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Industry: Email Alert RSS FeedDelayed endolymphatic hydrops: Study and review of clinical implications and surgical treatment - Brief Article
Ear, Nose & Throat Journal, Feb, 2001 by Tsun-Sheng Huang, Ching-Chen Lin
Case reports
Five selected case reports follow, describing two patients with ipsilateral DEH, the one with bilateral DEH, and two with contralateral DEH.
Case I (ipsilateral). A 19-year-old woman reported a severe sensorineural hearing loss in the left ear that began during her childhood following an episode of otitis media and mastoiditis. During the previous year, she had experienced episodic vertigo and tinnitus in the left ear.
Her physical examination revealed an atrophic scarring of the left tympanic membrane. Audiography showed residual responses at 0.25 and 0.5 kHz in the left ear and normal hearing in the right. ENG revealed a canal paresis in the left ear and a normal response on the right. Blood test results were unremarkable, but a mastoid x-ray showed sclerosis on the left. In 1979, ELS surgery was performed on the left ear, but it failed to control her vertigo. Three months later, when her vertigo had become incapacitating, a labyrinthectomy was reluctantly performed to relieve her symptoms.
Case 2 (bilateral). A 29-year-old woman had had a profound sensorineural hearing loss in both ears since the age of 4 years following an episode of high fever. During the previous year, she began to experience episodic vertigo and tinnitus and fullness in both ears.
A physical examination revealed that her eardrums were normal. Audiography confirmed a profound bilateral sensorineural hearing loss of 85 dB pure-tone average (PTA) in both ears, a 12% speech discrimination score (SDS) in the right ear, and an 8% SDS in the left. ENG revealed a reduced vestibular response in both ears. Blood test results were unremarkable, and dehydration testing was negative bilaterally. Radiologic study of the mastoids was also unremarkable.
Because the woman's vertigo was disabling, ELS surgery was performed on the right ear with an Austin endolymph dispersement drain in 1987. One month later, the same procedure was employed on the left ear. Afterward, the woman reported no recurrence of her vertigo attacks. She did occasionally experience adjunctive spells, which were controlled medically. She has aidable hearing.
Case 3 (ipsilateral). In 1987, a 26-year-old woman had suddenly experienced a nearly total deafness on the left side, which was accompanied by tinnitus and fullness in the same ear. Left ear audiometry revealed only residual responses at 1 and 2 kHz. No improvement was noted after medical treatment.
Two years later, the patient complained of episodic vertigo, nausea, and vomiting. ENG showed a normal vestibular function bilaterally. Audiography confirmed the total deafness on the left (10 dB PTA), a speech reception threshold of 10 dB, and a 100% SDS on the right side.
When 4 months of medical treatment proved to be ineffective, a cochleosacculotomy was performed on the left ear. The patient reported no further vertigo attacks postoperatively, but she did complain of dizziness and disabling disequilibrium. Streptomycin perfusion (0.1 ml of 25 [micro]g/ml streptomycin compound) of the labyrinth was initiated 7 months later. Postoperatively, the patient's fistula test was negative, and she exhibited no response to the maximal (icewater) caloric test. The patient continues to be asymptomatic.
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