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1.
Otolaryngol Head Neck Surg ; 162(5): 709-717, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32041493

RESUMO

OBJECTIVES: The goal of the study was to determine whether reactive oxygen species (ROS) mediates cytomegalovirus (CMV)-induced labyrinthitis. STUDY DESIGN: Murine model of CMV infection. SETTING: University of Utah laboratory. SUBJECTS AND METHODS: Nrf2 knockout mice were inoculated with murine CMV. Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) were then performed on these and uninfected controls. BALB/c mice were inoculated with murine CMV to determine whether a marker for ROS production, dihydroethidium (DHE), is expressed 7 days after inoculation. Finally, 2 antioxidants-D-methionine and ACE-Mg (vitamins A, C, and E with magnesium)-were administered 1 hour before and after infection in inoculated mice for 14 days. Temporal bones were harvested at postnatal day 10 for DHE detection. ABR and DPOAE testing was done at postnatal day 30. Scanning electron microscopy was also performed at postnatal day 30 to evaluate outer hair cell integrity. RESULTS: Nrf2-infected mice had worse hearing than uninfected mice (P < .001). A statistically significant increase in DHE fluorescence was detected in BALB/c-infected mice as compared with uninfected mice 7 days after inoculation. D-methionine- and ACE-Mg-treated mice demonstrated an attenuation of the DHE fluorescence and a significant improvement in ABR and DPOAE thresholds when compared with untreated infected controls (P < .0001). Scanning electron microscopy demonstrated less outer hair cell loss in the treated versus untreated infected controls. CONCLUSION: These results demonstrate for the first time that excessive ROS mediates CMV-induced hearing loss in a mouse model.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/metabolismo , Radicais Livres/metabolismo , Labirintite/metabolismo , Labirintite/virologia , Espécies Reativas de Oxigênio/farmacologia , Animais , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos BALB C , Microscopia Eletrônica de Varredura , Emissões Otoacústicas Espontâneas
2.
Otolaryngol Head Neck Surg ; 161(4): 658-665, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31060442

RESUMO

OBJECTIVE: Human otopathology following drill-out procedures for cochlear implantation (CI) in cases with labyrinthitis ossificans (LO) has not been previously described. This study uses the high sensitivity of histopathology to (1) evaluate surgical drill-out technique with associated intracochlear findings and (2) quantify spiral ganglion neuron populations in a series of patients with LO who underwent CI. STUDY DESIGN: Retrospective otopathology study. SETTING: Otopathology laboratory. SUBJECTS AND METHODS: Temporal bone (TB) specimens from cases with evidence of preoperative intracochlear fibroossification that required a drill-out procedure for CI electrode array insertion were included. All cases were histopathologically evaluated and 3-dimensional reconstructions of the cochleae were performed to interpret drilling paths and electrode trajectories. RESULTS: Five TB specimens were identified, of which 4 underwent drill-out of the basal turn of the cochlea and 1 underwent a radical cochlear drill-out. In multiple TBs, drilling was imprecise with resultant damage to essential structures. Two TBs showed injury to the modiolus, which was associated with substantially decreased or even absent neuronal populations within these areas. In addition, 2 cases with inadequate drill-out or extensive LO of the basal turn resulted in extracochlear placement of electrode arrays into the vestibule due to persistent obstruction within the basal turn. CONCLUSION: Otopathology highlights the challenges of drill-out procedures in cases of LO. Imprecise drilling paths, due to distortion of normal cochlear anatomy, risk injury to the modiolus and adjacent neurons as well as extracochlear placement of electrode arrays, both of which may contribute to poorer hearing outcomes.


Assuntos
Cóclea/patologia , Implante Coclear/efeitos adversos , Labirintite/cirurgia , Osso Temporal/patologia , Idoso de 80 Anos ou mais , Criança , Cóclea/anatomia & histologia , Cóclea/cirurgia , Implante Coclear/métodos , Perda Auditiva Neurossensorial/cirurgia , Humanos , Labirintite/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Gânglio Espiral da Cóclea/patologia , Osso Temporal/cirurgia , Resultado do Tratamento
3.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036742

RESUMO

Foreign bodies are commonly seen by the Ear, Nose and Throat emergency team with cotton wool being the most common aural foreign body seen in the adult population. Most complications secondary to aural foreign bodies described in the literature are minor and rarely require any surgical intervention. Here, we present two cases with impacted cotton wool as aural foreign bodies which resulted in suppurative labyrinthitis and osteomyelitis causing profound sensorineural hearing. These cases highlight the importance of considering aural foreign bodies in the differential diagnosis in those presenting with unilateral symptoms as significant complications, although rare, can occur, particularly in those with delayed diagnosis.


Assuntos
Meato Acústico Externo/microbiologia , Otopatias/microbiologia , Corpos Estranhos/complicações , Perda Auditiva Neurossensorial/etiologia , Otite Média Supurativa/diagnóstico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Meato Acústico Externo/patologia , Otopatias/tratamento farmacológico , Otopatias/patologia , Otopatias/cirurgia , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/tratamento farmacológico , Corpos Estranhos/cirurgia , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Labirintite/microbiologia , Imagem por Ressonância Magnética/métodos , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/patologia , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/etiologia , Otite Média Supurativa/etiologia , Resultado do Tratamento
4.
Otol Neurotol ; 40(4): e393-e398, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870366

RESUMO

OBJECTIVE: To demonstrate characteristic nystagmus findings in acute otitis media (AOM) complicated by serous labyrinthitis and discuss the mechanism of direction-changing positional nystagmus (DCPN) in this condition. PATIENTS: A patient with AOM complicated by serous labyrinthitis on the left side. INTERVENTION: Video nystagmography and 3D fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). MAIN OUTCOME MEASURES: Characterize positional nystagmus in a head-roll test observing the change of nystagmus direction in process of time and compare findings of temporal bone 3D FLAIR MRI. RESULTS: A previously healthy 50-year-old man who complained of acute otalgia, hearing loss, and vertigo was diagnosed with AOM complicated by serous labyrinthitis on the left side. A head-roll test performed on the day when vertigo developed showed persistent geotropic DCPN. While pre- and postcontrast T1-weighted MRI showed no signal abnormality in both inner ears, 10-minute delay postcontrast 3D FLAIR image showed enhancement in the inner ear on the left side. Four-hour-delay postcontrast 3D FLAIR images showed more conspicuous enhancement of the whole cochlea, vestibule, and semicircular canals on the left side. CONCLUSIONS: In AOM complicated by serous labyrinthitis, density of perilymph may increase due to direct penetration of cytokines and other inflammatory mediators from the middle ear into perilymph and breakdown of blood-labyrinth barrier that causes vascular leakage of serum albumin into perilymph. The density difference between perilymph and endolymph makes the semicircular canal gravity sensitive. A buoyant force is also generated by gravity, causing indentation of endolymphatic membrane in the ampulla and cupula displacement. Thus, at the early stage of serous labyrinthitis, a head-roll test may elicit persistent geotropic DCPN, of which the direction can be changed over time.


Assuntos
Labirintite/complicações , Labirintite/patologia , Nistagmo Patológico/patologia , Otite Média/complicações , Otite Média/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/etiologia , Nistagmo Fisiológico/fisiologia , Testes de Função Vestibular
5.
Cell Host Microbe ; 25(4): 513-525.e6, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30905438

RESUMO

In the inner ear, endolymph fluid surrounds the organ of Corti, which is important for auditory function; notably, even slight environmental changes mediated by trauma or infection can have significant consequences. However, it is unclear how the immune response is modulated in these tissues. Here, we report the local immune surveillance role of cleaved cochlin LCCL (Limulus factor C, Cochlin, and Lgl1) during Pseudomonas aeruginosa infection in the cochlea. Upon infection, the LCCL domain is cleaved from cochlin and secreted into the perilymph. This cleaved fragment sequesters infiltrating bacteria in the scala tympani and subsequently recruits resident immune cells to eliminate the bacteria. Importantly, hearing loss in a cochlin knockout mouse model is remedied by treatment with a cochlin LCCL peptide. These findings suggest cleaved cochlin LCCL constitutes a critical factor in innate immunity and auditory function and may be a potential therapeutic target to treat chronic otitis media-induced hearing loss.


Assuntos
Orelha Interna/imunologia , Orelha Interna/microbiologia , Proteínas da Matriz Extracelular/metabolismo , Imunidade Inata , Labirintite/imunologia , Infecções por Pseudomonas/imunologia , Pseudomonas aeruginosa/imunologia , Animais , Aderência Bacteriana , Modelos Animais de Doenças , Labirintite/patologia , Camundongos , Camundongos Knockout , Infecções por Pseudomonas/patologia
6.
AJNR Am J Neuroradiol ; 40(3): 551-557, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30792250

RESUMO

BACKGROUND AND PURPOSE: Our aim was to identify whether specific patterns of ossification in labyrinthitis ossificans are associated with the known risk factors. Labyrinthitis ossificans has been described as sequela of prior temporal bone trauma, prior infection, and other disorders including sickle cell disease. Specific patterns of mineralization in the membranous labyrinth associated with these risk factors has not been previously described. MATERIALS AND METHODS: This was a retrospective study evaluating temporal bone CT scans at our institution from November 2005 to May 2018 in patients with labyrinthitis ossificans. Membranous labyrinthine structures evaluated for ossification included the following: basal, middle, and apical cochlear turns; lateral, posterior, and superior semicircular canals; and the vestibule for both ears in all patients. These structures were assigned a severity score, 0-4, based on degree of mineralization. Clinical records were reviewed for potential labyrinthitis ossificans risk factors. Basic descriptive statistics and a mixed model were used to correlate the degree and patterns of ossification with clinical history. RESULTS: Forty-four patients (58 ears) with labyrinthitis ossificans were identified and evaluated. The most common risk factors were chronic otomastoiditis (n = 18), temporal bone surgery (n = 9), temporal bone trauma (n = 6), sickle cell disease (n = 5), and meningitis (n = 4). For all etiologies, the semicircular canals were most severely affected, and the vestibule was the least. In patients with prior temporal bone surgery, significantly greater mineralization was seen in the basal turn of the cochlea (P = .027), the vestibule (P = .001), and semicircular canals (P < .001-.008). No significant pattern was identified in patients with meningitis, sickle cell disease, or trauma. CONCLUSIONS: Significant patterns of mineralization in labyrinthitis ossificans were observed in patients with prior temporal bone surgery. For all etiologies, the semicircular canals were most severely affected. No significant mineralization pattern was observed in patients with chronic otomastoiditis, meningitis, sickle cell disease, or prior temporal bone trauma.


Assuntos
Labirintite/patologia , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Labirintite/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Eur J Radiol ; 110: 74-80, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599877

RESUMO

Conductive hearing loss (CHL) commonly results from middle ear fluid and inflammation (otitis media). Less commonly in patients with CHL, the middle ear cleft is well aerated or 'dry' with absence of soft tissue or fluid clinically and on imaging. There are numerous causes for this but they can be clinically challenging to diagnose. This pictorial review aims to illustrate and discuss the CT features of both common and less common causes of CHL in patients with a "dry middle ear cavity".


Assuntos
Orelha Média/diagnóstico por imagem , Perda Auditiva Condutiva/etiologia , Adolescente , Adulto , Idoso , Ossículos da Orelha/anormalidades , Ossículos da Orelha/diagnóstico por imagem , Ossículos da Orelha/lesões , Feminino , Perda Auditiva Condutiva/diagnóstico por imagem , Humanos , Bigorna/anormalidades , Bigorna/diagnóstico por imagem , Labirintite/complicações , Labirintite/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Miringoesclerose/complicações , Miringoesclerose/diagnóstico por imagem , Otosclerose/complicações , Otosclerose/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Cirurgia do Estribo/efeitos adversos , Tomografia Computadorizada por Raios X , Membrana Timpânica/anormalidades
9.
Emerg Med Clin North Am ; 37(1): 1-9, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454772

RESUMO

Infections of the ear are a common presentation to an acute care environment. In this article, the authors aim to summarize the most common presentations, and diagnostic and treatment options for typical infections of the ear. This article is geared toward the emergency physician, urgent care provider, and primary care provider who will likely be the initial evaluating and treating provider to assist them in determining what treatment modalities can be managed in a clinic and what needs to be referred for admission or specialty consultation.


Assuntos
Otite/diagnóstico , Emergências , Humanos , Labirintite/diagnóstico , Labirintite/terapia , Otite/terapia , Otite Externa/diagnóstico , Otite Externa/terapia , Otite Média/diagnóstico , Otite Média/terapia
10.
Cochlear Implants Int ; 20(1): 47-50, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30232935

RESUMO

INTRODUCTION: Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin. Iron overload occurs in thalassemia, with blood transfusion therapy being the major cause. Deferoxamine continues to be the mainstay of therapy to remove excess iron in patients requiring long-term transfusions. One of the most important complications of deferoxamine therapy is neurosensory toxicity, including sensorineural hearing loss (SNHL). Labyrinthine hemmorhage (LH) is thought to result from altered capillary hemodynamics or reperfusion injury. It is theorized that LH incites a reparative response that cascades from fibrosis to sclerosis and ultimately ossification of the inner ear structures. CASE PRESENTATION: We present a case of 3-year-old thalassemic child with bilateral profound sensorineural hearing loss. Patient was on regular blood transfusions with chelation therapy. HRCT temporal bone and MRI brain and temporal bone had features of labyrinthitis ossificans (LO). Child underwent uniateral cochlear implantation and postimplantation speech perception and production outcomes were normal. DISCUSSION: This case illustrates the unique feature of labyrinthitis ossificans in a thalassemia patient which has not yet reported in the English literature. Hearing screening of all thalassemia patients and therefore early diagnosis of SNHL prompts early intervention and improved quality of life.


Assuntos
Implante Coclear , Perda Auditiva Neurossensorial/cirurgia , Quelantes de Ferro/efeitos adversos , Labirintite/cirurgia , Talassemia/tratamento farmacológico , Pré-Escolar , Perda Auditiva Neurossensorial/induzido quimicamente , Humanos , Labirintite/induzido quimicamente
11.
J Int Adv Otol ; 15(1): 156-159, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30541729

RESUMO

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting the small- and medium-sized arteries that may present with hearing impairment. In rare cases, PAN may be associated with progressive labyrinthitis ossificans (LO), an otologic emergency requiring early cochlear implantation (CI) to restore hearing before the complete, irreversible cochlear ossification. We report the first case in the literature of a patient affected by PAN with bilateral sudden sensorineural hearing loss and rapid LO who underwent "emergency" bilateral simultaneous CI. This case report emphasizes the importance of an early audiological evaluation in patients with PAN when LO is suspected. Multidisciplinary approach is mandatory when facing organ-specific manifestations in patients with PAN. Detailed discussion is provided with particular regard to clinical and radiological presentation as well as CI outcomes in such a rare and challenging case.


Assuntos
Cóclea/transplante , Labirintite/cirurgia , Poliarterite Nodosa/complicações , Cóclea/diagnóstico por imagem , Cóclea/patologia , Cóclea/cirurgia , Implante Coclear/métodos , Implantes Cocleares/normas , Feminino , Fibrose , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Labirintite/etiologia , Labirintite/patologia , Livedo Reticular/diagnóstico , Livedo Reticular/etiologia , Pessoa de Meia-Idade , Poliarterite Nodosa/patologia , Janela da Cóclea/patologia , Resultado do Tratamento , Vestíbulo do Labirinto/patologia , Vestíbulo do Labirinto/cirurgia
12.
Otol Neurotol ; 39(10): e992-e995, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30444844

RESUMO

OBJECTIVE: To describe and characterize facial nerve stimulation (FNS) patterns in patients with labyrinthitis ossificans who underwent cochlear implantation (CI) for sensorineural hearing loss. PATIENTS: Five ears in four patients with labyrinthitis ossificans who underwent CI and subsequently developed FNS. INTERVENTIONS: CI, electrode mapping, and/or explantation to resolve FNS. MAIN OUTCOME MEASURES: FNS, postoperative computed tomography imaging, and resolution of FNS. RESULTS: Fourteen ears with labyrinthitis ossificans underwent CI over an 11-year period at a single institution; 5 of these ears exhibited postoperative FNS (35.7% incidence). Four cases had involvement of basal electrodes, while all five cases had middle and/or apical electrode stimulation. All cases had resolution of FNS with CI reprogramming, however, the resultant map in two cases provided minimal audiologic benefit and patients became nonusers in that ear. CONCLUSIONS: FNS arising from all cochlear regions is possible in patients with labyrinthitis ossificans who undergo CI. Mapping and electrode deactivation can resolve symptoms, but resultant audiologic benefit is variable and may lead to explantation.


Assuntos
Implante Coclear/efeitos adversos , Nervo Facial , Labirintite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Pré-Escolar , Feminino , Perda Auditiva Neurossensorial/cirurgia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
13.
Otol Neurotol ; 39(8): 1005-1011, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30113560

RESUMO

OBJECTIVE: Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. STUDY DESIGN: Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. SETTING: Emergency Department. PATIENTS: Patients who presented with a primary diagnosis of AOM or acute mastoiditis. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. RESULTS: A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). CONCLUSIONS: ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.


Assuntos
Abscesso Encefálico/etiologia , Paralisia Facial/etiologia , Hospitalização , Labirintite/etiologia , Mastoidite/etiologia , Meningite/etiologia , Otite Média/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicare , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
14.
Otol Neurotol ; 39(8): 1045-1052, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30020263

RESUMO

OBJECTIVE: Distinguishing intralabyrinthine schwannoma (ILS) from labyrinthitis is crucial in deciding patient management between surgery and medication; however, the clinical and radiological differentiation between ILS and labyrinthitis is difficult, especially when labyrinthitis shows contrast-enhancement mimicking ILS on magnetic resonance imaging (MRI). This study aimed to evaluate the quantitative characteristics of signal intensity on 3T MRI for differentiating ILS from contrast-enhancing labyrinthitis (CEL). STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Between July 2003 and June 2017, 9 subjects diagnosed with ILS (16 MRI cases) and 9 subjects diagnosed with CEL (9 MRI cases) were enrolled in the study. MAIN OUTCOME MEASURES: Normalized signal intensity on contrast-enhanced T1-weighted image (nCE-T1), normalized signal intensity on T2-weighted image (nT2), and normalized signal intensity on contrast-enhanced fluid-attenuated inversion recovery image (nFLAIR) were measured and compared between ILS and CEL. The diagnostic performance of these values was assessed using receiver operating characteristic (ROC) analysis. RESULTS: In ILS, the nCE-T1 and the nT2 were significantly higher and lower, respectively, than in CEL (all, p < 0.05); and the nFLAIR did not significantly differ (p > 0.05). The maximal nCE-T1 achieved the highest area under the curve (AUC) in differentiating ILS and CEL, followed by the mean nCE-T1, the mean nT2, and the maximal nT2. Combination of the nCE-T1 and the nT2 showed higher AUC than the nCE-T1 alone, but without statistical significance (p = 0.340). CONCLUSIONS: Quantitative measurement of the signal intensity on MRI can be a viable imaging tool for differentiating ILS from CEL.


Assuntos
Neoplasias da Orelha/diagnóstico por imagem , Labirintite/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Am J Med ; 131(12): 1431-1437, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29859806

RESUMO

Dizziness is a common symptom encountered by all physicians. Dizziness and related symptoms are frequently linked to 1 or more of a list of contributors that includes benign paroxysmal positional vertigo, Ménière disease, migraine, acute peripheral vestibulopathy, cerebral ischemia, and anxiety disorders. Awareness of these common clinical patterns increases the likelihood of making a rapid, accurate diagnosis.


Assuntos
Tontura/diagnóstico , Tontura/etiologia , Vertigem Posicional Paroxística Benigna/diagnóstico , Humanos , Labirintite/diagnóstico , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/diagnóstico , Neuronite Vestibular/diagnóstico
16.
Acta Vet Scand ; 60(1): 31, 2018 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788991

RESUMO

BACKGROUND: An aural cholesteatoma, more appropriately named tympanokeratoma, is an epidermoid cyst of the middle ear described in several species, including dogs, humans and Mongolian gerbils. The cyst lining consists of stratified, keratinizing squamous epithelium with central accumulation of a keratin debris. This case report describes vestibular ganglioneuritis and perineuritis in a dog with chronic otitis, bilateral tympanokeratomas and presumed extension of otic infection to the central nervous system. CASE PRESENTATION: An 11-year-old intact male Dalmatian dog with chronic bilateral otitis externa and sudden development of symptoms of vestibular disease was examined. Due to the dog's old age the owner opted for euthanasia without any further examination or treatment and the dog was submitted for necropsy. Transection of the ears revealed grey soft material in the external ear canals and pearly white, dry material consistent with keratin in the tympanic bullae bilaterally. The brain and meninges were grossly unremarkable. Microscopical findings included bilateral otitis externa and media, unilateral otitis interna, ganglioneuritis and perineuritis of the spiral ganglion of the vestibulocochlear nerve and multifocal to coalescing, purulent meningitis. A keratinizing squamous epithelial layer continuous with the external acoustic meatus lined the middle ear compartments, consistent with bilateral tympanokeratomas. Focal bony erosion of the petrous portion of the temporal bone and squamous epithelium and Gram-positive bacterial cocci were evident in the left cochlea. The findings suggest that meningitis developed secondary to erosion of the temporal bone and ganglioneuritis and/or perineuritis of the vestibulocochlear nerve. CONCLUSIONS: Middle ear tympanokeratoma is an important and potentially life-threatening otic condition in the dog. Once a tympanokeratoma has developed expansion of the cyst can lead to erosion of bone and extension of otic infection to the inner ear, vestibulocochlear ganglion and nerve potentially leading to bacterial infection of the central nervous system.


Assuntos
Colesteatoma/veterinária , Doenças do Cão/diagnóstico , Labirintite/veterinária , Neurite (Inflamação)/veterinária , Otite Média/veterinária , Animais , Colesteatoma/diagnóstico , Colesteatoma/patologia , Doenças do Cão/patologia , Cães , Labirintite/diagnóstico , Labirintite/patologia , Masculino , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/patologia , Otite Média/diagnóstico , Otite Média/patologia
17.
Otol Neurotol ; 39(3): 340-343, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29337715

RESUMO

OBJECTIVE: To report the presentation, diagnosis, management, and convalescence of labyrinthine sequestrum (LS) and summarize all previously published cases. PATIENT(S): Eleven-year-old female with LS. INTERVENTION(S): Multidisciplinary diagnostic evaluation and treatment. MAIN OUTCOME MEASURES: Imaging and laboratory findings, medical and surgical treatment. RESULTS: We describe a case of LS secondary to medically recalcitrant suppurative otitis media in an 11-year-old female and review all eight previously reported cases. The index patient presented after 6 months of otitis media, profound unilateral hearing loss, with symptoms suggesting meningitis. Temporal bone CT demonstrated marked bony destruction of the left otic capsule. Gadolinium-enhanced MRI showed an enhancing process with evidence of meningitis and subdural empyema. The patient was treated with surgical debridement and culture directed antibiotic therapy. Posttreatment imaging showed resolution of intracranial infection with fibrous bony healing of the otic capsule resembling fibrous dysplasia. CONCLUSION: LS is a rare form of labyrinthitis characterized by centrifugal destruction of the otic capsule. The current index case highlights the importance of combined medical and surgical treatment and describes for the first time in the literature the fibrous ossification of the otic capsule following disease resolution.


Assuntos
Labirintite/etiologia , Otite Média Supurativa/complicações , Infecções Estreptocócicas/complicações , Criança , Orelha Interna , Empiema Subdural/etiologia , Feminino , Perda Auditiva Unilateral/etiologia , Humanos , Meningite/etiologia , Streptococcus anginosus
18.
Auris Nasus Larynx ; 45(2): 248-253, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28943053

RESUMO

OBJECTIVE: To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population. METHODS: A retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography. RESULTS: The average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%. CONCLUSION: The diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/etiologia , Vertigem Posicional Paroxística Benigna/terapia , Neoplasias Encefálicas/complicações , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Achados Incidentais , Hemorragias Intracranianas/complicações , Labirintite/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais , Lesões do Pescoço/complicações , Procedimentos Cirúrgicos Otológicos , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
19.
Otol Neurotol ; 38(10): e445-e450, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29065095

RESUMO

OBJECTIVES: To report a unique clinical entity "cochlear implant associated labyrinthitis," characterized by a distinct constellation of clinical symptoms and pattern of electrode impedance fluctuations. STUDY DESIGN: Retrospective chart review. METHODS: All patients that underwent cochlear implantation between January 2014 and December 2016 were retrospectively reviewed. All subjects with acute onset dizziness, device performance decline, and characteristic erratic pattern of electrode impedances occurring after an asymptotic postoperative interval were identified and reported. RESULTS: Five patients with the above criteria were identified, representing 1.4% of all implant surgeries performed during this time. The median age at time of implantation was 71 years, and the median time interval between implantation and onset of symptoms was 126 days. All patients exhibited acute onset dizziness, subjective performance deterioration, erratic impedance pattern, and two experienced worsening tinnitus. Two of five patients underwent subsequent CT imaging, where good electrode placement was confirmed without cochlear ossification. Two of five patients received oral prednisone therapy. All patients reported a subjective improvement in symptoms and stabilization of electrode impedances. Three patients subsequently received vestibular testing, where significantly reduced peripheral vestibular function was identified. CONCLUSIONS: We describe a unique clinical entity, "cochlear implant associated labyrinthitis," characterized by a distinct constellation of clinical symptoms and corresponding electrode impedance anomalies. The exact cause for this event remains unknown, but may be related to viral illness, delayed foreign body reaction to the electrode, or a reaction to electrical stimulation. Future studies characterizing this unique clinical entity are needed to further elucidate cause and optimal management.


Assuntos
Implantes Cocleares/efeitos adversos , Labirintite/etiologia , Adulto , Idoso , Implante Coclear , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Audiol Neurootol ; 22(2): 116-123, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28848089

RESUMO

The Cogan syndrome is a rare disorder characterized by nonsyphilitic interstitial keratitis and audiovestibular symptoms. Profound sensorineural hearing loss has been reported in approximately half of the patients with the Cogan syndrome resulting in candidacy for cochlear implantation in some patients. The current study is the first histopathologic report on the temporal bones of a patient with the Cogan syndrome who during life underwent bilateral cochlear implantation. Preoperative MRI revealed tissue with high density in the basal turns of both cochleae and both vestibular systems consistent with fibrous tissue due to labyrinthitis. Histopathology demonstrated fibrous tissue and new bone formation within the cochlea and vestibular apparatus, worse on the right. Severe degeneration of the vestibular end organs and new bone formation in the labyrinth were seen more on the right than on the left. Although severe bilateral degeneration of the spiral ganglion neurons was seen, especially on the right, the postoperative word discrimination score was between 50 and 60% bilaterally. Impedance measures were generally higher in the right ear, possibly related to more fibrous tissue and new bone found in the scala tympani on the right side.


Assuntos
Cóclea/patologia , Síndrome de Cogan/patologia , Perda Auditiva Neurossensorial/patologia , Labirintite/patologia , Rampa do Tímpano/patologia , Gânglio Espiral da Cóclea/patologia , Osso Temporal/patologia , Cóclea/cirurgia , Implante Coclear , Síndrome de Cogan/reabilitação , Orelha Interna/patologia , Perda Auditiva Neurossensorial/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Gânglio Espiral da Cóclea/citologia , Osso Temporal/cirurgia
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