The influence of voluntary muscle contractions upon the onset and modulation of tinnitus

OBJECTIVE

To evaluate the frequency of tinnitus onset (in normal subjects) and modulation (in tinnitus patients) during muscle contractions, estimating possible risk factors.

MATERIAL AND METHOD

This case-control study enrolled 121 tinnitus patients and 100 healthy volunteers who underwent medical history, ENT examination and 16 maneuvers of muscular contraction (head, neck and limbs). Modulation data were compared between patients with and without normal audiometry, well-defined diagnosis and symptoms of craniomandibular disorders.

RESULTS

The ability to modulate tinnitus (65.3%) was significantly higher than that to originate tinnitus (14.0%). The head and neck musculature was significantly more efficient than that of the limbs. Audiometric pattern, well-defined etiology and symptoms of craniomandibular disorders showed no relation to tinnitus modulation.

CONCLUSIONS

Somatic modulation is a characteristic aspect of tinnitus.

The transmastoid retrolabyrinthine approach in vestibular schwannoma surgery

OBJECTIVE

We conducted a prospective analysis of 22 patients with small vestibular schwannoma and useful hearing who were operated on via a transmastoid retrolabyrinthine approach between January 1994 and March 1999.

PATIENTS AND METHODS

The average age was 35 years, and there were 14 females and 8 males. All patients had unilateral tumors, with 10 of them occurring in the right ear and 12 occurring in the left ear. The following parameters were included in our protocol: total removal of the tumor, intraoperative difficulties or complications, immediate postoperative complications, facial score 10 days and 3 months after the surgery, and audiologic evaluation 90 days after the surgery.

RESULTS

A good exposure of the internal auditory canal was possible in 19 cases. In 3 patients we had to change the approach to a translabyrinthine one to achieve total removal of the tumor in all patients. Hearing was preserved at the same preoperative levels in 31% of the cases.

CONCLUSIONS

The retrolabyrinthine approach offered security to the facial nerve, no morbidity, and good percentage of hearing preservation. It is also easily changeable to a translabyrinthine approach when more exposure is necessary.

A Rapid and Safe Middle Fossa Approach to the Geniculate Ganglion and Labyrinthine Segment of the Facial Nerve

The middle fossa approach provides neurotologic surgical access to lesions of the geniculate ganglion and the labyrinthine portion of the facial nerve as well as to the internal acoustic canal, and therefore helps preserve cochlear function. Although this approach is widely used, surgeons are still not certain which anatomic landmarks are best to locate the facial nerve and internal acoustic canal without causing labyrinthine damage. The purpose of this article is to describe a fast and safe technique to expose the geniculate ganglion and the labyrinthine portion of the facial nerve in two structures of the middle ear: the cochleariform process and the tympanic portion of the facial nerve. We prospectively evaluated 32 patients who underwent surgical facial nerve exploration via the middle fossa approach. Our goal was to determine the incidence of intraoperative difficulties and complications; we found none, and hearing levels could not be maintained in only one of the 32 patients. Our technique allowed us to decompress the first genu and the labyrinthine segment of the nerve. It also allowed us to reach and manipulate its tympanic segment in a very short amount of surgical time.

A rapid and safe middle fossa approach to the geniculate ganglion and labyrinthine segment of the facial nerve

The middle fossa approach provides neurotologic surgical access to lesions of the geniculate ganglion and the labyrinthine portion of the facial nerve as well as to the internal acoustic canal, and therefore helps preserve cochlear function. Although this approach is widely used, surgeons are still not certain which anatomic landmarks are best to locate the facial nerve and internal acoustic canal without causing labyrinthine damage. The purpose of this article is to describe a fast and safe technique to expose the geniculate ganglion and the labyrinthine portion of the facial nerve in two structures of the middle ear: the cochleariform process and the tympanic portion of the facial nerve. We prospectively evaluated 32 patients who underwent surgical facial nerve exploration via the middle fossa approach. Our goal was to determine the incidence of intraoperative difficulties and complications; we found none, and hearing levels could not be maintained in only one of the 32 patients. Our technique allowed us to decompress the first genu and the labyrinthine segment of the nerve. It also allowed us to reach and manipulate its tympanic segment in a very short amount of surgical time.

A new therapeutic procedure for treatment of objective venous pulsatile tinnitus

Pulsatile tinnitus usually means a turbulent flow within the vessels. We describe a 54-year-old man with a disabling objective pulsatile tinnitus due to a diverticulum of the sigmoid sinus toward the ipsilateral mastoid. We performed a surgical intervention via the endovascular route using coils to obliterate the diverticulum and a stent to avoid coil migration. The patient had a complete and immediate remission of the pulsatile tinnitus. This procedure has been described only in arterial circulation.

Lidocaine test in patients with tinnitus: rationale of accomplishment and relation to the treatment with carbamazepine

OBJECTIVES

There is strong evidence in the literature about the effect of local anesthetics such as lidocaine in controlling tinnitus; these agents act by stabilizing hair cell membrane and cochlear nerve fibers. However, the effect of intravenous lidocaine is transient, and its oral analog (tocainide) does not have the same efficacy for long-term treatment in patients with tinnitus. Some oral anti-epileptic drugs (carbamazepine, for instance) have been used alternatively in several studies. The aim of this work is to evaluate the response to intravenous lidocaine in patients with intractable tinnitus and the effect of oral carbamazepine in long-term maintenance of tinnitus relief.

PATIENTS AND METHODS

We studied prospectively 50 patients (28 females and 22 males; mean age 50.9 years) who underwent the lidocaine test, performed by a 3-min intravenous infusion of 2% lidocaine chloridrate. The patients who experienced any relief after the test started treatment with oral carbamazepine in ascending dosages (50-600 mg/day).

RESULTS

The results were classified as tinnitus abolition (18%), marked relief (32%), partial relief (26%), unchanged (22%), or worsening (2%). The lidocaine test showed favorable results in 76% of patients, especially those with bilateral tinnitus (P < 0.001). Afterwards, 50% of patients treated with carbamazepine maintained the improvement of tinnitus (P = 0.0034).

CONCLUSION

The authors conclude that intravenous lidocaine is effective in reducing intractable tinnitus and that there is a close association between lidocaine and oral carbamazepine effects. Therefore, carbamazepine can be used for the treatment of tinnitus when the patient achieves improvement of symptom after the lidocaine test.

Ear and nose foreign body removal in children

The removal of foreign bodies in children is very common in the otolaryngologist's daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

Continuous, high-frequency objective tinnitus caused by middle ear myoclonus

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.

Nasal chondroma: a case report and review of the literature

Although rare tumors, chondromas will on occasion be encountered by the otolaryngologist in his routine daily practice. The authors describe a nasal myxochondroma in an 8-year-old child, which was removed satisfactorily surgically, with no signs of recurrence even after 4 years of follow-up. Because chondromas may also present as nasal polyps, the knowledge of cartilaginous tumors in the nose plays a pivotal role for a better approach to these patients.

Septic thrombosis of orbital vessels due to cutaneous nasal infection

The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. Patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.

Otological lesions in pachyonychia congenita syndrome

The authors report a case of a patient with pachyonychia congenita syndrome, a rare genodermatosis inherited as an autosomal dominant trait, who also had otological lesions beyond the other classic signs and symptoms of the syndrome. Many kinds of treatment have already been proposed, but all failed to show satisfactory results. A new, cheap and easy-to-use treatment was developed in this study, using keratoplastics interpolated with humectant lotion for 90 days. The results after three years of follow-up are still thoroughly satisfactory.

A pathway for information transmission to the ear

The use of implantable hearing aids and cochlear implants as an aid to neurosensory deafness is becoming an established procedure. The transmission of a processed speech signal is accomplished either transcutaneously via radiofrequency or percutaneously by connector coupling. Whereas the former is sensitive to electromagnetic interference, the latter increases the risk of infection. To overcome these disadvantages, an infrared (IR) system for transmission through the tympanic membrane was devised and tested. The transmitter/receiver consisted of an IR light emitting diode (LED; 920nm) and a photovoltaic cell. The LED was placed inside the auditory canal of four dogs and the photovoltaic cell in the tympanic cavity over the cochlear promontory. A sinusoidal signal modulation was applied to the LED. The emitted signal was detected undistorted after crossing the tympanic membrane, with an average absorbance of 20%. High-frequency cut-off was adequate for cochlear implant purposes and audio prosthetic devices in general. The authors conclude that the tympanic membrane may be used as a translucent sealed interface to transmit data in the audio range to the middle and inner ears, with small power loss, good frequency response, and immunity to interface.

A Pathway for Information Transmission to the Ear

The use of implantable hearing aids and cochlear implants as an aid to neurosensory deafness is becoming an established procedure. The transmission of a processed speech signal is accomplished either transcutaneously via radiofrequency or percutaneously by connector coupling. Whereas the former is sensitive to electromagnetic interference, the latter increases the risk of infection. To overcome these disadvantages, an infrared (IR) system for transmission through the tympanic membrane was devised and tested. The transmitter/receiver consisted of an IR light emitting diode (LED;920nm) and a photovoltaic cell. The LED was placed inside the auditory canal of four dogs and the photovoltaic cell in the tympanic cavity over the cochlear promontory. A sinusoidal signal modulation was applied to the LED. The emitted signal was detected undistorted after crossing the tympanic membrane, with an average absorbance of 20%. High-frequency cut-off was adequate for cochlear implant purposes and audio prosthetic devices in general. The authors conclude that the tympanic membrane may be used as a translucent sealed interface to transmit data in the audio range to the middle and inner ears, with small power loss, good frequency response, and immunity to interface.