High frequency audiometry and chronic renal failure.

High frequency audiometry with pure tones from 9 to 18 kHz was performed in 37 patients with chronic renal failure undergoing conservative medical treatment and in a control group of 96 patients (age range 30 59 years for both groups). It was noted that the high frequency thresholds were significantly higher for the patients with chronic renal disease, and further deterioration of hearing function was observed at the examination performed after 1 year of follow-up. It was concluded that high frequency audiometry is a sensitive method for detecting hearing changes in patients with chronic renal failure and can be used to monitor these patients.

Cognitive potentials in children with learning disabilities.

A group of 16 children, aged from 8 to 14 years, with learning disabilities, were studied by means of a series of conventional and sensitized audiological tests, including recording of the late cognitive electrical responses (P300). They had no otolaryngological or neurological complaints but expressive language disorders (difficulties in speaking and/or writing), receptive language disorders (difficulties in reading and text comprehension), and lack of concentration and/or restlessness. Their audiograms, speech discrimination and immitance tests were normal. The P300 responses, as compared with those found in 20 normal controls within the same age group, occurred at significantly longer latency periods.

The use of homogeneous human amniotic tissue to repair tympanic membrane perforations

Human amniotic tissue previously treated with sodium hypochlorite and ethyl alcohol and stored in pure glycerol was employed to repair total and partial tympanic membrane perforations in 43 patients who underwent tympanoplasty or tympano-mastoidectomy. Follow-up varied from nine to 54 months. Closure of the perforation was obtained in 35 patients (81.4 per cent). Success rate was higher in tympanoplasty (84.8 per cent) than in tympanomastoidectomies (70 per cent). Functional improvement in hearing level was obtained in 65.7 per cent of the cases. In 25.7 per cent the hearing levels were unchanged and in 8.57 per cent they became worse. It was concluded that human amniotic tissue is an adequade material for tympanic membrane repair.

[Cavernous hemangioma of the internal auditory canal. Apropos of a case]. / Hémangiome caverneux intracanalaire. A propos d'un cas.

A case of cavernous hemangioma in the internal auditory canal was reported. There were no specific symptoms or physical or neurotological findings to differentiate from acoustic neuroma. The clinical and surgical aspects of this rare tumor were reviewed and discussed.

The perilymphatic hypertension syndrome.

Perilymphatic hypertension is usually related to gushers which occur in the operating room when the stapes footplate is punctured or removed. These patients present defects in the modiolus, or enlarged cochlear aqueducts, which allow easy access of spinal fluid to the perilymphatic space. This syndrome was detected in children and appears to present consistent audiological patterns. They present a mixed hearing loss and in spite of the presence of an air-bone gap the stapedial reflexes are present. These children benefit from the use of hearing aids but show very little insertion gain in the low frequencies when tested with real-ear measurements.

Sudden vertigo of central origin.

Intense vertiginous attacks with sudden onset and of several months' duration were observed in a group of patients following viral infection. Neurotological examination revealed different types of signs of involvement of the central vestibular apparatus. All of these patients became dizzier when medicated with vestibular depressor drugs, and could obtain symptomatic relief with corticosteroids. They became asymptomatic after a period of 3-4 months from the onset of the disease, but the signs of central vestibular involvement persisted for 6-12 months.

Controlled clinical trial of pentoxifylline versus cinnarizine in the treatment of labyrinthine disorders.

Seventy-six patients with labyrinthine diseases of vascular origin were treated in a 6-week double-blind comparative study with either 400 mg pentoxifylline ('Trental') or 75 mg cinnarizine 3-times daily. Clinical evaluations, supported by audiological tests and vectornystagmography, were carried out before and after treatment. Statistical analysis of the results showed pentoxifylline to be globally superior to cinnarizine and especially to have a more intense antivertiginous effect. No significant differences were observed between the two drugs in respect of tinnitus and hearing loss therapy. Side-effects were occasional, mild and well tolerated in the pentoxifylline group, and more pronounced and frequent with cinnarizine.

Calcium antagonists as a peripherally acting labyrinthine suppressant in humans.

A total of 908 patients with peripheral vestibular disorders were treated with calcium antagonists for periods of 10 to 120 days in a series of controlled clinical trials using a placebo or other medication for comparison. The cumulative analysis of the results indicates that cinnarizine, flunarizine and bencyclan have produced good clinical results, particularly in patients with vascular problems. A comparison between different doses used in different trials revealed a correlation of good clinical results to smaller doses of some of these medications.

Vestibular disorders caused by defective enzyme mechanisms in the small intestine.

A group of patients suffering from long periods of unsteadiness and presenting hyperreflexia in response to torsion swing and/or caloric stimulations were found to have abnormal results in glucose and lactose tolerance tests, but normal or reduced insulin liberation. Biopsies of the jejunal mucosa have shown abnormal enzyme activity or deficiencies in transport mechanisms. The use of a diet suited to each specific deficiency resulted in a high percentage of relief from the vestibular symptoms of these patients.

Glucose, insulin and inner ear pathology.

One hundred consecutive patients with a clinical suspicion of metabolic inner ear disorder were submitted to a 5-hour glucose tolerance test with simultaneous titration of insulin. It was found that 82% of the patients presented abnormal glucose and/or insulin values. The analysis of the results revealed hypo- or hyperglycemia were present in only 41% of the cases, and that all patients had normal fast values for glucose. Hyperinsulinemia was the most frequent abnormality and was found to constitute the determining factor of the inner ear disorders. 26 of the patients presented Meniere's disease. The pathophysiological model for insulin-induced Meniere's disease is discussed. Follow-up data indicate that these patients respond well to a diet with reduced intake of small molecule carbohydrates.

Econazol no tratamento das otites medias agudas ou cronicas reacutizadas. / Econazole in the treatment of acute or reacutized chronic otitis media

O estudo terapeutico duplo-cego, exclusivamente topico, foi efetuado com o uso de econazol + triamcinolona ou placebo (propilenoglicol), em 60 casos de otites medias agudas ou cronicas reacutizadas/

A inibicao da fixacao ocular a prova calorica. Pesquisa vecto-electronistagmografica em individuos normais. / Ocular fixation inhibition to caloric test. Vectoelectronystagmographic search in normal subjects

A prova calorica com agua foi realizada em 39 individuos normais, com o objetivo de apreciar a ocorrencia do efeito inibidor da fixacao ocular sobre a intensidade do nistagmo pos-calorico. A investigacao foi realizada a luz do vecto-electronistagmografia, metodo ideal para a avaliacao precisa da direcao e da velocidade angular da componente lenta das respostas nistagmicas. Verificou-se que o efeito inibidor da fixacao ocular esteve presente as 4 estimulacoes caloricas na maioria dos casos e a sua ausencia foi um achado de ocorrencia esporadica e somente numa unica estimulacao calorica

Da frequencia nistagmica do nistagmo espontaneo e semi-espontaneo em individuos normais, sindromes vestibulares perifericas e do sistema nervoso central. Pesquisa vecto-electronistagmografica. / Nystagmus frequence of spontaneous and semi-spontaneous nystagmus in normal subjects, peripheral and central nervous system vestibular syndromes. Electronystagmographic study

Foram examinados 40 individuos normais, 44 casos de sindromes vestibulares perifericas e 46 casos de sindromes do sistema nervoso central a VENG, com o objetivo de analisar a ocorrencia e o numero de batimentos do nistagmo espontaneo e semi-espontaneo. Verificou-se a ocorrencia esporadica em normais e frequente nas sindromes perifericas, so com os olhos fechados.Nas sindromes centrais a ocorrencia foi muito frequente, com os olhos fechados e/ ou abertos. Em relacao ao numero de batimentos, os valores limites encontrados em normais somente foram ultrapassados em alguns casos centrais. Ainda em relacao ao numero de batimentos, verificou-se a ausencia do efeito inibidor de fixacao ocular nos casos com nistagmo espontaneo e na maioria das posicoes cardinais do olhar, nos casos com nistagmo semi-esponaneo

Do indice de fixacao ocular do nistagmo pos-calorico em individuos normais, a vecto-electronistagmografia. / Ocular fixation rates of post-caloric nystagmus in normal subjects to vectoelectronystamography

A prova calorica com agua foi efetuada em 40 individuos normais com a finalidade de analisar a ocorrencia do efeito inibidor da fixacao ocular sobre a intensidade do nistagmo pos-calorico, exprimida em termos de frequencia nistagmica no perido de culminancia da prova de FITZGERALD & HALLPIKE (1942), a vecto-electronistagmografia. Verificou-se que a ausencia do efeito inibidor da fixacao ocular a prova calorica ocorreu em parcela significativa da casuistica normal, numa, duas, tres ou todas as estimulacoes termicas, o que sugere ser a frequencia nistagmica destituida de importancia semiologica na avaliacao clinica desse fenomeno visual, ao contrario do descrito para a velocidade angular da componente lenta do nistagmo pos-calorico, na mesma casuistica

Da velocidade angular real maxima da componente rapida do nistagmo pos-calorico em individuos normais. / On the maximum real angular velocity of the rapid component pos-caloric nystagmus in normal subjects

A prova calorica foi realizada em 38 individuos normais com o intuito de se avaliar o comportamento dos valores absolutos e relativos da velocidade angular real maxima da componente rapida do nistagmo pos-calorico, a prova de FITZGERALD & HALLPIKE (1942) com vecto-electronistagmografia.Verificou-se que foi possivel estabelecer limites criticos normais dos valores absolutos e relativos desse parametro, que podem ser uteis para a identificacao de alteracoes quantitativas na patologia otoneurologica

The Mondini dysplasia--from early diagnosis to cochlear implant.

The early diagnosis of the Mondini dysplasia by means of electrocochleography and temporal bone polytomography, and the prevention of further hearing loss through the endolymphatic subarachnoid shunt operation, brought new data on the follow-up of patients with this malformation. They were found to present specific medical and educational problems. Children with concomitant serous otitis media were found to develop profound hearing loss following insertion of ventilation tubes due to fistula formation in the oval window. One cochlear implant, employing the technique developed by William House, was performed in a 22-year-old patient in whom the dysplasia had not been previously recognized. The importance of early diagnosis and treatment will be emphasized.