Unilateral Tinnitus Research Articles

The effectiveness of two types of low-level laser therapy in patients with persistent tinnitus.

Tinnitus is a perception disorder of sound with no hearing impulse. It is a very common otology complaint that leads to worsening quality of life. The experience of sound is only the product of neural system activity, with no matching mechanical or vibratory activity in the cochlea, and is unrelated to any external stimuli. Low-level laser therapy (LLLT) is a medical treatment of tinnitus that uses low-energy-level lasers or light-emitting diodes to stimulate or inhibit cellular function. The study included nine patients aged 20-68 years with unilateral or bilateral tinnitus. It was a self-controlled clinical trial study on subjective tinnitus. All patients attended the ENT outpatient Department, Rzgari Teaching Hospital, Erbil, Iraq. Two types of low-level laser therapy (LLLT) devices were used for patients. The first tool, a soft laser called a Tinnitool, has a wavelength of 660 nm and a power of 100 mW. The second tool is a Tinnitus Pen, which has a wavelength of 650 nm and a power of 5 mW. Seven females (77.7%) and two males (22.2%) participated in this study during one month. The mean age of the study sample was 44 years, with a standard deviation of 15.59 years. There was a significant improvement in the comparison of both types of therapy low-level laser before and after treatment, which reduced the tinnitus level among patients from 70% before treatment to 59% and 65.50%, respectively, after one month of treatment. A paired t test was applied to assess this difference before and after treatment. LLLT devices can be an effective device tool for the treatment of tinnitus and can reduce the symptoms of annoyance that affect the life of the sufferer.

The significance of extended high-frequency audiometry in tinnitus patients with normal hearing as evaluated via conventional pure tone audiometry.

This study was designed to determine whether extended high-frequency audiometry was capable of better differentiating between participants with normal hearing who did or did not have subjective tinnitus. A total of 96 study participants were enrolled: 36 patients with unilateral tinnitus, 28 patients with bilateral tinnitus and 32 volunteers as controls. All 96 participants exhibited normal audiometry findings and hearing thresholds. Extended high-frequency audiometry was used to evaluate these patients. There were differences between the extended high-frequency hearing thresholds of affected and unaffected ears in those with unilateral tinnitus, and in the 20-29-year-old bilateral tinnitus group, at 11.2, 12.5 and 14 kHz. Unilateral tinnitus subgroups had higher extended high-frequency hearing thresholds than those in control subjects, at all extended high frequencies. Extended high-frequency audiometry can offer additional information regarding the hearing status of patients with tinnitus who exhibit normal pure tone thresholds when analysed via conventional hearing thresholds.

Characterizing the most Popular Tinnitus Inquiries: Is Tinnitus Incidence on the Rise Since COVID-19?

Approximately 50 million US adults experience chronic tinnitus, yet search behaviors and topics of concern to these patients have not been investigated on a national level. Observational. Online database and tertiary otology clinic. Nationwide and institutional samples. None. A search engine optimization tool was utilized to extract metadata on "People Also Ask" (PAA) questions pertaining to tinnitus. Website quality was assessed using JAMA benchmark criteria. Search volume trends were investigated along with institutional-level data on tinnitus incidence. Of the 500 PAA questions assessed, the majority (54.0%) contained value-type content. The most popular question categories pertained to tinnitus treatment (29.3%), alternative treatment approaches (21.5%), technical details (16.9%), and timeline of symptoms (13.4%). Patients were most interested in treatment with wearable masking devices and most commonly searched for tinnitus as being attributable to a neurologic etiology. Online searches pertaining to unilateral tinnitus symptoms have increased >3-fold since the onset of the COVID-19 pandemic. Likewise, review of patient encounters at our tertiary otology clinic revealed a nearly 2-fold increase in tinnitus consultations since 2020. Topics of interest and concern identified herein may inform the development of patient education materials and help guide clinical practice. Online search data suggest an increase in tinnitus searches since the onset of COVID-19, which did correlate clinically with an increase in tinnitus consultations at our institution.

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator.

Typewriter tinnitus refers to a special kind of staccato tinnitus, which is mostly described by patients as Morse code, popcorn, or machine-gun. It has been accepted that the mechanism of typewriter tinnitus is caused by the neurovascular compression of the cochleovestibular nerve. Patients who suffered from typewriter tinnitus have exhibited a good response to carbamazepine or oxcarbazepine, but there is a risk of recurrence after treatment cessation. The present study aims to determine the value of auditory brainstem response (ABR) in diagnosing typewriter tinnitus and predicting relapse after drug withdrawal. Patients who presented with typewriter tinnitus from March 2019 to March 2022 were included for the present retrospective study. The auditory and vestibular test results and drug treatment effects were collected and analyzed. Patients with idiopathic unilateral subjective tinnitus, who were matched by age to patients with typewriter tinnitus at a ratio of 2:1, were consecutively recruited for the control group. Eighteen patients with typewriter tinnitus and 38 controls were included. Ears with typewriter tinnitus had longer interpeak latency (IPL) I-III, and wave III and V latencies, and a higher ratio of IPL I-III ≥2.3 ms based on ABR, when compared to the unaffected side and controls ( p <0.05). Seventeen patients with typewriter tinnitus responded positively to medication. Among these patients, seven patients had a relapse after drug cessation, while 10 patients did not have a relapse. The relapse group had significantly longer IPL I-III and wave V latency, older age, and poorer hearing, when compared to the nonrelapse group ( p < 0.05). Furthermore, IPL I-III had the largest area under the receiver operating characteristic curve, and the optimal cutoff was 2.4 ms (sensitivity, 100.0%; specificity, 66.7%). There were no significant differences in other demography or other clinical test results between the relapse and nonrelapse groups ( p > 0.05). Ramsay Hunt syndrome and neuromyelitis optica spectrum disorders were identified in two cases. Prolonged IPL I-III based on ABR can help in the diagnosis of typewriter tinnitus and its prognosis after treatment cessation. Patients with IPL I-III greater than 2.4 ms, older age and poorer hearing are more likely to relapse. In addition to the neurovascular conflict of the cochleovestibular nerve, the etiologies of neuroinflammation and demyelinating diseases are also possible for typewriter tinnitus.

The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing

The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing

The Effect of Tinnitus and Related Characteristics on Subcortical Auditory Processing.

The primary aim of this study was to evaluate whether individuals with tinnitus exhibited evidence of reduced inhibition and increased excitation at the subcortical auditory processing level. Based on the proposed mechanism of tinnitus generation, including peripheral auditory insult that triggers reduced inhibition and subcortical hyperactivity, it was hypothesized that a tinnitus group would yield reduced amplitudes for the most peripheral auditory brainstem response (ABR) component (wave I) and larger amplitudes for the most central ABR component (wave V) relative to controls matched on factors of age, sex, and hearing loss. Further, this study assessed the relative influence of tinnitus presence versus other related individual characteristics, including hearing loss, age, noise exposure history, and speech perception in noise on these ABR outcomes. Subcortical processing was examined using click-evoked ABR in an independent groups experimental design. A group of adults who perceived daily unilateral or bilateral tinnitus were matched with a control group counterpart without tinnitus by age, hearing, and sex (in each group n = 18; 10 females, 8 males). Amplitudes for ABR waves I, III, V, and the V/I ratio were compared between groups by independent t-tests. The relative influence of tinnitus (presence/absence), age (in years), noise exposure history (subjective self-report), hearing loss (audiometric thresholds), and speech perception in noise (SNR-50) was determined based on the proportional reduction in error associated with accounting for each variable of interest using multiple regression. Between-group trends were consistent with smaller amplitudes for all ABR components in individuals with tinnitus. Contrary to our hypotheses, however, none of the tinnitus compared with control group differences in ABR outcomes were statistically significant. In the multiple regression models, none of the factors including tinnitus presence, age, noise exposure history, hearing loss, and speech perception in noise significantly predicted ABR V/I ratio outcomes. The presence of reduced inhibition and subcortical hyperactivity in the tinnitus group was not supported in the current study. There were trends in ABR outcomes consistent with reduced peripheral to central brainstem auditory activity in the tinnitus group, but none of the group differences reached significance. It should also be noted that the tinnitus group had poorer extended high-frequency thresholds compared with controls. Regardless, neither tinnitus presence nor any of the proposed related characteristics were found to significantly influence the ABR V/I ratio. These findings suggest that either reduced subcortical inhibition was not a primary underlying mechanism for the tinnitus perceived by these subjects, or that ABR was not a reliable indicator of reduced subcortical inhibition possibly due to characteristics of the sample including a skewed distributions toward young and normal hearing individuals with little tinnitus distress.

Audiology for the Neurosurgeon

Many conditions that neurosurgeons manage are associated with audiologic symptoms. Unilateral hearing loss and tinnitus, poor suprathreshold speech understanding, and dizziness are hallmarks of retrocochlear lesions. Understanding the difference between air and bone conduction thresholds and the importance of speech discrimination helps differentiate types of hearing loss and their neurological importance. Acoustic reflex, otoacoustic emissions, and auditory brainstem response testing are objective measures used to determine function of the auditory structures. Accurate interpretation of these results can aid neurosurgeons in making differential diagnoses and determining surgical approaches. Cooperation among neurosurgeons, otolaryngologists, and audiologists ensures abnormal auditory symptoms are assessed correctly.

Can Auditory and Vestibular Findings Differentiate Vestibular Migraine and Meniere's Disease?

Besides evaluating the auditory and vestibular systems of patients with vestibular migraine (VM) and Meniere's disease (MD), this study aimed to examine the clinical overlaps between these two conditions by detailed evaluation of the patient's symptoms. Subjects and. The ears of the patients with VM and MD were evaluated and patients' vestibular and auditory complaints were questioned particularly. Pure tone audiometry, vestibular evoked myogenic potential (VEMP) responses, and caloric test results were evaluated for objective measurements. The VM group had better air-conduction and boneconduction threshold and speech reception threshold and speech discrimination score test values (p<0.05). Regarding the interaural N1-P1 asymmetry ratio, the cervical VEMP between the groups had significant differences (p=0.019). The MD group had more unilateral tinnitus and ear fullness complaints and canal paresis results (p<0.01). The VM group had more motion sickness complaints (p<0.01). If only ears with hearing loss are evaluated; there was no significant difference between VM and MD, but regardless of hearing level or only the patients with normal hearing were evaluated, the VM group had better hearing levels. It should be considered that patients with VM may have VM-independent hearing loss, and patient complaints should be sufficiently detailed to make an accurate distinction from MD.

Clinical characteristics and psychoacoustic analysis of acute and chronic subjective tinnitus.

This study aimed to understand the demographics, clinical characteristics, and psychoacoustic status of subjective tinnitus patients to explore the factors associated with acute and chronic tinnitus in the general hospitals of Shanghai. A cross-sectional study was conducted to investigate the clinical characteristics and psychoacoustic status of subjective tinnitus patients with history greater than 1month. Data were collected during January 2021 and January 2022 from eight general hospitals in five districts of Shanghai, China. All patients accepted questionnaires and acoustic examination, then SPSS 22.0 and GraphPad Prism 8.0.2 were applied for data analysis. Among the 359 tinnitus patients, 126 cases were diagnosed with acute tinnitus, 58 cases were subacute tinnitus, and 175 cases were chronic tinnitus. Patients with acute and chronic tinnitus differed in terms of side of tinnitus, hearing loss, frequency of tinnitus, severity of tinnitus, anxiety, depression, and sleep status. Different characteristics were included in the multivariate ordinal logistic regression analysis. Persistent tinnitus (OR=2.00, p=.008), high frequency hearing loss (OR=4.77, p < .001), depression (OR=1.23, p < .001) were found to be positively associated with the course of tinnitus. Unilateral tinnitus (OR=0.48, p=.003), mild (OR=0.29, p=.001) and moderate (OR=0.46, p=.038) hearing loss, VAS scores (OR=0.82, p=.032), anxiety (OR=0.81, p < .001), THI scores (OR=0.98, p=.002), and sleep disorders (OR=0.94, p=.025) were found to be negatively associated with the course of tinnitus. Patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression. Our study demonstrated that patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression.

Transient profound hearing loss and severe facial nerve palsy in schwannomas within the internal acoustic canal: A case report.

Vestibular schwannoma is the most common intracranial schwannoma and constitutes ~8% of all intracranial tumors in adults with an estimated incidence rate of ~1.3/100.000. Facial nerve schwannomas and cochlear nerve schwannomas are rare, and information regarding incidence rates of these is still missing in the literature. All three variants of nerve origin present most frequently with unilateral hearing loss, unilateral tinnitus and disequilibrium. Facial nerve palsy is a common finding in facial nerve schwannomas but a rare finding with vestibular schwannomas. The symptoms are normally persistent and often progress over time, leading to therapeutic interventions that predispose to quality of life-reducing morbidities, e.g., deafness and/or imbalance. The case report describes a 17-year-old male who, during a 1-month period, presented with profound unilateral hearing loss and severe facial nerve palsy followed by complete remission. An MRI scan showed a 5×8-mm schwannoma within the internal acoustic canal. Profound hearing loss together with concomitant severe peripheral facial nerve palsy in small schwannomas within the internal acoustic canal may show spontaneous and total remission within weeks of symptom debut. This knowledge, as well as possible remission of objective findings, should be considered before interventions with potential severe morbidity are suggested.

The interference of tinnitus on sound localization was related to the type of stimulus.

Spatial processing is a major cognitive function of hearing. Sound source localization is an intuitive evaluation of spatial hearing. Current evidence of the effect of tinnitus on sound source localization remains limited. The present study aimed to investigate whether tinnitus affects the ability to localize sound in participants with normal hearing and whether the effect is related to the type of stimulus. Overall, 40 participants with tinnitus and another 40 control participants without tinnitus were evaluated. The sound source discrimination tasks were performed on the horizontal plane. Pure tone (PT, with single frequency) and monosyllable (MS, with spectrum information) were used as stimuli. The root-mean-square error (RMSE) score was calculated as the mean target response difference. When the stimuli were PTs, the RMSE scores of the control and tinnitus group were 11.77 ± 2.57° and 13.97 ± 4.18°, respectively. The control group performed significantly better than did the tinnitus group (t = 2.841, p = 0.006). When the stimuli were MS, the RMSE scores of the control and tinnitus groups were 7.12 ± 2.29° and 7.90 ± 2.33°, respectively. There was no significant difference between the two groups (t = 1.501, p = 0.137). Neither the effect of unilateral or bilateral tinnitus (PT: t = 0.763, p = 0.450; MS: t = 1.760, p = 0.086) nor the effect of tinnitus side (left/right, PT: t = 0.389, p = 0.703; MS: t = 1.407, p = 0.179) on sound localization ability were determined. The sound source localization ability gradually deteriorated with an increase in age (PT: r2 = 0.153, p < 0.001; MS: r2 = 0.516, p = 0.043). In conclusion, tinnitus interfered with the ability to localize PTs, but the ability to localize MS was not affected. Therefore, the interference of tinnitus in localizing sound sources is related to the type of stimulus.

A comparison of interaural asymmetry, audiogram slope, and psychometric measures of tinnitus, hyperacusis, anxiety and depression for patients with unilateral and bilateral tinnitus

Objective To evaluate differences in tinnitus impact, hyperacusis and hearing threshold level (HTL) between patients with unilateral and bilateral tinnitus. For patients with unilateral tinnitus, to compare audiological variables for the tinnitus ear and the non-tinnitus ear. To assess whether the presence of unilateral tinnitus increases the likelihood of interaural hearing asymmetry (relative to bilateral tinnitus) that warrants referral for an MRI scan. Design Retrospective cross-sectional. Study Sample Data regarding HTLs and responses to self-report questionnaires were collected from the records of 311 patients attending a tinnitus clinic. Results 38.5% had unilateral tinnitus and the ears with tinnitus had higher HTLs and greater HTL slopes than the ears without tinnitus. There was no significant difference in tinnitus impact and hyperacusis between patients with unilateral and bilateral tinnitus. 40% of patients with unilateral tinnitus and 13% of patients with bilateral tinnitus had a between-ear difference in HTL ≥15 dB at two adjacent frequencies (2AF15 asymmetry). Unilateral tinnitus increased the risk of 2AF15 asymmetry by a factor of 4.4. Conclusions Unilateral tinnitus increases the risk of having interaural asymmetry in HTLs that warrants referral for an MRI scan.

Comodulation Masking Release in Tinnitus Frequency and One Lower Octave of Tinnitus Frequency.

Inhibitory function is the basis of many perceptual and non-perceptual abilities in the auditory system. In people with tinnitus, decreased inhibitory function in the central auditory system has been proven. This disorder is caused by an increase in neural activity caused by an imbalance between stimulation and inhibition. The aim of this study was to evaluate and compare inhibitory function in persons who had tinnitus, at and one octave lower than the tinnitus frequency. Studies show that inhibition has very important role in comodulation masking release. According to inhibitory dysfunction in people with tinnitus, in this study we assessed comodulation masking release in tinnitus frequency and one lower octave. Participants were divided into two groups. Group 1 consisted of 7 individuals with unilateral tonal tinnitus at 4kHz and group 2 included 7 individuals with unilateral tonal tinnitus at 6kHz. Paired test, in each group separately, showed that the comodulation masking release and Across Frequency comodulation masking release differed significantly between tinnitus frequency and one octave lower in each group (p < 0.05). In fact, the disinhibition in the area around the frequency of the tinnitus seems to be greater than the tinnitus frequency area. It seems that the results of CMRs can be used in planning and managing the treatment of people with tinnitus (such as sound therapy, etc.).

CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence.

To investigate the imaging features of unilateral pulsatile tinnitus (PT) with jugular bulb wall dehiscence (JBWD). Computerized tomography angiography images of unilateral PT patients were reviewed between 2019 and 2021. Thirty-one symptomatic JBWD patients without sigmoid sinus wall dehiscence (SSWD) were included. Thirty-eight patients with SSWD were used as the control group. The prevalence of JBWD was calculated. The area and height of the jugular bulb, the extent of dehiscence, the presence of jugular bulb diverticulum, posterior condylar emissary vein (PCEV), oblique occipital sinus (OOS), venous outflow laterality (VOL), the degree of transverse sinus stenosis (TSS), and the pituitary height to sella turcica ratio were compared between the two groups. The prevalence of JBWD was 12.1%, and JBWD was established as a causative diagnosis in 5.0% of unilateral PT patients. There were no statistical differences in the gender, symptomatic side, or VOL between the two groups. The area of the jugular bulb was larger and the height was higher (parea < 0.001, pheight = 0.005). The prevalence of jugular bulb diverticulum was higher in the JBWD group (p = 0.002). The degree of symptomatic TSS was less severe (p < 0.001), and the prevalence of bilateral TSS was lower in the JBWD group (p < 0.001). The pituitary height to sella turcica ratio was greater (p = 0.004), the prevalence of PCEV (p = 0.014) was lower, and OOS (p = 0.015) was greater in the JBWD group. The correlating factors of PT with JBWD and PT with SSWD are significantly different. These findings can further facilitate early and efficient PT treatment. • The incidence of jugular bulb dehiscence (JBWD) accounted for approximately 12.1% in pulsatile tinnitus (PT) patients, and JBWD was established as a causative diagnosis in 5.0% of PT patients. • PT required large blood flows and abnormal flow patterns, whether in JBWD or sigmoid sinus wall dehiscence groups. • JBWD causing PT has some unique characteristic findings on CT.

Diagnosis and treatment strategies of 56 cases of middle ear myoclonus

Objective: To analyze the clinical characteristics and treatment of middle ear myoclonus. Methods: Fifty-six cases of middle ear myoclonus were enrolled in Shandong Provincial ENT Hospital, Shandong University from September 2019 to August 2021, including 23 males and 33 females. The age ranged from 6 to 75 years, with a median age of 35 years; Forty-seven cases were unilateral tinnitus, nine cases were bilateral tinnitus. The time of tinnitus ranged from 20 days to 8 years. The voice characteristics, inducing factors, nature (frequency) of tinnitus, tympanic membrane conditions during tinnitus, audiological related tests, including long-term acoustic tympanogram, stapedius acoustic reflex, pure tone auditory threshold, short increment sensitivity test, alternate binaural loudness balance test, loudness discomfort threshold, vestibular function examination, facial electromyography, and imaging examination were recorded. Oral carbamazepine and/or surgical treatment were used. The patients were followed up for 6-24 months and the tinnitus changes were observed. Results: Tinnitus was diverse, including stepping on snow liking sound, rhythmic drumming, white noise, and so on. The inducing factors included external sound, body position change, touching the skin around the face and ears, speaking, chewing and blinking, etc. Forty-four cases were induced by single factor and 9 cases were induced by two or more factors. There was no definite inducing factor in 1 case. One patient had tinnitus with epilepsy. One case of traumatic facial paralysis after facial nerve decompression could induce tinnitus on the affected side when the auricle moved. Tympanic membrane flutter with the same frequency as tinnitus was found in 12 cases by otoscopy, and the waveform with the same frequency as tinnitus was found by long-term tympanogram examination. There were 7 patients with no tympanic membrane activity by otoscopy, the 7 cases also with the same frequency of tinnitus by long-term tympanogram examination, but the change rate of the waveform was faster than that of the patients with tympanic membrane flutter. All patients with tinnitus had no change in hearing. One case of tinnitus complicated with epilepsy (a 6-year-old child) was treated with antiepileptic drug (topiramate) and tinnitus subsided. One case suffered from tinnitus after facial nerve decompression for traumatic facial paralysis was not given special treatment. Fifty-four cases were treated with oral drug (carbamazepine), of which 10 cases were completely controlled and 23 cases were relieved; 21 cases were invalid. Among the 21 patients with no effect of carbamazepine treatment, 8 patients were treated by surgery, 7 patients had no tinnitus after surgery, 1 patient received three times of operation, and the third operation was followed up for 6 months, no tinnitus occurred again. The other 13 cases refused the surgical treatment due to personal reasons. Conclusions: Middle ear myoclonus tinnitus and the inducing factors manifestate diversity. Oral carbamazepine and other sedative drugs are effective for some patients, and surgical treatment is feasible for those who are ineffective for medication.

Efficacy and factors influencing outcomes of customized music therapy combined with a follow-up system in chronic tinnitus patients

BackgroundsTinnitus is a meaningless sound signal perceived by the patients in the absence of auditory stimuli. Due to the complex etiology and unclear mechanism, specific therapies for tinnitus are still in the exploratory stage. In recent years, personalized and customized music therapy has been proposed as an effective method for tinnitus treatment. The aim of this study was to explore the efficacy of customized therapy with a well-designed follow-up system in the treatment of tinnitus through a large sample one arm study and to identify the relevant factors affecting the treatment outcome.MethodsThe study investigated a total of 615 patients with unilateral or bilateral chronic tinnitus who received personalized and customized music therapy for 3 months. A complete follow-up system was designed by the professionals. Questionnaires of Tinnitus Handicap Inventory (THI), Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Scale (VAS) were used to evaluate the therapeutic effects and relevant factors affecting the efficacy of therapy.ResultsThe results showed a decreasing trend in THI and VAS scores after 3 months of therapy, with statistically significant differences between pre- and post-therapy time points (P < 0.001). All patients were divided into 5 groups according to THI scores, and the mean reduction score in catastrophic, severe, moderate, mild and slight group was 28, 19, 11, 5, 0 respectively. The proportion of tinnitus patients with anxiety was higher than that with depression (70.57% and 40.65%, respectively), and there were statistically significant differences between HADS-A/D scores pre- and post-therapy. Binary logistic regression showed that the baseline of THI, VAS scores, the duration of tinnitus and the state of anxiety prior to therapy were significant influencing factors of therapeutic efficacy.ConclusionsThe magnitude of reduction in THI scores after music therapy depended on the severity of the patients' tinnitus, the higher the initial THI scores, the greater the potential for improvement in tinnitus disorders. Music therapy also reduced the anxiety and depression levels of tinnitus patients. Therefore, personalized and customized music therapy with a comprehensive follow-up system may be an effective treatment option for chronic tinnitus patients.Graphical abstract

Sinonasal Inverted Papilloma Extirpation by Endoscopic Approach: a Case Report

Introduction :Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and other symptoms.The diagnostic examination are histopathological examinations, CT scans and MRI.Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depend to the krouse classification. Case description : A 44 year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressiveright nasal obstructionappeared two years ago that turn into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasalinverted papilloma with krouse 2 classificationbased on clinical examination, radiological finding and preoperative endoscopy. Patient was treated with sinonasal inverted papiloma extirpation via endoscopic approach. Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses, and biopsy is the gold standard for diagnostic tests. At the same time, the main treatment is done by surgical approachdepend on the krouse classification.

Analysis of auditory brain stem response and otoacoustic emission in unilateral tinnitus patients with normal hearing

ObjectiveIn patients with unilateral tinnitus with normal hearing, several studies have compared the ipsilateral and contralateral ears; however, few studies have investigated its relationship with the duration of tinnitus. We compared the auditory brainstem response and otoacoustic emission parameters between ipsilateral and contralateral ears in adults with unilateral tinnitus and normal hearing. MethodsThis retrospective review included 84 patients with unilateral tinnitus and normal hearing who underwent auditory brainstem response and otoacoustic emission; they were categorized according to the duration of tinnitus. The latencies and amplitudes of waves I, III, and V, and V/I ratio of both ears in auditory brainstem response, and the results of distortion-product otoacoustic emission and transient evoked otoacoustic emission were examined. The auditory brainstem response parameters, distortion-product otoacoustic emission parameters, and transient evoked otoacoustic emission parameters between the ipsilateral and contralateral ears along the duration of tinnitus were analyzed. Moreover, the failure rates of both distortion-product otoacoustic emission and transient evoked otoacoustic emission between the ears along with the duration and the effects of the variables on the amplitude and latency of each wave were examined. ResultsIn this study, laterality seemed to have an effect on wave I latency in the multiple linear regression analysis. The distortion-product otoacoustic emission failure rate of the ipsilateral ear was higher than that of the contralateral ear in all patients. However, there was no remarkable difference between the ears in the distortion-product otoacoustic emission and transient evoked otoacoustic emission parameters throughout the duration. ConclusionWe found that outer hair cells and the distal portion of the cochlear nerve are possible pathologic lesions in tinnitus with normal hearing and cochlear synaptopathy could be suspected. Further studies, including those on inner hair cells and higher central cortex, are needed.

Symptoms: Sudden Hearing Loss and Aural Fullness

Symptoms: Sudden Hearing Loss and Aural Fullness

Arachnoid Granulation Causing Unilateral Pulsatile Tinnitus Treated With Dural Venous Sinus Stenting.

Large arachnoid granulations that protrude into dural venous sinuses and partially obstruct outflow are an underappreciated etiology of pulsatile tinnitus (PT). Endovascular dural venous sinus stenting is thought to diminish turbulent venous outflow and may relieve obstruction caused by arachnoid granulations. Four patients at two institutions were evaluated for unilateral PT. Magnetic resonance imaging and digital subtraction angiography revealed moderate-to-severe stenoses from large arachnoid granulations within the implicated transverse sinus. All patients underwent venous manometry and endovascular sinus stenting. All patients experienced immediate and complete remission of their PT. Stenoses were relieved by a mean of 93% by Warfarin-Aspirin Symptomatic Intracranial Disease criteria. There were no procedural or periprocedural complications. All patients continued to report complete symptom resolution at a mean of 8-month follow-up. PT from arachnoid granulations are an underappreciated pathomechanism. Endovascular dural venous sinus stenting is an effective intervention for treating unilateral PT secondary to large arachnoid granulation.