1/12. July 2001: 58-year-old man with a temporal bone mass.The July 2001 Case of the Month (COM). A 58-year-old man with right ear hearing loss since childhood presented with a two year history of dizziness and vertigo. Neuroradiological studies showed a large mass arising from the petrous portion of the temporal bone. The lesion was resected and microscopic examination revealed a cholesterol granuloma with a small component of cholesteatoma. It is important to distinguish between cholesterol granuloma and cholesteatoma because of treatment differences. However, these two entities can occasionally be seen together and rare giant variants have been described.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/12. Managements of complicated otitic abscess.The advent of antibiotics has significantly reduced the incidence and associated morbidity of otogenic complications. Its presentation, however, has dramatically changed and appears as a masked condition despite the presence of a potentially fatal complication. Between 1998 and 2001, 3 cases of otitic abscesses, including mastoid subperiosteal abscess, zygomatic abscess, and retropharyngeal abscess, were collected retrospectively. Their clinical presentation, results of investigations, and response to treatment were reviewed. After admission, intravenous antibiotics were prescribed and early surgeries were performed for eradication of infection source. The patients exhibited excellent postoperative recovery, without facial palsy, vertigo or other complications. To be a contemporary otologist, we should not overlook such severe complications of otologic diseases. Appropriate intravenous antibiotics and adequate surgeries, as soon as possible, are recommended. Advanced magnetic resonance imaging or computed tomographic scans of the temporal bone with wider windows are necessary.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
3/12. Hypertrophic chronic pachymeningitis associated with chronic otitis media and mastoiditis.We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal meninges. Middle ear inflammation appeared to induce pachymeningitis and to exacerbate associated symptoms, leading to a decline in the patient's overall condition. Bilateral mastoidectomies were effective in improving her general condition. Her hearing improved only on the right side because ossiculoplasty was performed only on that side. Her facial movement progressively improved and pachymeningitis diminished over time. We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
4/12. Aerotitis: cause, prevention, and treatment.Aerotitis, an acute inflammation of the middle ear caused by the difference in air pressure between the airplane cabin and the middle-ear space, is becoming more common in the united states as our society becomes increasingly mobile. We describe a case in which a 33-year-old woman with a resolving upper respiratory tract infection and mildly blocked eustachian tubes flew on a business trip. During ascent, her ears became blocked. This blockage was partially alleviated by a Valsalva's maneuver. On descent, however, her ears became severely blocked, she experienced intense pain, and her tympanic membranes ruptured. She became nauseated and vomited. Her hearing became significantly diminished and she experienced vertigo. On landing, she was taken to a local emergency room and treated with penicillin and antivertiginous medication. Subsequent otologic evaluation revealed severe permanent sensorineural hearing loss. The vestibular symptoms lasted several months. She now requires hearing aids on a permanent basis. Suggestions are presented for prevention and treatment of aerotitis.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
5/12. From the aerospace medicine Residents' teaching File. Case #36.A designated naval aviator was evaluated after several episodes of vertigo related to a zoom climb flight profile. Workup led to the diagnosis of alternobaric vertigo. Contributing factors were concurrent upper respiratory infection and functioning left pressure equilibration (PE) tube for chronic otitis media.- - - - - - - - - - ranking = 2keywords = vertigo (Clic here for more details about this article) |
6/12. vestibular nerve section in patients with chronic otitis media.Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.- - - - - - - - - - ranking = 3keywords = vertigo (Clic here for more details about this article) |
7/12. temporomandibular joint dysfunction in infancy.temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders. Often, associated joint clicking or popping, aural fullness, vertigo, tinnitus, subjective hypoacusis, and nausea occur. As it has not been previously reported in infants, we would like to describe our experience with this disorder in an 11-month-old boy who was referred to our clinic with a presumed diagnosis of otitis media. The embryology of the temporomandibular joint is reviewed and appropriate treatment with anti-inflammatory analgesics, warm compresses, orthodontics, and external brace appliances is discussed. Because of referral patterns in the infant age group, the pediatric otolaryngologist should be similar with this entity and its presentation in children.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
8/12. Clinical evaluation of vertigo.In attempting to outline the clinical evaluation of these patients with vertigo we have discussed examples which range in order from benign self-limited disease to those requiring emergency surgery or extensive diagnostic evaluation. We sought also to illustrate how the logic of hypothesis testing is generally employed by clinicians in approaching this or other diagnostic problems. The examples were chosen to illustrate the indications for, as well as the limitations of, the various diagnostic modalities--caloric testing, electronystagmography, audiometric testing, roentgenographic and nuclear medicine procedures--which may be employed by the clinician. Most of the skills discussed in our paper, though traditionally accorded to the fields of neurology and otolaryngology, would seem to be fundamental for any general physician, while the problem of vertigo is an example of how common ambulatory problems may require knowledgeable approach to sort self-limited from more serious illnesses as well as to utilize procedures with purpose and efficiency.- - - - - - - - - - ranking = 6keywords = vertigo (Clic here for more details about this article) |
9/12. Meniere's syndrome and otitis media.We here present a clinical study of 37 patients with Meniere's syndrome. Meniere's syndrome can occur subsequent to and in some cases simultaneously with chronic otitis media. When otitis media which has occurred many years earlier in childhood becomes inactive, leading to sequelae of Meniere's later in life, full-blown Meniere's symptom-complex with vertigo tends to occur; whereas when active chronic otitis media accompanies Meniere's, cochlear Meniere's syndrome tends to predominate. endolymphatic hydrops is described in pathological cases of labyrinthitis and in 11 human temporal bone cases where there is evidence of chronic otitis media in the absence of visible labyrinthitis. A discussion of pathogenic factors includes considerations of quantity of endolymph due to hypodevelopment of the endolymphatic duct and sac related to mastoid hypocellularity and otomastoiditis in childhood and to other endolymphatic malabsorptions and also considerations of endolymph quality which can influence endolymph production as well as absorption.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
10/12. A case of acquired petrous cholesteatoma associated with insidious middle ear infection treated by staging the surgical procedures.Surgical treatment of petrous cholesteatoma is difficult, especially in infected cases, since it often involves vital structures. We report the case of a patient successfully treated for an infected petrous cholesteatoma by staging the surgical procedures to reduce the risk of intracranial complications. The patient, a 53-year-old man, was referred to our hospital because of vertigo during coughing or strenuous effort. The left side mastoid cavity was open to the external ear canal and wholly covered with cholesteatoma epithelium with purulent discharge. The superior basal turn of the cochlea, superior and posterior semicircular canals, and roof of the internal auditory canal were eroded. Conservative treatment was not effective in eradicating the otorrhea. Four weeks after the first operation (radical mastoidectomy), the second operation was conducted following a combined middle cranial fossa and transmastoid approach. The postoperative course was uneventful. Normal facial nerve function was preserved and unsteadiness disappeared, but hearing could not be preserved. The MRI examination, performed one year after surgery, did not reveal any evidence of residual cholesteatoma.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
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