Left Tinnitus Research Articles

Clinical analysis of 50 patients with abnormal pulsatile tinnitus in sigmoid sinus

Objective: To analyze the disease characteristics, diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus. Methods: Fifty patients (from Shandong Provincial ENT Hospital, Shandong University between February 2014 and July 2020) with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively. The tinnitus characteristics, imaging findings, surgical methods, intraoperative findings and postoperative tinnitus changes were recorded. The patients were followed up for 6-12 months. The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery. There were 50 patients with unilateral venous pulsatile tinnitus, including 49 females and 1 male. The age ranged from 17 to 67 years, with a median age of 44 years. There were 45 cases of right tinnitus and 5 cases of left tinnitus. The degree of tinnitus before operation was grade Ⅱ or above, including 4 cases of gradeⅡ, 11 cases of grade Ⅲ, 22 cases of grade Ⅳ and 13 cases of grade Ⅴ. Results: Thirty-seven cases were cured, 8 cases were ineffective (no change in tinnitus), 3 cases were markedly effective (tinnitus grade decreased by 3 in 2 cases, 4 in 1 case), and 2 cases were effective (tinnitus grade decreased by 1). The difference of tinnitus grade before and after operation was statistically significant (Z=-5.70,P<0.05). Temporal bone CT showed 36 cases of sigmoid diverticulum (including 17 cases with sigmoid sinus dehiscence), 12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus. Thirty-five cases were performed with closure of sigmoid sinus diverticulum, 4 cases were performed with resurfacing of the sigmoid plate, 5 cases were performed with narrowing of sigmoid sinus, 4 cases were performed with simple opening of pre sigmoid mastoid air chamber, 1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus, and 1 case was performed with opening of pre sigmoid mastoid air chamber combined with closure of sigmoid sinus diverticulum. Conclusions: Venous pulsatile tinnitus is common in women. The common causes may be sigmoid sinus wall abnormalities such as sigmoid sinus diverticulum and perisigmoid bone defect. Imaging examinations are helpful for diagnosis. Venous pulsatile tinnitus can be treated with surgery.

Isolated tinnitus – premonitory symptom of an evolving auditory dysfunction: a retrospective analysis

Background: Tinnitus manifests frequently with hearing loss. Isolated tinnitus in patients with self-professed normal hearing may have underlying auditory dysfunction. Methods: We retrospectively reviewed the audiometry record of our department from January 2019 to October 2021. Pure tone audiometry thresholds of patients with isolated tinnitus were analyzed along with the demographics, degree and type of hearing loss. Results: Of 255 (132 males/123 females) patients, mean age 39.7±15.2 years (range: 10-80 years), tinnitus was maximum (49%) prevalent among 20-40 years group, 5.8% among the pediatric population and 8.6% amidst ≥60 years populace. Males predominated (52%) throughout except at 21-30 years age. 83% exhibited some degree of hearing loss (42% bilateral minimal loss, 11% bilateral mild hearing loss). 7% right ears (mostly &gt;50 years age group) and 11% left ears showed greater than mild hearing loss. Bilateral tinnitus presented more (52%) followed by left tinnitus (29%) than right (19%). Mild hearing loss predominated right tinnitus presentation while minimal loss was recorded in left and bilateral tinnitus. However, greater than mild degree of hearing loss was clustered among bilateral tinnitus (14%) followed by left tinnitus (11%) than right tinnitus (6%). 18% had sensorineural deafness and all these patients had bilateral tinnitus. 30% had high frequency hearing loss and 39% among these had 4 kHz dip. Conclusions: Isolated tinnitus may be a premonitory symptom of an underlying or an evolving auditory dysfunction. Bilateral tinnitus followed by left tinnitus presentation warrant higher index of suspicion.

Unusual manifestation of cerebellopontine angle medulloblastoma with tinnitus and sensorineural hearing loss

Abstract BACKGROUND. Medulloblastoma is the most common central nervous system embryonal tumor in children. In adults, this tumor is extremely rare, accounting for nearly 1% of primary brain tumors. Raised intracranial pressure signs are common manifestations of posterior fossa tumors, but tinnitus and/or sensorineural hearing loss are very uncommon presenting symptoms. MATERIAL AND METHODS. Starting from a very rare case of a 39-year-old male with left tinnitus and progressive left sensorineural hearing loss as isolated symptoms of a medulloblastoma, we performed a literature survey using the PubMed, ProQuest, Web of Science, Science Direct, Wiley Online search engines for patients with medulloblastoma and tinnitus and/or sensorineural hearing loss. RESULTS. All patients found in the relevant literature with auditory dysfunctions presented sensorineural hearing loss. Other frequent manifestations were: ataxia, facial numbness, vertigo, headache, nystagmus. Two patients were found with tinnitus and sensorineural hearing loss as isolated symptoms of medulloblastoma, as in our case, and in two other cases the sensorineural hearing loss was the unique symptom. With refers to the onset of medulloblastoma, just 3 patients had the first symptoms sensorineural hearing loss and tinnitus. Concerning the tumor location, in patients manifested with isolated tinnitus and sensorineural hearing loss, like our patient, the tumor arised from the internal auditory meatus, extended to the cerebellopontine angle or involved the vestibulocochlear nerve. With regards to treatment, surgery in association with radiotherapy and chemotherapy was elected in most cases (38%). CONCLUSION. It is important to pay attention at patients with isolated auditory dysfunction that may mimic significant posterior fossa tumors, such as a medulloblastoma.

Comparative analysis of population distribution, severity, emotional, and cognitive characteristics among different side idiopathic tinnitus patients

To provide basis for prevention and treatment by analyzing the clinical features, emotional and cognitive states and their correlations of idiopathic tinnitus. Cross-sectional study was used. Thirty-six right, 44 left, and 46 bilateral idiopathic tinnitus patients diagnosed in Beijing Tongren Hospital were prospectively enrolled from October, 2020 to February, 2022. The clinical data was recorded and the THI, DBI, STAI, and MoCA were evaluated. The clinical features and the incidence of severe tinnitus, hearing lose, anxiety, and cognitive impairment were compared by one-way ANOVA, Kruskal-Wallis H, and chi-square test. The correlation between tinnitus or hearing and emotional and cognitive states were evaluated by multivariable correlation analysis. There was no significant difference in age, BMI, years of education, tinnitus duration, and the incidence of hearing loss among groups (F=0.730,P=0.484;F=1.535,P=0.219;F=1.506,P=0.226;χ²=4.242,P=0.120;χ²=6.672,P=0.083). In right, left, and bilateral tinnitus patients, the number of severe tinnitus was 12, 7, and 20 cases and the incidence was 33.3%, 15.9%, and 43.5%; the number of depression was 13, 14, and 26 cases and incidence was 36.1%, 31.8%, and 53.5%; the number of trait anxiety was 3, 2, and 10 cases and the incidence was 8.3%, 4.5%, and 21.7%. Compared with left tinnitus patients, the incidence of severe tinnitus, depression, and trait anxiety was higher in bilateral tinnitus patients (χ²=8.139,P=0.004;χ²=5.558,P=0.018;χ²=5.753,P=0.007). The incidence of state anxiety and cognitive impairment were no significant difference among groups (χ²=0.142,P=0.931;χ²=1.338,P=0.512). The overall incidence of state anxiety and cognitive impairment were 16.7%(21/126) and 37.3%(47/126) respectively. There was positive correlation between THI score and BDI, S-AI, and T-AI scores (r=0.529,P=0.001; r=0.649,P<0.001; r=0.483,P=0.003) and negative correlation between THI and MoCA scores (r=-0.364,P=0.029) in right tinnitus group. The positive correlation was found between THI score and BDI, S-AI, and T-AI scores in left tinnitus group (r=0.508,P<0.001; r=0.506,P<0.001; r=0.357,P=0.017). The positive correlation between THI score and BDI, S-AI, and T-AI scores (r=0.753,P<0.001; r=0.527,P<0.001; r=0.536,P<0.001) and the positive correlation between tinnitus duration and MoCA score(r=0.334,P=0.023) were also found in bilateral tinnitus group.

Failure of Gan CRM Overcome by Successful Semont Manoeuvre in BPPV Post Head Trauma: A Case Study

Objective: Benign paroxysmal positional vertigo (BPPV) is one of common peripheral vestibular problem reported that head injury is one of common cause among young age. In current situation it only treated by medication or injection by medical officer and specialist. Medication is not an optimal treatment and it only symptomatic therapy and often need chronic prescriptions if not treated properly. There are an optimum specific manoeuvre offers curative therapy in majority of BPPV cases such as Epley’s manoeuvre, Gan Canal repositioning Manoeuvrer (CRM) and Semont manoeuvre. Semont manoeuvre is one of selected manoeuvre that recently done in posterior BBPV case if Epley’s and Gan CRM failed, but less practice among our clinician due to less exposure.&#x0D; Case Studies: A 22 -year-old gentleman, complain of imbalance, difficulty in walking and vertigo for the past few days. He history of moderate traumatic brain injury (left parietooccipital Epidural Haemorrhage) and surgical intervention done last 5 days ago. He also complained of reduced hearing and on off left tinnitus over left side. No prominent psychological involvement reported.&#x0D; Detail physical and balance assessment done using BAL EX Foam test Modified Dix Hallpike Test (DHT) done. During the left DHT there is rotatory up beating nystagmus then it proceeds with GRM three-time, 1 session on previous day and 2 session on the current day but it was failed. Then proceed with Semont manoeuvre by specialist in vestibular rehabilitation. After 10 minutes of manoeuvre, modified DHT done and show negative result found there is no nystagmus.

Vasküler loop sendromunda anterior inferior serebellar arterin çapı ve vasküler loop tipinin klinik bulgular ile ilişkisi: klinik radyoloji çalışması

Objective: Tinnitus and vertigo are common audiovestibular symptoms in the population. Many diseases can lead to the appearance of these symptoms, but the exact cause can often not be determined. It has been suggested that compression of the cranial nerves by vascular structures may be the cause of various clinical manifestations. This is known as microvascular compression syndrome. Some studies have stated that vascular compression syndromes are a serious pathology, while many studies have argued that vascular compression is only a radiological finding. We aimed to contribute to the literature on vascular compression syndrome and vascular loop types, which is still a controversial topic, and to determine the location of the diameter change in the anterior inferior cerebellar artery in the compression syndrome.&#x0D; Material and Method: Patients who underwent a Magnetic Resonance Imaging (MRI) examination of Temporal Bone due to a complaint of tinnitus or vertigo were retrospectively examined. The complaints of the patients, the diameters of the anterior inferior cerebellar artery (AICA) and the types of vascular loop were evaluated in the high resolution 3D fast imaging employing steady-state acquisition (FIESTA) sequence, according to the CHAVDA classification. The statistical relationship between the age of the patients, anterior inferior cerebellar artery diameters and vascular loop types and their clinical manifestations was investigated.&#x0D; Results: A total of 52 patients were enrolled in the study, of which 28 (53.8%) were male and 24 (46.2%) were female. The mean age of all patients was 47.58±18.734 years. The mean right AICA diameters of the patients were 1.10±0.206 mm, the mean left AICA diameter was 1.11±0.253 mm. Type 1 in 29 patients, type 2 in 12 patients, type 3 vascular loop in 4 patients were observed for the right side, while type 1 in 29 patient, type 2 in 12 patients, and type 3 in 7 patients were observed for the left side. There was no significant difference between vascular loop and tinnitus on the right and left (p=0.705; p=0.335, respectively). There was no significant difference between the right vascular loop and the left vascular loop and the vertigo (p&gt;0.999; p=0.425, respectively). There was no significant difference between the right tinnitus, left tinnitus and vertigo in terms of the diameters of the right and left AICA in the patients (p=0.782; p=0.762; p=0.408; p=0.915, respectively).&#x0D; Conclusion: Vascular compression syndromes are clinical conditions that show symptoms over cranial nerves. Although the vascular loop syndromes originating from AICA have been discussed a lot recently, it is seen that there is no definite opinion. In our study, no association of AICA diameter and vascular loop type with clinical findings was found.

O30 Case report of Cogan syndrome in a child with audiovestibular dysfunction and ocular inflammation

Case report - IntroductionCogan syndrome is a very rare disorder of probable autoimmune vasculitic origin, first described in 1934. The age of onset seems to range from 3 to 50 years with an average age of disease onset at 29 years. It is characterised by audiovestibular dysfunction and ocular inflammation. The cause remains unknown and the epidemiology of the disease is purely based on case reporting. As of 2015, there were fewer than 250 case reports. Interestingly, it seems extremely rare in Arabic and Middle Eastern countries in which a new case has been recently diagnosed and is being reported in this abstract.Case report - Case descriptionA 14-year-old girl of Arabic origin first presented to the ENT specialist with a 3-week history of balance problems, left tinnitus and sensorineural hearing loss in both ears worse on the left. She first received treatment for vestibular neuritis with no improvement. Two months later, she complained of bilateral red eyes and excessive lacrimation when diffuse interstitial keratitis was diagnosed by the ophthalmologist. An array of blood tests including a full autoimmune disease was arranged and a rheumatology opinion was sought.The patient had a normal inflammatory response and her screen for antinuclear antibodies, extractable nuclear antigen, rheumatoid factor and antineutrophil cytoplasmic antibodies were all negative. A full virology screen was also negative. Having failed to respond to all supportive treatment modalities, a trial of a tapering 2-week course of prednisolone starting at 25mg daily was instigated. The patient’s symptoms improved by more than 50% on glucocorticoids subsequent to which the diagnosis of Cogan syndrome was anticipated. As the patient’s symptoms relapsed when glucocorticoids were stopped, she was recommenced on prednisolone 25mg in line with azathioprine 100mg daily. The patient’s hearing, which was almost lost in the left ear, improved significantly by more than 70% initially, and then to normal hearing as stated by the patient supported by special ENT testing. Her balance problems and vertigo also improved remarkably. Her tinnitus, which was the last symptom to resolve, almost went away over the subsequent 2 months. The patient had already come off glucocorticoids 6 months down the line, and stayed on azathioprine 75-100mg daily for almost a year after which gradual weaning was trialled and then eventually succeeded. She has now been off azathioprine for 6 months without experiencing any disease relapse.Case report - DiscussionCogan syndrome can be difficult to diagnose particularly in children. The diagnosis is essentially clinical depending on the presence of audio-vestibular symptoms and interstitial keratitis along with a prompt response to immunosuppressive medication.In this patient, the consistent clinical picture supported by the positive response to glucocorticoids especially in the absence of an alternative diagnosis would have made the diagnosis of Cogan syndrome likely.Given the rarity of this disorder, there are no classification criteria as yet hence the ongoing need for case reporting. Moreover, there is no clear guidance on the duration of immunosuppressive treatment of this condition.Case report - Key learning pointsIt is pivotal in managing conditions with a suspected autoimmune origin to have a multidisciplinary approach involving other relevant specialties in a holistic approach.The prompt response to glucocorticoid therapy still remains the key in securing the diagnosis of a number of conditions in clinical practice especially in the absence of diagnostic criteria and/ or supportive investigations such as serological and tissue-based testing.Case reporting has a crucial role in enhancing awareness of rare medical conditions.

Abnormal resting state EEG power spectral in patients with tinnitus on different sides of the ear

Tinnitus is a symptom of sound perception in the absence of external sound stimulation, and most patients have unilateral tinnitus, with more tinnitus on the left than on the right. In this paper, the resting EEG data of 10 patients with binaural tinnitus, 10 patients with left tinnitus and 10 healthy controls were collected, and two 10-s segments of resting EEG data were intercepted from each group for approximately 10 min. The absolute and relative power was calculated by fast Fourier transform. The results showed that more frequency bands were significantly different in the left tinnitus patients compared to the bilateral tinnitus patients and the right tinnitus patients, and where significant differences were demonstrated, the absolute and relative power was higher in the Delta and Theta bands of the tinnitus patients than in the control group. In conclusion, these results compare the resting state EEG power spectrum abnormalities in patients with tinnitus on different sides with healthy controls from an electroencephalographic perspective, and are expected to be used as an evaluation criterion in the future to provide a more refined and precise treatment plan for patients with tinnitus on different sides and to improve the efficiency of treatment.

Clinical management strategies of pulsatile tinnitus with transverse sinus stenosis

Objective: To study the clinical diagnosis and treatment strategies for vein-related pulsatile tinnitus patients with transverse sinus stenosis. Methods: The clinical data of patients with vein-related pulsatile tinnitus, from January 2015 to August 2019, were collected,whose digital subtraction angiography showing transverse sinus stenosis. Taking December 2019 as the last follow-up time, we analyzed the clinical characteristics, CT angiography and digital subtraction angiography results, lumbar puncture pressure and cerebrospinal fluid composition, and other auxiliary examination results (pure tone audiometry, fundus examination of papilledema, carotid ultrasonography, bone density screening, endocrinous test), as well as tinnitus handicap inventory, treatment options and follow-up results. Results: 83 patients were enrolled with female of 89.2% (74/83) and male of 10.8%(9/83); 65.1% (54/83) with right tinnitus, 31.3% (26/83) with left tinnitus, and 3.6% (3/83) with bilateral tinnitus; 67.5% (56/83) with right dominant sinus, 19.3% (16/83) with left dominant sinus, 13.3% (11/83) with bilateral equalization; Bilateral and ipsilateral stenosis accounted for 55.4% and 44.6% respectively; BMI was overweight or obese in 41 cases (49.4%, 41/83). Patients with tinnitus handicap inventory level three or above accounted for 79.5% (66/83). Eventually, 33 patients chose conservative observation (39.8%, 33/83), 40 patients (48.2%), 8 patients (9.6%) and 2 patients (2.4%) received sigmoid sinus-related surgery, interventional surgery, or emissary vein occlusion respectively. The mean follow-up time of 74 patients was 26.2 months. The data of 48 surgery patients showed that the pressure differences of venous sinus among the recurrent patients were more obvious; Interventional surgery with simultaneous stenting placement was effective. Tinnitus did not decrease in two patients with emissary vein occlusion. Analysis of 26 patients with lumbar puncture revealed eight cases of normal cranial pressure and 18 cases of high cranial pressure. The sinus pressure difference between the two groups was different (P=0.025), but the difference of age of onset, concomitant symptoms, BMI, proportion of empty sella or papilledema was not statistically significant (P>0.05). Conclusions: The evaluation of patients with vein-related pulsatile tinnitus requires a standardized procedure. Papilledema cannot be used as a sensitive indicator in patients with early intracranial hypertension. Venous sinus pressure difference may be one of the indicators of intracranial hypertension, and the lumbar puncture is the gold standard for the diagnosis. Weight loss can be used as a conservative treatment during the observation period. Significant sinus stenosis is a risk factor for recurrence in patients undergoing sigmoid sinus surgery. Interventional stenting is an effective treatment for tinnitus secondary to transverse sinus stenosis.

Giant Cell Tumor of the Temporal Bone With Skull Base and Middle Ear Extension

We report on a patient who presented to the ear, nose, and throat (ENT) clinic with an 8-month-old left non-pulsatile tinnitus. Imaging studies, Neck computed tomography (CT) and magnetic resonance imaging (MRI) revealed soft tissue mass in the left middle ear with invasion to the middle cranial fossa and external auditory canal. J Med Cases. 2021;12(4):149-151 doi: https://doi.org/10.14740/jmc3627

Case report: rare presentation of primary angiomyolipoma in the middle ear

BackgroundAngiomyolipoma (AML) is a common, chronic disease usually localized in kidney and liver organs; but occurring frequently outside the kidney or liver.Case presentationWe describe an unusual case of a 62-year-old female patient with AML in the middle ear. She presented with left earache, tinnitus and hearing loss. Preoperative computed tomography and magnetic resonance imaging seemed to reveal a middle ear cholesteatoma. The patient underwent surgical resection of this lesion, and the AML was finally confirmed by histopathological examination. The patient was discharged on the 8th postoperative day and did not seek further treatment.ConclusionsExtraperitoneal AML is rare and accurately identified by histopathology. The recommended management is surgery for AML in the middle ear.

P309 Tinnitus rTMS treatment guided by local synchronicity of the resting state fMRI – A case report

Objectives In tinnitus rTMS treatment, the inhibitory 1 Hz stimulation is commonly delivered to left auditory cortex and/or left temporoparietal junction (TPJ). We aimed to improve rTMS-targeting with fMRI measurements. Methods A patient with whiplash and head trauma originated brain injury leading to constant headache, bilateral tinnitus and hearing deficit, and depression. Tinnitus handicap index (0–100) (THI) was 74 before therapy. The patient received two 4-week rTMS therapy series. Primary treatment side was left based on literature and MRI perfusion images. Targets were on primary auditory cortex bilaterally and on left TPJ. Several adjustments to target locations were tested in chasing of the positive patient feedback. Inhibitory TMS-parameters for each target were 1 Hz and 1000–1500 pulses. Before and after treatment series resting-state fMRI was acquired and a local synchrony measure (ReHo) was computed. Results After the first treatment series the left side tinnitus was relieved (THI dropped from 74 to 22) but right side tinnitus remained and later THI got back to 74. After three months, patient received the second series and left side tinnitus was again attenuated, but right side tinnitus remained. Then fMRI ReHo analysis was re-checked and a hypersyncronous right posterior temporal cortex spot was noticed. Using that as an rTMS-target led to a quick attenuation of the remaining right side tinnitus. THI dropped to 12 and the treatment effect has persisted. Conclusions fMRI informed personalized rTMS-treatment has the potential to target the correct gyrus and hemisphere without extensive trial and error, at least in tinnitus.

正円窓小窩, 内耳道への進展を認めた迷路内神経鞘腫の1例

Intralabyrinthine schwannomas (ILSs) are rare benign neoplasms arising from distal branches of the cochlear, superior vestibular, or inferior vestibular nerves. We report on a case of ILS with extensions to the round window niche and internal auditory canal (IAC) in a 47-year-old male. The patient noticed sudden hearing loss and tinnitus in his left ear at the age of 36, received steroid therapies, but was left with complete deafness. He had suffered from repetitive vertigo attacks for 6 months at 41. At 46 when he presented with deterioration of his left tinnitus, he was finally diagnosed as having ILS on enhanced MRI and constructive interference in steady-state analysis. The tumor was located in all turns of cochlea, vestibule, and the fundus of the IAC. Because follow-up MRI suggested growth of the IAC tumor, we performed total removal of the tumor via the translabyrinthine and transcanal approaches. The tumor had invaded only the cochlear nerve in the IAC and appeared in the round window niche in the middle ear. Pathological examination showed an Antoni A type schwannoma with fibrous changes of the semicircular canals. We should remember this inner

Spontaneous pneumarthrosis of the atlantoaxial joint

The authors describe the case of a 29-year-old man presenting with left retrooccipital and cervical pain associated with left ear fullness and rhythmic tinnitus. Head rotation movements on the right side and the Valsalva maneuver increased symptoms. A CT scan identified hyperpneumatization of the left temporal bone extending to the occipital bone as well as pneumarthrosis of the atlantoaxial joint. Surgical treatment involving obliteration of the fistula with bone and fat grafts via a computer-aided transmastoid approach was proposed. The surgery resolved all of the patient's symptoms except for the ear fullness. In this case the authors described an original treatment for spontaneous atlantoaxial pneumarthrosis. Long-term follow-up is needed to evaluate the risk of the recurrence of abnormal occipital bone pneumatization and to assess joint function.

Medio-Lateral Postural Instability in Subjects with Tinnitus

Background: Many patients show modulation of tinnitus by gaze, jaw or neck movements, reflecting abnormal sensorimotor integration, and interaction between various inputs. Postural control is based on multi-sensory integration (visual, vestibular, somatosensory, and oculomotor) and indeed there is now evidence that posture can also be influenced by sound. Perhaps tinnitus influences posture similarly to external sound. This study examines the quality of postural performance in quiet stance in patients with modulated tinnitus. Methods: Twenty-three patients with highly modulated tinnitus were selected in the ENT service. Twelve reported exclusively or predominately left tinnitus, eight right, and three bilateral. Eighteen control subjects were also tested. Subjects were asked to fixate a target at 40 cm for 51 s; posturography was performed with the platform (Technoconcept, 40 Hz) for both the eyes open and eyes closed conditions. Results: For both conditions, tinnitus subjects showed abnormally high lateral body sway (SDx). This was corroborated by fast Fourrier Transformation (FFTx) and wavelet analysis. For patients with left tinnitus only, medio-lateral sway increased significantly when looking away from the center. Conclusion: Similarly to external sound stimulation, tinnitus could influence lateral sway by activating attention shift, and perhaps vestibular responses. Poor integration of sensorimotor signals is another possibility. Such abnormalities would be accentuated in left tinnitus because of the importance of the right cerebral cortex in processing both auditory–tinnitus eye position and attention.

Bow Hunter's Syndrome Masquerading as Definite Ménière's Disease

Bow Hunter's syndrome (BHS) results from vertebral-basilar insufficiency secondary to mechanical stenosis or occlusion of the unilateral vertebral artery at the atlanto-axis during head rotation. It is sometimes difficult to detect BHS, which is often ignored at other processes. A 44-year-old woman had up to 13 episodes of acute vertigo with left tinnitus, which was related to head rotation. Pure tone audiometry documented left side hearing impairment, so definite Ménière's disease was impressed; however, electronys-tagmography, a caloric test, posturagraphy, a cervical vestibular evoked myogenic potential, color-coded duplex sonography and magnetic resonance imaging/angiography disproved this. Ménière's disease was impressed and was attributed to BHS, which was related to a vertebral-basilar artery anomaly. The patient was treated conservatively and changed her work-style, and the symptoms did not recur over the following half year. Therefore, BHS can masquerade as Ménière's disease. We report this condition because of its rarity.

Thickness of the Human Round Membrane in Ménière's Disease

RESULTS: The population mean age was 51.48 15. 44.26% of the patients were males. 58.83% of the patients identify the tinnitus as a pure tone sound. Bilateral tinnitus was found in 79 (43.17%) patients. 54 (29.50%) patients had right tinnitus, and 50 (27.33%) left tinnitus. The associated pathologies were presbycusis (39.34%), sudden deafness (10.93%), acoustic trauma (7.65%), primary hydrops (4.37%), otosclerosis (4.37%), meningioma (1.04%), acoustic neuroma (1.04%), and temporal bone fracture (0.55%). In 4.92% of the patients we could not identify the cause. 25.68% of the patients had normal pure tone and speech audiometry. The equiparation volume media of tinnitus was 6.2db over pure tone threshold. The minimal masking level media was 11.9db pure tone threshold. CONCLUSION: The mean age of the affected population was 51.52 /- 15. The three most common etiologies of tinnitus in this population were presbycusis, deafness and acoustic trauma. Tinnitus was also found in a group of patients with normal hearing. Tinnitus was identified as a pure tone sound in almost a half of the population, and frequently compromised both ears.

めまい急性期の状態を観察しえた片頭痛関連性めまいの２症例

Although many patients with both episodic vertigo and migraine have been reported, we have few opportunities to observe pathological nystagmus during an attack in these patients. We report herein on two cases with migraine associated vertigo (MAV) in which neuro-otological findings could be observed at the acute stage of vertigo. The first patient was a 46-year-old woman, with migraine without aura. She visited our clinic complaining of an episodic dizzy feeling with a migrainous headache and phonophobia. On the first examination, she did not show nystagmus or disequilibrium. Four months later, she had further acute vertigo attacks, during which she showed right beating spontaneous nystagmus lasting for 3 hours. Her vertigo attack and headache are currently well-controlled with lomerizine. The second case was a 47-year-old woman who visited our clinic complaining of vertigo accompanied by a migrainous headache and left tinnitus. On the first examination, there were no remarkable findings except for 35% canal paresis of the left ear on caloric testing. Later, she showed direction fixed spontaneous nystagmus during a vertigo attack lasting for a few days. This patient's vertigo attack and headache have also been well-controlled with lomerizine. These cases showed that patients with MAV could have acute asymmetrical disorders of the vestibular system. The lesion site was considered to be in the peripheral vestibular system at least in the second case. However, the actual pathophysiology of MAV remains unclear.

Gustatory disturbance due to a cerebellar hemangioblastoma

A 67-year-old man was admitted to our neurosurgical department with a 2-month history of gait instability, nausea, vomiting, hypoesthesia of the left arm, tinnitus and pain of the left ear. He also...

Ocena skuteczności leczenia pacjentów z szumami usznymi za pomocą krioterapii ogólnoustrojowej

The aim of the study was evaluation of effectiveness of whole-body cryotherapy in patients with tinnitus. The research was carried out in 120 patients (aged 20-68) with tinnitus, divided into two groups: I--80 patients treated by cryotherapy and II--40 patients non treated. There were: 73 women and 47 men. Among patients of I group: 39 reported bilateral tinnitus, 20 reported right tinnitus, 15 reported left tinnitus and 6 reported tinnitus in head. Duration of the ailment took from 1 month to 23 years. The methods included: taking a history, otolaryngological physical examination, audiometry establishing level of tinnitus, medical consultation, X-ray examination of chest and cervical spine and CT of head. After examinations and additional consultations the patients were qualified for cryotherapy unless there were some contraindications. The patients underwent 10 procedures in two cycles with the weekend break. They were in cryochamber in temperature of -110 degrees C for 3 minutes. After cryotherapy they used kinesitherapy for 45 minutes. Intensity and troublesomeness of tinnitus was evaluated using self-assessment chart (point scale 0-100) and audiometry establishing level of tinnitus before and after treatment. The results indicates complete elimination of tinnitus in 4 patients, decrease in their intensity in 47 patients, maintenance of the ailment on the same level in 13 people and slightly increase of tinnitus in 16 patients. In audiometry we could observe in I group changes in frequency of tinnitus in 138 ears and changes in intensity of tinnitus in 91 ears. After treatment decrease of average hearing loss and average hearing damage were observed. Treatment of tinnitus may be effective by using whole-body cryotherapy.