Role of impacted cerumen in hearing loss.

We performed a study to determine if cerumen in the ear canal causes significant hearing loss and to ascertain if there is any correlation between the amount of cerumen and the degree of hearing loss. Our study was conducted on 109 ears in 80 patients. The results indicated that impacted cerumen does cause a significant degree of conductive hearing loss. We found no significant correlation between the length of the cerumen plug and the severity of hearing loss. Nor did we find any significant correlation between the presence of impacted cerumen and variables such as age, sex, ethnicity, or affected side.

Liver-directed neonatal gene therapy prevents cardiac, bone, ear, and eye disease in mucopolysaccharidosis I mice.

Mucopolysaccharidosis I (MPS I) due to deficient alpha-L-iduronidase (IDUA) activity results in accumulation of glycosaminoglycans in many cells. Gene therapy could program liver to secrete enzyme with mannose 6-phosphate (M6P), and enzyme in blood could be taken up by other cells via the M6P receptor. Newborn MPS I mice were injected with 10(9) (high dose) or 10(8) (low dose) transducing units/kg of a retroviral vector (RV) expressing canine IDUA. Most animals achieved stable expression of IDUA in serum at 1240 +/- 147 and 110 +/- 31 units/ml, respectively. At 8 months, untreated MPS I mice had aortic insufficiency, increased bone mineral density (BMD), and reduced responses to sound and light. In contrast, MPS I mice that received high-dose RV had normal echocardiograms, BMD, auditory-evoked brain-stem responses, and electroretinograms. This is the first report of complete correction of these clinical manifestations in any model of mucopolysaccharidosis. Biochemical and pathologic evaluation confirmed that storage was reduced in these organs. Mice that received low-dose RV and achieved 30 units/ml of serum IDUA activity had no or only partial improvement. We conclude that high-dose neonatal gene therapy with an RV reduces some major clinical manifestations of MPS I in mice, but low dose is less effective.

Sintomas otoneurológicos: investigaçäo por meio de um questionário / Otoneurologic symptoms: investigation by means of a questionaire

Muitos autores ressaltam a importância da aplicaçäo de um questionário que resuma as manifestaçöes clínicas de pacientes com queixas otoneurológicas e auxilie na definiçäo da hipótese diagnóstica da doença. O objetivo do presente estudo é realizar um levantamento, utilizando uma anamnese abrangente, sobre os sinais e sintomas direta ou indiretamente relacionados com os distúrbios otoneurológicos em pacientes que seriam submetidos ao exame vestibular. Avaliamos 300 questionários contendo perguntas sobre tontura, perda auditiva, zumbido, outros sintomas associados, antecedentes pessoais e familiares. A faixa etária dos pacientes variou de 6 a 83 anos de idade; 199 neram do sexo feminino e 101 do sexo masculino. O levantamento mostrou que os sintomas com maior prevalência foram zumbido, tonturas, perda auditiva, dor de cabeça, náuseas, desiquilíbrio à marcha, instabilidade, escurecimento da visäo. A aplicaçäo de um questionário mais acurado auxiliou para estabelecer o diagnóstico sindrômico, topográfico e etiológico, dos quadros clínicos otoneurológicos.

[Combined drug therapy in patients with chronic otitis media and mucositis]. / Kompleksnaia konservativnaia terapiia bol'nykh khronicheskim srednim otitom s mukozitom.

The data of the authors own studies using conservative therapy in patients with chronic otitis media (COM) and mucositis are presented. The efficiency of treatment of these patients is shown depending on the method of treatment (the highest efficiency being noted in the main group of patients in whom the altered middle ear mucosa was concurrently exposed to autoserum (AS) and magnetic laser therapy (MLT). The efficiency of this or that conservative treatment was found to be related to the magnitude of altered middle ear mucosal changes: the more marked the signs of mucositis are, the more difficult it is to achieve a positive result. The results of treatment were assessed visually (under an operating microscope), bacteriologically, cytologically, and crystallographically. There was a correlation between the visual assessment of obtained treatment results and crystallographic findings. The high efficiency of the proposed treatment in patients with COM and mucositis is determined by the concurrent combined AS and MLT exposure of the entire thickness of the changed mucosa and by the stimulating action of MLT on AS. This conservative therapy can pretend to be the method of choice in treating patients with COM and mucositis.

Troy, Mycenae, and the otologic demise of Herr Heinrich Schliemann.

Heinrich Schliemann (1822-1890) was a self-made man with a remarkable aptitude for language and an excellent business mind. He was also the founder of Aegean archeology, providing a factual base for the writings of Homer, which until then had been considered merely a collection of mythologic poems. During his life, Schliemann suffered from ear trouble, ultimately dying from an otogenic temporal lobe brain abscess. He consulted many of the most famous 19th century otologists and was eventually operated on by the famous Professor Schwartze. We present the life and death of arguably the most famous man of his day as drawn from a number of biographic sources and speculate on the ear pathology that ultimately lead to his demise.

Medical management of migraine-related dizziness and vertigo.

Historically, review of migraine-related vestibular symptoms has focused on the various clinical presentations that occur and the results of diagnostic studies of vestibular function. Treatment of vestibular symptoms related to migraine has been proposed similar to that used for headache control, but few examples of the effectiveness of this therapy have been published. The purpose of this study is to present the various approaches that can be used to manage vestibular symptoms related to migraine, and to evaluate the overall effectiveness of these treatment approaches. This was a retrospective review of 89 patients diagnosed with migraine-related dizziness and vertigo. The character of vestibular symptoms, pattern of cochlear symptoms, results of auditory and vestibular tests, and comorbidity factors are presented. Treatment was individualized according to symptoms and comorbidity factors, and analyzed regarding effectiveness in control of the major vestibular symptoms of episodic vertigo, positional vertigo, and nonvertiginous dizziness. Medical management included dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture. Complete or substantial control of vestibular symptoms was achieved in 68 (92%) of 74 patients complaining of episodic vertigo; in 56 (89%) of 63 patients with positional vertigo; and 56 (86%) of 65 patients with non-vertiginous dizziness. Similarly, aural fullness was completely resolved or substantially improved in 34 (85%) of 40 patients; ear pain in 10 (63%) of 16 patients; and phonophobia in 17 (89%) of 19 patients. No patient reported worsened symptoms following medical management. The conflicting concept of a central disorder (migraine) as the cause of cochlear and vestibular dysfunction that often has peripheral features is discussed.

The operation and death of Henry Schliemann.

Henry Schliemann's reputation as an archeologist, a linquist, a financial genius and a scholar is seldom recognized by Americans. His discovery of the ruins of Troy changed Homeric myths and legends into history and made him the founder of Aegean archeology. Recent popular books on Schliemann sketchily describe him otologic problems which eventually led to his death of an otogenic brain abscess. From a number of bibliographic sources, the details of Schliemann's ear history and the final months of his illness are recounted. The important information of Schliemann's ear operation by the famous Professor Swartze is presented.