The clinical records of 68 patients of acoustic neuroma diagnosed at the Department of Otolaryngologyor Neurosurgery of University of Tsukuba Hospital from March 1988 to December 1996 werereviewed. The majority of patients presented with asymmetric hearing loss and/or tinnitus. Fifty-onecases were diagnosed by otolaryngologists and the tumor sizes were large in 19 cases, medium in 7cases, small in 17 cases and ear tumor in 11 cases (including 3 cases with neurofibromatosis II). Theother 16 cases (2 cases were neurofibromatosis II), including 9 large, 3 medium, 6 small size tumorsand no ear tumor, were diagnosed by neurosurgeons or others. Twenty-four cases were identified by CT and/or MRI after assessments of otological examinations including pure tone audiograms, equilibriumtests and auditory brainstem responses (ABRs), whereas 25 and 16 cases were directly diagnosedby CT and/or MRI with or without an assessment with pure tone audiogram, repectively. Althoughfurther studies, especially prospective survey on the frequency of abnormal ABRs and the rate oftumor identification in suspected patients (patients with asymmetric hearing loss or unexpectedotologic complaints) are necessary, the results obtained suggested that ABR is the most efficient andeconomical screening technique to select the cases for CT and/or MRI examinations.
Forty five patients with inner ear damage due to acute otitis media were clinically evaluated.The age of patients ranged from 11 to 74 years (average 43.6 years old). Most of the patientscomplained of a hearing loss and ear fullness after otalgia, and about half of the patients experiencedtinnitus and vertigo. All patients showed a mixed hearing loss in pure tone audiometry. 40out of 45 patients (89%) showed spontaneous nystagmus or caloric dysfunction. Bone threshold inpure tone audiometry was correlated with caloric dysfunction, indicating that the more the damageof the cochlea, the higher the involvement of vestibule. They were treated by systemic administrationof antibiotics, steroids and vitamins, and all the patients showed remarkable recovery of hearing (28 cases out of 38 were completely recovered) and disappearance of spontaneous nystagnus.
Hearing acuity at higher frequency range was investigated by using a tinnitus audiometer. First, frequency and sound pressure level of the sound generated by the tinnitus audiometer wasmeasured. The measured frequency values were close to those indicated by the tinnitus audiometer.On the other hand, the measured sound pressure values were different from those indicated by thetinnitus audiometer. However, the measured intervals for the sound pressure levels were almost thesame as those for indicated by the tinnitus audiometer. Secondly, hearing thresholds in 25 normal subjects were assessed. Mean and standard deviationfor subjects' age were 22.0 and 1.5 years, respectively. There was significant gender difference atfrequencies of 250, 9190, and 13929Hz and there was significant left and right difference at frequenciesof 10556, 12126, and 16000Hz. All tests were done from the right ear. In order to evaluatethe possible effect of order, retests were performed from left ear in two subjects at four monthsinterval. However there was no consistent tendency for order. In addition, retests were performedin two subjects from right ear. Mean and standard deviation for the difference between thresholdsfor the first test and the second test were 4.7 and 4.0dBs, respectively. It is presumably said from our results that the high frequency audiometry above conventionalfrequency ranges is difficult to be evaluated but useful in some cases.
Paget's disease, a chronic progressive bone disease of unknown origin, described as osteitis deformansby James Paget in 1877. This disease is comparatively prevalent in Europe and America, while it is rarely found in Japan. We report a case of Paget's disease with hyperostosis in the temporalbone and bilateral high-frequency sensorineural hearing loss detectable by pure-tone audiometry.
A 29-year old female with multiple sclerosis showed a very slightly low-frequency hearing loss, but speech audiometry showed 85%(55dB) in the left ear. Auditory evoked brainstem response (ABR) of the left side slowed a normal peak I with an absence of subsequent peaks. MRI demonstrateda lesion within the left eight nerve root and multiple small central lesions beneath the lateralventricles. After 6 months audiometry, the most speech audiometry and caloric test revealed complete recovery.We diagnosed that sudden hearing loss and dizziness might be the symptoms of multiple sclerosis.