Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease with unknown etiology. Although sacroiliac joint involvement is the classic sign along with the formed immune mediators, it may result in immune-mediated inner ear disease and may cause damage to the audiovestibular system. Vestibular evoked myogenic potentials (VEMP) is a clinical reflex test used in the diagnosis of vestibular diseases and is performed by recording and evaluating the muscle potentials resulting from the stimulation of the vestibular system with different stimuli. The aim of this study is to evaluate the cervical VEMP test results in AS patients without vestibular symptoms. Thirty-three patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. VEMP wave latency, P13-N23 wave amplitude, and VEMP asymmetry ratio (VAR) values were compared between the groups. The relationship between clinical and laboratory findings of the AS patients and VEMP data were also investigated. Compared with healthy people, this study shows the response rate of patients with ankylosing spondylitis was reduced in the VEMP test, and P13-N23 wave amplitude showed a decrease in AS patients who had VEMP response (p < 0.001). There was no correlation between the clinical and laboratory findings and VEMP findings in patients with ankylosing spondylitis. The data obtained from this study suggest that AS may lead to decreased sensitivity of the vestibular system.

Unilateral ear fullness and temporary hearing loss diagnosed and successfully managed as a temporomandibular disorder: a case report.

BACKGROUND AND OVERVIEW: A 73-year-old woman had a 4-month history of debilitating left-sided otic fullness, hearing loss, and a watery sensation in her ear without obvious cause. She had consulted with an otolaryngologist who cleared the ear of all middle ear pathology and then placed ventilation tubes in the tympanic membrane to relieve her symptoms of ear fullness. The ventilation tubes did not produce long-lasting relief so she was referred to the dental clinic. CASE DESCRIPTION: The patient did not have substantial symptoms of jaw dysfunction or jaw pain and was clearly bothered more by her ear symptoms; she exhibited the following signs and symptoms: limited mandibular range of motion (37 millimeters), crepitation in the left temporomandibular joint (TMJ), active trigger points in the left superficial masseter, and severe pain on palpation in the left TMJ (lateral and dorsal). A panoramic radiograph and maxillary computed tomography scan revealed moderate degenerative changes observed bilaterally in the TMJs. A diagnosis of localized osteoarthritis (OA) of the TMJ (TMJ-OA) and masticatory myofascial pain was given. The authors provided 3 months of treatment that included self-applied physical therapy (stretch and thermal packs), full-arch stabilization splint, trigger point injection, and a TMJ injection using triamcinolone acetonide (20 milligrams). RESULTS: The patient reported a 90% improvement in her TMJ and ear-related symptoms as a result of the treatments. The authors speculated that TMJ-OA and myofascial muscle disorders are potentially contributory to a tensor tympani muscle dysfunction, which could explain her ear fullness and hypoacusis. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Diagnosis and management of TMJ dysfunction (pain on palpation, OA, and limitation of motion) should be considered when patients have symptoms of unexplained ear fullness and have been cleared for ear infection or other ear-related pathology.

Omega-3 fatty acids: a promising possible treatment for Meniere's disease and other inner ear disorders of unknown origin?

A consolidated therapy for "idiopathic" acute disorders of the inner ear, including Meniere's Disease (MD), does not exist despite the long-lasting and widespread attempts: this lack is strictly linked to pathogenic uncertainties. According to the theoretical model that our group developed and tested over the years, a possible cause of labyrinthine damage could be identified in systemic hemodynamic changes followed by an abnormal peripheral vasoconstriction: the latter could be responsible for a more or less prolonged ischemia able to threaten a highly energy-requiring and complicated organ as the inner ear. A possible way to treat MD attacks - as well as other inner ear disorders that possibly share the same origin - according to our model should be addressed to modulate the peripheral circulation and to maintain the balance of ion exchange, acting both on systemic hemodynamics and on cell and organelle membranes. Despite the absence of such a proposal in the English literature, a reliable solution could derive from the supplementation of the intake of a nutritional principle as Omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) that seem to theoretically fulfil all the requirements necessary to achieve a homeostasis of the inner ear.

Management of patient with Cogan's syndrome: a case report.

INTRODUCTION: Cogan syndrome-CS, is a rare autoimmune disease defined as an inflammation of the eyes followed by bilateral audiovestibular symptoms. CASE PRESENTATION: This is case report of S. A. male, born on April 18th 1986 from Elbasan, presented with the gastrointestinal, audiovestibulary and eyes disorders, weight loss and progressive fatigue. CT-scan showed an inflammation in lymph nodes in the right lower quadrant of his abdomen. MRI examination showed inner ear inflammation. Ophthalmologic examination revealed that patient was very sensitive to light and visual acuity was lowing 5/10 LE and 6/10 RE, a slit-lamp examination ascertained the interstitial keratitis, iritis and conjunctivitis. CONCLUSION: Considering all diseases manifestations, the results of all examinations, a diagnose of CS was finally made. The treatment with steroids and immunosupresors showed an improvement of diseases but hearing loss was not reversed.

Assessment of changes in cochlear function with pneumolabyrinth after middle ear trauma.

OBJECTIVE: To describe a case of pneumolabyrinth secondary to tympanic membrane/ossicular trauma and the subsequent recovery of sensorineural hearing loss managed with conservative measures. PATIENTS: A 15-year-old boy presented to an outside hospital with signs and symptoms of acute hearing loss, vertigo, and tinnitus after penetrating injury to his right tympanic membrane. In addition, computed tomography demonstrated air density within the vestibule. INTERVENTIONS: The patient was managed conservatively with bed rest, avoidance of straining, corticosteroids, and antibiotics. MAIN OUTCOME MEASURES: Computed tomography, audiologic testing. RESULTS: Patient recovered near-normal hearing subjectively. There was closure of the air-bone gap (

Embolic inner ear decompression illness: correlation with a right-to-left shunt.

OBJECTIVES/HYPOTHESIS: Inner ear decompression illness is thought to be a rare phenomenon in recreational divers, isolated signs and symptoms of inner ear dysfunction usually being attributed to inner ear barotrauma. STUDY DESIGN: We present 11 cases of inner ear dysfunction in nine divers with inner ear decompression illness. RESULTS: All nine divers had significant right-to-left shunt as diagnosed by transcranial Doppler sonography. CONCLUSIONS: The authors thought that mechanism of causation in these cases may have been intravascular bubble emboli and that inner ear decompression illness may be more common among recreational divers than currently recognized. Failure to treat inner ear decompression illness with recompression therapy can result in permanent disability. Because the differential diagnosis between inner ear barotrauma and inner ear decompression illness can be impossible, the authors suggested that divers who present with inner ear symptoms following a dive should have recompression immediately after having undergone bilateral paracentesis.

Inner ear decompression sickness in sport compressed-air diving.

OBJECTIVE: We report our experience over the past 12 years with recreational diving-related inner ear decompression sickness (IEDCS). STUDY DESIGN: Retrospective, consecutive case series. METHODS: Twenty-four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow-up. RESULTS: These 29 cases represent 26% of the severe decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the decompression schedule. The mean time from surfacing to appearance of symptoms was 47 +/- 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo-cochlear injury. Except for one patient who had central as well as peripheral vestibulo-cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty-six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05). CONCLUSIONS: IEDCS related to compressed-air recreational diving is more common than previously thought, and might occur even when no decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.

A substrain of NZB mouse as an animal model of autoimmune inner ear disease.

A substrain of an autoimmune-prone mouse, NZB/kl, was found to show spontaneous elevation of the auditory brainstem response (ABR) threshold with age. Morphological examination of the inner ear in NZB/kl mice with high ABR thresholds revealed pathological changes confined to the stria vascularis, including marked thickening of the capillary basement membrane which contained many foamy structures, and vacuolar degeneration of the intermediate cells. Circular or granular IgM deposits and some IgG deposits were found in the stria vascularis in the mice with high ABR thresholds, suggesting that deposits of immune complexes (mainly IgM antibodies) could cause strial damage that resulted in the ABR threshold elevation. Another substrain of NZB mice, NZB/san, showed lower levels of IgM immune complexes and anti-ss DNA antibodies, and did not develop either inner ear morphological changes or a high ABR threshold. NZB/kl mice may provide a useful animal model for studying the mechanism of autoimmune inner ear disease.

Chronic perilymph fistula in the guinea pig with implications in the human.

To improve understanding of the pathophysiology of perilymph fistulas, a predictable animal model of a chronic fistula was developed. Our findings suggest that guinea pig fistulas do not remain patent for prolonged periods. By extrapolating these findings to humans, we postulate that the symptoms and signs of perilymph fistula are possibly due not to one prolonged constant fistula, but rather a series of "blowouts" from an inherent congenital or posttraumatic weak spot in either the round or oval window. We feel that a diagnosis of perilymph fistula must be considered in any patient presenting with a Meniere's-like symptom set concomitant with a congenital inner ear deformity or a history of inner ear trauma.

[Neuropharmacology of the autonomic vestibular syndrome]. / Neirofarmakologiia vestibulovegetativnogo sindroma.

It was found during studies on man and experiments on animals that various neuromediator systems of the organism (M-cholinergic, H1-histaminergic, dopaminergic, and opioidergic) are involved in the genesis of VVS. In addition, animal experiments showed that of great importance in the process are different regulatory peptides, in particular, substance P and beta-endorphin. The findings indicate that some neuropeptides may be used in the future in man for VVS prevention. At neuronal level the role of opioid peptides in realization of vestibulovegetative reactions is decoded and a number of possible mechanisms of their action is established. The study of the human hormonal status in VVS revealed complex neuroendocrine changes occurring in the organism. Based on the knowledge of some neurohormonal and neurochemical mechanisms of VVS pathogenesis, a new drug prevention and therapy of seasickness was proposed, efficacy of opioid antagonists naloxone and nalorphine was shown.

Auditory evoked potential alterations induced by pulsed ultrasound.

Diagnostic levels of pulsed ultrasound were applied abdominally over the uteri of pregnant rats for five minutes daily during the first 20 days of gestation. The average energy output of the ultrasound machine at the optimum focal length of the transducer (5.4 cm) was 7.2 mW/sq cm. Postnatal auditory evoked potentials demonstrated a significant alteration in the offspring of the treated animals when compared with similarly treated, but nonexposed controls. This alteration only occurred in the high frequency range. Neither light nor electron microscopy revealed significant morphologic alterations in the cochlear elements of the exposed offspring. Although a cochlear deficit occurred in a range known to be important to the rat's hearing, several issues make this data reassuring to clinicians using diagnostic levels of pulsed ultrasound: the total amount of ultrasound exposure was higher than would be expected with human use, the defect was mild, and the absence of clear-cut morphologic abnormalities may indicate the presence of a minimal, or even reversible, defect.