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Sudden Sensorineural Hearing Loss as Prodromal Symptom of Anterior Inferior Cerebellar Artery Infarction

Sudden sensorineural hearing loss is a clinical condition characterized by a sudden onset of unilateral or bilateral hearing loss. In recent years sudden deafness has been frequently described in association with anterior inferior cerebellar artery (AICA) infarction generally presenting along with other brainstem and cerebellar signs such as ataxia, dysmetria and peripheral facial palsy. The authors report a rare clinical case of a 53-year-old man who suddenly developed hearing loss and tinnitus without any brainstem or cerebellar signs. Computed tomography of his brain was normal, and the audiological results localized the lesion causing deafness to the inner ear. Surprisingly, magnetic resonance imaging showed an ischemic infarct in the right AICA territory. This case represents the fifth in the literature to date but it confirms that AICA occlusion can cause sudden deafness even without brainstem or cerebellar signs. Therefore, we recommend submitting the patient for neuroimaging, as an emergency, in order to exclude infarction of the AICA territory. By doing this, it may be possible to limit the extent of the lesion by commencing early therapy.

from ORL -Journal for Oto-Rhino-Laryngology and Its Related Specialties


Superior semicircular canal dehiscence and lack of the tympano-ossicular system: Favourable functional aspects of a coincidental finding

Objectives: Our objectives were to report the functional conditions of superior semicircular canal dehiscence (SSCD) associated with the post-inflammatory lack of tympano-ossicular system. Methods: A 40-year-old male, initially referred for bilateral ear discharge due to a left cholesteatoma and a right unstable ‘intact bridge’ tympanoplasty, underwent a left open mastoidectomy without a tympano-ossicular reconstruction. Two years later, he had a conversion of the ‘intact bridge’ tympanoplasty into an open mastoidectomy without reconstruction on the right side. Moreover, he had a bilateral SSCD diagnosed by means of vestibular evoked myogenic potentials (VEMPs) and high-resolution computed tomography (HRCT). Results: Combination of the absence of the tympano-ossicular system and SSCD resulted in surprisingly good hearing function. Conclusions: The reported bilateral near-to-normal hearing function outlines the possibility of a favourable outcome deriving from the association of two different adverse conditions. This presents an opportunity for reflection on the pathophysiology of sound transmission, and indicates the usefulness of including the radiological investigation of the bone overlying the superior semicircular canal even when investigating inflammatory middle ear diseases.<p><p>from <a href=”Audiological” _mce_href=”″><em>Audiological”>″><em>Audiological Medicine</em></a></p>

Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss: Clinical evaluation and laboratory investigation

ITD at 5 mg/ml did not add effect to systemic steroids in improving hearing outcomes in patients with ISSHL. An increase in dexamethasone concentration led to large variations in pharmacokinetics in animal study, showing potential value in optimizing the drug delivery protocols and improving the therapeutic results.

from Auris Nasus Larynx

Vestibular substitution: comparative study

Conclusion: These preliminary results indicate the efficacy of the electrotactile vestibular substitution system in improving patients’ symptoms of vestibulopathy, and constitute evidence of successful sensory substitution.

from the Journal of Laryngology and Otology

Sensorineural deafness in Tanzanian children—Is ototoxicity a significant cause? A pilot study

Ototoxic drugs given to sick infants with “fever”, without weight recording or gentamicin level monitoring, was the probable cause of a third of all severe/profound deafened Zanzibarian children.

The Ministry of Health and Social Welfare in Zanzibar have reacted by issuing posters to all health facilities advising hearing testing in all children three months after discharge following “fever” admission.

This is a pilot study and the apparent findings need to be confirmed by a well designed prospective study as soon as possible.

from the International Journal of Pediatric Otorhinolaryngology

Acoustically evoked, short latency negative response in children with sensorineural hearing loss

Conclusion: The presence of an acoustically evoked, short latency negative response is dependent not on residual hearing but on normal saccular function. This response can be measured in patients who cannot contract their neck muscles

from the Journal of Laryngology and Otology

Results for audiology and distortion product and transient evoked otoacoustic emissions in patients with systemic lupus erythematosus

Conclusion: Our findings do not completely agree with those of previous temporal bone histopathological studies. However, our results do support a general picture of low frequency hearing loss in systemic lupus erythematosus patients. We consider these results to be related to endolymphatic and cochlear hydrops, and we suggest that electrocochleography could be performed in further studies for clarification of this subject.

from the Journal of Laryngology and Otology

Dose-Dependent Sustained Release of Dexamethasone in Inner Ear Cochlear Fluids Using a Novel Local Delivery Approach

The thermo-reversible triblock copolymer poloxamer 407 was investigated as a drug delivery vehicle for micronized dexamethasone into the middle and inner ears of guinea pigs. The study characterized the gelation and in vitro release kinetics of poloxamer formulations. In vivo, the pharmacokinetic profile of formulations containing varying concentrations of poloxamer and dexamethasone was examined following intratympanic administration. Significant drug levels within the perilymph were observed for at least 10 days, while systemic exposure was minimal. The sustained-release kinetics profile could be significantly modulated by varying the concentrations of both poloxamer and dexamethasone. Assessment of auditory function revealed a small transient shift in hearing threshold, most probably of conductive nature, which resolved itself within a week. No significant histological changes of the round window membrane or cochlea could be noted. Poloxamer 407 thus represents an effective and safe delivery system to achieve sustained release of dexamethasone to the inner ear.

from Audiology & Neuro-Otology

Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss

Conclusions: Considering the cost of hyperbaric oxygen therapy and its inconvenience to patients, this treatment should only be considered in patients suffering sudden hearing loss if there are contraindications to standard medical treatment.

from the Journal of Laryngology and Otology

Poly(ADP-ribose) polymerase-1 (PARP-1) longer alleles spanning the promoter region may confer protection to bilateral Meniere’s disease

Conclusion: The longer alleles (CA)17-20 of the promoter region of PARP-1 gene may confer some protection against bilateral Meniere’s disease (BMD). Objective: To analyze microsatellite (CA)n polymorphisms in the promoter region of PARP-1 gene and seek out risk and protective variants for BMD. Subjects and methods: Eighty patients from two ethnically defined groups with definite BMD, according to the diagnostic scale of the American Academy of Otolaryngology Head and Neck Surgery, were compared with a group of 371 normal controls from the same origin in a prospective multicenter study. We developed a specific amplification protocol to determine the PARP1-promotor CA microsatellite polymorphisms. Results: We found that the longer alleles (CA)17-20 had a very low frequency in BMD (2/160, 1.3%, OR = 7.33 (1.77-30.37, 95% CI), corrected p=0.012), suggesting that it may confer some protection against BMD.

from Acta Oto-Laryngologica

Endolymphatic space imaging in patients with delayed endolymphatic hydrops

Conclusion: Magnetic resonance imaging (MRI) after intratympanic gadolinium injection can reveal endolymphatic hydrops (ELH) in patients with delayed ELH (DELH). Patients with contralateral DELH may have bilateral ELH. Objective: DELH has previously been diagnosed based on clinical history, hearing and vestibular examinations. DELH is classified into three types: ipsilateral, contralateral and bilateral indicate the side with the longstanding hearing loss. Ipsilateral DELH occurs in the ear with a profound hearing loss, contralateral DELH in the better hearing ear and bilateral DELH in both ears. Imaging diagnosis of the endolymphatic space may add a new dimension to the diagnosis and treatment of DELH. Patients and methods: Gadodiamide hydrate was diluted eightfold with saline. The diluted gadodiamide hydrate was injected intratympanically through the tympanic membrane in two patients with ipsilateral DELH and five patients with contralateral DELH. One day after the injection, 3 Tesla MRI was performed to evaluate the endolymphatic space. Results: ELH was observed in all patients. In three patients who underwent bilateral intratympanic injection of gadolinium and were diagnosed with contralateral DELH, ELH was observed bilaterally. In one of these three patients, ELH was observed in the cochlea on the left and in the vestibule on the right.

from Acta Oto-Laryngologica