Sonovestibular symptoms evaluated by computed dynamic posturography.

The investigation of stability under bilateral acoustic stimulation was undertaken in an attempt to mimic the real-life conditions of noisy environment (e.g., industry, aviation). The Tullio phenomenon evaluated by computed dynamic posturography (CDP) under acoustic stimulation is reflected in postural unsteadiness, rather than in the classic nystagmus. With such a method, the dangerous effects of noise-induced instability can be assessed and prevented. Three groups of subjects were submitted. The first (group A) included 20 patients who complained of sonovestibular symptoms (i.e., Tullio phenomenon) on the background of an inner-ear disease. The second group (B) included 20 neurootological patients without a history of Tullio phenomenon. Group C consisted of 20 patients with normal hearing, as controls. A pure-tone stimulus of 1,000 Hz at 110 dB was delivered binaurally for 20 seconds during condition 5 and condition 6 of the CDP sensory organization test. The sequence of six sensory organization conditions was performed three times with two intermissions of 15-20 minutes between the trials. The first was performed in the regular mode (quiet stance). This was followed 20 minutes by a trial carried out in quiet stance in sensory organizations tests (SOTs) 1 through 4, and with acoustic stimulation in SOT 5 and SOT 6. The last test was performed in quiet stance throughout (identical to the first trial). A significant drop in the composite equilibrium score was witnessed in group A patients upon acoustic stimulation (p < .0001). This imbalance did not disappear completely until 20 minutes later when the third sensory organization trial was performed. In fact, the composite score obtained on the last SOT was still significantly worse than the baseline. Group B and the normal subjects (group C) showed no significant change in composite score. As regards the vestibular ratio score, again, group A marked a drop on stimulation with sound (p < .004). This decrease contrasted once more with the other two groups. The leading sensory organization pattern was vestibular dysfunction (i.e., 40%, 10%, and 0% before acoustic stimulation in groups A, B, and C, respectively). The initial proportion of vestibular dysfunction increased on acoustic stimulation to 55% in group A, but this subsequently decreased in the third trial. The percentages of vestibular dysfunction remained constant during repeated trials in the other two groups. The positive medical history of sonovestibular symptoms was confirmed objectively by CDP with sound stimulation with a high statistical significance. This establishes the described method as a sensitive testing technique for validating the existence of the Tullio phenomenon in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and acute acoustic trauma. All patients who suffered phonic trauma, chronic exposure to noise (e.g., aviation employees, industry and army personnel), or other neurootological disorders and who complain of sonovestibular symptoms should be tested for the presence of the Tullio phenomenon. This should be carried out preferably by means of CDP with acoustic stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise.

Correlations between audiogram and objective hearing tests in sensorineural hearing loss.

Owing to its subjective nature, behavioral pure-tone audiometry often is an unreliable testing method in uncooperative subjects, and assessing the true hearing threshold becomes difficult. In such cases, objective tests are used for hearing-threshold determination (i.e., auditory brainstem evoked potentials [ABEP] and frequency-specific auditory evoked potentials: slow negative response at 10 msec [SN-10]). The purpose of this study was to evaluate the correlation between pure-tone audiogram shape and the predictive accuracy of SN-10 and ABEP in normal controls and in patients suffering from sensorineural hearing loss (SNHL). One-hundred-and-fifty subjects aged 15 to 70, some with normal hearing and the remainder with SNHL, were tested prospectively in a double-blind design. The battery of tests included pure-tone audiometry (air and bone conduction), speech reception threshold, ABEP, and SN-10. Patients with SNHL were divided into four categories according to audiogram shape (i.e., flat, ascending, descending, and all other shapes). The results showed that ABEP predicts behavioral thresholds at 3 kHz and 4 kHz in cases of high-frequency hearing loss. Also demonstrated was that ABEP threshold estimation at 3 kHz was not affected significantly by audiogram contour. A good correlation was observed between SN-10 and psychoacoustic thresholds at 1 kHz, the only exception being the group of subjects with ascending audiogram, in which SN-10 overestimated the hearing threshold.

[Local treatment of purulent chronic otitis media with ciprofloxacin].

We evaluated the efficacy of ciprofloxacin eardrops compared to tobramycin and to a placebo in the treatment of chronic suppurative otitis media. 60 ears were randomly assigned to treatment for 3 weeks with ciprofloxacin, tobramycin or placebo eardrops. The organism most commonly isolated from the ear discharge was Pseudomonas aeruginosa. The clinical responses were 78.9% and 72.2%, respectively, in the ciprofloxacin and tobramycin groups, while it was only 41.2% in the placebo group. Treatment with ciprofloxacin eardrops seemed to be at least as efficient as treatment with tobramycin. Considering the lack of ototoxicity of ciprofloxacin, this treatment may be best for chronic otitis media.

Chronic otitis media treated topically with ciprofloxacin or tobramycin.

OBJECTIVE: To evaluate the efficacy of ciprofloxacin compared with tobramycin and placebo ear drops in the treatment of chronic suppurative otitis media without cholesteatoma. DESIGN: Sixty ears (in 51 patients) were randomly divided into 3 treatment groups: ciprofloxacin hydrochloride, tobramycin, and placebo interventions. SETTING: The otolaryngology department of a university teaching hospital. INTERVENTION: All ears were treated topically for 3 weeks. MAIN OUTCOME MEASURES: Each patient received a small, numbered bottle and was instructed to instill 5 drops 3 times daily for 3 weeks. The final clinical and bacteriologic assessment was made after 3 weeks. RESULTS: The organism most commonly isolated from the ear discharge was Pseudomonas aeruginosa. Its sensitivity to ciprofloxacin and tobramycin was 94.2% and 70.6%, respectively. The clinical response was 78.9%, 72.2%, and 41.2% in the ciprofloxacin, tobramycin, and placebo groups, respectively. The bacteriologic response rate was 66.7% for the ciprofloxacin and tobramycin groups and 20% for the placebo group. Treatment with ciprofloxacin ear drops seemed to be as effective as treatment with tobramycin. CONCLUSION: While the lack of ototoxicity of ciprofloxacin was not tested in our study, this treatment may be considered as a potential topical therapy for cases of chronic suppurative otitis media.

Pediatric and Geriatric Tinnitus.

The subject of tinnitus in the population extremes-children and the elderly-is ignored by the literature, probably because children do not complain of tinnitus spontaneously, whereas it is only one challenge among other major health problems in the elderly. A short review of the literature on this subject is presented. Presbytinnitus, defined as tinnitus that accompanies the progressive hearing loss of presbycusis is classified as: type 1 (normal aging affecting the cochlea), and type II (preexistent sensorineural hearing loss accompanied by multiple systemic complaints, especially of sensory ones). The incidence of tinnitus in presbycusis is 11%. Like in other age groups, there is no significant gender predilection in the prevalence of tinnitus, but a correlation was demonstrated between the severity of tinnitus and exposure to noise. Hypertension was associated with a lower incidence of tinnitus, as compared to normotension and hypotension. Several treatment modalities of geriatric tinnitus are reviewed: the superiority of the band-noise masker in patients with presbycusis, as compared to electrical promontory stimulation; amino-oxyacetic in presbycusis and Meniere's disease; zinc supplementation in marginally zinc-deficient elderly patients in improving sensorineural hearing loss and tinnitus; aeration of the middle ear in presbycusis caused by secretory otitis media. Pediatric tinnitus has an incidence of 13% in children who passed an audiometric screening test, and 23-60% in those with hearing loss, 44% in secretory otitis media, but only 3% complain spontaneously because that the child considers tinnitus to be a normal event. There is no significant difference between children with tinnitus and those without in terms of hearing level, age, gender, or etiology of the deafness. Despite the fact that often children do not mention it, tinnitus may incite behavioral problems.

Brainstem auditory evoked potentials with increased stimulus rate in patients suffering from systemic lupus erythematosus.

Central nervous system involvement in systemic lupus erythematosus is frequently occult, may be the presenting sign, and is a bad prognostic indicator. At present, there is no reliable, sensitive laboratory test for the evaluation and diagnosis of subclinical central nervous system involvement of the disease. Brainstem auditory evoked potentials with and without increased stimulus rate have been used to diagnose ischemic lesions in the central nervous system. Brainstem auditory evoked potentials, with and without increased stimulus rate, was used to investigate 15 systemic lupus erythematosus patients, 20 normal participants, and 5 patients receiving corticosteroids for bronchial asthma. A significant statistical difference was found in the net effect of increased stimulus rate in comparisons of the systemic lupus erythematosus patients with the normal group. Brainstem auditory evoked potentials, with increased stimulus rate, demonstrated subclinical involvement of the central nervous system in systemic lupus erythematosus, reinforcing the notion that increased stimulus rate measures are sensitive to ischemic changes, in this case, even in neurologically asymptomatic patients.

Magnesium suppression of early afterdepolarizations and ventricular tachyarrhythmias induced by cesium in dogs.

The mechanism by which magnesium therapy suppresses some ventricular tachyarrhythmias characterized by a prolonged QT interval (e.g., torsades de pointes) is unknown. Since early afterdepolarizations have been proposed as a cause of the long QT syndrome and the related ventricular tachyarrhythmias, we hypothesized that magnesium therapy would suppress both the early afterdepolarizations and the ventricular arrhythmias. The present study was performed to test that hypothesis. Using monophasic action potentials (MAP) recorded with a contact electrode from the right ventricular endocardium to demonstrate early afterdepolarizations, cesium chloride (168 mg/kg iv) was administered before, during, and 1 to 2 hr after discontinuation of a magnesium infusion (1 to 2 mg/kg/min for 20 to 30 min). Before magnesium infusion, cesium induced early afterdepolarizations that were 49.7 +/- 1.6% (mean +/- SE) of the amplitude of the corresponding monophasic action potential. The amplitude of the early afterdepolarization decreased to 31.2 +/- 3.8% of the MAP amplitude during magnesium infusion (p less than .003) and increased to 48.0 +/- 4.0% 1 to 2 hr after termination of the magnesium infusion (p less than .003). Cesium induced sustained monomorphic ventricular tachycardia, torsades de pointes, or ventricular fibrillation in 12 of 13 dogs before magnesium infusion, and in eight of 11 dogs 1 to 2 hr after stopping infusion, but in only three of 13 dogs during magnesium infusion. Cesium prolonged the corrected QT interval from 338 +/- 16 msec (control) to 387 +/- 14 msec before (p less than .003), 356 +/- 12 msec during (p less than .003), and 406 +/- 16 msec after stopping the magnesium infusion (p less than .003).(ABSTRACT TRUNCATED AT 250 WORDS)