Cases reported "Hearing Disorders"

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1/20. chiropractic care of a patient with temporomandibular disorder and atlas subluxation.

    OBJECTIVE: To describe the chiropractic care of a patient with cervical subluxation and complaints associated with temporomandibular disorder. CLINICAL FEATURES: A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. INTERVENTION AND OUTCOME: High-velocity, low-amplitude adjustments (ie, Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms improved and eventually resolved after 9 visits. CONCLUSION: The chiropractic care of a patient with temporomandibular disorder, headaches, and subluxation is described. Clinical issues relevant to the care of patients with this disorder are also discussed.
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ranking = 1
keywords = vertigo
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2/20. Traumatic perilymphatic fistula: how long can symptoms persist? A follow-up report.

    In the past 18 years 68 ears (average 3.8 per year) were explored for perilymphatic fistula (PLF). A total of nine (13%) ears had a fistula identified at operation. patients with a previous history of otologic surgery were excluded from this review. The most common etiology for PLF was head trauma (4 of 9). Most patients had persistent symptoms lasting months (average 6.7). Eighty-three percent of all patients had sudden or fluctuating hearing loss, 77 percent had vertigo or dysequilibrium, and 61 percent had tinnitus. vertigo was the most commonly improved symptom postoperatively, and only 25 percent of patients had improved hearing. There were no major complications. The authors discuss indications for operation, criteria for diagnosis of PLF, and audiometric and electronystagmographic findings. This report agrees with other recent data indicating that exploration for fistula is an uncommon procedure performed by otologists.
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ranking = 1
keywords = vertigo
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3/20. Labyrinthotomy with streptomycin infusion: early results of a multicenter study. The LSI multicenter study Group.

    Early results for hearing and vertigo are reported for 47 labyrinthotomies with streptomycin infusion (LSI) by 13 coinvestigator-surgeons. Sixty-eight percent of patients had worse hearing after surgery (10 dB or 15% word recognition). patients with a preoperative pure-tone average better than or equal to 40 dB appeared to suffer less postoperative hearing loss than those with a greater preoperative deficit. Severe to profound postoperative hearing loss was experienced by 27 patients (57%), all of whom had preoperative pure-tone averages worse than 40 dB. Opening the endolymphatic space was associated with a deleterious effect on hearing. Because of persistent vertigo, 17 percent of patients required a secondary procedure during the period of observation. These early results indicate that LSI is associated with a significant risk of postoperative hearing loss. Of the 13 coinvestigator-surgeons, four have stopped using LSI, while one considers his results satisfactory. The remaining surgeons have taken an intermediate position and feel it is useful in selected cases. Longer follow-up is required to judge the efficacy of LSI for controlling vertigo. We are currently studying these long-term results.
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ranking = 3
keywords = vertigo
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4/20. facial nerve schwannomas: different manifestations and outcomes.

    BACKGROUND: The purpose of this study was to provide data on the different clinical presentations of facial nerve schwannoma, the appropriate planning for the management of schwannoma of various origins, and the predictive outcomes of surgical management. methods: A retrospective study was conducted in a tertiary referral hospital. We reviewed 8 consecutive cases of facial nerve schwannoma diagnosed and managed between 1993 and 2001. RESULTS: facial nerve schwannomas originated in the internal auditory canal (IAC) (2 cases), parotid gland (2 cases), intratemporal portion (3 cases), and stylomastoid foramen (1 case). Tumor of the stylomastoid foramen presented as an intra- and extratemporal mass. The initial presenting symptom of the 8 patients was facial nerve paralysis in 4 patients, hearing loss in 2, facial numbness in 1, and an infra-auricular mass in 1. Facial palsy occurred in 7 patients during the course of the disease. One patient with a mass in the parotid gland did not show facial palsy up to 1 year after presentation of the initial symptom (facial numbness). facial nerve paralysis was most severe in intratemporal tumors and less severe in parotid tumors. The patients with IAC suffered from hearing loss and intermittent vertigo and showed decreased vestibular function. The patients with intratemporal tumors also complained of hearing loss. The tumors were completely removed by superficial parotidectomy for parotid tumors; the translabyrinthine approach for 1 IAC tumor and 1 intratemporal tumor; the middle fossa approach for the other IAC tumor; the transmastoid approach for mastoid tumors; and the infratemporal fossa approach for intratemporal and extratemporal tumors. End-to-end cable grafts for the facial nerve were performed in 5 out of 8 cases. In 2 cases, the facial nerve was preserved after the resection of the mass. One case showed complete loss of the peripheral branch of the facial nerve. CONCLUSIONS: facial nerve schwannoma can present in various ways. By examining the site of origin and the presenting symptoms and signs, we were able to diagnose facial nerve schwannoma preoperatively. According to the operative management of the facial nerve, the postoperative outcome of facial function could be estimated. Our finding could be pivotal in the management of the facial nerve schwannoma.
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ranking = 1
keywords = vertigo
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5/20. water may cure patients with meniere disease.

    OBJECTIVES/HYPOTHESIS: We examined whether sufficient water intake is effective in the long-term control of vertigo and hearing activity in patients with meniere disease (MD) for whom conventional therapy has proven unsuccessful. STUDY DESIGN: The authors conducted a time-series study with historical control. methods: Eighteen patients with MD in group 1 drank 35 mL/kg per day of water for 2 years. Twenty-nine patients with MD treated with the conventional dietary and diuretic therapy for more than 2 years during 1992 to 1999 at the same hospital were enrolled in a historical control of group 2. RESULTS: patients in group 1 dramatically relieved vertigo and significantly improved in the hearing of the worst pure-tone average of three frequencies (0.125, 0.25, and 0.5 kHz) (low PTA) during the last 6 months of the study period. In contrast, patients in group 2 became worse in both the four- (0.5, 1, 2, and 4 kHz) frequency PTA and the low PTA, although their vertigo did improve. The number of patients whose hearing were improved, unchanged, and worse were 4, 12, and 2 in group 1 and 2, 11, and 16 in group 2, respectively. CONCLUSION: Deliberate modulation of the intake of water may be the simplest and most cost-effective medical treatment for patients with MD. Larger studies will be needed to confirm these results in a larger patient cohort.
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ranking = 3
keywords = vertigo
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6/20. Otologic and otoneurologic injuries in divers: clinical studies on nine commercial and two sport divers.

    In the past two decades, we have seen a great increase in the number of injuries from commercial and sport diving. During this time, our knowledge of the physiology and pathophysiology of diving has also increased. As a result, we now can accurately diagnose and successfully treat many of these injuries. Of the commercial and sport divers examined as pateints in the Department of otolaryngology at the University of texas Medical Branch in Galveston, Tex., between September, 1974, and May, 1975, 11 showed positive otologic and otoneurologic findings which are reported herein. One patient was surgically explored for an oval window fistula. In localizing and classifying these injuries, we have utilized extensive and broad-based test batteries, which include complete history, otologic and otoneurologic physical examination, audiometry, a central auditory test battery, and a vestibular test battery. These tests are described. The findings in each of the divers are illustrated and analyzed. This article further describes the use of these test batteries, which were employed to localize otoneurologic pathology in this sample of injured divers. Based on these cases, we have expanded and modified Edmonds' classification of the etiology of vertigo related to diving. We feel that the test batteries which we describe, or similar tests, should be part of the otologic and otoneurologic workup of injuries divers.
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ranking = 1
keywords = vertigo
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7/20. perilymph fistula: the iowa experience.

    Ninety-one patients with demonstrable perilymph fistulas presented with an amazing array of signs and symptoms ranging from unilateral tinnitus and aural fullness to sudden-and-profound hearing loss, roaring tinnitus, and whirling vertigo. Between 1977 and 1984, 214 exploratory tympanotomies for suspected perilymph fistula (PLF) were performed on 177 patients. One hundred six primary (initial) fistulas were found in 95 ears and 26 recurrent fistulas were identified. Eighty-two percent of the 91 patients with PLF had auditory symptoms, 8% with auditory symptoms as the sole complaint. Eighty-one percent of the patients had vestibular symptoms, 12% with vestibular symptoms alone. The type of hearing loss and the nature of the vestibular symptoms were widely variable. Of the 58 patients with preoperative auditory symptoms, 49% had improved hearing (23% improved to serviceable range), after closure of PLFs. Ninety-five percent of the patients who presented with vestibular symptoms had elimination of or decrease in their dizziness to the extent that it no longer interfered with their daily activities. The highest incidence of recurrent fistula was associated with grafts using fatty tissue. patients with Mondini deformity were at particularly high risk for fistula recurrence.
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ranking = 1
keywords = vertigo
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8/20. Juvenile Meniere's disease.

    The authors report their experience in the diagnosis and treatment of Meniere's disease in childhood. They believe it to be essential to carry out a complete battery of audio-vestibular tests, with particular reference to dehydration procedures, which in this age group are considered to be more significant for a correct diagnosis than in adults. After stressing the importance of eliminating other forms of disease which manifest themselves with vertigo, the authors conclude by asserting the efficacy of medical treatment with diuretics and they support the surgical procedure of endolymphatic-mastoid drainage as a valid means of contending with the hydrops.
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ranking = 1
keywords = vertigo
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9/20. ataxia and hearing loss secondary to perilymphatic fistula.

    ataxia is rarely attributed to lesions of the peripheral vestibular system. In 1973, the first case of ataxia and hearing loss secondary to a labyrinthine fistula was reported. Until now, this syndrome has not been reported in patients under the age of 10 years. A case is presented of a 5-year-old boy with symptoms of ataxia and hearing loss as well as vertigo and tinnitus after head trauma. Three physical findings appear to be most characteristic of patients with perilymphatic fistulas: a positive fistula response, positive positional testing with the involved ear down, and evidence of vestibular ataxia when testing station and gait. The absolute diagnosis of perilymphatic fistula can only be established by exploration of the middle ear space. If a fistula is found, it may be sealed with soft tissue and, if this fails, actual stapedectomy may be required.
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ranking = 1
keywords = vertigo
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10/20. Titration streptomycin therapy for bilateral Meniere's disease: a preliminary report.

    Intramuscular dosages of streptomycin sulfate were titrated in eight patients with bilateral Meniere's disease in an attempt to alleviate disabling vertigo and hearing loss. It appears possible to eliminate the vertiginous episodes, preserve or improve hearing, and avoid ataxia and oscillopsia in most of these individuals. At present we consider this treatment regimen our first choice of therapy in people with bilateral active Meniere's disease or in patients whose only hearing ear is actively fluctuating and in whom associated disabling vertigo is present. Great caution and supervision should be exercised in the use of streptomycin titration therapy in the individual with bilateral Meniere's disease, as further experience is required to determine the efficacy of this form of management.
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ranking = 2
keywords = vertigo
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