Cochleovestibular syndrome caused by sphenoiditis

Due to sphenoiditis, the patient developed a cochleovestibular syndrome at the labyrinthine level which was eliminated only by surgical treatment of sphenoiditis. This observation suggests that sphenoiditis can be referred to the factors responsible for hearing and vestibular disorders. Another interesting observation was that in the presence of pus in the sphenoidal sinus contrast X-ray did not reveal a filling defect. Such a finding was not the first of this type seen by the author.     

Cochleovestibular dysfunction in ankylosing spondylitis

Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim of this study was to evaluate the functions of the cochlea and the vestibular system in patients with AS. The study group consisted of 32 patients with AS and 30 healthy volunteers as a control group. Otorhinolaryngologic examinations were performed in all patients together with pure-tone audiometry, speech tests, impedancemetry, transient evoked otoacoustic emission (TEOAE) and electronystagmography (ENG). A significant difference was found between the 2 groups with regard to pure-tone averages at high frequencies in each ear (p < 0.05). The rates of reproducibility in TEOAE testing were significantly lower in patients with AS (p = 0.03). The signal-to-noise rates of the response values were lower at all frequencies in patients with AS, but a statistically significant difference was only observed at 2, 3 and 4 Hz (p < 0.05). ENG revealed pathologies in 11 patients with AS (34%), 8 of which were central (25%) and 3 of which were peripheral (9%). No correlation was found between cochleovestibular dysfunction and age, sex, disease duration, activity and medication taken. This study demonstrated that there is an association between AS and cochleovestibular dysfunction.     

Cochleovestibular dysfunction in patients with diabetes mellitus, hypertension and dyslipidemia

Introduction and objectivePolygenic or multifactorial inheritance of chronic disorders (MICD) contribute to irreversible cochleovestibular impairment. Our aim was to determine the type and degree of cochleovestibular dysfunction (CVD) in patients with MICD.MethodsCross-sectional. We studied 385 patients with type 2 diabetes mellitus, systemic arterial hypertension and dyslipidemia who were referred to Otorhinolaryngology Unit with hearing and vestibular symptoms. The auditory function was evaluated using conventional tonal audiometry and the vestibular function by electronystagmography. Duration of the disease and number of comorbidities, hearing thresholds at 125-8000 Hz pure tones, speech audiometry, oculomotor evaluation and thermal caloric tests were also analysed.ResultsA total of 66.7% (95% CI, 61.8-73.4) of patients had 1 comorbidity; 27.7% (95% CI, 23.3-32.5) had 2 and 5.4% (95% CI, 3.4-8.2) had systemic arterial hypertension, diabetes mellitus and dyslipidemia. The mean age was 62 years (SD 12.9) and 57.1% were women. The majority showed obesity, physical inactivity and smoking (77.4%; 95% CI, 72.8-81.4). Cochlear dysfunction was more common than CVD (98.9%; 95% CI, 97.3-99.7 versus 36.1%; 95%CI, 31.2-41.1; P=.001). However, the presence of CVD was significant in patients over 60 years (χ²_tend, P≤.001, odds ratio: 6.43) and with MICD ≥11 years old (χ²_tend, P≤.001, odds ratio: 4.57).ConclusionsCochlear dysfunction occurs in patients with MICD and the impact is greater than that of vestibular dysfunction. However, the age factor, duration and number of MICDs contribute to CVD. It is necessary to act on the MICDs and lifestyles to improve CVD.     

Multiple cranial nerve dysfunction caused by neurosarcoidosis

Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII). When cranial nerve dysfunction occurs, it is very important to take neurosarcoidosis into consideration.     

Cochleovestibular anomalies in children with cholesteatoma

OBJECTIVE: To describe the cochleovestibular apparatus on computed tomography (CT) imaging in patients with cholesteatoma. We asked whether cochleovestibular anomalies coexist in individuals with cholesteatoma. STUDY DESIGN: Randomized, controlled, prospective measurement. METHODS: A database search yielded 145 children with cholesteatoma: 31 met inclusion criteria by not having sensorineural hearing loss, not having an associated syndrome, and having digitally stored temporal bone CT imaging available. Prospective measurement of 31 individuals (62 ears) with unilateral cholesteatoma and 32 normally hearing nonsyndromic controls (64 ears) was performed by a neuroradiologist blinded to the study objective. Twenty-six temporal bone aspects on axial imaging were evaluated (16 measurement, 10 calculated from measurement). RESULTS: The cholesteatoma group had a larger endolymphatic fossa and vestibular aqueduct, and there was a trend for the lateral semicircular canal vestibule to be smaller as compared with controls. Subgroup analysis revealed a gradient in prevalence of these findings being most common in the congenital cholesteatoma group, intermediate in the acquired cholesteatoma group, and least common in controls. There were no differences in measurements between ears with cholesteatoma and contralateral disease-free temporal bones. CONCLUSIONS: Children with cholesteatoma have abnormal vestibular anatomy. The gradient in prevalence of these findings may suggest a relationship between congenital and acquired cholesteatoma. These may include a generalized temporal bone anomaly that predisposes to cholesteatoma formation, or a third variable such as genetic mutation may predispose to both anomalous cochleovestibular formation and cholesteatoma.     

Cochleovestibular nerve involvement in multifocal fibrosclerosis

Objectives: To report a case of multifocal fibrosclerosis with a nine-year follow up, and to discuss this disease's radiological appearance and management. The disease is a rare systemic disorder of unknown cause characterised by fibrous proliferation involving multiple anatomical sites. Case report: A 50-year-old woman presented with histological findings characterised by similar inflammatory processes involving the meninges, pituitary gland, peritoneum, retroperitoneum and orbits, prompting a search for a common pathophysiology. A diagnosis of multifocal fibrosclerosis was postulated. Symptom improvement was noted after treatment with prednisone and azathioprine. Conclusion: This is the first documented case of involvement of the cochleovestibular nerve in a patient with multifocal fibrosclerosis. The rare association between fibrotic diseases and masses showing various clinical patterns should be kept in mind by otolaryngologists, and imaging performed to investigate for multifocal fibrosclerosis. However, diagnosis can only be confirmed with tissue biopsy and histopathological examination.     

Cochleovestibular nerve sections in labyrinthectomized patients

Labyrinthectomy is indicated for a patient who has unilateral peripheral labyrinthine disease with unserviceable hearing loss. For most patients, labyrinthectomy provides complete relief from intractable vertigo. Some patients continue to have persistent vertigo, however, even after a complete destructive labyrinthectomy. Only after cochleovestibular nerve sections were these patients relieved of intractable vertigo. Representative cases of cochleovestibular nerve sections in labyrinthectomized patients are presented. The reason why the cochleovestibular nerve section relieves the symptom of vertigo in labyrinthectomized patients is not clear. Labyrinthectomy destroys vestibular sense organs, while cochleovestibular nerve section eliminates spontaneous activity and prevents the possibility of nerve regeneration by excision of the ganglion. For those patients who required vestibular nerve sections, there may have been abnormal excitation of vestibular nerve fibers. This might be explained by incomplete labyrinthectomy, regeneration of vestibular nerve fibers, contribution from vestibular ganglia or nonfunctioning cochlea, and vascular loop syndrome.     

Pituitary-adrenal dysfunction caused by nivolumab for head and neck cancer

Nivolumab exerts antitumor effects by inhibiting binding of PD-L1 to PD-1, and offers proven effectiveness in various disease areas, including cancers of the head and neck. The mechanisms of action lead nivolumab to induce immune-related adverse events (irAE). We report a case of pituitary-adrenal dysfunction to isolated adrenocorticotropic hormone (ACTH) deficiency as an irAE of nivolumab in a patient treated for head and neck cancer. This is the first report of an irAE of nivolumab in the field of head and neck squamous cell cancer. The patient was a man in his 50s with cancer of the tongue and hypopharynx that recurred after chemoradiotherapy, surgery and chemotherapy. After starting nivolumab, irAEs developed after 8 courses. The case was managed from the early stages in collaboration with the endocrinology department. Pituitary-adrenal hypofunction due to isolated ACTH deficiency was diagnosed on the basis of endocrine tests. The patient responded to hydrocortisone replacement therapy and has been able to continue treatment with nivolumab while continuing oral hydrocortisone. Although irAEs involving pituitary gland disorders are rare, these events can become life-threatening when severe. Early diagnosis and treatment are essential and require regular blood sampling and collaboration with specialists from an early stage.     

喉源性阻塞性睡眠呼吸暂停低通气综合征的临床观察

目的 探讨喉源性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的病因、临床表现和治疗特点。方法 回顾分析13例经治疗喉原发病使OSAHS获得有效治疗而确诊为喉源性OSAHS的病例,总结分析其病因、临床表现和治疗特点。结果 造成喉源性OSAHS发病原因包括双侧声带麻痹、喉乳头状瘤、会厌肿瘤、会厌软化等,主要由声门和会厌病变引起喉内呼吸道狭窄所致;此类患者多不肥胖,声门病变导致OSAHS者多数存在轻度呼吸困难,经治疗喉原发病,OSAHS获得了很好疗效。结论 喉腔疾病可以导致喉源性OSAHS的发生,临床上喉源性OSAHS并非罕见,治疗喉原发病可以使喉源性OSAHS得到有效治疗。