Central tinnitus — diagnosis and treatment. observations simultaneous binaural auditory brain responses with monaural stimulation in the tinnitus patient

Central tinnitus is defined as an abnormal sensation of sound which is perceived by the patient and established by neurotologic diagnosis to be retrocochlear and/or within the central nervous system in location. A method of diagnosis and evaluation using evoked response audiometry (ABR) is reported. A clinical test, Simultaneous Binaural Auditory Brain responses with monaural stimulation (ABR) for central location of tinnitus is presented. The use of a diagnostic approach to the selection of a tinnitus masker will be presented. Electrophysiologic indices for central tinnitus have been observed based on short latency ABR recordings. A classification has been presented. The use of lidocaine I.V. therapy with ABR recordings is presented. The concept, diagnosis, and techniques at this time, relating to central tinnitus, are presented as clinical observations. These observations are a beginning for the establishment of an electrophysiologic series of indices which can be interpreted as an electrophysiologic correlate of tinnitus to be supported by basic clinical research.     

The loudness of tinnitus

Although tinnitus causes considerable suffering to many patients, its loudness is small in most cases. Traditionally the loudness is measured with a binaural loudness balance procedure. It is stated that when there is recruitment in the ear to which the test tone is presented, the intensity of the test tone is smaller than its loudness. Therefore in the case of recruitment in the ear to which the test tone is presented, the loudness of tinnitus will be underestimated. In this study the loudness in a group with recruitment in the ear to which the test tone was presented was compared with the loudness in a group with a normal ear to which the test tone was presented. The present results show that although recruitment does have a certain effect, it is very small.     

Jugulotympanic paraganglioma (glomus tumour) presenting with recurrent epistaxis

A case is presented where a left jugulotympanic paraganglioma (JTP) extended to the nasopharynx and the patient presented with recurrent epistaxis. Although initial biopsy of an aural polyp had been suggestive of the diagnosis several years previously, the diagnosis was not confirmed until the patient presented with recurrent epistaxis and severe anaemia. To the best of our knowledge, this is the first case reported of such a presentation of JTP.     

Well-differentiated intra-osseous osteosarcoma in the mandible of a six-year-old child

The case of an osteosarcoma arising in the mandible of a six-year-old child is presented. It was originally misdiagnosed as a desmoplastic fibroma, and after initial curettage continued to grow for twelve years. The differential diagnosis is presented and details of the surgical access and difficulties encountered in the surgical removal of this very large tumour are described. The relationship between pre-existing disease and osteosarcoma of the mandible is discussed, and the difficulties experienced in distinguishing between the fibro-osseous lesions and osteosarcoma of the mandible are highlighted. The case is presented as a well-differentiated, intra-osseous osteosarcoma with subsequent transformation into a high-grade, conventional osteosarcoma.     

Adenoid cystic carcinoma of the salivary glands: clinicopathological survey of 51 patients

A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.     

The sequential septo-rhinoplasty.

In septo-rhinoplastic surgery it is helpful to follow a logical series of stages for correcting abnormalities of various anatomic components of the nose. A suggested order of staging of the typical nasal plastic operation is presented. By following a logical sequence of surgical stages, the least correctable components are modified first, and each successive stage of the procedure is related to the result obtained in the previous stage. Technical considerations are presented in each stage suggested, and the analysis and correction of intranasal abnormalities to restore normal nasal function is emphasized. Specific preoperative problems and the results of suggested methods of correction are presented.     

Chemodectoma of the larynx

Two cases of laryngeal chemodectoma are presented. They illustrate the differences between benign and malignant varieties of this tumour. The problem of differentiating between these two types at an early stage is discussed and a possible treatment policy is presented.     

Pilomatrixoma masquerading as a parotid mass

A case report of pilomatrixoma masquerading as a parotid, tumor is presented. Although well known to dermatologists and knowledgeable pathologists, this is, to our knowledge, the first time this entity has been presented in the otolaryngologic literature. Radiographic, sialographic, and histopathologic features of this tumor are presented with differential diagnoses. Because this is strictly a benign lesion, treated by local excision, the importance of correct histopathologic diagnosis is emphasized. The ultimate intent of this report is to make otolaryngologists aware of this entity so that they might include it in the differential diagnosis of calcified masses presenting in the parotid region.     

Recurrent adenotonsillitis: A new concept

An update of original data is presented. These data continue to confirm the physiological effect of adenotonsillectomy on the abnormal oropharyngeal and nasopharyngeal microflora of children with recurrent adenotonsillitis. A new concept suggesting a bacterial-viral etiology of recurrent adenotonsillitis is presented. The advantages of such a concept are reviewed.     

Multiple congenital epulis: A case report with spontaneous regression

The congenital epulis is a rare lesion that occurs exclusively in newborns. It is presented as a gingival growth generally seen in maxillary alveolar ridge of female newborn, with the potential to interfere with respiration and feeding. Approximately 10% of the cases are multiple and spontaneous regression is rare. This report describes a case of a 3-days-old female newborn, who presented multiple congenital epulis. The largest lesion prevented the lips sealing and compromised the feeding. Under local anesthesia, the largest tumor was excised, whereas the smallest lesion presented complete spontaneous regression within one month of follow up. After 12 months, no signs of recurrence are observed.     

Inverted papilloma of the nose. Apropos of a case associating polyps and an inverted papilloma of the nose]

In this article is presented a case report of a 59 years old woman with a medical history of recurrent nasal polyps (from 20 years ago). This woman presented an inverted papilloma in the middle meatus of the lateral wall of the nasal cavity simultaneously with the nasal polyps, and she was faced with surgical intranasal removal. The patient, two years later, presented again nasal polyps, but without any indication of the recurrence of the inverted papilloma. It is noticed the value of the local surgical removal of the inverted papilloma in patients who do not present extensive tumors.     

Mucoepidermoid carcinoma in a cervical cyst: A case of branchiogenic carcinoma?

A patient with a primary oral epidermoid carcinoma with presumed neck metastasis is presented who at operation was found to have a cervical mucoepidermoid carcinoma arising in the wall of a benign cyst. The case for considering this tumor a primary branchioma of mucoepidermoid type is presented, and the criteria for making the diagnosis of branchiogenic carcinoma are discussed.     

Neurofibroma of the posterior pharyngeal wall

Benign tumours of the hypopharyx are exceedingly rare. A case report of a 53 year old male who presented with a neurofibroma of the posterior pharyngeal wall having complaints of muffled voice and dysphagia is presented for its clinical interest.     

Prenatal diagnosis of airway compromise: EXIT (ex utero intra-partum treatment) and foetal airway surgery

Four cases of potential airway obstruction diagnosed in the early antenatal period are presented. Their management is outlined, and the need for a multidisciplinary team approach to these problems is highlighted. The experience of the ex-utero intrapartum treatment (EXIT) procedure is presented, and the first attempt at intra-uterine tracheal surgery is introduced.     

Papillary squamous cell carcinoma of the oropharynx

A case of papillary squamous cell carcinoma of the oropharynx is reported. The lesion was located in the base of the tongue and grossly presented a characteristic finger-like pattern of growth. The clinicopathological profile of the neoplasm is presented and the differential diagnosis with other exophytic squamous cell carcinomas is discussed.     

Bleeding ears: a case of Munchausen syndrome by proxy

A case is presented of a child who initially presented with genuine aural symptoms and pathology. Over a period of time it became apparent that the persistent aural bleeding, which is an uncommon feature of Chronic Suppurative Otitis Media, was the result of trauma inflicted by its mother; a case of Munchausen syndrome by proxy (MSBP).     

The selective effects of central masking on brain stem potentials

The effect of contralateral white noise stimulation on ipsilaterally presented click evoked brain stem potentials was examined. Continuous contralateral white noise does not influence the brain stem response components but pulsed white noise simultaneously presented with the clicks produced a central masking effect which was observed as an amplitude reduction confined to Wave V. Our findings confirm those of Zwislocki (1971) that pulsed noise is a more effective central masker than continuous noise. A computer addition of the responses to pulsed white noise and clicks recorded independently revealed no reduction in Wave V amplitude but the response to the two stimuli presented simultaneously showed a specific reduction in Wave V amplitude. No change in the latency of Wave V was observed to suggest any 'cross-over' masking of the click stimulus. Patients with total unilateral deafness did not exhibit this phenomenon. The effect of a time delay of the masker to one ear in relation to the click presented to the other ear reduced the amplitude of Wave V less than when the two stimuli were presented simultaneously. The reduction in the amplitude, being specific to Wave V, suggests that the effect is central and that the particular locus for this aspect of central masking is at the level of the inferior colliculus.     

Cerebellopontine angle meningioma resulting in middle-ear polyp

Extracranial spread of meningiomas to involve the middle ear is very rare. We present the case of a 43-year-old woman with a known cerebellopontine angle meningioma who subsequently presented with left-sided otalgia and a middle-ear mass extruding through the tympanic membrane due to local invasion of the meningioma. The tumour was excised surgically. A discussion of the relevant literature is also presented.     

Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration

Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.