Cases reported "Tinnitus"

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1/39. Persistent bilateral hearing loss after shunt placement for hydrocephalus. Case report.

    Transient hearing decrease following loss of cerebrospinal fluid (CSF) has been reported in patients undergoing lumbar puncture, spinal anesthesia, myelography, and/or different neurosurgical interventions. The authors present the first well-documented case of a patient with persistent bilateral low-frequency sensorineural hearing loss after shunt placement for hydrocephalus and discuss the possible pathophysiological mechanisms including the role of the cochlear aqueduct. These findings challenge the opinion that hearing decreases after loss of CSF are always transient. The authors provide a suggestion for treatment.
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2/39. Familial progressive vestibulocochlear dysfunction caused by a COCH mutation (DFNA9).

    OBJECTIVE: To describe the decline of vestibulocochlear function in a man with vestibulocochlear dysfunction caused by a Pro51Ser mutation within the COCH gene on chromosome 14q12-13 (DFNA9). methods: A follow-up of more than 15 years was performed in a single case. Clinical investigations were supplemented by oculomotor, vestibular, and auditory tests. RESULTS: A 50-year-old man had had progressive sensorineural hearing loss and dysequilibrium for 15 years; he had been asymptomatic at the age of 35 years. He suffered from instability in the dark, head movement-dependent oscillopsia, paroxysmal positional vertigo, and vertigo with and without nausea. Hearing impairment started unilaterally, predominantly in the high frequencies. He also reported tinnitus. Disease progressed to severe bilateral high-frequency hearing impairment and vestibular areflexia. Fluctuation of vestibulocochlear function was documented and mentioned by the patient. CONCLUSIONS: Our patient proved to suffer from an autosomal dominant vestibulocochlear disorder caused by a COCH gene mutation. The remarkable medical history has some features in common with meniere disease; however, there are also different clinical and neurophysiological features. In the family, phenotypic variability is present.
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3/39. Objective tinnitus in children.

    OBJECTIVE: To discuss the various symptoms and causes of objective tinnitus in children. STUDY DESIGN: Retrospective case review. patients: Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma. MAIN OUTCOME MEASURE: The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner. RESULTS: Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus. CONCLUSION: The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.
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4/39. Cerebellar arteriovenous malformation with facial paralysis, hearing loss, and tinnitus: a case report.

    OBJECTIVE: To describe cerebellar arteriovenous malformation in a 21-year-old man with symptoms resembling those of ear disease and to discuss the relationship between the findings of neurotologic examination and magnetic resonance imaging. STUDY DESIGN: Case report. SETTING: Department of otolaryngology, Head-and-neck Surgery of the Kyoto University Hospital, which is a tertiary care center, in Kyoto, japan. PATIENT: A 21-year-old man had cerebellar arteriovenous malformation and symptoms resembling those of ear disease: recurrent left facial paralysis, left retrocochlear hearing loss, and tinnitus. Auditory brainstem responses showed only waves I and II on his left side. Downbeat nystagmus was seen by anteflexion and retroflexion of his neck. He also experienced a slight sensory disturbance on the left side of his face and right lower extremity. magnetic resonance imaging and vertebral angiography revealed a cerebellar arteriovenous malformation and a varix functioning as a drainer of the arteriovenous malformation surrounded by an edematous region probably induced by a small hemorrhage in the brainstem. INTERVENTION: Conservative treatment, including intravenous prednisolone, vitamin B12, and oral adenosine triphosphate was performed followed by total extirpation of the arteriovenous malformation. CONCLUSION: In examining patients with peripheral facial paralysis (sometimes recurrent with a short interval) and other symptoms resembling those of ear disease, especially those suggesting certain central disorders, it is important to take intracranial arteriovenous malformation into consideration because the condition may be sometimes life threatening if overlooked.
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5/39. Abrupt onset of sensorineural hearing loss and tinnitus in a patient with capillary telangiectasia of the pons.

    Capillary telangiectasia is often found incidentally on magnetic resonance imaging and may be associated with minor neurologic symptoms, but there has been little evidence about whether such lesions are responsible for these symptoms. Here we report a case of capillary telangiectasia of the right mid pons, which was associated with the abrupt onset of tinnitus and sensorineural hearing loss. Examination of the auditory brain stem responses showed abnormalities of waves III and IV on the left and bilateral prolongation of the interwave intervals. Optokinetic nystagmus showed slight left-right asymmetry.
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6/39. Orthostatic tinnitus: an otological presentation of spontaneous intracranial hypotension.

    Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, low cerebrospinal fluid (CSF) pressure without apparent causes for CSF loss, and diffuse pachymeningeal gadolinium enhancement on cranial MRI. Hearing is affected in some patients with SIH. A case of SIH with orthostatic tinnitus is reported. A 51-year-old woman developed a severe headache that was almost completely relieved on recumbency. Cranial MRI with gadolinium infusion showed diffuse enhancement of the dura mater. Radionuclide cisternography demonstrated CSF leaks at the upper and lower thoracic levels. Epidural blood patches at these leak sites alleviated the orthostatic headache, however, orthostatic tinnitus and muffled hearing persisted. Initial audiometry was unremarkable; repeat audiometry performed 6 weeks later demonstrated low-frequency hearing loss in the right ear. Continuous epidural saline infusion for 3 consecutive days was performed; auditory symptoms disappeared 4 weeks thereafter. This case illustrates that orthostatic tinnitus represent intracranial hypotension even in the absence of orthostatic headache. MRI with gadolinium infusion should be carried out in the evaluation of patients with orthostatic tinnitus.
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7/39. Neuronavigated rTMS in a patient with chronic tinnitus. Effects of 4 weeks treatment.

    Clinical, neurophysiological and neuroimaging data suggest that chronic tinnitus resembles neuropsychiatric syndromes characterised by focal brain activation. Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an efficient method in treating brain hyperexcitability disorders. In one patient suffering from chronic tinnitus, [18F]deoxyglucose PET revealed increased metabolic activity in a circumscript area of the left primary auditory cortex (PAC). The effect of MRI and PET guided neuronavigated 1 Hz rTMS of this area was evaluated in a single-blind, sham-controlled, cross-over manner, followed by a 4-week open treatment. Following active stimulation there was a remarkable effect, enduring several weeks, on tinnitus sensation, which was paralleled by altered cortical excitability. These findings suggest that neuronavigated rTMS of increased PAC activity might offer a new option for treating auditory phantom perceptions like chronic tinnitus.
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8/39. Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: a short case series.

    BACKGROUND: Clinical as well as neurophysiological and neuroimaging data suggest that chronic tinnitus resembles neuropsychiatric syndromes characterized by focal brain activation. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an efficient method in treating brain hyperexcitability disorders by reducing cortical excitability. methods: In three patients suffering from chronic tinnitus, the effect of magnetic resonance imaging and positron emission tomography guided neuronavigated 1 Hz rTMS on auditory cortex activity was evaluated, using a sham controlled double-blind crossover design. RESULTS: Two of three patients revealed clearly increased metabolic activity in circumscript areas of the primary auditory cortex (PAC), allowing a selective stimulation of these cortical areas with low-frequency rTMS. Considerable improvement in tinnitus was achieved in these patients. CONCLUSIONS: Neuronavigated rTMS of increased PAC activity may help to better understand the neuronal basis of chronic tinnitus and might offer a new option for treating auditory phantom perceptions like chronic tinnitus.
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9/39. Magnetic and electrical stimulation of the auditory cortex for intractable tinnitus. Case report.

    tinnitus is a distressing symptom that affects up to 15% of the population for whom no satisfactory treatment exists. The authors present a novel surgical approach for the treatment of intractable tinnitus, based on cortical stimulation of the auditory cortex. tinnitus can be considered an auditory phantom phenomenon similar to deafferentation pain, which is observed in the somatosensory system. tinnitus is accompanied by a change in the tonotopic map of the auditory cortex. Furthermore, there is a highly positive association between the subjective intensity of the tinnitus and the amount of shift in tinnitus frequency in the auditory cortex, that is, the amount of cortical reorganization. This cortical reorganization can be demonstrated by functional magnetic resonance (fMR) imaging. transcranial magnetic stimulation (TMS) is a noninvasive method of activating or deactivating focal areas of the human brain. Linked to a navigation system that is guided by fMR images of the auditory system, TMS can suppress areas of cortical plasticity. If it is successful in suppressing a patient's tinnitus, this focal and temporary effect can be perpetualized by implanting a cortical electrode. A neuronavigation-based auditory fMR imaging-guided TMS session was performed in a patient who suffered from tinnitus due to a cochlear nerve lesion. Complete suppression of the tinnitus was obtained. At a later time an extradural electrode was implanted with the guidance of auditory fMR imaging navigation. Postoperatively, the patient's tinnitus disappeared and remains absent 10 months later. Focal extradural electrical stimulation of the primary auditory cortex at the area of cortical plasticity is capable of suppressing contralateral tinnitus completely. transcranial magnetic stimulation may be an ideal method for noninvasive studies of surgical candidates in whom stimulating electrodes might be implanted for tinnitus suppression.
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10/39. Objective high-frequency tinnitus of middle-ear myoclonus.

    tinnitus produced by middle-ear myoclonus is a rare condition. In this article, a rare case of unilateral continuous high-frequency objective tinnitus caused by middle-ear myoclonus is described. This condition appears to be the second case reported in the literature. Otoscopic examination revealed visible rhythmic movements of the tympanic membrane. Weak clicking sounds were heard around the right ear by auscultation. Direct stimulation of the soft palate showed no evidence of palated myoclonus. Tympanometry confirmed rhythmic changes in the middle-ear compliance. The condition was effectively treated with a muscle relaxant (orphenadrine citrate).
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