Eighth Nerve Lesions Research Articles

Patient-reported involvement of the eighth cranial nerve in giant cell arteritis

IntroductionThe frequency of eighth nerve lesions in patients with giant cell arteritis (GCA) has rarely been examined. However, sudden onset deafness has been recorded as a presenting feature of GCA on several occasions. This study sought to establish how common this and other symptoms of eighth nerve involvement are in a large retrospective survey.MethodsWe contacted 170 patients with GCA and 250 matched PMR patients, inviting them to participate in a questionnaire survey of symptoms of eighth nerve dysfunction. We compared the presence of deafness, tinnitus, loss of balance and vertigo in both groups and examined the relationship between the onset of these symptoms and other features of GCA.ResultsA total of 317 patients were recruited. The percentage of patients with symptoms of possible vestibulocochlear disease prior to commencement of steroid therapy was significantly greater among GCA patients than PMR patients for all domains. Hearing loss which was twice as common in GCA as in PMR (53% vs 26%) [p = 0.001]. Deafness was concurrent in 35% of GCA patients with other symptoms and 45% reported colocation with headache. Recovery with steroids occurred in 56% of these.ConclusionSymptoms of eighth nerve dysfunction are present in over half of patients with GCA. Recovery with steroids was predicted by concurrence with headache in terms of both timing and location. It appears that eighth nerve involvement, especially acute hearing loss, is a not infrequent feature of GCA and often responds well to steroid therapy. Clinicians should enquire about these symptoms when evaluating a patient for possible GCA.Key Points• Deafness is a frequent presenting feature of giant cell arteritis.• Vertigo, tinnitus and loss of balance are also often reported by GCA sufferers.• Steroid therapy is more likely to relieve these symptoms if they are ipsilateral and concurrent with headache.

Perinatal cytomegalovirus and toxoplasmosis: challenges of antepartum therapy.

The purpose of antepartum and neonatal for congenital infections is to reduce the potential for short-term and long-term morbidity and mortality. The degree of clinical acceptance of antepartum and/or neonatal varies greatly among the congenital infections classified as (Toxoplasma, rubella, cytomegalovirus, herpes simplex) infections. The use of acyclovir to prevent or reduce the severity of neonatal herpes infections is considered standard for infants with potential perinatal exposure. Maternal antepartum for syphilis with penicillin targeting achievement of adequate fetal drug levels is considered the standard of care to reduce the sequelae of congenital syphilis. Although there is no real therapy for congenital rubella, the prevention of sequelae of congenital rubella is best achieved by primary prevention (preventing maternal infection) by vaccination of all women of childbearing age with rubella vaccine before conception (because it contains a live-attenuated virus, rubella vaccine is contraindicated during pregnancy). The status of antepartum and primary prevention to decrease the sequelae of congenital cytomegalovirus (CMV) and toxoplasmosis is much less clear than for the other TORCH infections. To validate the utility of antepartum or neonatal in reducing the sequelae of congenital infection, one must first understand the patterns of morbidity (both short-term and long-term) and mortality associated with a specific congenital infection in the absence of treatment. This must include an understanding of the severity as well as the frequency of each of the significant sequelae reported for that type of infection. Only after exploring the natural history of congenital infection can we proceed to determining the efficacy of potential therapeutic regimens. Congenital infections can produce a wide variety of sequelae, some immediately apparent (structural defects, intrauterine fetal demise), others discovered only after the passage of time (developmental delay, progressive sensory loss). Congenital rubella is associated with structural defects, and congenital syphilis may cause fetal demise. Congenital infections with CMV and Toxoplasma gondii are more commonly linked with long-term sequelae that may not be apparent at birth and even until the child reaches school age. The long-term sequelae associated with congenital CMV and toxoplasmosis can be categorized into sensory deficits, developmental delay/mental retardation, and central nervous system lesions. Ocular abnormalities including chorioretinitis, optic nerve atrophy, and retinal detachment occur more commonly after congenital toxoplasmosis. In contrast, sensorineural hearing loss due to cochlear or eighth nerve lesions occurs more typically as a sequelae of congenital CMV.1 Central nervous system lesions that may occur after either CMV or toxoplasmosis include intracranial calcifications, microcephaly, hydrocephalus, and periventricular radiolucencies (low brain substance density extending from the frontal and occipital horns to surround the lateral ventricles). Central nervous system lesions can be diagnosed by ultrasound (intrauterine or neonatal), computed tomography (CT), or magnetic resonance imaging (MRI). Developmental delay and mental retardation commonly are assessed using the Bayley Scales of Infant Development and/or the Wechsler Primary and Preschool Scale of Intelligence.2 Ocular abnormalities are detected by fundoscopic examination, pupillary reflexes, visual acuity, and refractive status.1 Sensorineural hearing loss must be differentiated from conductive hearing loss (due to external or middle ear lesions) by Auditory Evoked Brainstem Responses or Impedance Audiometry. For both CMV and toxoplasmosis, we will describe prevalence, modes of transmission, mechanisms of congenital infection, immediate and long-term sequelae of congenital infection, potential for antepartum prophylaxis/therapy to reduce neonatal sequelae, and methods for primary prevention by prevention of maternal infection.

Audiologic findings in unilateral deafness resulting from contralateral pontine infarct

Audiologic findings in unilateral deafness resulting from contralateral pontine infarct KAREN JO DOYLE, MD, PhD, CYNTHIA FOWLER, PhD, and ARNOLD STARR, MD, Irvine and Long Beach, California F o c a l brain stem infarction has been uncommonly associated with unilateral sensorineural hearing loss (SNHL). Kumar et al. (1986) 1 found a single case of brain stem infarction among 200 cases of unilateral SNHL. Previous case reports of unilateral S N H L after brain stem infarct have been the result of lesions of the ipsilateral cochlear nuclei in the dor- solateral medulla. 2,3 Wada and Starr (1983) 4 deter- mined that an experimentally produced lesion of the lateral lemniscus produced a unilateral contralateral abnormality in the N 3 portion of wave III of the auditory brain stem response (ABR) in guinea pigs. We report a case of unilateral S N H L after a con- tralateral focal pontine infarct verified by magnetic resonance imaging (MRI) and A B R testing. CASE REPORT A 63-year-old man with a history of hypertension was admitted to the Veterans Administration Medical Cen- ter-Long Beach in June 1994 with a urinary tract infec- tion. During his admitting physical examination, a neuro- logic examination was performed that revealed a right- sided hearing loss. The neurologic examination was otherwise normal. He reported that he had had a stroke in April 1994 and had spent several days in another hospital. The records and MRI scans from that hospital- ization were obtained. The admission physical examina- tion from April revealed a blood pressure of 170/86, a central right facial palsy, a right-sided hearing loss, nys- tagmus (direction not given), and unsteady gait. Labora- tory examination revealed normal cerebrospinal fluid chemistries and cell counts and negative VDRL. The MRI From the Divisions of Otolaryngology-Head and Neck Sur- gery and Audiology (Drs. Doyle and Fowler), Veterans Administration Medical Center; and the Departments of Otolaryngology-Head and Neck Surgery (Drs. Doyle and Fowler) and Neurology (Dr. Starr), University of California Irvine. Received for publication April 28, 1995; revision received June 27, 1995; accepted July 17, 1995. Reprint requests: Karen Jo Doyle, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, University of Cali- fornia Irvine Medical Center, Bldg. 25, Route 81, 101 The City Dr., Orange, CA 02668. OTOI.A~YNGOI. HZAO NECK SUnG 1996;114:482-6. from April 1994 demonstratd a dorsally located infarct involving the medial left portion of the upper pons, as well as ischemic changes of the periventricular deep white matter (Figs. 1 and 2). He was referred 3 weeks after the stroke to the Audi- ology Department for evaluation of his right-sided hearing loss. Audiogram revealed a fiat, severe SNHL in the right ear and a moderate high-frequency SNHL above 2000 Hz in the left ear (Fig. 3). Speech discrimination was 0% in the right ear and 92% in the left ear. Acoustic reflexes were absent in the right ear. ABR was performed with condensation and rarefaction dicks presented 10/second at 95 dB nSL (Fig. 4). In the left ear, all components were identified, and their intercomponent times were within normal limits. In the right ear, wave I was present for condensation clicks at 1.98 msec, and no other waves were identified. Transient and distortion-product otoacoustic emissions (OAEs) were performed. In the right ear, tran- sient emissions were present with energy present through 3000 Hz with 81% reproducibility, similar to those ob- tained from the left ear (Fig. 5). Distortion-product OAEs (2F2 - F1 = 1.221; F1 = 70 dB SPL; F2 = 70 dB SPL) were present across frequencies in the right ear and through F2 = 3000 Hz in the left ear. Repeat MRI with gadolinium of the internal auditory canals was performed, and they were normal. DISCUSSION Although we used the combined term sensorineu- ral hearing loss, the majority of patients with S N H L have lesions of the sensory apparatus, whereas neu- ral lesions, including spiral ganglion degeneration, eighth nerve lesions, and central auditory pathway lesions from the cochlear nuclei to the temporal cortex, are found less frequentlyJ A m o n g the causes of hearing loss, cerebrovascular infarction of the auditory pathways has been described infrequently. A 1986 report of 200 cases of unilateral S N H L found 42 individuals with confirmed retrocochlear lesions, of which there was one lesion adjacent to the co- chlear nucleus and a second patient with a pontine lesion? The most commonly found central lesions in that study were cerebellopontine angle tumors, cen- tral nervous system lues, and multiple sclerosis. Lownie and Parnes (1991) 2 found two cases of ipsi- lateral S N H L caused by infarcts of the cerebellum

か牛神経または下部脳幹障害例のＡＢＲ診断について

か牛神経または下部脳幹障害例のＡＢＲ診断について

Management of the Acoustic Neuroma in an Only Hearing Ear

Heightened physician awareness of the sociologic and psychologic trauma related to deafness coupled with an increased emphasis on early diagnosis has prompted the employment of sophisticated diagnostic studies in an attempt at identification of an acoustic neuroma as a cause of hearing loss. Because profound bilateral hearing impairment is a catastrophic event, the management and care of an individual with an eighth nerve lesion in an only hearing ear remains a significant challenge for both patient and physician. In this article we will summarize our experience with this unique patient population through case presentations that will include diagnostic testing and intraoperative and perioperative findings. The literature regarding diagnosis and management will be reviewed. Recommendations for options available in the care of these patients will be discussed.

The stapedius reflex tests in retrocochlear hearing disorders.

The commonly used parameters of the stapedius reflex responses in the diagnosis of sensorineural hearing disorders are the reflex threshold level and the persistence of the reflex response on prolonged stimulation, i.e., the reflex decay test. With the object of establishing the sensitivity of these reflex parameters to identify tumours affecting the eighth nerve in the early stages, a series of 97 such cases were examined. The mean hearing loss of the affected ears was 32 dB; 28 of the cases still had normal thresholds of hearing; 95 of the ears demonstrated elevated reflex thresholds and/or pathologic reflex decay. To check the specificity of the test, a control series with sensorineural hearing loss and reflex threshold elevation or pathologic reflex decay was analysed with respect to clinical diagnoses. In every third case of reflex threshold elevation and in every second case of reflex decay, the medical diagnosis confirmed a disease known to be associated with retrocochlear dysfunction. It was also noted that none of the cases with brain stem lesion demonstrated reflex decay--an observation which supports the idea of the reflex decay phenomenon as specifically associated with eighth-nerve lesions.

Brainstem evoked response audiometry in confirmed eighth nerve tumors

Brainstem evoked response audiometry has been described as an effective predictor of eighth nerve disease. This study reports audiologic findings in 52 cases of surgically confirmed eighth nerve and cerebellopontine angle tumors. The results of brainstem audiometry were consistent with an eighth nerve lesion in 51 cases. Its use in site of lesion tests is highly recommended.

Brainstem auditory evoked potentials for detection of retrocochlear pathology.

Since May 1976 the techniques of brainstem auditory evoked potential (BAEP) testing have been used as a clinical tool in evaluating patients with neurotologic disease in the Department of Otolaryngology and Communicative Disorders at the Cleveland Clinic Foundation. A total of 676 patients was tested using this technique and included patients with primary otologic complaints as well as patients with neurologic disorders. Patients were evaluated with suspected multiple sclerosis, for threshold assessment, children at risk for possible sudden infant death syndrome, brainstem gliomas, systemic neurologic or metabolic disorders, and the final group of 408 patients or 60% were tested for suspected eighth nerve lesions. In the group of patients studied for detection of an eighth nerve lesion, the BAEP test was extremely useful if the result was found to be normal, for at the time of this report, no patient with an eighth nerve lesion, such as an acoustic neuroma, had a normal BAEP test result. However, abnormal results in the BAEP test were found in approximately 34% of patients who underwent Pantopaque® myelography for definitive detection of an eighth nerve lesion in which the myelogram was normal. This unusually high false-positive rate is thought to be the result of testing a different patient population than those that have previously been reported in the literature. There still may be some eighth nerve pathology present; however, the results of the BAEP test which have been suggestive of an eighth nerve lesion remain unexplained at this time. The BAEP test is a very important part of the evaluation of patients with neurotologic disease; however, it is not sufficiently understood to eliminate the need for a complete work-up in patients suspected to have a retrocochlear lesion.

Acoustic stapedial reflex latency versus BERA wave V latency in the detection of eighth nerve lesions

The parameter of latency of the acoustic stapedial reflex was used to test the hypothesis that a retrocochlear lesion involving the afferent portion of the reflex arc will result in a slowed neural conduction time. Measurements of middle-ear muscle activity were made by use of an electro-acoustic impedance bridge modified to permit presentation of tonal stimuli 300 ms in duration with 10-ms rise/fall time for test frequencies of 1000 and 2000 Hz. Both contralateral and ipsilateral values were obtained for absolute reflex latency and interaural latency differences on four clinical populations which included cochlear lesions due to Meniere's disease and surgically confirmed acoustic tumor. Results reveal a dramatic prolongation of latency in the presence of retrocochlear lesions. Comparisons drawn between the acoustic reflex latency test and BERA wave V latency, obtained with tone pip stimuli, indicate that stapedial reflex latency is a more efficient method of tumor detection. [Work supported by American Hearing Research Foundation, Chicago, IL.]

Acoustic reflex and reflex decay. Occurrence in patients with cochlear and eighth nerve lesions.

Acoustic reflex and reflex decay tests were administered to 50 normal ears, 50 ears with hearing loss due to noise trauma, 50 ears that had Meniere disease, and 28 ears that had involvement of the eighth nerve. In one normal ear, ten noise trauma ears, 11 Meniere disease ears, and 24 eighth nerve lesion ears to reflexes or reflex decay that were suggestive or retrocochlear lesions were observed. Acoustic reflex and reflex decay results are also compared to tone decay results for these patients.

The Modified Tone Decay Test (MTDT) as a Screening Procedure for Eighth Nerve Lesions

No AccessJournal of Speech and Hearing DisordersResearch Article1 Feb 1963The Modified Tone Decay Test (MTDT) as a Screening Procedure for Eighth Nerve Lesions David S. Green David S. Green Google Scholar More articles by this author https://doi.org/10.1044/jshd.2801.31 SectionsAboutPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In Additional Resources FiguresReferencesRelatedDetailsCited by British Journal of Audiology30:1 (37-43)1 Jan 1996Abnormalities of ICP loudness adaptation at 1000 Hz associated with higher frequency (cochlear) lossJennifer L. Janson, Ernest M. Weiler, David E. Sandman, Laura L. Kretschmer, Todd Nelson and Eleanor Stromberg Otolaryngologic Clinics of North America18:2 (241-255)1 May 1985The Use of Subjective and Objective Audiologic Test Procedures in the Diagnosis of Multiple SclerosisElizabeth Protti-Patterson and Maxine L. Young International Journal of Audiology23:3 (321-332)1 Jan 1984Tone Decay in Subjects with the Single-Channel Cochlear ImplantJudith A. Brimacombe and Laurie S. Eisenberg E. Harris Nober and Gerard L. Kupperman (1981) Physiogenic Hearing Impairment in Adults Communication Disorders10.1007/978-1-4757-9760-2_3 Otolaryngologic Clinics of North America6:1 (53-71)1 Feb 1973Audiologie Tests in the Differential Diagnosis of VertigoJohn M. Page Annals of Otology, Rhinology & Laryngology77:2 (332-337)1 Apr 1968XXXIII Atypical Responses to the SisiRichard L. Hughes Annals of Otology, Rhinology & Laryngology77:1 (78-87)1 Feb 1968VIII Retrocochlear Lesions: Problems in Early DiagnosisRobert F. Balas and Will P. Pirkey Journal of Neurosurgery24:3 (621-628)Audiological Aspects of the Diagnosis of Acoustic NeuromasE. W. Johnson and J. L. Sheehy Volume 28Issue 1February 1963Pages: 31-36 Get Permissions Add to your Mendeley library History Published in issue: Feb 1, 1963 Metrics Topicsasha-topicsasha-article-typesleader-topicsCopyright & PermissionsCopyright © 1963 American Speech-Language-Hearing AssociationPDF downloadLoading ...

Clinical observations on excessive threshold adaptation.

In 1955, Lierle and Reger¹reported an unusual finding in connection with their extensive studies of threshold tracings obtained with the Békésy-type audiometer. When subjects were asked simply to trace threshold for a fixed frequency over a 20-minute period, they found that the tracings remained relatively constant in two cases of end-organ lesion, but dropped markedly in one patient with a subsequently confirmed eighth-nerve tumor. In other words, in the case of end-organ lesion, the intensity level required to maintain a threshold response did not change appreciably over the 20-minute tracing period. In the case of eighth-nerve lesion, however, the patient rapidly required more and more intensity to keep the tone at threshold. Similar results were subsequently reported by Kos.² This finding is, of course, exactly opposite to the earlier observations of Dix and Hood.³According to these investigators, the threshold "adaptation" exemplified by the gradual decline

Locus of the lesion in recruiting ears.

The place of loudness recruitment testing in otological diagnosis has been recognized for more than 10 years. However, until recently, the diagnostic value of such tests was limited to the differentiation of conductive and perceptive types of hearing losses. The value of these procedures with respect to the further delineation of the anatomical locus of the lesion in perceptive losses was not realized. With the recent publication of recruitment studies on abnormal ears of various types, the diagnostic value of recruitment testing was increased significantly. De Bruine-Altes 3 was one of the first to include enough varieties of verified causative classifications to make general delineating conclusions; however, there was still a need for data on persons with eighth nerve lesions. Dix, Hallpike, and Hood 7 were among the first to supply such information and to call attention to the value of recruitment testing in differentiating cochlear and noncochlear lesions in

Modern aspects of the recruitment phenomenon.

TABLE OF CONTENTS Introduction Recruitment and hearing aids Recruitment and neural lesions Partial Recruitment In severe lesions In conductive lesions The normal impedance function The pathological impedance function The dynamogram Loudness in bone conduction The 2,000 bone conduction dip in otosclerosis In mixed types of deafness Recruitment in cases of herpes oticus Recruitment in multiple sclerosis Testing technique Older techniques Hood's perstimulatory test Lüscher's test Comment General considerations Acoustic trauma Ménière's disease Fatigue Eighth-nerve lesion Conclusions Summary <h3>I. INTRODUCTION</h3> FEW ITEMS in modern audiological research have attracted so much interest as the recruitment phenomenon. The story of its still young history reveals many remarkable features. It will be the purport of this paper to discuss the fallacies of recruitment testing, a routine which has

Tobacco and eighth nerve lesions. Report of nine cases

The LaryngoscopeVolume 35, Issue 11 p. 855-867 Article Tobacco and eighth nerve lesions. Report of nine cases† Dr. V. K. Hart, Dr. V. K. Hart Davis Hospital, Statesville, N. C.Search for more papers by this author Dr. V. K. Hart, Dr. V. K. Hart Davis Hospital, Statesville, N. C.Search for more papers by this author First published: November 1925 https://doi.org/10.1288/00005537-192511000-00005Citations: 2 † Read before the Section on E., E., N., and T., State Medical Meeting. Pinehurst, N. C, Apr. 29, 1925. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume35, Issue11November 1925Pages 855-867 RelatedInformation