Cases reported "Cochlear Diseases"

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1/6. Could vestibular evoked myogenic potentials (VEMPs) also be useful in the diagnosis of perilymphatic fistula?

    The role of vestibular evoked myogenic potentials (VEMPs) is at this time indisputable in the study of vestibular disorders. Furthermore, VEMPs are widely accepted as a diagnostic tool when a superior semicircular canal dehiscence (SCD) is suspected, presenting in such cases a lowering of threshold values able to raise a recordable response due to increased inner ear immittance. According to the same principle, the possibility of another kind of alteration having the same effect on the inner ear might be considered when high-resolution computed tomography has excluded the presence of an SCD. In this paper four cases are described in which high-resolution computed tomography showed normal features without any labyrinthine dehiscence and VEMP threshold values were lowered; the appropriateness of suspecting a perilymphatic fistula in such cases and resorting to VEMPs in detecting a perilymphatic fistula is discussed.
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keywords = perilymphatic
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2/6. ventriculoperitoneal shunt as treatment for perilymphatic fistula: a report of six cases.

    We report six cases of perilymphatic fistula in patients who received ventriculoperitoneal shunts as part of their final mode of therapy. The last of our 6 patients actually received a ventriculoperitoneal shunt as her initial mode of therapy. All but one had benign intracranial hypertension. All six felt better (less disequilibrium, tinnitus, and pressure and occasional hearing improvement) after LP with removal of 15-20 ml of cerebrospinal fluid.
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keywords = perilymphatic
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3/6. Endoscopic diagnosis of idiopathic perilymphatic fistula.

    The usefulness of endoscopic examination for the diagnosis of idiopathic perilymphatic fistula (IPLF) was investigated. Eight patients presenting with unilateral sensorineural hearing loss and vertigo underwent endoscopic examination by the transtubal or transtympanic approach. In 5 out of the 8 patients, transtubal endoscopy was carried out using a superfine flexible endoscope. With this approach, no abnormal findings were visualized. A perilymphatic leak from the round window was observed in 2 patients by means of transtympanic examination using a needle scope. These findings were confirmed in both patients by microscopic observation during tympanotomy. In one patient who was finally diagnosed with IPLF, the transtympanic endoscopy failed to detect perilymphatic leakage. Although incision of the tympanic membrane is necessary for the examination, transtympanic endoscopy is useful for the diagnosis of IPLF. Further improvement of the superfine flexible fiberscope is necessary before transtubal observation of the tympanic cavity can be effectively conducted.
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ranking = 1.1666666666667
keywords = perilymphatic
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4/6. Perilymphatic fistula with no visible leak of fluid into the middle ear: a new method of intraoperative diagnosis using electrocochleography.

    A new method for the intraoperative diagnosis of a perilymphatic fistula is presented. Two cases are reported in which the test clearly indicated the presence of a fistula even though no visible leak of fluid was noted by the surgeon. In each case, there was a clear history of vertigo and hearing loss. Preoperatively, the presence of a perilymphatic fistula was suggested using raised intrathoracic pressure test in electrocochleography (ECochG). During the surgery, there was no visible leak of fluid into the middle ear. Electrocochleography was undertaken intraoperatively by placing an electrode in the round window niche and suctioning the oval window area; in neither case was any ECochG change seen. Next the electrode was repositioned on the oval window and when the round window area was suctioned, obvious ECochG changes occurred. Action potential (AP) amplitude dramatically decreased in both cases and summating potential (SP) increased in one case.
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keywords = perilymphatic
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5/6. Spontaneous perilymphatic fistula: electrophysiologic findings in animals and man.

    The case against the occurrence of spontaneous perilymphatic fistulas is presented. Electrophysiologic findings both in animals and in man suggest that small holes in either the round or oval window are not associated with any significant hearing loss. Removal of perilymph may cause some changes in the electrocochleogram that can be reversed when the perilymph is replaced. Tympanotomy surgery, especially when performed with the injection of local anesthetic solutions may result in transudates in the middle ear that are difficult to differentiate from perilymph leaking out from the inner ear. Perilymphatic fistulas were excluded by performing a posterior myringotomy under general anesthesia in 162 congenitally deaf ears. If fluid was present it was suctioned, and if no change occurred on the intraoperative electrocochleogram, it was concluded that no fistula existed. Based on the electrophysiologic findings and the clinical observations in over 240 ears, it was concluded that spontaneous perilymphatic fistulas do not exist. The author accepts that perilymphatic fistulas occur after surgery, especially after stapedectomy, and that they can occur after head injury or barotrauma. However, these should heal readily; persistent or intermittent fistulas are an otologic rarity.
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ranking = 1.1666666666667
keywords = perilymphatic
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6/6. Mesothelial cell proliferation in the scala tympani: a reaction to the rupture of the round window membrane.

    The inner layer of the round window membrane is composed of mesothelial cells and this mesothelial cell layer extends to the scala tympani. This study describes the histopathologic findings of temporal bone analysis from a patient with bilateral perilymphatic fistula of the round window membrane. The left ear showed proliferation of mesothelial cells in the scala tympani of the basal turn adjoining the round window membrane. This cell proliferation is thought to be a reaction to the rupture of the round window membrane.
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keywords = perilymphatic
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