Topical gentamicin-induced acute vestibulopathy: A case report.

Evidence suggests that otologic injury from ototopical aminoglycoside preparations is infrequent when used to treat ear infections with an intact tympanic membrane. Meanwhile, parenteral administration of aminoglycosides, is well known to be associated with a significant incidence of cochlear and vestibular damage. The discrepancy between topical and parenteral ototoxic effects is thought to result from a combination of factors, including the protective function of debris overlying the round window membrane, low antibiotic concentrations of topical antibiotic preparations, length of exposure and inability to detect subtle hearing or vestibular changes. Herein, we present a case of acute vestibulopathy following a 2-week course of topical gentamicin otic drops. Awareness of vestibulotoxicity following topical gentamicin therapy is prudent as vestibulopathic symptoms can be severely debilitating.

The role of endoscopic medial maxillectomy in sinus disease.

PURPOSE OF REVIEW: The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. RECENT FINDINGS: Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. SUMMARY: The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended.

Extent of maxillary sinus surgery and its effect on instrument access, irrigation penetration, and disease clearance.

BACKGROUND: Middle meatal antrostomy (MMA) provides limited access to the anteromedial and inferior aspect of the maxillary sinus (MS) often resulting in residual disease and inflammatory burden. Newer extended procedures, such as mega-antrostomy (Mega-A) and extended modified mega-antrostomy (EMMA), have been developed to address this limitation. This study assesses the effect of varying extent of MS surgery on irrigation penetration and access of instrumentation. METHODS: The MS of 5 fresh-frozen cadavers were sequentially dissected. Irrigation was evaluated with a squeeze bottle (SB) in different head positions and using different volumes of fluid. Surgical reach and visualization were examined using common sinus instruments and different angled endoscopes. A disease simulation was also performed to check for residual debris after instrumentation and irrigations. RESULTS: Irrigation penetration improved as antrostomy size increased (p < 0.0001), with a significant difference observed between the extended procedures and MMA. The effect of the volume was significant for SB (p < 0.0001) but head positions appeared irrelevant (p = 0.613). Overall visualization improved for Mega-A and EMMA. A similar trend was seen for the reach of the instruments to all sinus wall subsites. EMMA facilitated the most removal of "sinus disease" in the disease simulation model when compared with both MMA and Mega-A, due to its reach of the anteroinferior aspects of the maxillary sinus. CONCLUSIONS: High-volume irrigation using SB achieved good sinus penetration, irrespective of head position. Extended MS procedures appear to further increase irrigation penetration as well as surgical access.

Management of sphenoid lateral recess encephalocoeles.

PURPOSE OF REVIEW: Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. RECENT FINDINGS: Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. SUMMARY: SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear.

Baro-otolagia Secondary to Cholesteatoma.

BACKGROUND: Baro-otalgia is a common complaint among passengers in an aircraft, in particular those who had a recent upper respiratory tract infection. The underlying pathophysiology is secondary to unequal aeration of the middle ear cleft with the surrounding atmosphere and it can be explained using Boyle's Law. We describe an unusual presentation of baro-otalgia in a pilot secondary to cholesteatoma obstructing the aditus despite normal middle ear pressure equalization provided by a grommet in the ear. CASE REPORT: A 26-yr-old pilot with a presenting complaint of conductive hearing loss was diagnosed and treated for congenital cholesteatoma. His hearing improved, but 4 yr later he developed ear pain during the cruising phase of flight at an altitude of 9144 m (30,000 ft) above sea level. This pain persisted until descent to 4876 m (16,000 ft). Despite insertion of a middle ear ventilating tube, he remained symptomatic, requiring further investigation. This led to the diagnosis of recurrent cholesteatoma obstructing the aditus to the mastoid cavity. Upon surgical removal of the cholesteatoma, symptoms resolved. DISCUSSION: We hypothesize that the recurrent cholesteatoma caused obstruction to normal aeration of the mastoid air cells during the changing atmospheric air pressure, thus producing pain. This is akin to sinus barotrauma instead of the usual pathophysiology underlying barotitis.Govindaraju R, Adaikappan M, Rajagopalan R. Baro-otolagia secondary to cholesteatoma. Aerosp Med Hum Perform. 2017; 88(1):65-67.

A rare case of vertebrobasilar dolichoectasia presenting with ipsilateral facial paresis and concomitant severe sensorineural hearing loss

@#p style=text-align: left;strongOBJECTIVE:/strong To report a case of vertebrobasilar dolichoectasia presenting with ipsilateral facial nerve paresis and concomitant severe sensorineural hearing loss.METHODS/strong:br /strongDesign:/strong Case Reportbr /strongSetting:/strong Secondary Government Hospitalbr /strongPatient:/strong One RESULTS:/strong We report a case of vertebrobasilar dolichoectasia with concomitant ipsilateral facial nerve paresis and severe sensorineural hearing loss in an elderly female. She presented to us with left facial nerve palsy House-Brackmann Grade III and prior history of ipsilateral sensorineural hearing loss. MRI of the brain showed normal inner ear structures but revealed a dilated and tortuous basilar artery with compression on the left medulla and possible branches of anterior inferior cerebellar artery as it coursed superiorly and possible partial thrombosis of proximal basilar artery.CONCLUSION:/strong Concomitant facial nerve paresis and sensorineural hearing loss can be the clinical presentations of this rare but important condition. MRI is vital in diagnosing vertebrobasilar dolichoectasia./p

Hearing loss after noise exposure.

The higher field strength magnetic resonance imaging (MRI) such as 3 Tesla (T) and above generates noise that has potential detrimental effects on the hearing. Temporary threshold shifts following MRI examination have been reported for MRI with lower field strength. Such effect, however, have not been reported so far for a 3T MRI. We report a case that exemplifies the possible detrimental effects of a 3 T MRI generated noise on the auditory system. Our patient underwent investigation of his chronic backache in a 3 T MRI unit and developed hearing loss and tinnitus post-MRI examination. Hearing assessment was done using pure tone audiogram, distortion product otoacoustic emission (DPOAE) and brainstem electrical response audiometry (BERA) which revealed a unilateral sensorineural hearing loss which recovered within 3 days. However the tinnitus persisted. This is possibly a case of temporary threshold shift following noise exposure. However a sudden sensorineural hearing loss remains the other possibility.

Low lying larynx.

We report a rare case of laryngotracheal anomaly and its possible etiology and mode of presentation. A teenager presented with voice change and a neck lump. Investigations revealed a laryngeal anomaly in which the larynx was hyperdescended. It was accompanied by low lying thyroid gland and hyoid bone together with an absence of a cervical segment of the esophagus and trachea. The anomaly only became noticeable secondary to pubertal changes in the thyroid cartilage of the teenager. An embryological defect during the formation of the laryngotracheal tube and esophagus is a possible explanation of this anomaly. The present case probably represents the third reported of its kind.