Auditory effects of chronic alcoholism

Clinical reports of hearing loss, tinnitus, and auditory hallucinations, as well as empirical studies of auditory phenomena, have sparked interest in the auditory effects of chronic alcoholism. The auditory system, owing to its multi-synaptic course through the central nervous system and to the many techniques available for diagnostic evaluation, affords a special opportunity for examination of transmission breakdown in alcoholics. The present paper reviews several different approaches to the study of disrupted hearing: histologic evidence: threshold measurement, evoked potential data; acoustic reflex studies; and behavioral central auditory evaluation. The review explores effects attributed to both peripheral and central loci, and outlines the ramifications for research and treatment.

A study of the effects of cardiopulmonary bypass surgery on auditory function

Cardiopulmonary bypass surgery is commonplace in many medical centers and rare instances of unilateral hearing loss in these patients have been reported and have been attributed to embolism. Two more patients are reported and their discovery prompted a study of pre and postoperative hearing in 68 patients at Newark Beth Israel Medical Center, where a single team performs the cardiopulmonary bypass surgery. Previous similar studies showed no changes following CPB surgery. Almost all patients have been male and prolonged pump times (over 150 min.) were noted in 7 of 11 reports. Based on changes in hearing found on pre and postoperative testing in the 6 patients, 3 groups were developed: those with no change and those with slight changes were compared with those having average deficits of more than 10 db. Prolonged pump times occurred only twice in the series and were not associated with loss. A second milder form of hearing loss, which was bilateral and affected the high tones, was noted in significant numbers. Two of these patients had persistent tinnitus after surgery. Although the series is small, there appears to be an increased susceptibility in males to the development of high tone loss as well. Based on the preponderance of males, with their high incidence of basilar artery atherosclerosis, and the frequent prolonged pump times, perfusion failure seems to be the most likely etiology for the rare cases of hearing loss accompanying cardiopulmonary bypass surgery.

Wegener's granulomatosis with otological and nervous system involvement

Wegener's granulomatosis usually presents to the otolaryngologist with nasal manifestations. Complications including otologic and central nervous system symptoms occur in 20-40 per cent of cases. Two such cases presented to our clinic with nasal manifestations initially, one subsequently developing otologic sequelae and one progressive sensory motor neuropathy. These patients were followed to determine the reversibility of the otologic and sensory motor neuropathy while on therapy. The otologic changes remain and this patient was required to use a hearing aid. The sensory motor neuropathy improved rapidly so that the other patient's ability to walk soon became normal but sensory deprivation continues below the ankle bilaterally. The literature concurs with findings that involvement of the central nervous system and special sense organs such as the cochlea have limited reversibility once they occur, and early detection, therapy, and prevention of such complications are most important.

[Analysis of fluctuating sensorineural hearing loss (author's transl)]

Many inner ear diseases are accomplished with fluctuating hearing loss. Fluctuating hearing loss is a symptom which possibly can be caused by biophysical, biochemical, toxic, bioelectrical and immunological changes in the cochlea. An analysis of the different forms of this diseases could open up new aspects of pathogenesis and therapy.

Endolymphatic duct obstruction from a jugular bulb diverticulum

Herniation of the jugular bulb into the middle ear is uncommon. Extension of a jugular bulb diverticulum into the petrous pyramid is rare. In ten previously reported cases in the literature, only the radiographic appearance of the lesion was stressed. Of interest to otolaryngologists is the fact that in seven of the cases there was an ipsilateral sensorineural hearing loss. Other symptoms included tinnitus and vertigo. One patient had been diagnosed as having Menière's disease. We document an additional case (a patient who had “classical Menière's disease”) and report the first known surgical exploration of this venous anomaly. The diverticulum extended high into the petrous bone and was found to obliterate the distal segment of the endolymphatic duct. To our knowledge, this is the first time that a cause and effect relationship has been recognized between endolymphatic hydrops and a jugular bulb diverticulum. We propose that the diverticulum, by obstructing the endolymphatic duct, was directly responsible for the Menière's-like symptoms.

A hearing survey in diabetes mellitus

A sample of 50 diabetics was compared with a control group matched for age and sex. Twenty-two of the diabetics were insulin-dependent. Subjects and controls were examined otologically and then tested audiometrically using pure tone audiometry, speech audiometry and tone decay after the method of Owens. No significant difference was found between the two groups on pure tone audiometry and speech testing showed all diabetics and controls to be normal. A statistically significant incidence of type-2 tone decay was found in the overall group of diabetics at 2000 Hz. This may reflect early presbycusis.

Gross and microscopic anatomy of the eighth cranial nerve in relationship to the solitary schwannoma

Surgical advances over the past two decades, allowing the discovery of smaller solitary schwannomas of the VIIIth cranial nerve and their extirpation with preservation of the VIIth cranial nerve, have lead to attempts to resect the tumor without completely resecting its nerve of origin. This paper reports the macroscopic and microscopic observations of 22 solitary schwannomas of the VIIIth cranial nerve as they relate to the nerve of origin. Nine tumors were removed, en bloc with the VIIIth nerve, transversely subserially sectioned and studied by light microscopy. Four of the en bloc cases and 13 additional cases were studied by biopsying the VIIIth nerve branches, lateral, and the VIIIth nerve trunk medial to the tumor. The results suggest that the VIIIth nerve is involved throughout the extent of the tumor and, in some cases, beyond the tumor limits with intraneural invasion by tumor cells. There is an immediate dispersion of VIIIth nerve fibers to extremely small aggregates dispersed peripherally about the tumor surface. These fiber aggregates are not surgically dissectable from the tumor because of the difficulty in identifying the fibers and because of tumor infiltration of normal appearing nerves. The pure tone threshold average of 500-2,000 Hz. tends to correlate more closely with the number of cochlear fibers present, lateral to the tumor, than do other auditory tests. The percent of unilateral vestibular weakness does not correlate with the number of fibers present in the superior vestibular nerve. In summary, these histologic data suggest that complete tumor resection from VIIIth nerve fibers may be beyond our present technological capabilities. They further suggest severe limits to accurate identification of candidates for this conservation surgery.

Failures in surgery for stapedial otosclerosis

The causes for failure in surgery for stapedial otosclerosis are many. Most of these occur in the early postoperative period. Failures occurring later are due to either a breakdown of the reconstructed transformer system or to a labyrinthitis due to failure of the vestibular seal. The role of cochlear otospongiosis in producing late failures has not been sufficiently emphasized. This clinical review of 105 surgical failures examined consecutively during the years of 1975 through 1979 will demonstrate the importance of cochlear otospongiosis in this consideration. The fate of the unoperated-on ear in unilateral surgical failures will be demonstrated. Control of the progressive sensorineural hearing loss in these instances can be gained by the use of sodium fluoride therapy.

Cochlear Pathology after stapedectomy

Two patients experienced sensorineural hearing losses for different reasons following stapedectomy. One had an immediate severe sensorineural hearing loss following a fat-wire implant. Postmortem histologic study revealed severe cochlear degeneration, presumably caused by necrosis of the fat graft. The other patient experienced progressive fluctuating sensorineural hearing loss and vertigo several years after the introduction of the Teflon-wire prosthesis. Postmortem histologic study of this ear showed that the prosthesis had impaled the saccule, causing collapse of its wall with subsequent cochlear endolymphatic hydrops. These findings underscore the importance of atraumatic surgical technique in the performance of successful stapedectomy.

Shooting, sensorineural hearing loss, and workers' compensation

Pure-tone audiograms of 29,953 workers with histories of shooting and occupational noise exposure were analyzed. The analysis was based on the asymmetry of hearing loss. Results of this study show that shooting is related to asymmetrical hearing loss, suggesting that shooting may cause an additional amount of hearing loss other than that due to occupational noise exposure. Asymmetry was found to increase as the length of shooting history increased and was significant only at 2 kHz and above and most prominent at 4 kHz. Results also indicated that as long as compensable frequencies remain below 3 kHz the shooting effect is not likely to influence compensation for workers with histories of less than ten years of shooting.

[Jugular foramen neurinoma--report of a case (author's transl)]

A case of jugular foramen neurinoma was presented in detail with a review of fifty-seven cases reported in the literature. A thirty-six-year old man was admitted to the hospital with complaints of tinnitus and hearing loss in the right side with vertigo. Neuro-otological examination revealed the definite sensorineural hearing loss and the disturbance of vestibular function on the right. Cranial nerve palsy was not revealed except for the right eighth nerve. Craniotomogram and axial view showed enlargement of the right jugular foramen. CT, vertebral angiogram and pneumoencephalotomogram demonstrated a space taking lesion at the right cerebellopontine angle. By suboccipital craniectomy a walnut-size tumor was disclosed at the jugular foramen with total removal. However, the origin of the tumor was not confirmed. The post-operative course was uneventful and hearing loss was gradually improved.

Auditory function of Friedreich's ataxia. Electrophysiologic study of a family

Hearing function and auditory brainstem potentials were evaluated in nine members of three generations of a family affected with Friedreich's ataxia. The characteristic findings were high-frequency sensorineural hearing impairment of varying severity and diminished or absent N1, N2, and N3 responses. These electrophysiologic aberrations correlate topographically with previously reported pathological observations.

The ENT problems following the Birmingham bombings

The ENT problems following the Birmingham bombings of 1974 are presented. It is during the positive phase of bomb blast that the tympanic membrane ruptures. Spalling is a likely explanation for the mechanism of rupture of the tympanic membrane specially in large perforations. Tympanic membrane defects involving 80 per cent of the surface area of the drumhead or more persisted, whereas those involving less than 80 per cent healed with conservative treatment. The majority of perforations (81.4 per cent) healed spontaneously, with a three-layered membrane. A month should be allowed for the healing of every 10 per cent loss of the surface area of the drumhead. During surgical repair of persistent perforations, the malleus handle was found to be on a deeper plain than the long process of the incus. Tympanic membrane perforations did not protect the inner ear, the sensorineural deafness producing either a high tone or a flat loss. One in four of the victims seen in the hospital complained of deafness. A patient who suffered blast injuries to the lung also developed cord palsy.