Sudden or fluctuating hearing loss and vertigo in children due to perilymph fistula

Five cases are presented of children with rapid onset of sensorineural hearing loss, disequilibrium, or both, who were found at exploratory tympanotomy to have a perilymph fistula. Four of the children had histories suggesting that antecedent barotrauma or physical exertion contributed to the development of the fistula. One child with congenital unilateral craniosynostosis had a residual temporal bone abnormality on the same side as the perilymph fistula. Two children had identifiable anatomic abnormalities in the middle ear. A classification of perilymph fistula is proposed that describes a congenital, an acquired, and a combined type of fistula. Inner ear fluid dynamics and patency of the cochlear aqueduct appear to be important factors in pathogenesis. Children with unexplained fluctuating or sudden onset of sensorineural hearing loss, and children with unexplained disequilibrium or vertigo should be suspected of having a perilymph fistula. The history can be singularly important in raising the suspicion that a perilymph fistula may be present. Although audiometric, vestibular, and radiographic studies can be helpful, there is no way to prove the presence or absence of a fistula without directly viewing the middle ear. Tympanotomy with repair of the fistula does not assure improvement in hearing.

Management of the labyrinthine fistula

Preoperative, operative and postoperative findings in 97 cases of labyrinthine fistula are presented. The majority of patients had had symptoms of chronic otitis media for 20 years or more and manifested some degree of sensorineural hearing impairment. Two-thirds had experienced dizziness. The fistula was limited to the lateral semicircular canal in 83 cases and involved the labyrinth more extensively in 14 instances. The intact canal wall technique was used in less than 60% and an open cavity technique in a quarter of the cases. Severe or total sensorineural hearing impairment developed postoperatively in 8% of the lateral canal cases and in over half of the extensive fistula cases. Five per cent had incapacitating dizziness for up to 6 months postoperatively. When a labyrinthine fistula is encountered in an only hearing ear, a classified modified radical mastoidectomy is usually recommended. In other instances, the procedure performed will vary with the status of the opposite ear, the extent of the fistula, the sensorineural function of the involved ear and the size of the mastoid.

The etiology of neurosensory hearing defects in preterm infants

We retrospectively investigated the influence of gestational age, perinatal risk, and the duration of incubator care periods in 193 surviving preterm infants with a gestational age between 28 and 36 weeks raised in our intensive care nursery incubators from 1965--1967. 24 (12.4%) of the children showed definite neurosensory hearing defects, which were particularly encountered in the high frequencies. No correlation could be substantiated between hearing difficulties and hyperbilirubinemia, streptomycin application and gestational age. This study does not support the assumption that the duration of noise exposure in currently used incubators is a major determinant for the development of deafness in otherwise healthy preterm infants. Our study did show, however, a strong correlation between the sum of all perinatal risk factors and neurosensory hearing loss.

The longitudinal course of congenital rubella encephalitis in nonretarded children

The neurologic course of congenital rubella syndrome was traced in 29 nonretarded children to 9 to 12 years. During the first two years, manifestations involved abnormal tone and reflexes (69%), motor delays (66%), feeding difficulties (48%), and abnormal clinical behavior (45%). Hearing loss was documented in 76%. From three to seven years, poor balance, motor incoordination (69%), and behavioral disturbances (66%) predominated. Hearing losses increased to 86%. Currently, at 9 to 12 years, 25 have residua which include learning deficits (52%), behavioral disturbances (48%), poor balance (61%), muscle weakness (54%), and deficits in tactile perception (41%). Two additional children now have hearing loss. The encephalitic manifestations of congenital rubella syndrome are diverse. Overriding problems differ at each phase of childhood. Current deficits influence progress in educational and home environments. For these children, adequate intelligence alone does not guarantee academic success.

Hearing impairment in children of low birthweight

Audiometer evaluations were carried out on a population of 204 low birth weight (LBW) children and 123 controls. In the LBW group, 6 children (3.3%) had a bilateral loss and 5 (2.5%) had a unilateral sensorineural high-frequency hearing loss. No case of sensorineural hearing loss was found among the controls. There were 13 (6.4%) cases of conductive loss among the LBW sample, compared with 3 (2.4%) among the controls. Correlation coefficients showed a relationship between sensorineural impairment and: bilirubin level, incubator time, antibiotic history, and neurological status. Subsequent multiple classification analyses showed that, while incubator time and bilirubin level are each significant predictors of sensorineural loss, this is not the case with antibiotics or neurological status. Neurological status was closely associated with the syndrome of LBW, high bilirubin level, extended incubator time and sensorineural loss. However, no significant relationship could be found between neurological impairment and these predictors nor can it be regarded as useful in predicting hearing loss in this population.

The incidence, site, treatment and fate of labyrinthine fistula

Although the incidence of labyrinthine fistula appears to be similar in most reported series, the number of patients reported to have a positive response to the fistula test do not. This may be due to a lack of uniformity in the performance of the test. The method of the author, the direction of eye movement and its diagnostic significance are described. The occurrence and mechanism of severe sensorineural hearing loss in 5 out of 20 patients in whom the matrix was removed accidently from the fistula during mastoidectomy is discussed.

The case for small fenestra stapedectomy

Eight hundred stapedectomies were analyzed to evaluate the long-term results with four prostheses. It was concluded that limitation of fenestra size played a most important part in the outcome of stapedectomy, especially in regard to the preservation of high-frequency bone conduction response over prolonged periods. Other advantages deriving from small fenestra stapedectomy included significantly fewer fistulae and severe sensorineural losses.

Basilar artery migraine presenting as fluctuating hearing loss and vertigo

A review of the literature on basilar artery migraine as well as a brief overview of classic migraine is given. Diagnosis and management are also discussed as well as six case histories.

Arteriolar sclerosis as a cause of presbycusis

Temporal bones, brains, and kidneys of 40 patients over 50 years of age were studied histopathologically, paying special attention to angiosclerotic changes. The histopathologic findings were correlated with audiometric and manometric records obtained while the patients were alive. A close relation existed among the lumen narrowing of the internal auditory artery, spiral ganglion atrophy, and hearing loss. The angiosclerotic changes of the Willis' circle, encephalomalacia, and hearing loss were also related.

Can an operation of deaf ear be dangerous for hearing?

After a single or modified radical mastoidectomy the hearing of the contralateral ear was followed by pure tone audiometry in 55 patients. In 12 patients a sensorineural--mostly high tone--hearing loss of at least 20 dB was found in the contralateral ear. In six cases this was persistent. The number of patients with hearing loss increased with increasing operation time. The cause of this hearing loss must be the noise of the bone-cutting burr.

Ear damage due to diving

Diving injury may affect all parts of the ear during all types of diving. Divers are regularly exposed to noise and 120 dB(A) is measured during ventilation of a hyperbaric chamber. Ear canal squeeze, possibly with drum perforation, may give a transient conductive hearing loss. Middle ear squeeze, possibly with drum perforation, also gives a transient conductive loss. Inner ear barotrauma, possibly with perilymph fistula, most often results in transient vertigo and lasting sensorineural high tone loss, often resembling a noise-induced loss. Decompression sickness and gas embolism can also damage the inner ear. A change of breathing gas during deep diving has damaged the labyrinth, most likely due to counter diffusion. The authors have seen two cases of over window perilymph fistula resulting from diving. One of them also suffered a burst ear drum on the same side. His hearing returned to normal after surgical repair.

Late syphilis. Otologic symptoms and results of the FTA-ABS test

The clinician occasionally encounters a patient whose cochleovestibular symptoms are thought to be due to late syphilis mainly on the basis of a reactive FTA-ABS test. I describe 21 such patients, 11 of whom had either a spurious- or a false-positive reaction. The following suggestions may avoid an inaccurate diagnosis of late syphilis in such patients: (1) repeat all reactive serological tests for syphilis (STS); (2) rule out false-positive reactions; (3) request the degree of fluorescence (1+ to 4+) on all reactive FTA-ABS tests; (4) obtain a Treponema pallidum immobilization (TPI) test on all patients with repeatedly reactive (1+) FTA-ABS tests--a nonreactive TPI test rules out the diagnosis of syphilis; (5) if a TPI test cannot be performed, a repeatedly reactive (1+) FTA-ABS test in the absence of a reactive nontreponemal STS probably represents a false-positive reaction; (6) clinical judgment is the final determinant of whether a patient has or should be treated for late syphilis.