Cases reported "Vertigo"

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1/19. Sudden unilateral hearing loss with simultaneous ipsilateral posterior semicircular canal benign paroxysmal positional vertigo: a variant of vestibulo-cochlear neurolabyrinthitis?

    We describe 4 patients who all simultaneously developed a sudden total or partial unilateral sensorineural hearing loss and an unusual acute peripheral vestibulopathy in the same ear characterized by posterior semicircular canal benign paroxysmal positional vertigo with intact lateral semicircular canal function. Two patients also had ipsilateral loss of otolith function. The vertigo resolved in all 4 patients after particle-repositioning maneuvers. The findings of audiometry and vestibular tests indicated that the lesion responsible for this syndrome was probably located within the labyrinth itself rather than within the vestibulocochlear nerve and that it was more likely a viral vestibulocochlear neurolabyrinthitis than a labyrinthine infarction.
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ranking = 1
keywords = labyrinthitis
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2/19. Delayed endolymphatic hydrops: study and review of clinical implications and surgical treatment.

    Delayed endolymphatic hydrops (DEH) differs from Meniere's disease in that it occurs in pre-existing ear pathology in patients who have a profound unilateral or total deafness that was caused by infection, trauma, or unknown causes during childhood or adulthood. We performed a retrospective review of 160 patients with ipsilateral, contralateral, or bilateral DEH. Eighty-seven patients who did not respond to medical therapy underwent surgical treatment. Our findings indicate that the more conservative surgical procedures--endolymphatic sac surgery, cochleosacculotomy, and streptomycin perfusion--are all as effective as and less destructive than labyrinthectomy for controlling vertigo. The clinical results of this study would seem to support the observations of others that DEH and Meniere's disease are related disorders caused predominantly by cases of viral labyrinthitis with unknown etiology.
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ranking = 0.2
keywords = labyrinthitis
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3/19. Severe audiovestibular loss following ear syringing for wax removal.

    Syringing of the ear is one of the commonest procedures performed for cleaning cerumen from the external auditory canal. Common complications following syringing are pain, external auditory canal trauma and otitis externa. Hearing and vestibular loss are often mentioned as a complication in descriptions of this technique, but we have not been able to find a reported case of such an occurrence. We report one such a case.
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ranking = 0.00045429279573605
keywords = otitis
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4/19. Labyrinthine fistula detection: the predictive value of vestibular symptoms and computerized tomography.

    A retrospective case record study of 20 patients in Oslo operated on for chronic otitis media with labyrinthine fistula between 1986 and 1999 was performed in order to estimate the incidence of, and identify predictors for, labyrinthine fistulas. The incidence of fistula was 0.3 per 100 000, with a median age at diagnosis of 37 years. The median duration of chronic otitis media prior to labyrinthine fistula detection was significantly correlated with age at surgery. Subjective hearing loss (90%), otorrhoea (65%) and dizziness (50%) were presenting symptoms. Modified canal-wall-down mastoidectomy was performed in all patients. Preoperative hearing levels could not predict postoperative hearing outcome. Positive signs of fistula were found in only 4 patients (20%). Correspondingly, computerized tomography (CT) diagnosed the fistula in 11 patients (55%). The seven patients presenting without dizziness and with a negative CT scan and fistula test were characterized by lower age, absence of previous middle ear surgery, lower preoperative pure-tone thresholds for bone conduction and better hearing outcome after surgery. In conclusion, the identification of a younger group of patients presenting with fewer symptoms indicates that fistulas should be suspected in all patients undergoing surgery for chronic middle ear and mastoid disease.
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ranking = 0.0009085855914721
keywords = otitis
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5/19. Horizontal canal benign paroxysmal positioning vertigo with ipsilateral hearing loss.

    The etiology of benign paroxysmal positioning vertigo (h-BPPV) of the horizontal semicircular is unknown. Insight was obtained from two patients with h-BPPV and associated hearing impairment. Based on the different inner ear lesion patterns in neurolabyrinthitis contrary to ischemic labyrinthine infarction we assessed multiple vestibulo-cochlear functions for the first time in two patients who suffered from h-BPPV with sudden unilateral hearing loss. While in patient no. 1 the lesion pattern (posterior canal paresis in addition to the sudden hearing loss) could possibly be caused by ischemia of the common cochlear artery, the lesion pattern of patient no. 2 (hearing loss and ipsilateral paresis of the posterior and horizontal semicircular canal) exceeds the typical vascular labyrinthine territories and may indicate viral neurolabyrinthitis.
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ranking = 0.4
keywords = labyrinthitis
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6/19. Superior semicircular canal dehiscence syndrome. Case report.

    The authors present the case of a man who had superior semicircular canal dehiscence syndrome in addition to chronic otitis media. This case is atypical because the patient coincidentally had middle ear and mastoid disease, which previously had been treated surgically. The prior ear surgery delayed the diagnosis of superior semicircular canal dehiscence syndrome and increased the complexity of the repair of the superior semicircular canal dehiscence. Superior semicircular canal dehiscence syndrome is a recently recognized syndrome resulting in acute or chronic vestibular symptoms. The diagnosis is made using history, vestibular examination, and computerized tomography studies. Neurosurgeons should be aware that patients with superior semicircular canal dehiscence syndrome who experience disabling chronic or acute vestibular symptoms can be treated using a joint neurosurgical-otological procedure through the middle cranial fossa.
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ranking = 0.00045429279573605
keywords = otitis
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7/19. 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.
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ranking = 0.0018171711829442
keywords = otitis
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8/19. Simultaneous acute superior nerve neurolabyrinthitis and benign paroxysmal positional vertigo.

    An acutely vertiginous 47-year-old woman presented to the emergency department with simultaneous acute left neurolabyrinthitis and left posterior canal benign paroxysmal positional vertigo (BPPV). Gaze nystagmus from the neurolabyrinthitis hampered diagnosis of the BPPV. However, once the BPPV was identified and treated, the patient's subjective vertigo improved rapidly. Concomitant BPPV should not be overlooked when a diagnosis of acute neurolabyrinthitis is made in the emergency department.
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ranking = 1.4
keywords = labyrinthitis
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9/19. Contrast enhancement of the labyrinth on MR scans in patients with sudden hearing loss and vertigo: evidence of labyrinthine disease.

    The sudden onset of hearing loss and vertigo presents a difficult diagnostic problem. We describe the finding of labyrinthine enhancement on MR images in five patients with sudden unilateral hearing loss or vertigo or both and correlate the MR findings with audiologic and electronystagmographic studies. All patients were studied with T2-weighted axial images through the whole brain, contrast-enhanced 3-mm axial T1-weighted images through the temporal bone, and enhanced T1-weighted sagittal images through the whole brain. Cochlear enhancement, on the side of hearing loss only, was found in all five patients. The presence of associated vestibular enhancement correlates with objective measures of vestibular function on the electronystagmogram. In two patients, the resolution of symptoms 4-6 months later correlated with resolution of the enhancement on gadopentetate dimeglumine-enhanced MR images. Two patients had luetic labyrinthitis. No labyrinthine enhancement was seen in a series of 30 control subjects studied with gadopentetate dimeglumine-enhanced MR using the same protocol. Labyrinthine enhancement in patients with auditory and vestibular symptoms is a new finding and is indicative of labyrinthine disease. While abnormalities on electronystagmograms and audiograms are nonspecific and indicate only a sensorineural problem, gadopentetate dimeglumine-enhanced MR may separate patients with retrocochlear lesions, such as acoustic neuromas, from those in whom the abnormal process is in the labyrinth or is intraaxial. This group of patients underscores the importance of identifying and commenting on the structures of the membranous labyrinth when evaluating MR studies of the internal auditory canal and the cerebellopontine angle in individuals with hearing loss.
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ranking = 0.2
keywords = labyrinthitis
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10/19. 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.
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ranking = 0.00045429279573605
keywords = otitis
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