Tinnitus: Report of Ten Cases of Perilymphatic Fistula and/or Endolymphatic Hydrops Improved by Surgery.
6
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Presented are ten cases of patients with perilymphatic fistula and/or endolymphatic hydrops who had tinnitus as a major complaint. Tinnitus and its degree of severity often correlate closely with the state of health or hydrodynamic integrity of the inner ear, as these cases illustrate.Keywords:
Endolymphatic hydrops
Labyrinth Diseases
Cite
From August 1989 to August 1994, 173 arteriovenous fistules were constructed in 162 patients for permanent hemodialysis: 49 autogenous and 124 graft fistulas (polytetraflouroethylene (PTFE)-119, others-5). Previous access procedures were noted in 93 graft fistulas (76%) versus 8 autogenous fistulas (16.3%). In the immediate postoperative period, 13 graft fistulas (10.6%) developed complications (5 anastomotic hemorrhages, 4 thrombosis, 3 hypotension without hemorrhage, and 1 sepsis), while 2 (4.1%) autogenous fistulas developed immediate postoperative complications (1 anastomotic hemorrhage and 1 thrombosis). Graft fistulas had a higher, although not statistically significant incidence of immediate postoperative complications versus autogenous fistulas. These graft fistula complications were associated with multiple access procedures and required surgical exploration. Based on these results, we should make every effort to construct the autogenous fistula as the first choice of hemodialysis access procedure in properly selected patients.
Hemodialysis access
Cite
Citations (4)
Tinnitus is one of the three classical symptoms of Ménière's disease (MD), an inner ear disease that is often accompanied by endolymphatic hydrops. Previous studies indicate that tinnitus in MD patients is dominated by low frequencies, whereas tinnitus in non-hydropic pathologies is typically higher in frequency. Tinnitus of rather low-frequency (LF) quality was also reported to occur for about 90 s in normal-hearing participants after presentation of intense, LF sound (120 dB SPL, 30 Hz, 90 s). LF sound has been demonstrated to also cause temporary endolymphatic hydrops in animal models. Here, we quantify tinnitus in two study groups with chronic (MD patients) and presumably transient endolymphatic hydrops (normal-hearing participants after LF exposure) with a psychophysical procedure. Participants matched their tinnitus either with a pure tone of adjustable frequency and level or with a noise of adjustable spectral shape and level. Sensation levels of matching stimuli were lower for MD patients (mean: 8 dB SL) than for normal-hearing participants (mean: 15 dB SL). Transient tinnitus after LF-exposure occurred in all normal-hearing participants (N = 28). About half of the normal-hearing participants matched noise to their tinnitus, the other half chose a pure tone with frequencies below 2 kHz. MD patients matched their tinnitus with either high-frequency pure tones, mainly above 3 kHz, or with a noise. Despite a significant proportion of MD patients matching low-pass (roaring) noises to their tinnitus, the range of matched stimuli was more heterogeneous than previous data suggested. We propose that in those participants with noise-like tinnitus, the percept is probably generated by increased spontaneous activity of auditory nerve fibers with a broad range of characteristic frequencies, due to an impaired ion balance in the cochlea. For tonal tinnitus, additional mechanisms are conceivable: focal hair cell loss can result in decreased auditory nerve firing and a central auditory overcompensation. Also, normal-hearing participants after LF-exposure experience alterations in spontaneous otoacoustic emissions, which may contribute to a transient tonal tinnitus.
Endolymphatic hydrops
Pure tone audiometry
Cite
Citations (15)
Secondary endolymphatic hydrops (SEH) has clinically been found to have a significant incidence of occurrence in patients with subjective idiopathic tinnitus (SIT) of a severe disabling type. The diagnosis is made clinically and has been established by integration in a medical audiological tinnitus patient protocol of the clinical history with results of electrodiagnostic cochleovestibular testing that fulfill the diagnostic criteria of inner-ear disease consistent with Ménière's disease. SEH is hypothesized to be a factor, not an etiology, influencing the clinical course of SIT. Alterations over time (i.e., delay in the homeostatic mechanisms in normnal function of the fluid compartments of the inner-ear perilymph, endolymph, or brain cerebrospinal fluid) result in endolymphatic hydrops and interference in normal function of the inner ear, with resultant inner-ear complaints that can be highlighted by tinnitus rather than by vertigo. The endolymphatic hydrops may be either localized or diffuse within the cochlear or vestibular labyrinth. The etiologies and mechanisms of cochleovestibular-type tinnitus are multiple and are influenced by the SEH. Classically, the tetrad of symptoms--episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and ear blockage--associated with the histopathological correlate endolymphatic hydrops has been diagnosed as Ménière's disease. Specifically, key etiological agents that have been identified as playing a role in the clinical course of tinnitus (e.g., noise exposure, stress) may serve as "triggers" or stressors (or both), resulting in interference in normal biochemical and physiological function of sensorineural structures in the inner ear or in neural structures in the brain. In both conditions, the alterations over time (i.e., delay) in the clinical manifestation of the tetrad of symptoms of inner-ear dysfunction, when highlighted by SIT rather than vertigo, otherwise fulfill the criteria for diagnosing SEH. The chief complaint of SIT, when presenting as one of the tetrad of inner-ear symptoms and otherwise diagnosed as Ménière's disease, has also been associated clinically with perfusion asymmetries in brain, identified by nuclear medicine brain imaging (single-photon emission computed tomography [SPECT] of brain), and reflects an interference in homeostasis in the blood-brain labyrinth or blood-brain barriers, with a resulting SEH. The medical significance of the SIT in some patients may be a gradual, progressive sensorineural hearing loss. The inclusion of SPECT of brain in SIT patients demonstrates a global approach for improving the accuracy of diagnosing the SIT symptom, for focusing on the contribution of central nervous system dysfunction to the development of SEH, and for understanding and influencing the clinical course of SIT.
Endolymphatic hydrops
Endolymph
Etiology
Perilymph
Cite
Citations (16)
Endolymphatic hydrops
Caloric test
Cite
Citations (11)
AbstractA new technique for the restoration of basal sensorineural hearing loss in Mb Meniere was described. Three cases with unilateral basal sensorineural hearing loss, fullness of the ear, and tinnitus were reported. In the acute stage of their disease the patients were treated in a pressure chamber where it was possible to increase or decrease the air pressure within the range ± 110 cm H2O. The equilibration of middle ear pressures to surrounding air pressures was checked. Exposure to underpressure resulted in a rise of the hearing thresholds at low frequencies and relief of subjective symptoms. When the air pressure was increased the hearing thresholds were lowered and the sensation of tinnitus and fullness of the ear was accentuated. Changes in air pressure did not affect the healthy ear or the high frequencies in the diseased ear. Hearing improvement attained at exposure to underpressure seemed to remain at atmospheric pressure level. The investigation was performed on the hypothesis that a distended membranous labyrinth might cause a venous congestion of the vestibular aqueduct, resulting in impaired endolymph absorption in the endo-lymphatic sac. Possible effects of changes in environmental air pressure on the inner ear were discussed.
Endolymph
Vestibular aqueduct
Basal (medicine)
Endolymphatic hydrops
Cite
Citations (60)
Endolymphatic hydrops
Perilymph
Spiral ganglion
Cochlear duct
Endolymphatic sac
Endolymph
Basilar membrane
Cite
Citations (50)
Presented are ten cases of patients with perilymphatic fistula and/or endolymphatic hydrops who had tinnitus as a major complaint. Tinnitus and its degree of severity often correlate closely with the state of health or hydrodynamic integrity of the inner ear, as these cases illustrate.
Endolymphatic hydrops
Labyrinth Diseases
Cite
Citations (6)
Endolymphatic hydrops
Cite
Citations (39)
Ménière's disease is an inner ear disorder, associated with episodes of vertigo, fluctuant hearing loss, tinnitus, and aural fullness. Ménière's disease is associated with endolymphatic hydrops. Clinical evidences show that this disease is often incapacitating, negatively affecting the patients' everyday life. The pathogenesis of Ménière's disease is still not fully understood and remains unclear. Previous numerical studies available in the literature related with endolymphatic hydrops, are very scarce. The present work applies the finite element method to investigate the consequences of endolymphatic hydrops in the normal hearing, associated with the Ménière's disease. The obtained results for the steady state dynamics analysis are in accordance with clinical evidences. The results show that the basilar membrane is not affected in the same intensity along its length and that the lower frequencies are more affected by the endolymphatic hydrops. From a clinical point of view, this work shows the relationship between the increasing of the endolymphatic pressure and the development of hearing loss.
Endolymphatic hydrops
Basilar membrane
MENIERE DISEASE
Cite
Citations (5)
Delayed endolymphatic hydrops (DEH), a disease entity that can be differentiated from Ménière's disease, typically develops in patients who have experienced a profound, long-term hearing loss in one ear. This condition was first reported by Kamei et al. ('71), who indicated that it occurred in about 20% of patients who had had unilateral profound deafness since early childhood (UPDC), and it appeared at various stages of adulthood, during or after puberty. Wolfson and Leiberman ('75) and Nadol et al. ('75) reported other types of unilateral profound deafness causing this condition that were due to viral and bacterial labyrinthitis, head trauma, or sudden deafness. Schuknecht ('78) defined DEH and classified it into two types: the ipsilateral type, in which vestibular symptoms identical to the vestibular symptoms of Ménière's disease develop in a previously deafened ear, and the contralateral type, in which a fluctuating hearing loss and/or vestibular symptoms develop in the hearing ear. The underlying pathophysiologic mechanism for the development of DEH has been explained as progressive endolymphatic hydrops in the inner ear due to delayed atrophy or fibrous obliteration of the endolymphatic resorption system, resulting from a previous inner-ear injury. In the ipsilateral type, episodic vertigo is not usually accompanied by fluctuating hearing levels and tinnitus because the hearing loss is profound. The period between the onset of pre-existent deafness in one ear and the onset of DEH ranges from several months to 74 years. The cause of the pre-existent deafness is UPDC in more than half of the cases of both types of DEH. Almost all kinds of other degenerative disorders of the inner ear are mostly due to inflammation (viral and bacterial) and trauma (physical and acoustic). The ipsilateral type of DEH is more frequently seen than the contralateral type. The onset age of the contralateral type is higher, in general, than that of the ipsilateral type. Medical treatment may be effective for both types of DEH. Complete relief from episodic recurrent vertigo may be expected in 65% of cases within 5 years after the onset of vertigo and in 90% of cases within 10 years. Labyrinthectomy or vestibular nerve section in the deaf ear is curative in the ipsilateral type, but no satisfactory surgical therapy is available for the contralateral type of the disease. The audiological definition of DEH by Schuknecht seems, however, to be somewhat arbitrary, as the patients' symptoms form a continuous spectrum with other Ménière's syndrome cases, occurring in association with less-marked degrees of sensorineural hearing loss. The existence of the contralateral type of DEH due to UPDC, which often shows typical symptoms of Ménière's disease, seems to suggest that Ménière's disease may occur as a delayed sequela of subclinical damage of the inner ear, especially damage sustained in childhood.
Endolymphatic hydrops
Labyrinthitis
Cite
Citations (1)