Use of a screening RAST in a large neuro-otologic practice

Evidence in the literature emphasizes the role of the immune system in disorders of the inner ear and eustachian tube. We initially investigated the presence of inhalant allergy in selected patients seen for otologic problems by means of a screening radioallergosorbent test (RAST), using either a microscreen or a limited antigen panel. This study analyzed the results of tests performed over a 2-year period on 186 patients seen by one of us (WLM) for treatment of vertigo (66%), tinnitus (63%), hearing loss (49%), aural fullness (48%), Meniere’s quadrad (27%), balance disturbance other than true vertigo (21%), and eustachian tube dysfunction (4%). We found an incidence of immunoglobulin E-mediated hypersensitivity of nearly 40% in a patient population selected solely for neuro-otologic symptoms and not for sinonasal symptoms. This figure is more than double that quoted for the general population. We also found a surprisingly high incidence of mold antigen atopy in this selected population. Allergy can contribute to a number of otologic symptoms, including eustachian tube dysfunction, vertigo, tinnitus, hearing loss, aural fullness, and nonspecific balance disturbance. Allergy also has been emphasized as an etiologic factor in a portion of patients diagnosed with Meniere’s syndrome. A screening RAST, combined with clinical evaluation, appears to be an excellent tool for evaluating these patients for inhalant allergy as part of a comprehensive workup. (Otolaryngol Head Neck Surg 1997;117:653-9.)     

Endolymphatic sac tumors in von Hippel-Lindau disease

OBJECT: Von Hippel-Lindau (VHL) disease is a hereditary multiple-neoplasia syndrome mapping to chromosome 3p25-26. Endolymphatic sac (ELS) tumors have been identified as a neoplastic manifestation of VHL disease. The purpose of this study was to evaluate comprehensively the natural history of inner ear disease in a large population of patients with confirmed or suspected VHL disease and to correlate the clinical features with the VHL genotype. METHODS: The authors collated and analyzed clinical and genotypic data obtained in patients enrolled in an Institutional Review Board-approved protocol in which families and individuals affected by VHL disease were studied. These data included results from multidisciplinary history workups and physical examinations, imaging studies, and a battery of audiological tests. One hundred seventy-five patients were enrolled in the study, 129 with confirmed VHL disease and 46 of their family members in whom test results for VHL disease were negative and who served as controls. Twenty-one patients had ELS tumors that were evident on magnetic resonance images; three of them had bilateral ELS lesions. Hearing loss, often sudden in onset and severe to profound in nature, vestibulopathy, aural fullness, and tinnitus represented the primary symptoms of ELS tumor. Distinct patterns of auditory and vestibular dysfunction occurred at different stages of the disease. Phenotypic data showed that 17 of 21 patients with ELS tumors did not have pheochromocytomas, whereas all had VHL disease affecting the kidney, all but two had VHL disease affecting the central nervous system, and all but one had disease affecting the pancreas. Genotyping revealed 10 rearrangements (partial deletions), eight single bp substitutions, and one 3-bp insertion. Although there was no difference in the incidence of hearing loss between populations, symptoms of imbalance and aural fullness were more common in patients with VHL disease but without imaging evidence of ELS tumor than they were in family members who did not have VHL disease (p < 0.01). CONCLUSIONS: Endolymphatic sac tumors are frequently associated with VHL disease. Symptoms of disequilibrium or aural fullness in patients with VHL disease may be an early indication of endolymphatic dysfunction. Patients with VHL disease provide a unique opportunity to examine the effects of specific gene mutations and a discrete neoplastic process on the human inner ear. The study of ELS tumors in this group also provides a pathological model of ELS function and supplies evidence for a role of the ELS in clinical Ménière-like disease(s).     

Oral steroid regimens for idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To determine hearing recovery in patients with idiopathic sudden hearing loss treated with varying amounts of oral steroids. STUDY DESIGN AND SETTING: A retrospective chart review (n = 75) in a tertiary care clinic examined sudden hearing loss patients treated with 1 60-mg prednisone taper, 1 course of steroid less than a 60-mg taper, or any 2 courses of oral steroid. RESULTS: Overall, 35% of the patients recovered a clinically significant amount of hearing. Recovery was associated with immediate treatment (within 2 weeks from onset), better hearing at the onset of treatment, and treatment with the higher dose of prednisone in patients with just 1 additional symptom (dizziness or tinnitus). Patients tended to continue to experience some recovery in hearing up to 4 months after treatment. CONCLUSION: Immediate treatment of patients with unilateral idiopathic sudden hearing loss and additional symptoms (dizziness or tinnitus) with a 14-day course of 60 mg prednisone (with taper) is recommended. EBM rating: B-3.     

Fabry病患者心肾损害的临床特点及相关因素

目的本研究旨在探讨中国Fabry病患者心肾损害的临床特点及相关因素。 方法收集108例Fabry病患者的临床资料，分别按照是否存在肾脏损害、是否存在心血管损害及是否存在心肾联合损害进行分组，分析各组的临床特点及相关因素。 结果(1)与无肾脏损害组相比，合并肾脏损害的患者在神经精神、眼部、心血管、消化和呼吸系统方面均有部分症状的发生率高(P<0.05)；肾脏损害的独立相关因素为听力下降、耳鸣、高血压。(2)与无心血管损害组相比，合并心血管损害的患者年龄更大、病程更长(P<0.05)，注意力下降、抑郁和(或)焦虑，角膜涡状浑浊、结膜及视网膜血管迂曲、晶状体后囊浑浊、耳鸣、听力下降、恶心呕吐、慢性肾功能不全及慢性支气管炎发生率更高(P<0.05)；心血管损害的相关因素为抑郁和(或)焦虑、确诊时的年龄。(3)与无心肾损害组及只有心血管或只有肾脏损害组相比，心肾联合损害组的年龄更大、病程更长(P<0.05)，抑郁和(或)焦虑、耳鸣、听力下降、感音性耳聋、恶心呕吐及慢性支气管炎的发生率更高(P<0.05)；心肾联合损害的独立相关因素为确诊时的年龄及耳鸣。 结论同时或单独有心肾损害的患者很多系统症状的发生率较无心肾损害的患者高、且症状更严重。肾脏损害的相关因素为高血压、耳鸣和听力下降；心血管损害的相关因素为抑郁和(或)焦虑及确诊时的年龄。     

Otologic injuries caused by airbag deployment.

Airbags are clearly successful at mitigating injury severity during motor vehicle accidents. Deployment unfortunately has introduced new injury-causing mechanisms. A retrospective review of 20 patients who sustained otologic injuries resulting from airbag inflation was conducted. The most common symptoms were hearing loss in 17 (85%) and tinnitus in 17 (85%). Objective hearing loss was documented in 21 of 24 (88%) subjectively affected ears; this included unilateral and bilateral sensorineural, unilateral conductive, and mixed hearing losses. Ten patients (50%) had dysequilibrium. Four subjects (20%) had a tympanic membrane perforation; each required surgical closure. Ear orientation toward the airbag was found to be associated with hearing loss (P = 0.027), aural fullness (P = 0.039), and tympanic membrane perforation (P = 0.0004). A wide variety of airbag-induced otologic injuries occur and may have long-term sequelae. It is important for health care personnel to be aware of these potential problems.     

Postoperative sudden sensorineural hearing loss after posterior lumbar decompression: a case report

PURPOSE: We report a case in which a patient sustained a dural tear during spinal surgery under general anesthesia complicated by a severe and persistent unilateral sensorineural hearing loss. CLINICAL FINDINGS: A 51-yr-old man with no previous otological history underwent a posterior lumbar decompression surgery in the prone position under general anesthesia. A small dural tear was discovered intra-operatively and was repaired by sutures. Surgery lasted for eight hours with over 3 L of blood loss. Recovery from anesthesia was otherwise uneventful. A unilateral right-sided sensorineural hearing loss was discovered shortly after completion of surgery. This was associated with mild tinnitus but no vertigo. There was no aural fullness, pain, headache or postural element to his symptoms. Despite extensive investigations, treatment and follow-up by an otorhinolaryngologist, his symptoms failed to improve 18 months following surgery. DISCUSSION: The possible etiologies, preventive strategies, prognosis and management plan of this rare complication are discussed.     

Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial.

OBJECTIVE: To investigate the efficacy of dexamethasone inner ear perfusion by intratympanic injection in hearing loss, tinnitus, aural fullness, and vertigo in the treatment of unilateral Ménière's disease and compare it with the control group. STUDY DESIGN AND SETTING: A prospective, randomized, double-blind study with 2-year follow-up comparing changes secondary to dexamethasone inner ear perfusion versus placebo consisting of saline solution. PATIENTS: Twenty-two patients having definite Ménière's disease as outlined by the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium. All the patients were older than 18 years of age and were not receiving any other form of treatment with steroids for their Ménière's disease. METHOD: Five consecutive daily intratympanic injections of dexamethasone or placebo to the involved ear. RESULTS: In the dexamethasone group at 2-year follow-up, complete control of vertigo (class A) was achieved in 9 of 11 patients (82%) and substantial control of vertigo (class B) in the remaining 2 patients (18%.) In the control group only 7 of 11 patients (64%) finished the 2-year follow-up because in the other 4 patients (36%) we had to give another treatment for the continuing vertigo and thus they were classified as failure (class F.) From the 7 patients who have finished the follow-up of 2 years in the control group, 4 patients (57%) achieved class A, 2 patients (29%) achieved class C, and 1 patient (14%) class F. CONCLUSIONS: Dexamethasone (4 mg/mL) inner ear perfusion in a group of patients with unilateral Ménière's disease (Shea's stage III) showed 82% of complete control of vertigo over placebo (57%). There was also a subjective improvement in tinnitus (48%), hearing loss (35%), and aural fullness (48%) in the dexamethasone group compared with 20%, 10%, and 20% respectively in the control group.     

The prevalence of hearing loss in children with congenital diaphragmatic hernia: A longitudinal population-based study

BackgroundThe true prevalence of hearing loss among children with congenital diaphragmatic hernia (CDH) is unknown, with some studies reporting rates up to 60%.PurposeThe purpose of this study was to determine the prevalence of hearing loss among children with CDH and compare it to age-matched controls.MethodsWe used population-based datasets to compare the number of hearing loss diagnoses in children younger than 10 years-of-age born between 1992 and 2009 with CDH to date-of-birth matched controls without CDH. Factors associated with CDH disease severity were analyzed to determine their effect on the prevalence of hearing loss. A sensitivity analysis was performed to determine if selection bias of improved care over the course of the study affected hearing loss in CDH patients. The prevalences of hearing loss were compared using Fisher's exact tests and statistical significance was defined as p < 0.05.ResultsA total of 529 children, 38 CDH cases and their 491 date-of-birth matched controls, met the inclusion criteria. Hearing loss was found in 7 children with CDH (18.4%) compared to 26 (5.3%) controls; the risk ratio (RR) of hearing loss was 3.48 (95%CI = 1.61–7.49, p = 0.006). There was no association between CDH disease severity and hearing loss.ConclusionsCDH is associated with hearing loss compared to the general population. Our results suggest that congenital factors may contribute to hearing loss in CDH more than perinatal exposures.Level of evidence3.     

Tumors of the endolymphatic sac in patients with von Hippel-Lindau disease: implications for their natural history, diagnosis, and treatment

OBJECT: Endolymphatic sac tumors (ELSTs), which often are associated with von Hippel-Lindau (VHL) disease, cause irreversible hearing loss and vestibulopathy. Clinical and imaging surveillance protocols provide new insights into the natural history, mechanisms of symptom formation, and indications for the treatment of ELSTs. To clarify the uncertainties associated with the pathophysiology and treatment of ELSTs, the authors describe a series of patients with VHL disease in whom serial examinations recorded the development of ELSTs. METHODS: Patients with VHL disease were included if serial clinical and imaging studies captured the development of ELSTs, and the patients underwent tumor resection. The patients' clinical, audiological, and imaging characteristics as well as their operative results were analyzed. Five consecutive patients (three men and two women) with a mean age at surgery of 34.8 years and a follow-up period of 6 to 18 months were included in this study. Audiovestibular symptoms were present in three patients before a tumor was evident on neuroimaging. Imaging evidence of an intralabyrinthine hemorrhage coincided with a loss of hearing in three patients. Successful resection of the ELSTs was accomplished by performing a retrolabyrinthine posterior petrosectomy (RLPP). Hearing stabilized and vestibular symptoms resolved after surgery in all patients. No patient has experienced a recurrence. CONCLUSIONS: Audiovestibular symptoms, including hearing loss, in patients with VHL disease can be the result of microscopic ELSTs. Once an ELST has been detected, it can be completely resected via an RLPP with preservation of hearing and amelioration of vestibular symptoms. Early detection and surgical treatment of small ELSTs, when hearing is still present, should reduce the incidence and severity of hearing loss, tinnitus, vertigo, and cranial nerve dysfunction, which are associated with these tumors.     

Risk of progressive sensorineural hearing loss and Meniere’s disease after breast implantation

OBJECTIVE: The association of various immunologic abnormalities with the presence of silicone breast implants in women has been described. In addition, some studies report a correlation between autoimmune disorders and silicone breast implants, whereas other studies indicate no difference in the incidence of disease between women with silicone breast implants and control groups. Until recently, no reports had attempted to identify an association between silicone breast implants and hearing impairment. A recent study suggested a possible correlation between prior silicone breast implants and the development of various forms of hearing loss. This study tried to determine whether such a correlation could be duplicated. METHODS: To determine whether such a correlation could be established, we studied 119 female patients with either Meniere’s disease or progressive sensorineural hearing loss and 100 age-matched healthy controls. Subjects completed questionnaires that provided various types of information, including the presence or absence of previous silicone breast implants. Serum from all 119 patients with Meniere’s disease and progressive sensorineural hearing loss had been subjected to previous Western blot testing for reactivity to a 68 kD protein associated with certain forms of autoimmune hearing loss. RESULTS: Results indicated no significant difference in frequency of prior silicone breast implants among the patients with Meniere’s disease, patients with sensorineural hearing loss, or controls. The presence or absence of the 68 kD protein also was not significantly relevant to the frequency of silicone breast implants. CONCLUSIONS: Our data did not show evidence of a significant relationship between the presence of silicone breast implants and later development of Meniere’s disease, progressive sensorineural hearing loss, or positive 68 kD serum. (Otolaryngol Head Neck Surg 1998;118:747-50.)     

Otosyphilis: a review of 85 cases.

OBJECTIVE: To review the clinical manifestations and the follow-up hearing results of the treatment modalities in the patients with otosyphilis. STUDY DESIGN AND SETTINGS: A retrospective review between 1984 and 2000 at a university hospital. Patients who presented with cochleovestibular symptoms and were confirmed seropositive for specific treponemal tests were included. Excluded were patients older than 70, or who had other identified causes of cochleovestibular symptoms. RESULTS: Subjects included 56 males and 29 females with an average age of 59.5 years (range, 40 to 70). Common presenting symptoms included hearing loss (90.6%), tinnitus (72.9%), and vertigo (52.9%). The cerebrospinal fluid analysis was positive in 5.4%. The overall respective hearing results in the short- and long-term follow-up were improved or stable in 93.4% and 83.3% of patients. Even though adding steroids and neurosyphilis regimens tended to improve and stabilize hearing, the results were not statistically significant among treatment modalities. CONCLUSION: Further study about hearing outcomes among treatment modalities is suggested.     

Microvascular decompression for cochlear symptoms

OBJECT: The object of this study was to evaluate the efficacy of a new neurovascular decompression technique in relieving symptoms of cochlear nerve dysfunction. METHODS: Nineteen patients with slowly progressive hearing loss, low-frequency fluctuating hearing loss, and high-pitched tinnitus due to neurovascular compression (NVC) of the eighth cranial nerve in a triangular space between the seventh and eighth cranial nerves (the VII-VIII triangle) of the cerebellopontine angle (CPA) were treated using a new technique for microvascular decompression that was developed by anatomical study in 24 cadaver specimens of the CPA. In 12 of 19 patients the anterior inferior cerebellar artery (AICA) was observed to cause compression in the VII-VIII triangle and this vessel was easily mobilized medially for placement of a silicone sponge or Teflon cushion between the compressing artery and nerve. Postoperatively, hearing loss of 20 dB or more that was present in 11 of the 19 patients with NVC improved by more than 5 dB in seven (64%), including the patient with the most severe hearing loss. Of 18 patients presenting with tinnitus preoperatively, eight (44%) had no tinnitus and an additional nine (for a total of 94%) had good improvement in tinnitus after surgery and at long-term follow up. CONCLUSIONS: The microvascular decompression technique described is highly successful in treating symptoms due to direct or indirect compression of the cochlear nerve, with minimal risk of complications. Recordings of auditory brainstem responses confirmed the clinical diagnosis of NVC of the eighth cranial nerve and correlated with clinical results after microvascular decompression of the cochlear nerve.     

Cost-effective evaluation of asymmetric sensorineural hearing loss with focused magnetic resonance imaging

The poor sensitivity of audiometric brain stem response for small vestibular schwannomas (acoustic neuromas) creates a dilemma for the physician evaluating a patient with signs and symptoms of retrocochlear disease. Magnetic resonance imaging is recognized as the gold standard for the evaluation of these problems, but if a complete examination of the internal auditory canals and head is done on every patient, the cost is high. Although less expensive, screening with audiometric brain stem response risks missing up to 33% of small tumors. Therefore we developed a focused magnetic resonance imaging sequence for evaluation of patients with asymmetric sensorineural hearing loss and/or nonpulsatile tinnitus. The protocol includes a T ₁ -weighted sagittal localizer, pregadolinium and postgadolinium T ₁ -weighted 3-mm contiguous axial slices through the internal auditory canal and the region of the cerebellopontine angle, and T ₂ -weighted axial images through the entire brain. Total scanning time is about 12 minutes, and the estimated cost is $300 to $500. We retrospectively reviewed the imaging records of 485 screening examinations done during an 18-month period. Twenty-four patients had diagnoses definitely or probably producing the hearing loss for an overall positive rate of 5%. By eliminating the need for follow-up audiometric or electrophysiologic studies, we believe a focused magnetic resonance imaging–based diagnostic scheme is actually more cost-effective on a cost-per-patient basis. (Otolaryngol Head Neck Surg 1997;116:567-74.)     

Long-term effectiveness of ear-level devices for tinnitus.

OBJECTIVE: This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who purchased and used ear-level devices (hearing aids or sound generators). STUDY DESIGN AND SETTING: Patients were evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to patients 6 to 48 months after their initial appointment. RESULTS: Follow-up questionnaires from 150 patients were reviewed. Fifty patients purchased and used hearing aids, 50 patients purchased and used in-the-ear sound generators for an average of 18 months after their initial appointment; 50 patients did not use ear-level devices. At follow-up, all 3 groups of patients exhibited significant reductions in Tinnitus Severity Index scores and self-rated tinnitus loudness. Patients who used ear-level devices reported greater improvement than patients who did not use hearing aids or sound generators. CONCLUSIONS: Ear-level devices such as hearing aids or sound generators can help a significant number of patients who experience chronic tinnitus. Both types of devices reduce patients' perception of tinnitus and can facilitate habituation to the symptom. Amplification provides additional benefits of improved hearing and communication.     

The clinical characteristics of tinnitus in patients with vestibular schwannoma.

Objectives: To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with unilateral sporadic vestibular schwannoma (VS) to describe the clinical characteristics of tinnitus in this population. Further, to ascertain which of the proposed mechanisms of tinnitus generation in VS was supported. Design: Retrospective case note and database review. Setting: Tertiary university teaching hospital departments of audiology and neuro-otology. Participants: Nine hundred forty-one patients with unilateral sporadic VS, diagnosed during the period 1986 to 2002. Twenty-three additional patients were excluded due to missing clinical data. Main outcome measures: The presence or absence of tinnitus, and its rated subjective severity were analyzed in conjunction with data regarding patient demographics, symptoms, signs, and diagnostic audiovestibular test findings. Results: No statistical association at the 5% level was found between tinnitus presence/absence and patient age, gender, 2- to 4-kHz audiometric thresholds, ipsilateral auditory brainstem response abnormality, length of history, tumor side, nor caloric test abnormality. Statistically significant associations were found between tinnitus presence/absence and tumor size (p = 0.012) and type of hearing loss (progressive, sudden, fluctuant, nil) with a tendency for patients without hearing loss to be less likely to experience tinnitus. Statistically significant associations were identified between classification of tinnitus severity and age at diagnosis (p < 0.001) (greater age being associated with greater tinnitus severity), abnormal findings on caloric testing (p = 0.01) (abnormal calorics being associated with greater tinnitus severity), and tinnitus as a principal presenting symptom (p < 0.001) (this being associated with greater tinnitus severity). Conclusions: The analysis does not identify any single one of the proposed mechanisms for tinnitus as being the obvious culprit. In fact, even in a homogeneous group of patients such as this, there is evidence of multiple mechanisms that are not mutually exclusive. The association between increased tinnitus severity in older patients, patients with canal pareses on caloric testing, and with tinnitus as a principal presenting symptom should be borne in mind by the clinician.     

Laparoscopic sleeve gastrectomy for the treatment of idiopathic intracranial hypertension in patients with severe obesity

BackgroundSevere obesity is a major risk factor for idiopathic intracranial hypertension (IIH). Data on the role of bariatric surgery for the treatment of this condition are scarce.ObjectiveTo evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) on treating IIH in severely obese patients.SettingTwo university bariatric surgery centers.MethodsProspectively collected data from consecutive patients undergoing LSG were retrospectively analyzed. Patients with IIH and referred by neuroophthalmologists for bariatric surgery were included in the analysis.ResultsFifteen female patients with IIH underwent LSG (median age: 31 yr). Median preoperative body mass index was 42.1 kg/m². Preoperatively, 14 patients (93.3%) had chronic headaches, 8 (53.3%) pulsatile tinnitus, and 1 (6.6%) epistaxis episodes. Ophthalmologic assessment showed bilateral papilledema in all patients, of whom 13 had visual symptoms. Median initial cerebrospinal fluid opening pressure was 31 cmH₂ O (range: 25–50 cmH₂ O); 4 patients required repeated decompressing lumbar punctures (1 ventriculoperitoneal shunt). LSG was successfully performed in all patients. No patients were lost to follow-up. Mean excess weight loss was and 87.4% and 88.1% 1 and 2 years after LSG, respectively. Headaches totally resolved in 13 patients (93.3%) and improved in 1 (P < .001). Pulsatile tinnitus (P = .013), epistaxis, visual symptoms (P < .001), and papilledema (P < .001) significantly resolved. Medication was stopped in 14 patients (93.3%). Two years after LSG, IIH outcomes for 7 patients reaching this time point remained unchanged.ConclusionThis study suggests that LSG is effective for severely obese patients with IIH, resulting in complete remission or significant improvement of their symptoms as well as medication discontinuation.     

Results of surgical treatment for Menière's disease

In 1985 the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium established revised guidelines for reporting treatment results for Menière's disease. Since then little information regarding the newly adapted criteria and their effects on the evaluation process has appeared. Thus we compared the results of different surgical procedures for Menière's disease using both the 1985 and 1972 guidelines. One hundred nine surgical procedures from 1969 to 1985 were reviewed. Six different surgical procedures were evaluated: the Cody-Tack, cochleosacculotomy, endolymphatic mastoid shunt, endolymphatic subarachnoid shunt, translabyrinthine vestibular nerve section, and transcanal labyrinthectomy. Results show that 68% of patients who had a Cody-Tack procedure continued to have vertiginous episodes in the same frequency postoperatively. Hearing was worse in 17 of these 25 patients. Of the patients who had a cochleosacculotomy, most had significant control of their vertiginous symptoms, but 10 patients had greater than 10 dB hearing loss postoperatively. Patients who had an endolymphatic mastoid shunt performed had better results when the 1972 guidelines were applied. In this group, the 1985 guidelines indicate that only 35% of the patients had significant relief of their vertiginous symptoms and 47% had hearing loss greater than 10 dB postoperatively. Six of the seven patients who underwent an endolymphatic subarachnoid shunt obtained significant relief of their vertiginous episodes, but hearing loss was more than 10 dB in four patients. Those patients who had either a labyrinthectomy or a translabyrinthine vestibular nerve section had relief of their vertiginous episodes. We conclude that the new guidelines appear to be superior to the 1972 guidelines for reporting results for the treatment of Menière's disease.     

Hearing preservation surgery in acoustic neuroma patients with normal hearing

Acoustic neuroma (AN) patients who had normal hearing accounted for 7% of all our AN cases. It is important to identify AN patients who have normal hearing but are suffering from tinnitus, dizziness, or vertigo, or a combination of these symptoms (without hearing loss), in order to make an early diagnosis. Patients who experience sudden hearing loss and recover completely should also be thoroughly examined in order to rule out AN. In this article, we describe an investigation of the clinical features and results of hearing preservation surgery in AN patients with normal hearing. The overall hearing preservation rate was 57%. The hearing preservation rate did not depend on the auditory brainstem response (ABR) pattern, tumor size, or the origin of the tumor. We think that patients must be properly informed concerning all aspects of the surgery, including the possibility that hearing and/or facial nerve function cannot be preserved.     

Hearing Preservation Surgery in Acoustic Neuroma Patients with Normal Hearing

Acoustic neuroma (AN) patients who had normal hearing accounted for 7% of all our AN cases. It is important to identify AN patients who have normal hearing but are suffering from tinnitus, dizziness, or vertigo, or a combination of these symptoms (without hearing loss), in order to make an early diagnosis. Patients who experience sudden hearing loss and recover completely should also be thoroughly examined in order to rule out AN. In this article, we describe an investigation of the clinical features and results of hearing preservation surgery in AN patients with normal hearing. The overall hearing preservation rate was 57%. The hearing preservation rate did not depend on the auditory brainstem response (ABR) pattern, tumor size, or the origin of the tumor. We think that patients must be properly informed concerning all aspects of the surgery, including the possibility that hearing and/or facial nerve function cannot be preserved.     

Intracranial venous sinus stenting for the treatment of lateral sinus stenoses: An analysis of 200 patients

PurposeThe purpose of this study was to analyze the long-term efficacy and safety of intracranial venous sinus stenting in a large cohort of patients with any type of presentation of primary lateral venous sinus stenosis (VSS).Materials and methodsA retrospective cohort study was performed including patients treated by venous sinus stenting for symptomatic VSS from 2012 to 2019. Successful primary resolution of symptoms without adjunctive treatment or recurrence, and complications after stenting were analyzed at the last follow-up time point.ResultsTwo-hundred patients were included. There were 14 men and 186 women with a mean age of 39 ± 14 (SD) years (age range: 13–75 years). Presenting symptoms included venous pulsatile tinnitus in 168 patients (168/200; 84%), idiopathic intracranial hypertension in 100 patients (100/200; 50%) and/or spontaneous cerebrospinal fluid leak in 35 patients (35/200; 17%). The overall rate of successful primary resolution of any typical presenting symptoms was 79% (95% CI: 73–85%). This rate ranged from 74% to 93% depending on the symptom with no significant difference between patients with and those without idiopathic intracranial hypertension (P = 0.08). Recurrence rate was 10% (95% CI: 6–14%). No death or permanent morbidity were observed during a median follow-up of 2.2 years (Q1, Q3: 1.4, 3.3; range: 1–7.7 years).ConclusionOur study shows that venous sinus stenting has a low morbidity and high success rate at long-term follow-up for the treatment of idiopathic intracranial hypertension, venous pulsatile tinnitus or spontaneous cerebrospinal fluid leak associated with VSS. The excellent safety suggests considering this treatment as first-line treatment when medical management is ineffective or poorly tolerated.