Effect of high dose intravenous vitamin C on idiopathic sudden sensorineural hearing loss: a prospective single-blind randomized controlled trial.

The aim of this prospective single-blind randomized controlled study was to evaluate the therapeutic efficacy of high dose intravenous vitamin C (HDVC) added to systemic steroid in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Between August 2010 and August 2011, 72 ISSNHL patients who participated in this study were randomly allocated to two groups: 36 to a control group, members of which were given systemic steroid treatment for 15 days, and 36 to a HDVC group, members of which were given HDVC (200 mg/kg/day) for 10 days in addition to steroid therapy followed by oral vitamin C (2,000 mg) for 30 days after discharge. Finally, we analyzed each group: 35 as a control group and 32 as a HDVC group. Auditory evaluations were performed by pure tone audiometry (PTA) before and ~1 month after treatment using Siegel's criteria. HDVC group showed significantly greater complete and partial recovery improvement (p = 0.035). In addition, the complete recovery rate in the HDVC group was more than twice that of the control group (p = 0.031). In the HDVC group, PTA improved from 67.6 ± 19.8 dB HL before treatment to 37.1 ± 28.8 dB HL at 1 month after treatment, whereas in the control group, PTA improved from 70.3 ± 12.4 to 47.6 ± 25.2 dB HL, which represented a significant intergroup difference (p = 0.030). In conclusion, HDVC may enhance hearing recovery in ISSNHL patients, which suggests that HDVC reduces levels of reactive oxygen metabolites produced by inner ear ischemia or inflammation, and that HDVC could be considered for the treatment of ISSNHL.

Clinical characteristics and natural course of recurrent vestibulopathy: a long-term follow-up study.

OBJECTIVES/HYPOTHESIS: To investigate the clinical characteristics and the natural course of recurrent vestibulopathy (RV). STUDY DESIGN: Retrospective study. METHODS: During the period April 2002 to February 2008, we reviewed the clinical records of 98 patients diagnosed with RV. All patients were approached by telephone and using a questionnaire. The analysis included age, sex distribution, natural history, pure-tone audiometry, caloric response, age at onset, and the characteristics of vertigo. RESULTS: Median follow-up was 63.1 months (range, 24-103 months). Patients had a mean age at onset of 39 years and a mean duration of 4.2 years. An obvious female predilection was found, and unilateral caloric paresis (≥ 25%) was seen in 35%. Of the 98 patients, symptoms resolved in 82% but were unchanged in 12%. RV developed to Ménière's disease in four patients and to migraine in two. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. CONCLUSIONS: The study suggests that in the majority of cases, vertigo spontaneously resolves and that the risks of development to Ménière's disease or migraine are low.

Sensation recovery of auricle following chronic ear surgery by retroauricular incision.

The aim of this prospective analysis was to objectify and quantify the sensory loss in the auricular area that occurs following surgery for chronic otitis media or cholesteatoma, and to assess the exact recovery time of the auricular sensation. Till now, no study has yet been conducted on the sensory loss that is developed after retroauricular incision is performed for chronic ear surgery. Forty-eight patients underwent surgery via retroauricular incision for chronic otitis media or for chronic otitis media or cholesteatoma between March 2009 and January 2010. The skin around the auricle was divided into six areas. The sensation of each area was assessed before the surgery and 3 days, 7 days, 1 month, 3 months, and 6 months after the surgery, using the Semmes-Weinstein monofilaments. The patients were also asked to record the sensation that they felt using the visual analog scale (VAS). In the objective sensory assessment, only area 5, which corresponds to the retroauricular area, showed significant sensory loss. Three months after the surgery, the sensation was recovered to a level comparable to that before the surgery in most of the patients. The mean subjective VAS score was 10 prior to the surgery, 8.56 (± 1.08) 3 months after the surgery, and 9.32 (± 0.74) 6 months after the surgery, respectively. In conclusion, following chronic ear surgery, the sensation of the auricle was recovered to the previous level within 3 months. Therefore, patients who are to undergo retroauricular incision should be informed that they will experience temporary sensory loss for approximately 3 months after the surgery.

Immunohistochemical and biomolecular identification of melatonin 1a and 1b receptors in rat vestibular nuclei.

OBJECTIVE: The aim of this study was to examine the localizations and expressions of melatonin 1a (MT1a) and 1b (MT1b) receptors in rat vestibular nuclei by immunohistochemical staining and reverse transcriptase-polymerase chain reaction. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats were used in this study. Antibodies for the MT1a and MT1b receptors were used in 10 rats, respectively. A further 10 animals were sacrificed for RT-PCR. Tissues containing medial vestibular nuclei were selectively isolated from brain stem slices for RT-PCR. RESULTS: MT1a and MT1b receptor immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. The presences of the mRNAs of the MT1a and MT1b receptors were confirmed by RT-PCR in medial vestibular nuclei and trigeminal ganglia. CONCLUSIONS: The present study demonstrates, for the first time, that MT1a and MT1b receptors are localized and expressed in rat vestibular nuclei. This study provides additional insight into the role of melatonin receptors during vestibular signal processing.

A rare case of pontomedullary infarction presenting with peripheral-type facial palsy.

Ipsilateral facial palsy (FP) of the peripheral-type can result from lesions involving the inferomedial tegmentum of the pons. However, cases of a medullary lesion with peripheral-type FP have rarely been reported. The authors experienced an 83-year-old man with a pontomedullary infarction who presented with ipsilateral peripheral-type FP. Brain diffusion MRI revealed a hyper-intense signal on the left dorsolateral portion of the upper medulla and pontomedullary junction. This case suggests that clinicians should take into account the possibility of a central lesion and brainstem infarction, even when patients present with peripheral-type FP.

Subcutaneous emphysema and pneumomediastinum after tonsillectomy.

Many patients and their families regard tonsillectomy as a minor operation because it is performed so commonly. However, although tonsillectomy is indeed a relatively safe surgical procedure, in extremely rare cases, it can be complicated by subcutaneous emphysema and pneumomediastinum. Although these complications resolve spontaneously in most cases, a few conclude in tension pneumothorax and other fatal complications. The mechanism by which subcutaneous emphysema and pneumomediastinum develop after tonsillectomy is poorly understood. We experienced a case in which subcutaneous emphysema, pneumomediastinum, and a deep defect in the tonsillar fossa were observed. The passage of air was shown by radiology and histopathology. Consequently, the case is reported here.