinthine fistula. Secondary objectives were to determine the prevalence of labyrinthine fistula in the study cohort, to analyze the role of computed tomography and to describe the hearing results after surgery. Methods: This retrospective cohort study included patients with an acquired middle ear cholesteatoma in at least one ear with no prior surgery, who underwent audiometry and tomographic examination of the ears or surgery at our institution. Hearing results after surgery were analyzed according to the labyrinthine fistula classification and the employed technique. Results: We analyzed a total of 333 patients, of which 9 (2.7%) had labyrinthine fistula in the lateral semicircular canal. In 8 patients, the fistula was first identified on image studies and confirmed at surgery. In patients with posterior epitympanic and two-route cholesteatomas, the prevalence was 5.0%; and in cases with remaining cholesteatoma growth patterns, the prevalence was 0.6% (p = 0.16). In addition, the prevalence ratio for labyrinthine fistula between patients with and without vertigo was 2.1. Of patients without sensorineural hearing loss before surgery, 80.0% remained with the same bone conduction thresholds, whereas 20.0% progressed to profound hearing loss. Of patients with sensorineural hearing loss before surgery, 33.33% remained with the same hearing impairment, whereas 33.33% showed improvement of the bone conduction thresholds' Pure Tone Average. Conclusion: Labyrinthine fistula must be ruled out prior to ear surgery, particularly in cases of posterior epitympanic or two-route cholesteatoma. Computed tomography is a good diagnostic modality for lateral semicircular canal fistula. Sensorineural hearing loss can occur post-surgically, even in previously unaffected patients despite the technique employed.

Resumo Introdução: A fístula labiríntica é uma das complicações mais comuns associadas ao colesteatoma. Representa uma perda erosiva do osso endocondral que recobre o labirinto. As razões para a ocorrência da fístula labiríntica induzida pelo colesteatoma ainda são mal compreendidas. Objetivo: Avaliar pacientes com colesteatoma, a fim de identificar possíveis fatores de risco ou achados clínicos associados à fístula labiríntica. Os objetivos secundários foram determinar a prevalência de fístula labiríntica no estudo de coorte, analisar o papel da tomografia computadorizada e descrever os resultados auditivos após a cirurgia. Método: Este foi um estudo de coorte retrospectivo. Foram incluídos pacientes com colesteatoma adquirido de orelha média em pelo menos um lado sem cirurgia prévia que haviam sido submetidos à audiometria e tomografia computadorizada de orelha ou cirurgia em nossa instituição. Os resultados auditivos após a cirurgia foram analisados de acordo com a classificação de fístula labiríntica e da técnica empregada. Resultados: Analisamos um total de 333 pacientes, dos quais 9 (2,7%) apresentavam fístula labiríntica no canal semicircular lateral. Em 8 pacientes, a fístula foi identificada na tomografia computadorizada e confirmada durante a cirurgia. Em pacientes com colesteatomas epitimpânicos posteriores e de via dupla, a prevalência foi de 5,0%; e nos casos com padrão de crescimento de colesteatoma remanescente, a prevalência foi de 0,6% (p = 0,16). Além disso, a taxa de prevalência de fístula labiríntica entre pacientes com e sem vertigem foi de 2,1. Dos pacientes sem perda auditiva neurossensorial antes da cirurgia, 80,0% permaneceram com os mesmos limiares de condução óssea, enquanto 20,0% progrediram para perda auditiva profunda. Dos pacientes com perda auditiva neurossensorial antes da cirurgia, 33,33% permaneceram com a mesma deficiência auditiva, enquanto 33,33% apresentaram melhora da média de dos limiares de condução óssea aos tons puros. Conclusão: A fístula labiríntica deve ser descartada antes do procedimento cirúrgico, particularmente nos casos de colesteatomas epitimpânicos posteriores e de dupla via. A tomografia computadorizada é uma boa modalidade diagnóstica para a fístula do canal semicircular lateral. A perda auditiva neurossensorial pode ocorrer pós-cirurgicamente, mesmo em pacientes previamente não afetados, a despeito da técnica empregada.

Different clinical presentation of intralabyrinthine schwannomas - a systematic review / Diferentes apresentações clínicas do schwannoma intralabiríntico --- uma revisão sistemática

Abstract Introduction: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

Resumo Introdução: Schwannoma intralabiríntico é um tumor benigno, raro, que afeta as porções mais terminais dos nervos vestibular e coclear. Este tumor pode ser classificado, de acordo com sua localização na orelha interna, em 10 subtipos. Objetivo: Realizar uma revisão abrangente das manifestações auditivas mais frequentes secundárias ao schwannoma intralabiríntico e descrever os possíveis mecanismos fisiopatológicos subjacentes. Método: Revisão sistemática da literatura até outubro de 2017 nas bases de dados PubMed, Web of Science e Scopus. O critério de inclusão foi manifestações clínicas do schwannoma intralabiríntico. Três pesquisadores avaliaram de forma independente os artigos e extraíram informações relevantes. Exemplificamos com a descrição de um caso de schwannoma intralabiríntico subtipo intravestibular com múltiplas formas de apresentações clínicas. Resultados: Vinte sete estudos contemplaram nossos critérios de inclusão. O subtipo do schwannoma intralabiríntico mais comum encontrado foi o intracoclear, seguido pelo intravestibular. Todos os casos apresentaram alteração auditiva, normalmente perda auditiva progressiva. Conclusão: O diagnóstico de schwannomas intralabirínticos baseia-se em exames de ressonância magnética de alta resolução e deve ser incluído no diagnóstico diferencial de pacientes com queixas vestibulococleares. Apesar de termos aproximadamente 600 casos na literatura, ainda nos falta descrição detalhada da evolução clínica dos pacientes em correlação com achados na ressonância magnética de ossos temporais e o subtipo tumoral.

A Case of Autoimmune Sensorineural Hearing Loss Responding to Cytotoxic Agent / 대한이비인후과학회지

Autoimmune sensorineural hearing loss is a rare disease characterized by bilateral sensorineural hearing loss, some in a progressive pattern and others in idiopathic or fluctuating pattern, often accompanied by vestibular symptoms. This disease is also known as autoimmune inner ear disease (AIED), which primarily involves the vestibulo-cochlear system. However, in some cases, it occurs in the context of systemic autoimmune disorder such as wegner granulomatosis, or the Bechet disease. Response to steroids has been the requisite clinical criterion for diagnosis. Treatment usually includes corticosteroids and immunosuppressive drugs. However, after continuous steroid treatment development of corticosteroids, resistance is common in many AIED. To patients with AIED, response to steroids is not only a criterion for diagnosis but also a criterion to test steroid-sparing therapies such as methotrexate. A 10 year-old boy presenting a fluctuating pattern of bilateral sensorineural hearing loss was treated with a cytotoxic agent in suspicion of autoimmune sensorineural hearing loss. We reviewed this case with reference to relevant publications in the medical literature.

Dehiscencia del canal semicircular superior como causa de tinnitus pulsátil / Superior semicircular canal dehiscence as cause of pulsatile tinnitus

RESUMEN El tinnitus se presenta en forma crónica en alrededor del 10% de los adultos, siendo el 4% de estos casos tinnitus pulsátil (TP). El TP se caracteriza por ser rítmico y sincrónico al latido cardiaco. Existen múltiples causas descritas, pero en un grupo importante de casos, no se logra objetivar su origen. Nuestro objetivo es presentar casos de dehiscencia del canal semicircular superior (DCSS) como causa de tinnitus pulsátil y su estudio. Se presentan dos pacientes evaluadas por tinnitus pulsátil. En ambos casos se descartan causas sistémicas, ECO doppler carotídeo sin alteración, angio TAC y RNM sin hallazgos. En reconstrucción de Pöschl se sospecha DCSS, por lo que se estudia con potenciales miogénicos evocados cVEMP y oVEMP con disminución de umbral y respuesta aumentada en oído afectado. En los casos expuestos el tinnitus aparece como síntoma único asociado a la presencia de DCSS, que fue confirmada con estudio imagenológico y VEMPs. El estudio con angio TAC permite pesquisar diversas causas asociadas. Los VEMPs confirman el diagnóstico, teniendo el oVEMP mayor sensibilidad. Como conclusión la DCSS es una entidad a tener presente como diagnóstico diferencial del tinnitus pulsátil y ante su sospecha se debe explorar con VEMPs.

ABSTRACT Tinnitus occurs chronically in about 10% of adults, being pulsatile tinnitus a 4% of these cases (TP). TP is characterized by being rythmic and sychronous to the heart beat. There are many described causes, but in a significant group of cases it is not possible to determine its origin. Our aim is present clinical cases of superior semicircular canal dehiscence (SSCD) as the cause of pulsatile tinnitus and its study. Clinical cases: Two patients present pulsatile tinnitus in her right ear. System causes were discarded, normal Carotid Doppler ultrasonography, Anglo CT scan and MRI without findings. In Pöschl reconstruction SSCD can be observed. Evoked myogenic potentials (VEMPs) by suspicion of SSCD Syndrome, cVEMP and oVEMP with a elevated amplitudes and lower thresholds ipsilateral response. In the cases exposed, tinnitus appears as a single symptom associated with the presence of SSCD which was confirmed with imaging studies and VEMPs. The AngioTAC allows to investigate several associated causes. The VEMPs confirm the diagnosis, with oVEMP having a greater sensitivity. The SSCD is an entity to have in my mind as a differential diagnosis of pulsatile tinnitus and, if suspected, should be explored with VEMPs.

Autoimmune Inner Ear Disease Mimicking Bilateral Ménière's Disease: A Case Report / 대한평형의학회지

Autoimmune inner ear disease (AIED) is a rare disease, accounting for < 1% of all cases of hearing impairment or dizziness. It is characterized by sensorineural hearing loss (SNHL) or vestibular dysfunction that results from an immunemediated process. Clinical features of AIED is SNHL that progresses over weeks to month with fluctuating hearing symptoms. Because there are no diagnostic laboratory and clinical feature, response to immunosuppressive therapy were important for diagnosis of AIED. Many diseases such as sudden SNHL and Meniere disease may also mimic AIED, a broad differential must be maintained in patients suspected of having AIED. We report a case of a 46-year-old female who presented with sudden hearing loss and vertigo. We could diagnose her as AIED with systemic lupus erythematous. The symptoms were improved treated with steroids.

Síndrome de dehiscencia del canal semicircular superior: a propósito de un caso / Canal dehiscence syndrome of the superior semicircular: in a case purpose

El síndrome de dehiscencia de canal semicircular superior (DCSS) es una patología descrita en 1998 por Minor y cols, presenta síntomas diversos incluido vértigo inducido por el sonido, hipoacusia y autofonía por la falta de cobertura ósea en dicho canal. El diagnóstico se basa en la clínica y la confirmación se obtiene mediante la tomografía computarizada de peñasco. El tratamiento será expectante o reparación quirúrgica de la continuidad si la clínica es incapacitante. En este artículo se presenta un caso clínico de DCSS con síntomas auditivos y vestibulares al emitir el fonema "mmm".

The superior semicircular dehiscence síndrome is a pathology described en 1998 by Minor et al. Which presents several symptoms incluid sound induced vértigo, hearing loss and autophony due to bone dehiscense of this semicircular canal. The diagnosis was based on clinical and confirmation is given by the temporal bone CT. Treatment is expectant or surgical repair of continuity if the clinic is disabling. In this paper we present a case of DCSS with auditory and vestibular symptoms in issuing the phoneme "mmm".

Intratympanic Steroid Injection in Tinnitus Management / 한양의대학술지

Intratympanic (IT) steroid injection has been used increasingly in various inner ear diseases instead of systemic steroid, because of the higher concentration of the drug into the target organ and the lower risk of the systemic side effect. Although there were several trials applying IT steroid injection on tinnitus, most of them failed to demonstrate its therapeutic effect more than controls. However, a study has shown a meaningful outcome when the therapeutic target is limited to acute tinnitus developed within 3 months. Although IT steroid injection treatment in tinnitus requires more evidence, when the therapeutic target is limited to the acute phase, IT steroid injection could be a treatment option for tinnitus. Early intervention, asymmetric hearing loss and unilateral tinnitus seem to be favorable factors for outcome of IT steroid injection.

Membrane Stress in the Human Labyrinth and Meniere Disease: A Model Analysis

Introduction The nature and extent of membrane damage encountered in Meniere disease remains unexplained. Pressure-induced membrane stress may underlie the characteristic hydropic distention. Analysis of stress in the several vestibular chambers may offer insight into the nature and progression of Meniere disease. Objective Membrane stress levels will be assessed by constructing a specific model of the human membranous labyrinth through the application of human dimensions to an existing generic model of the mammalian labyrinth. Methods Nominal dimensions for a model of the human membranous labyrinth were obtained from fixed human tissue. Stress proclivities were calculated and normalized based on shell theory applied to the various geometric figures comprising the model. Results Normalized peak stress levels were projected to be highest in the saccule (38.8), followed by the utricle (5.4), then ampulla (2.4), and lowest in the canal system (1.0). These results reflect macrostructural variations in membrane shape, size, and thickness among the several chambers of the labyrinth. These decreasing stress proclivities parallel the decreasing frequency of histologic lesions found in documented cases of Meniere disease. Conclusions This model analysis of a human membranous labyrinth indicates that substantial disparities in stress exist among the several vestibular chambers due to macrostructural membrane configuration. Low stress levels in the canals are the result of thick highly curved membranes, and the high levels computed for the saccule reflect its thin and relatively flat membranes. These findings suggest that chamber configuration may be a factor controlling the progression of endolymphatic hydrops in Meniere disease.(AU)

Fortificación del arroz para corregir la deficiencia de micronutrientes en niños de 6 a 59 meses de edad / Rice fortification to correct micronutrient deficiency in children 6-59 months old

Objetivo. Realizar una revisión sistemática de la literatura sobre la eficacia del consumo de arroz fortificado en el incremento de los niveles de hierro y otros micronutrientes en niños de 6 a 59 meses de edad, con la finalidad de evaluar su utilidad como intervención de salud pública. Métodos. La búsqueda se realizó en las bases de datos Medline, Embase, The Cochrane Library y LILACS. Se incluyeron ensayos clínicos aleatorizados (ECA) que evaluaron el consumo de arroz fortificado comparado con placebo u otras formas de intervención sobre la mejora de los niveles de hierro y otros micronutrientes. Para evaluar la calidad metodológica, se utilizó la lista de verificación CONSORT®. El riesgo de sesgo de los estudios se evaluó según la metodología de la Colaboración Cochrane®. Resultados. Se incluyeron siete ECA en la revisión. Todos los estudios mostraron mejoras significativas en indicadores del estado nutricional de hierro en los grupos intervenidos, sin reportar efectos adversos. No se evidenció mejoría en los niveles de vitamina A, ni en los indicadores antropométricos de peso y talla como resultado secundario de la intervención. Los estudios incluidos mostraron calidad metodológica moderada. Conclusiones. La fortificación del arroz representó una estrategia de intervención eficaz para corregir la deficiencia de hierro en la población infantil menor de cinco años. Su implementación como medida de salud pública requiere estudios locales que evalúen su efectividad en intervenciones a largo plazo y en mayor escala.

Objective. To carry out a systematic review of the literature on the effectiveness of fortified rice consumption in terms of increasing levels of iron and other micro­nutrients in children aged 6-59 months, with a view to evaluating its usefulness as a public health intervention. Methods. A search was conducted in MEDLINE, Embase, Cochrane Library, and LILACS databases. The review included randomized clinical trials (RCTs) that assessed the consumption of fortified rice, compared with a placebo or other forms of intervention, in terms of enhanced levels of iron and other micronutrients. The CONSORT® checklist was used to assess methodological quality. The risk of bias in the studies was assessed using the Cochrane® Collaboration methodology. Results. Seven RCTs were included in the review. All the studies showed significant improvements in indicators of nutritional iron status in the intervention groups, without reporting adverse effects. There was no evidence of improvement in vitamin A levels or in anthropometric indicators of weight and height as a secondary result of the intervention. The included studies showed moderate methodological quality. Conclusions. Rice fortification was an effective intervention strategy to correct iron deficiency in children under age 5. For implementation as a public health measure, local studies are needed to assess its effectiveness in long-term and large-scale interventions.

Clinical analysis of otogenic extracranial and intracranial complications / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical feature and treatment of extracranial and intracranial complications caused by otitis media.@*METHOD@#Three hundred and twenty patients of acute and chronic otitis media were admitted to our department between 2005 and 2014. Among them, 34 patients were diagnosed with extracranial and intracranial complications. The clinical features and treatment outcome were retrospectively studied. Of the 34 patients associated with complications, 25 had a single complication,8 had two complications and 1 had three complications. Complications included labyrinthitis in 14 cases, facial paralysis in 11, postauricular subperiosteal abscess in 6, Bezold abscess in 1, thrombophlebitis of sigmoid sinus in 2, otitis meningitis in land otogenic brain abscess in 8.@*RESULT@#Thirty-three patients were cured or improved and 1 patient died.@*CONCLUSION@#Due to the widespread use of antibiotics, the clinical manifestations of extracranial and intracranial complications of otitis media become more hidden and atypical. The surgery is the primary treatment method.

Comparison and analysis of ASSR test in sensorineural hearing loss children with cochlear lesion and retrocochlear lesion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the auditory steady-state response (ASSR) test data of severe sensorineural hearing loss children with cochlear lesion and those with retrocochlear lesion and find some specific phenomena of retrocochlear lesion in ASSR, then to improve diagnostic accuracy in clinical practice.@*METHOD@#Between 2008 to 2012. 96 children (179 ears) were diagnosed with "retrocochlear auditory nerve lesion" and recieved ASSR test (" retrocochlear lesion" group). Eighty-one (143 ears) the same age children (143 ears) were diagnosed as "cochlear auditory nerve lesion" and selected them as the "cochlear lesion" group. Twenty-six (50 ears) normal hearing children at the same age who had ASSR test records selected from the pediatric hearing center database of our hospital were selected as "normal control" group. Compare the difference of ASSR threshold, ASSR elicit rate and ASSR audiogram among the three groups.@*RESULT@#(1) ASSR threshold: Compared each frequency threshold in ASSR test with cochlear.lesion group, the retrocochlear lesion group with wave V and wave I had no significant difference in 500 Hz and 1000 Hz but had significant difference in 2000 Hz and 4000 Hz. As for the retrocochlear lesion group without wave V and wave I, there was a decline in 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz compared with cochlear lesion group. (1) ASSR elicit rate: When compared to retrocochlear lesion group, the cochlear lesion group had a significance lower elicit rate in the four frequency. (3) Number of elicit reactions in ASSR test . In the retrocochlear lesion group, the elicit reactions in all the four frequency in ASSR test was significantly higher than ochlear lesion group. (4) ASSR audiogram type. The proportion of rising curve audiogram in retrocochlear lesion group was 26.83% (with wave I and wave V), 40% (with wave I and without wave V ) and 33.80% (without wave I and wave V).@*CONCLUTION@#(1) Children with a severe hearing loss in ABR test and a rise type audiogram in ASSR test should be most possibly considered as retrocochlear lesion. (2) ASSR threshold cannot be used in determinate the severity of hearing loss in children with retrocochlear lesion.

Clinical analysis of labyrinthine fistula caused by choleseatoma otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical features of labyrinthine fistula and obtain the diagnosis, treatment and prognosis of different types of fistula.@*METHOD@#A retrospective analysis of 42 cases (43 ears) with labyrinthine fistula in our hospital from January 2007 to November 2014 was conducted. Data of preoperative clinical manifestation, auditory function, CT image, operative findings, treatment and postoperative recovery were collected and statistically analysed.@*RESULT@#Thirty-nine cases (40 ears) of the 42 cases (43 ears) which were diagnosed as labyrinthine fistula according to operative findings occurred in the lateral semicircular canal, 1 case occurred in the posterior semicircular canal, 1 case occurred in the superior semicircular canal, and 1 case occurred both in lateral and posterior semicircular canal. Before operation, 24 ears (55.8% ) experienced vertigo and 14 ears (32.6%) showed impaired bone conduction hearing threshold. According to Dornhoffer classification standard, 22 cases (23 ears) were diagnosed as type I fistula, 9 cases as type II fistula and 11 cases as type III fistula. There was no statistical difference among the 3 groups on type of hearing loss, vertigo, CT, facial nerve canal damage before operation and bone conduction hearing threshold, vertigo after operation.@*CONCLUSION@#An accurate diagnosis of labyrinthine fistula relies on the operative findings rather than preoperative clinical manifestation, auditory function or CT The surgical intervention should be individualized. There is no significant difference on postoperative recovery among different types of labyrinthine fistula.

Avaliação e tratamento da Vertigem Postural Paroxística Benigna: o que tem sido realizado nos últimos anos / Assessment and treatment of Benign Positional Paroxysmal Vertigo: what has been done in recent years / Evaluación y tratamiento del Vértigo Posicional Paroxístico Benigno: qué se hahecho en los últimos años

A Vertigem Postural Paroxística benigna é uma afecção do sistema vestibular periférico, caracterizada por crise vertiginosa súbita, de curta duração, desencadeada por movimentações cefálicas em diferentes posições. Levando em consideração o grande número de pacientes com essa fisiopatologia, o presente estudo objetivou apresentar uma revisão da literatura sobre esse assunto. O levantamento bibliográfico foi conduzido nas bases de dados LILACS, Medline e SciELO, focando-se nos artigos científicos publicados entre os anos de 2004 e 2014. Verificou-se nesta revisão que estudos sobre a Vertigem Postural Paroxística Benigna foram realizados nos últimos anos, abordando os métodos de avaliação e tratamento. Foi possível observar que o acometimento dos canais laterais ou de mais de um canal, assim como a vertigem postural positiva subjetiva e as orientações ao paciente, precisam ser mais explorados.

Benign Paroxysmal Positional Vertigo is a disorder of the peripheral vestibular system, characterized by sudden vertigo of short duration, triggered by head movements in different positions. Taking into consideration the large number of patients with this pathophysiology, the present study aimed to present a review of the literature on this subject. The literature survey was conducted in LILACS, Medline and SciELO databases, focusing on the scientific papers published between 2004 and 2014. It was found in this review that studies on Benign Paroxysmal Positional Vertigo have been made in recent years, addressing the methods of evaluation and treatment. It was observed that the onset of side canals or more than one canal, as well as the positive subjective postural vertigo, and instructing the patient, need to be further explored.

El vértigo posicional paroxístico benigno es un trastorno del sistema vestibular periférico, que se caracteriza por crisis vertiginosa súbita, de corta duración, provocada por movimientos de la cabeza en diferentes posiciones. Teniendo en cuenta el gran número de pacientes con esta fisiopatología, el presente estudio tuvo como objetivo presentar una revisión de la literatura sobre este tema. El estudio de la literatura se realizó en las bases de datos LILACS, Medline y SciELO, centrándose en los trabajos científicos publicados entre 2004 y 2014. Se encontró en esta revisión que estudios sobre el Vértigo Posicional Paroxístico Benigno se han hecho en los últimos años, con foco en los métodos de evaluación y tratamiento. Se observó que la acometida de los canales secundarios o de más de un canal, así como el vértigo postural positivo subjetivo, e las instrucciones al paciente, necesitan ser mas explorados.