Ear Complaints Research Articles

Intermittent headache and swelling in the temple

A 32-year old female patient was referred to our hospital for evaluation of headache. A preliminary diagnosis of possible temporal arteritits in young patient was made in the referral letter. She had been complaining of episodes of left sided headache for the last 2 years. The headache occurred mainly in the horning; it is mild to moderate in severity, associated with feeing of fullness in the left temple. The episodes were coming at no regular time, was not related to menstruation and was not accompanied by nausea, vomiting or photophobia. It lasts for few hours and then subsides, and she noticed that the sensation of fullness also disappears. She had no history of trauma. She denied any fever, weight loss, morning stiffness, or any sinuses, ear or eye complaints. She was diagnosed at one time as migraine headache and was given treatment for that. Clinical examination at the time of headache revealed afebrile patient with normal blood pressure and pulse. The left temple showed fullness compared to the right side but there was no redness or warmth of the overlying skin. There was an ill-defined slightly raised 5 × 4cm soft swelling in the left temple. There was no palpable thrill or audible bruit. The temporal artery was pulsating without any tenderness.

TYPICAL AND ATYPICAL PRESENTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE: The Role of Esophageal Testing in Diagnosis and Management

Gastroesophageal reflux disease (GERD) is a common disease with many typical and atypical forms of presentation. In the classic presentations of GERD with heartburn and regurgitation, esophageal testing, except for endoscopy, is only required for poorly responding patients or prior to surgical therapy. The atypical presentations of GERD, including chest pain, asthma, and ear, nose, and throat complaints, frequently are not associated with heartburn or regurgitation. Esophageal testing, particularly 24-hour pH monitoring is key to making the diagnosis and ensuring adequate acid suppression.

Contemporary Health Practices in the Burren

This is a cross sectional survey of health practices in the Burren, Co. Clare. The primary aim of this research is to examine people’s knowledge of and attitudes toward, folk medicine, alternative medicine and conventional medicine. The design is based on a 1930s folklore scheme, conducted by the Folklore Commission of Ireland. Employing the unique method of the folklore scheme, senior pupils from 11 national schools in the Burren, Co.Clare, were asked to write an essay on ‘Health Practices’, based on a research questionnaire developed for this purpose. With a 76% response rate, 133 essays were collected for analysis. High rates of knowledge were recorded for folk and alternative medicine (95% and 41% respectively). Usage rates for both non-conventional medical systems were considerably lower (23% and 16% respectively). Quantitative analysis of the data revealed that participants cannot be divided into exclusive groups of conventional and non-conventional users of health services. Also, symptom severity appears to be predictive of subsequent health service utilisation. 25% of conditions associated with folk medicine were minor dermatological complaints and 23% were ear, nose and throat complaints. Participants’ attitudes to hospitals do not seem to be indicative of their health practices, thus highlighting the complexity and contradictory nature of health-related attitudes and behaviour. Finally, social class differences were apparent in this sample - knowledge and use of folk medicine was higher amongst manual classes while alternative medicine appears to be a more middle class phenomenon. These differences were not statistically significant.

Validation of parameters for assessing Obscure Auditory Dysfunction--robustness of determinants of OAD status across samples and test methods.

About 5% of those presenting at an ENT clinic with ear or hearing complaints are found to have normal pure-tone thresholds. Many of this group complain specifically of difficulties understanding speech in background noise. We have termed this complaint 'Obscure Auditory Dysfunction' (OAD). Previous research on OAD (Saunders and Haggard, 1992) on a sample of 50 patients and 50 matched controls showed that 83% of the deviance (binary variance) in membership of group (OAD/control) could be explained by four variables, with three underlying factors. These four variables are performance threshold in noise for speech; discrepancy between this and a self-adjusted signal-to-noise ratio value (i.e. a measure of auditory confidence); dichotic listening performance; and performance on a psychoacoustic test, the threshold for detecting a tone in a spectrally notched noise. This paper reports a study on a further 59 new OAD patients and 64 unmatched controls, using the tests in the form present in the test package, plus certain others. For routine practice, slightly differing implementations of the auditory test techniques were used. Compared to the earlier sample, the new sample had poorer measures of speech reception threshold in noise and they considered themselves more handicapped by their OAD state; however there was no significant difference between the two samples on the other performance variables. Overall, the results demonstrate the robustness of the conclusions reached from the previous study, as the test-variable determinants of OAD status (i.e. case-control differences) were similar. The items on the OAD interview questionnaire which had shown significant differences between OADs and controls were also similar for the two OAD samples, giving a consistent picture of patient profile. These were: difficulties learning to read or write as a child (which relates to dichotic listening scores); adult ear problems; and tinnitus (which relate to the psychoacoustic scores). This necessary replication confirms the validity of the three-factor model of OAD status and the utility of the clinical test package based upon it.

Prevention of hyperbaric-associated middle ear barotrauma

To determine the efficacy of topical nasal decongestant in the prevention of middle ear barotrauma in patients undergoing hyperbaric oxygen therapy. Prospective, parallel, double-blind, randomized trial. University-affiliated community hospital emergency department with hyperbaric oxygen facilities. Sixty patients undergoing hyperbaric oxygen therapy; 30 subjects in each treatment arm. After randomization, consenting patients were given two sprays of oxymetazoline hydrochloride or sterile water, 15 minutes before hyperbaric oxygen therapy. Collected data included patient demographics, ear examinations before and after hyperbaric oxygen treatment, and subjective ear complaints. The otoscopic appearance of the tympanic membrane was graded according to the amount of hemorrhage in the eardrum, with Teed scores ranging from 0 (symptoms only) to 5 (gross hemorrhage and rupture). The treatment groups were similar with regard to age, sex, and medical history. Ear discomfort during hyperbaric oxygen therapy was present in 63% (19 of 30) of those receiving oxymetazoline versus 67% (20 of 30) of the control group (P = .99). Likewise, both groups had similar Teed scores after hyperbaric oxygen therapy (P = .88). No adverse effects were noted. The results of this pilot study suggest that topical decongestants may not be effective in preventing middle ear barotrauma during hyperbaric oxygen therapy.

Office Management Of The Draining Ear

Otorrhea is one of the most common ear complaints and is usually responsive to office treatment. The various causes of this condition are discussed and appropriate treatment options are detailed in this article. Topics include otorrhea from typanostomy tubes, chronic otitis media, external otitis and otorrhea, otorrhea after trauma, congenital anomalies and otorrhea, and neoplastic otorrhea.

Primary ciliary dyskinesia and the middle ear

The middle ear cavity and the eustachian tube contain a well-functioning mucociliary clearance system. To learn more about the importance of this mucociliary clearance, we studied patients with primary ciliary dyskinesia, in whom mucociliary clearance is absent. Thirty-six patients were investigated by means of a questionnaire; in 16 of these patients, otological and audiological studies could be performed. In patients with primary ciliary dyskinesia, a discrepancy was found between subjective ear complaints and the actual middle ear function. Moreover, it appeared that for the middle ear system, mucociliary clearance is of importance only in the first 3 decades of life. With aging, however, a deficient mucociliary clearance system in the middle ear and eustachian tube can be fully compensated for.

Koinzidenz chronisch-entzündlicher Nasennebenhöhlenaffektionen mit cochleo-vestibulären Störungen*

In the course of initial examination the authors frequently observed a coincidence of labyrinthine symptoms with radiologic signs of chronic sinusitis. Of 72 patients who were hospitalized for acute labyrinthine symptoms, 72% presented with these signs. On the other hand, 49% of the patients admitted to sinus surgery manifested labyrinthine symptoms. A well-pneumatized mastoid was found in both groups. In the control group, consisting of patients whose consultation was unconnected to ear or nose complaints, chronic sinusitis was found in 28% and labyrinthine symptoms in 24%, but the two together were only found in 11%. It was shown by means of the chi2 test that the two symptom complexes are interdependent (p less than 0.01). Histologic examination of the mucosa of paranasal sinuses and peri-labyrinthine cells does not at the moment provide a satisfactory explanation. Pathologic autonomic nerve connections between the two systems may lead to higher vulnerability of the labyrinths of patients with chronic sinusitis. Other possible explanations, i.e., relating to certain neuropeptides and a well-pneumatized mastoid, are discussed. The authors wish to emphasize that their study is based on clinical data. At the moment a satisfactory pathophysiological explanation is lacking. In addition to antiphlogistic and rheologic medication, long-term planning of sinus surgery should be recommended for all patients in whom the two symptoms occur simultaneously. Whether this can help prevent recurrences, or put an end to progressive processes, can only be determined after a longer observation period.

The effect of temporomandibular joint arthroscopy on ear function

Many patients with temporomandibular joint (TMJ) dysfunction also complain of subjective symptoms of ear dysfunction. This study was undertaken to evaluate preoperatively patients with ear complaints associated with TMJ pain and dysfunction and to examine the effect of essentially uncomplicated TMJ arthroscopy on subsequent ear function. Fourteen patients (22 joints) were examined arthroscopically. The patients were evaluated by an otologist, and hearing tests were obtained pre- and post-operatively. All patients had normal audiometric studies preoperatively, and these remained unchanged postoperatively. It was concluded that uncomplicated arthroscopy of the TMJ does not cause ear dysfunction.

Acoustic otoscopy in the diagnosis of otitis media

Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 ears) presenting to the emergency department with ear or upper respiratory complaints. We then evaluated the use of acoustic otoscopy in 34 adults (68 ears) with and without ear complaints. Using a reflectivity of 5 or more units to signify acute pathology in children, the sensitivity was 82%, and the specificity was 100%. Using a reflectivity of 6 or more units to indicate acute suppurative pathology in adults, the sensitivity was 83%, and the specificity was 95%. We found acoustic otoscopy to be objective, practical, and reproducible. We conclude that acoustic otoscopy is a valuable adjunct in the diagnosis of otitis media in children and adults.

アブミ骨上部構造消失例の臨床像

Preoperative hearing loss, microorganisms isolated from ear discharge, duration of ear complaints, the ages of patients, surgical treatment and postoperative restoration of hearing were studied in chronic suppurative and cholesteatomatous otitis media with destroyed stapedial superstructure. Pre- and postoperative hearing loss were determined by averaging air-bone gaps of 0.5, 1, and 2kHz.The following results were obtained.1) Dehiscence of the stapedial superstructure is more frequently found in cholesteatoma than in chronic suppurative otitis media. The stapedial superstructure was more rapidly destroyed in cholesteatoma.2) Pseudomonas aeruginosa was isolated with a significantly higher incidence from ear discharge of chronic purulent otitis media.3) Infection of plural micro-organisms was found to have no significant effects on stapedial destruction.4) Preoperative audiograms showed air-bone gags of 30dB or more at all frequencies in 42.9% of the patients, and 26.6% of them showed air-bone gaps of 30dB or more at all frequencies except one.5) Postoperative air-bone gaps were around 30dB in 7 of the 13 radical mastoidectomy ears.6) Postoperative air-bone gaps were 33.9dB for radical mastoidectomy, 29.0dB for type IV tympanoplasty and 25.8dB for modified type IV tympanoplasty.

A practical approach to the patient with vertigo: an outline of diagnosis and management for the nonspecialist.

A careful history is the most important part of a medical examination for vertigo, especially to establish whether it is acute, chronic or recurrent. If the patient spontaneously volunteers ear complaints, such as fullness, tinnitus, or hearing loss, the cause is probably otologic and deserves immediate referral. If no otologic complaints are volunteered, the whole body becomes a source of investigation. All nonvital drugs should be withheld while the vertigo study is progressing. A complete physical examination and blood profile should be carried out. Roentgenograms of the skull and chest should be obtained. Accurate diagnosis and proper management are possible only with prolonged follow-up. Unnecessary expense, inconvenience, and discomfort for the patient can be avoided by a screening audiogram to identify unilateral hearing loss. All unilateral hearing loss should be investigated thoroughly in order to diagnose serious retrocochlear disease early.

INSECT IN AUDITORY CANAL

To the Editor: The following incident may be of interest to your readers. A woman in her mid-40's phoned me one sunny afternoon stating that she had just experienced a sudden attack of severe pain in the right ear while she was outdoors. She disclaimed having had any previous upper respiratory trouble or ear complaint or nausea or dizziness. However, she added that since the onset of the pain she was experiencing intermittent rumbling or rustling sounds in the ear. I was at a loss to explain this phenomenon and was inclined to dismiss it as a neuralgia in an emotional woman. Still, at her insistence that the pain was unbearable I agreed to meet her at the office in a few minutes. When I first looked into the ear I saw nothing abnormal except a tiny bright red spot on the postero-inferior quadrant which appeared like a small hematoma.

Further psychosomatic aspects of otolaryngology.

For years I have observed all kinds and categories of ear, nose, and throat complaints, and in my opinion most of them were real. To detect organic pathology in the field of otolaryngology is a fairly simple task; to prorate accurately the importance of organic and functional disease coexisting in the same patient is more difficult; but to state with assurance that all a patient's complaints are functional in nature is to assume a position based on circumstantial evidence that is easy to believe (and may be correct) but is most impossible to prove. Psychosomatic disorders in the field of otolaryngology run rather true to form. Only in exceptional instances where circumstances causing a psychosomatic disability are unusual do we have embellishments that make a particular patient of unusual interest. The run-of-the-mill complaints of psychosomatic disease that come regularly into the office of an otolaryngologist we classify as follows: (a)

Primary cholesteatoma of the mastoid.

A TUMOR which resembled a primary or true cholesteatoma of the mastoid was observed in an elderly man. Roentgenograms suggested a secondary cholesteatoma, but histological examination established the diagnosis of primary cholesteatoma without cholesterol crystals. REPORT OF A CASE M. C., a 72-year-old man, came to the hospital with complaints of a swelling behind his right ear which had lasted for the previous three months and occasional slight dizziness. His past history showed that he had always had excellent health and his condition had been good except for some stomach ulcers which he had had a number of years ago. He had also received some shotgun wounds in his neck and chest about 25 years ago, which were accidentally discovered during the x-ray examination. He never had any ear complaints or discharge, pains, or the like. Examination of his ear revealed perfectly normal drum membranes without any perforation or scars.

Chronic maxillary sinusitis (suspected and unsuspected) in the tropics

The aim of the paper is to bring forward chronic maxillary sinusitis and its very varied symptomatology. Its importance lies in: 1. ( a) Its ability to produce sets of symptoms which simulate closely such conditions as tuberculosis of the lung, influenza, chronic malaria, malingering, and psychological abnormality; 2. ( b) The frequency and potential seriousness of its many and widespread complications; 3. ( c) Its ability to lie unsuspected while a complication receives a useless treatment. Common complications are ear, eye, throat and lung troubles; various neuralgias; general toxaemia; anaemia; fibrositis and joint troubles; gastro-intestinal disorders; and swelling of bones of the face. The symptoms complained of amongst 60 cases are described and discussed. They were: —headache, chronic cough, fever, “influenzal” attacks, asthma, fibrositis, malaise, lassitude, debility, mental dullness, ear complaints, haemoptysis, epistaxis, bony swelling, eye symptoms, and a hysterical fit. As a sign, a “nasal” voice was almost constant. Diagnostic methods were (1) Direct nasal examination with or without cocainization and postural test; (2) Proof puncture. No cases of dental causation have been seen. Treatment is described briefly. It is not difficult, and is very satisfactory.

Scientific Serials

Königliche Gesellschaft der Wissenschaften, Göttingen, January to March, 1885.—Memoir on Jacob Grimm, by F. Frensdorff. —On the optical properties of very thin metal plates, by W. Voigt.—Seventh annual report on the treatment of ear complaints in University Hospital, Gottingen, by Dr. K. Biirkner.—A contribution to the history of the Papacy during the tenth century, by Ludwig Weiland.—On the electric conductivity of liquid solutions in a state of extreme dilution, by Friedrich Kohlrausch.— On the Eris of Greek mythology, her outward appearance and representation in plastic art and literature, by Friedrich Wieseler. -On the theory of complex magnitudes formed of n units, by R, Dedekind.—The organic Aryan inflection of the locative case singular of the u declension, by A. Bezzenberger.—On Euler's integral in connection with Cauchy's “Memoire sur les Integrates definies,” by A. Enneper.—A demonstration of the multiplication theorem for the determinants, by M. Falk.—A contribution to the study of the sympathetic nerves in the higher mammals, by Fr. Huth.—On some definite integrals by A. Enneper.—On the maximum of a four-sided figure of given dimensions, by A. Enneper.