Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.
Cholesteatoma* ; Ear, Inner ; Female ; Fistula* ; Hearing Loss, Sensorineural ; Humans ; Labyrinthitis ; Meniere Disease ; Middle Aged ; Neuroma, Acoustic ; Otitis Media ; Semicircular Canals ; Vertigo* ; Vestibular Neuronitis

Eccrine poroma is described as a benign neoplasm originating from the intraepidermal eccrine duct of sweat glands. This tumor is known to arise in bare skin areas, but more rarely appeared in head and neck region. A 54-year-old female presented with a mass on the retroauricular aspect of the left auricle. There was a soft, protruding, and purple-colored, solitary mass of about 1.0x1.0 cm in size. After authors performed an excisional biopsy, eccrine poroma was confirmed histopathologically. Thus, we report a rare case of eccrine poroma of the ear with the review of literature.
Biopsy ; Ear ; Ear Auricle ; Female ; Head ; Humans ; Middle Aged ; Neck ; Poroma* ; Skin ; Sweat Glands

Temporal bone fracture and blunt head trauma was once considered as contraindication for the surgery. Increasing numbers of successful cochlear implantation are being reported. However, the outcome of cochlear implantation in severe damaged brain is unclear. A multichannel cochlear implant was successfully implanted in a 33-year-old man who had both sensorineural deafness, left hemiplegia due to bilateral transverse temporal bone fractures and severe right brain damage after a traffic accident.
Accidents, Traffic ; Adult ; Brain ; Brain Injuries* ; Cerebral Cortex* ; Cochlear Implantation* ; Cochlear Implants* ; Craniocerebral Trauma ; Deafness ; Hemiplegia ; Humans ; Skull Fractures ; Temporal Bone

Although cochlear implantation using posterior tympanotomy has been performed worldwide, other alternative approaches might be more beneficial and convenient in some selected cases. Of these, suprameatal approach was reported to be one of useful options in cases with narrow facial recess, anteriorly located facial nerve and an ossified cochlea. We describe a case of cochlear implantation using the modified suprameatal approach in a severely contracted mastoid cavity and suggest another indication of this approach.
Cochlea ; Cochlear Implantation* ; Cochlear Implants* ; Facial Nerve ; Mastoid*

Myoepithelioma, a generally benign tumor comprised of myoepithlial cells, is an uncommon salivary gland tumor. Myoepithelioma originates primarily in the parotid gland, but several isolated cases have been described. Although myoepithelioma has a benign nature, but there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that benign myoepithelioma originating from the auricle has not been reported in the English literature. We present a rare case of 27-year-old female who had recurrent benign myoepithelioma originating from the auricle and already had been given twice operations at the other clinic.
Adult ; Ear Auricle ; Female ; Humans ; Myoepithelioma* ; Parotid Gland ; Recurrence ; Salivary Glands

Stapes fractures without other ossicle problems are rare and ossicle problems due to explosion pressure are also rare. We describe a very rare case of stapes anterior crural fracture resulting from a land mine explosion. As this case suggests, a close examination of the ossicles is necessary during an exploration tympanotomy.
Bombs ; Explosions* ; Fractures, Bone ; Stapes*

BACKGROUND AND OBJECTIVES: To investigate whether different vestibular function tests such as cervical vestibular evoked myogenic potential (cVEMP) and caloric test were correlated with severity, pattern and prognosis in idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHODS: Ninety-two patients with unilateral ISSNHL were subjected to complete audiovestibular evaluation. cVEMP and caloric test results were compared with patients' initial and final audiogram. We classified patients in 4 groups as cochlear nerve (C) type, cochlear and superior vestibular nerve (C+S) type, cochlear and inferior vestibular nerve (C+I) type and cochlear, superior vestibular nerve, inferior vestibular nerve (C+S+I) type, for evaluation of the results. cVEMP and caloric tests were compared among the groups. RESULTS: Abnormal caloric test results and abnormal cVEMP results were found in 50% and 31.6% patients, respectively. Multivariate analysis showed that abnormal caloric result (canal paresis) is a significant negative prognostic factor. CONCLUSIONS: Initial vestibular function test can be valuable in predicting the final outcome in patients with ISSNHL.
Caloric Tests ; Cochlear Nerve ; Hearing Loss, Sensorineural* ; Hearing* ; Humans ; Multivariate Analysis ; Prognosis ; Vestibular Function Tests ; Vestibular Nerve

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.
Diagnosis ; Ear Diseases ; Ear, Inner ; Head ; Humans ; Labyrinthitis ; Retrospective Studies ; Semicircular Canals* ; Vertigo*

BACKGROUND AND OBJECTIVES: The Gaps-In-Noise (GIN) test is a measure to assess auditory temporal resolution, which is the ability to follow rapid changes in the envelope of a sound stimulus over time. We investigated whether unilateral tinnitus affects temporal resolution by the GIN performance. SUBJECTS AND METHODS: Hearing tests including the GIN test were performed in 120 ears of 60 patients with unilateral tinnitus who showed symmetric hearing within 20 dB HL difference up to 8 kHz (tinnitus-affected ears, 14.6+/-11.2 dB HL; non-tinnitus ears 15.1+/-11.5 dB HL) and 60 ears of 30 subjects with normal hearing. Comparisons were made between tinnitus and non-tinnitus side of patients and normal ears of controls. RESULTS: There was no significant difference of the mean GIN thresholds among tinnitus-affected ears (5.18+/-0.6 ms), non-tinnitus ears (4.98+/-0.6 ms) and normal ears (4.97+/-0.8 ms). The mean percentage of correct answers in tinnitus side (67.3+/-5.5%) was slightly less than that in non-tinnitus side (70.0+/-5.5%) but it was not significantly different from that in normal ears (69.4+/-7.5%). Neither the GIN threshold nor the GIN perception level in tinnitus ears has relation to sex, frequency and loudness of tinnitus, and audiometric data. Age only showed a significant correlation with the GIN performance. CONCLUSIONS: We found no evidence which supported the influence of unilateral tinnitus on auditory temporal resolution. These results imply that tinnitus may not simply fill in the silent gaps in the background noise.
Ear ; Hearing ; Hearing Tests ; Humans ; Noise ; Tinnitus*

BACKGROUND AND OBJECTIVES: This study investigated the effect of ageing on speech perception in quiet and in noise, with noise directed from front, right and left. SUBJECTS AND METHODS: Sixty Malay native adults with normal or near normal hearing comprising of 20 young adults (21 to 39 years old), 20 middle aged (40 to 59 years old) and 20 older adults (60 to 74 years old) participated in this study. Their speech perception ability was measured using the Malay Hearing in Noise Test (HINT) in four test conditions; 1) in quiet (HINT Q), 2) with noise from front (HINT NF), 3) with noise from right (HINT NR), and 4) with noise from left (HINT NL). Reception thresholds for sentences (RTSs) were measured in each of the aforementioned conditions using an adaptive method. RESULTS: The results showed that, 1) genuine age-related decline was found in speech perception performance in HINT (NF), 2) hearing threshold was a major determinant differentiating speech perception performance for HINT (Q) and HINT (NL) conditions, and 3) speech perception performance for HINT (NR) was determined by both age and hearing threshold. CONCLUSIONS: This study suggests that, in older adults, while hearing thresholds affect speech perception in quiet, other factors such as central auditory processing and cognitive functions might be more important determinant factors for speech perception performance in noise.
Adult ; Hearing* ; Humans ; Middle Aged ; Noise* ; Speech Perception* ; Young Adult