Idiopathic Labyrinthitis: Symptoms, Clinical Characteristics, and Prognosis.

BACKGROUND: Labyrinthitis is an inner ear disorder of unknown incidence, characterized by sudden hearing loss and concurrent vertigo. Cohort studies of patients diagnosed with labyrinthitis are nonexistent. This study aims to describe the clinical characteristics and prognosis of patients diagnosed with idiopathic labyrinthitis. METHODS: Patients with labyrinthitis in the absence of a clear viral, bacterial, or autoimmune pathogenesis were retrospectively identified from electronic patient files. Symptoms at presentation and results from vestibular testing were retrieved. The 9-item Vestibular Activity Avoidance Instrument, administered during follow-up interviews by telephone, was used to assess the presence of persistent balance problems and activity avoidance behavior. RESULTS: Sixty-one patients with idiopathic labyrinthitis were included. All patients had vestibular weakness at presentation. After a median of 61 months of follow-up (interquartile range 81), 72.5% of patients still experienced balance problems. Subjective hearing recovery only occurred in 20% of cases. CONCLUSION: Patients presenting in a tertiary dizziness clinic with idiopathic labyrinthitis have a poor prognosis for both hearing and balance function impairment. Prospective observational cohorts are required to establish objectifiable vestibular and audiological follow-up data.

Acute labyrinthitis: a manifestation of COVID-19 in a teenager.

Audiovestibular symptoms following COVID-19 have been long acknowledged, especially in adults. However, acute labyrinthitis presenting as an early manifestation of COVID-19 has not been reported in children. We report COVID-19-induced acute labyrinthitis in a teenager. We report on a boy in his early adolescence with a sudden onset of spinning sensation, imbalance and unilateral hearing loss with a positive SARS-CoV-2 test. Vestibular investigations point towards right labyrinthine hypofunction, and an audiometry test revealed right-sided severe hearing loss. Symptoms improved gradually with steroids and vestibular rehabilitation therapy. However, the long-term repercussions of post-COVID-19 acute labyrinthitis are unknown and must be followed up closely. To our knowledge, this is the first reported case of acute labyrinthitis secondary to COVID-19 in paediatrics. Additionally, we conducted a literature search to elucidate the outcome of COVID-19-induced acute vestibular syndrome in children.

Reversible Canalith Jam of the Horizontal Semicircular Canal Mimicking Cupulolithiasis.

OBJECTIVE: To describe a case of benign paroxysmal positional vertigo (BPPV) resulting in reversible horizontal semicircular canalith jam successfully treated with horizontal canal occlusion. A brief literature review of similar cases was performed. METHODS: Case report and literature review. RESULTS: A 68-year-old female presented with apogeotropic positional nystagmus, attributed to reversible horizontal canalith jam mimicking cupulolithiasis that was refractory to tailored repositioning maneuvers across months. She was unable to work due to the severity of her symptoms. She underwent surgical occlusion of the affected canal with immediate resolution of her symptoms. A literature review revealed similar cases of canalith jam mimicking cupulolithiasis. CONCLUSIONS: Reversible canalith jam, in which particles moving with horizontal head position alternate between obstructing the semicircular canal and resting on the cupula, can mimic signs of cupulolithiasis. This variant of BPPV can be effectively managed with surgical canal occlusion should symptoms fail to resolve after tailored repositioning maneuvers.

Acute vestibular syndrome and hearing loss mimicking labyrinthitis as initial presentation of multiple sclerosis.

Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.

Infections of the Ear.

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.

Dizziness.

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.

Bilateral tympanokeratomas (cholesteatomas) with bilateral otitis media, unilateral otitis interna and acoustic neuritis in a dog.

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.

Clinical examination and management of the dizzy patient.

Dizziness is the commonest reason for a GP appointment over the age of 75 years and many dizzy patients will end up in hospital. This article introduces the range of vestibular disorders commonly seen in hospital practice with a symptom-based approach and discusses the range of treatments that might be considered.

Hemorragia laberíntica secundaria a anticoagulantes orales / Labyrinthine haemorrhage secondary to oral anticoagulants

No disponible

Pneumolabyrinth with Labyrinthitis as the Suspected Cause.

Pneumolabyrinth is a rare condition with air bubbles existing in the vestibule and/or cochlea. We report a case of pneumolabyrinth without trauma that was suspected to be caused by labyrinthitis. A 65-year-old man presented with vertigo and hearing loss in the left ear after catching a cold. Computed tomography performed after there had been no improvement in the patient's symptoms showed the presence of air bubbles in the vestibule, semicircular canals and cochlea. The patient was transferred to our hospital with suspected perilymphatic fistula. Bacterial infection was suspected after the laboratory tests had indicated a severe inflammatory response, and the patient was treated with antibiotics. However, no bacteria were detected in a bacterial culture of the otorrhea. An exploratory tympanotomy was performed to improve the patient's staggering gait and to examine the middle ear, with no obvious fistula being observed. Subsequent fenestration of the round window revealed a white mass that appeared to contain bacteria which was collected from the cochlea and submitted for analysis and bacterial culture. However, no bacteria were detected and the mass contained white blood cells. We suspected pneumolabyrinth following labyrinth infection. However, the cause of air bubble formation remains unclear and needs to be validated with further research.

Cochlear changes in serous labyrinthitis associated with silent otitis media: A human temporal bone study.

PURPOSE: To determine histopathological findings in the cochlea of human temporal bones with serous labyrinthitis. MATERIALS AND METHODS: We compared human temporal bones with serous labyrinthitis (20 cases) associated with silent otitis media and without serous labyrinthitis (20 cases) to study location of serous labyrinthitis, the degree of endolymphatic hydrops, number of spiral ganglion cells and hair cells, loss of fibrocytes in the spiral ligament, and areas of the spiral ligament and stria vascularis. RESULTS: The serous labyrinthitis caused significant loss of outer hair cells in the lower basal (P=0.006), upper basal (P=0.005), and lower middle (P=0.011) cochlear turns, and significant increase in the degree of endolymphatic hydrops than the control group (P=0.036). No significant difference was found in the loss of inner hair cells, in the number of spiral ganglion cells and fibrocytes in the spiral ligament, and in areas of the stria vascularis and spiral ligament (P>0.05). CONCLUSIONS: Serous labyrinthitis resulted in significant loss of outer hair cells and significant increase in the degree of endolymphatic hydrops.

10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

The clinician's major role in management of the dizzy patient involves determining what dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to details of history, otolaryngological workup including vestibular assessment, and often use of diagnostic and management algorithms. There is paucity of published reports of the management outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients presenting with features of peripheral vestibular diseases attending the National Hospital Abuja Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to April 2014) was carried out. Both institutions adopted the same diagnostic and management protocols. Data extracted from anonymized databases created for this study include age, sex, vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278 subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV (n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32), Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10), climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo recorded the highest DHI score (95 % CI 75 ± 4.3), followed by cholesteatoma/perilymph fistula (95 % CI 72 ± 6.1) and labyrinthitis (95 % CI 62 ± 1.9). Pure tone audiometry (95 % CI 67.3 ± 3.43), followed by thyroid function tests (95 % CI 66.7 ± 23.55) and ice-water caloric testing (95 % CI 59.7 ± 2.69) were investigations with the highest yields. 86.5 % of cases were treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to 75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and treatment yield in a resource-constrained setting like ours. Most cases can be managed using non-operative measures.

[Vertigo in the Emergency Department: new bedside tests]. / Szédülés vizsgálata a sürgosségi osztályon: új, ágy melletti diagnosztikai eljárások.

According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.

Suppurative labyrinthitis associated with otitis media: 26 years' experience / Labirintite associada à otite média: experiência de 26 anos

ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.

Suppurative labyrinthitis associated with otitis media: 26 years' experience.

INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

Trichosporon asahii sepsis in a patient with pediatric malignancy.

Trichosporon asahii is a rare opportunistic infection, especially in children, causing a life-threatening fungal infection underlying hematologic malignancies. Predisposing factors for infection with this pathogen are immunodeficiency including underlying malignancy, organ transplantation, extensive burns, human immunodeficiency virus infection, corticosteroid therapy, prosthetic valve surgery, and peritoneal dialysis. In the literature, a breakthrough under caspofungin, micafungin therapy is reported. In this article we report on a 16-year-old patient with Ewing sarcoma who had T. asahii sepsis. The patient died although he had been receiving caspofungin for less than 3 months and amphotericin B therapy for 3 days. A postmortem study of conchal tissues revealed T. asahii and mucormycosis histopathologically, and blood culture grew T. asahii.

[Inflammatory diseases of the petrous portion of the temporal bone]. / Entzündliche Erkrankungen des Felsenbeins.

CLINICAL/METHODICAL ISSUE: Inflammatory lesions of the petrous portion of the temporal bone are very common and can be followed by cerebral complications. PRACTICAL RECOMMENDATIONS: Thin layer computed tomography (CT) is useful for detecting bony changes of the temporal bone and contrast-enhanced magnetic resonance imaging (CE MRI) is a sensitive method for detecting cerebral complications.

Vestibular neurolabyrinthitis: a follow-up study with cervical and ocular vestibular evoked myogenic potentials and the video head impulse test.

OBJECTIVES: The aim of this study was to evaluate prospectively, in a group of patients affected by vestibular neurolabyrinthitis (VN), a diagnostic protocol including cervical vestibular evoked myogenic potentials (C-VEMPs), ocular vestibular evoked myogenic potentials (O-VEMPs), and the video head impulse test (vHIT). METHODS: The diagnosis of VN was based on the patient's clinical history, an absence of associated auditory or neurologic symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function by use of the Fitzgerald-Hallpike caloric vestibular test and the ice test. RESULTS: In our series, 55% of the cases were superior and inferior VN, 40% were superior VN, and 5% were inferior VN. These cases, however, comprised different degrees of vestibular involvement, as the individual vestibular end organs have different prognoses. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. CONCLUSIONS: The implementation of C-VEMPs, O-VEMPs, and the vHIT in a vestibular diagnostic protocol has made it possible to observe patients with ampullary VN in a way that has not been feasible with other types of vestibular examinations. The age of the patient seems to have some impact on recovery from VN. When recovery occurs in the utricular and saccular nerves first and in the ampullary nerves subsequently, it may be reasonable to expect a more favorable outcome.