Cases reported "Tinnitus"

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11/39. Audiometric findings of patients with migraine-associated dizziness.

    OBJECTIVE: The objective of this study was to determine whether the audiometric findings of migraine-associated dizziness could be used to better distinguish migraine-associated dizziness from Meniere's disease. STUDY DESIGN: A retrospective chart review. SETTING: Tertiary, otology/neurotology practice. patients: Two groups of patients were studied, a migraine-associated dizziness and a Meniere's disease group. There were 76 and 34 patients in the migraine-associated dizziness and Meniere's disease groups, respectively. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Initial and follow-up pure-tone average and low-frequency pure-tone average were recorded for both groups. Independent samples t tests were used to test for mean differences in pure-tone average and low-frequency pure-tone average. RESULTS: Pure-tone average and low-frequency pure-tone average were significantly worse for patients in the Meniere's disease group at both the initial and follow-up assessments. Three patients in the migraine-associated dizziness group had an elevated pure-tone average (>/=26 dB) and/or low-frequency pure-tone average at initial and/or follow-up assessment. The remaining 73 migraine-associated dizziness patients had normal hearing. In the Meniere's disease group, only two patients had a normal pure-tone average and low-frequency pure-tone average at both initial and follow-up evaluations. The hearing difference between the two groups was significant even when controlling for age and duration of dizziness symptoms. CONCLUSION: Audiometric findings of patients with migraine-associated dizziness are most often normal. Unlike Meniere's disease, the sensorineural hearing loss in migraine-associated dizziness rarely progresses. These audiometric findings may help to distinguish migraine-associated dizziness from Meniere's disease when diagnostic ambiguity exists between these two diagnoses.
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12/39. Auditory and electrophysiological patterns of a unilateral lesion of the lateral lemniscus.

    Auditory disorders resulting from focal brainstem lesions are rarely symptomatic. Isolated lesions of the inferior colliculus have previously been reported, whereas no detailed description of a localized involvement of the lateral lemniscus is yet available. We report a unilateral lesion of the lateral lemniscus by a bleeding in a cavernoma. Symptoms included strictly contralateral tinnitus and auditory impairment, with normal pure-tone and speech audiometry. Conversely, the dichotic listening test revealed an extinction of contralateral ear input. The brainstem auditory evoked potentials disclosed a reduced and delayed wave V only after contralateral ear stimulation, while the middle latency evoked potentials were normal. This observation shows that a unilateral lesion of the lateral lemniscus can produce auditory symptoms. The dysfunction of auditory pathways is associated with specific electrophysiological abnormalities that can be assessed by evoked potential recording.
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13/39. Treatment of essential palatal myoclonus in a 10-year-old girl with botulinum neurotoxin.

    Palatal myoclonus (PM) is a rare neurotological disorder but is being reported with increasing frequency. Two forms, symptomatic and essential PM, have been identified as separate clinical entities and probably also have separate etiologies. In essential PM, brain imaging is unremarkable and a clicking noise caused by peritubal muscle contractions and often audible by the examiner usually is the patients' chief complaint. The treatment of essential PM with systemic application of anticonvulsants and related substances as well as by destructive surgical means has yielded unsatisfactory results. Recently, the use of botulinum neurotoxin has emerged as a new treatment option that seems particularly attractive due to its safety, complete reversibility, very few side effects, and minimal invasiveness. We report the case of essential PM in a 10-year-old girl who was successfully treated with botulinum toxin injections under eletromyographic guidance and we review the literature on the use of botulinum toxin in PM.
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14/39. Repetitive transcranial magnetic stimulation for tinnitus: a case study.

    OBJECTIVES/HYPOTHESIS: Correlate subjective improvements in tinnitus severity with restoration of cortical symmetry and sustained attention after neuronavigated low-frequency, repetitive transcranial magnetic stimulation (rTMS). STUDY DESIGN: Case study. methods: Positron emission tomography and computed tomography imaging (PET-CT) guided rTMS was performed on a 43-year-old white male with more than a 30 year history of bilateral tinnitus. rTMS was administered to the area of increased cortical activation visualized on PET-CT at a rate of 1 Hz for 30 minutes (1,800 pulses/session) for each of 5 consecutive days, with optimization applied on day 5 using single pulses of TMS to temporarily alter tinnitus perception. Subjective tinnitus severity was rated before and after rTMS using the tinnitus severity index with analogue scale. attention and vigilance were assessed before and after therapy using the psychomotor vigilance task (PVT), a simple reaction time test that is sensitive to thalamocortical contributions to sustained attention. Posttherapy PET-CT was used to evaluate any change in asymmetric cortical activation. RESULTS: The most marked reduction in tinnitus severity occurred after rTMS optimization; this persisted up to 4 weeks after rTMS. PVT testing showed the patient exhibited a statistically significant improvement in mean slowest 10% reaction times after rTMS (P = .004). PET-CT imaging 2 days after the cessation of rTMS showed no changes in cortical blood flow or metabolic asymmetries. CONCLUSIONS: Low-frequency rTMS applied to the primary auditory cortex can reduce tinnitus severity, with rTMS optimization yielding the most favorable results. Beneficial changes occurring in the patient's slowest reaction times suggest that attentional deficits associated with tinnitus may also respond to low-frequency rTMS.
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15/39. Acoustic measurements of objective tinnitus.

    ear canal sound pressure levels were measured from a 38-year-old woman who had experienced objective tinnitus in her right ear for approximately 2 years. The tinnitus sounded like a series of "sighs" that were synchronous with her pulse rate. Because the level of the tinnitus fluctuated in a pulsing manner, it appeared to be of vascular origin. Psychoacoustically, the tinnitus behaved like a low-pass masker (cutoff frequency = 1.5 kHz) of about 40 dB SPL. This masking effect was manifested as a low-frequency hearing loss in the subject's right ear. A miniature microphone system was used to monitor the tinnitus before, during, and after a jugular-vein ligation. Because the cause of the tinnitus was only generally known, acoustically monitoring the sound as the jugular vein and/or its tributaries were systematically clamped and then released enabled the site of generation to be known exactly. By monitoring the tinnitus during surgery, the effectiveness of the corrective procedure could be immediately evaluated. Hearing sensitivity in the affected ear returned to normal limits following the elimination of the tinnitus. One year after the surgery, the tinnitus was barely audible to the woman, but only when she positioned her head a specific way. The level of the tinnitus measured in this head-turned condition was markedly lower than the level obtained preoperatively.
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16/39. tinnitus associated spontaneous otoacoustic emissions. Active outer hair cell movements as common origin?

    In the mammalian inner ear, active mechanical processes contribute to cochlear micromechanics. Direct evidence of these are spontaneous otoacoustic emissions (SOAE) which have been registered in the human and animal ear canal. In mammals, outer hair cells (OHC) seem to be the origin of this mechanical energy, because they exhibit motile responses to various stimuli. Here we report on bilateral tinnitus and bilateral SOAE with both acoustical phenomena located in the same frequency range. In a playback of the SOAEs their frequences were identified as the pitch of the tinnitus. An additional criterion favoring a common pathomechanism of SOAEs and tinnitus resulted from masking effects. tinnitus and SOAEs from both sides were suppressed by the same tone, which indicates that the involved pathways are identical. Therefore we suggest that pathological long-term movements of only a small number of OHCs underlie both phenomena. From the SOAE emission spectra we calculated that not more than 60 OHCs might be involved.
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17/39. Periodic saccadic oscillations and tinnitus.

    A man with essential hypertension developed stereotyped cycles of oscillopsia and bilateral "sparking" tinnitus. eye movement recordings showed cycles of disconjugate opsoclonus, square-wave jerks, and saccadic dynamic overshoot disrupting stable fixation. neuroimaging studies were normal. We postulate a lesion episodically disturbing saccade-related neurons and central auditory neurons in the pons.
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18/39. Electrical tinnitus suppression (ETS) with a single channel cochlear implant.

    patients with intractable tinnitus in a dead ear were selected for electrical tinnitus suppression (ETS) first with a round window electrode inserted via the ear canal. Three patients have been selected for implantation with a UCH/RNID single channel extracochlear device to use with a sinusoidal tinnitus suppressor. We have also examined the effect of sinusoids on deafened implantees with tinnitus and conclude that tinnitus can be suppressed in some individuals with low frequency sine waves. Two patients are presented who have used cochlear implants to suppress their tinnitus for more than 18 months.
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19/39. aspirin abolishes tinnitus caused by spontaneous otoacoustic emissions. A case study.

    A series of experimental tests are presented indicating that numerous spontaneous otoacoustic emissions (SOAEs) are likely to provide the basis of monaural tinnitus for one female patient. For this patient, (1) the tinnitus disappeared only when all SOAE components were suppressed, (2) with all but one emission suppressed, the frequency of an external tone said to match the pitch of the tinnitus was close to the frequency of the unsuppressed SOAE, and (3) the isomasking contour for the tinnitus was frequency specific. All these tests indicated that the patient was likely to be hearing SOAEs. During subsequent aspirin administration, her SOAEs disappeared and her perception of her tinnitus was radically altered. The tinnitus was no longer described as monaural and "tonal" but instead was described as being "noise in the head."
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20/39. tinnitus remission objectified by neuromagnetic measurements.

    In a previous paper of ours (Hoke et al., 1989a) the hypothesis was put forward that the amplitude ratio of the two major waves of the auditory evoked magnetic field (AEF), M200/M100, is an objective measure which allows to discriminate between individuals suffering from tinnitus (ratio less than 0.5) and individuals without tinnitus (ratio greater than 0.5). We have now been able to trace the process of tinnitus remission in one exemplary case during a period of 256 days after acute onset of tinnitus (due to a noise trauma), in which the amplitude ratio recovered from 0 to a normal value of approximately 1. This very first objectification of tinnitus remission strongly supports our hypothesis and indicates that AEF may become an indispensable, invaluable tool in both tinnitus research and management.
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