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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 4 (contralateral). In 1983, a 40-year-old woman came to our institution with a profound sensorineural hearing loss in the left ear, which she had had since the age of 10 years following an attack of bacterial meningitis. The patient said that she was now experiencing a fluctuating hearing loss in the right ear, which was accompanied by tinnitus. The results of her otolaryngologic and physical examinations were unremarkable. Audiography revealed a profound sensorineural hearing loss in the left ear of 90 dB PTA and a low-frequency hearing loss in the right ear of 40 dB PTA with a 4-kHz dip. Tone-decay tests were negative on both sides. ENG with caloric testing produced a reduced vestibular response in the left ear and a normal response in the right. Computed tomography (CT) revealed hydrocephalus. The patient's glycerol test was positive in the right ear. The woman was diagnosed as having contralateral DEH associated with hydrocephalus, and medical treatment was prescribed.
Two years later, she returned complaining of serious disequilibrium, a transient floating sensation, and noise intolerance in the right ear. ENG again revealed a normal response in the right ear. Repeat audiography showed 95 dB PTA and a 0% SDS in the left ear and 40 dB PTA and 36% SDS in the right. High-resolution CT and pneumocisternography were both negative, indicating that there were no tumors in the cerebellopontine angle and internal auditory canals. A repeat glycerol test was again positive on the right. The patient's symptoms were controlled by medical therapy.
Five years later in 1990, the patient began to experience severe vertigo, nausea, and vomiting. Her hearing had deteriorated in the right ear and her disequilibrium had intensified. Her Romberg's test was positive. All other test results were similar to those previously conducted. The woman's disequilibrium and headaches had become so severe (which indicated recurrent hydrocephalus) that a ventriculoperitoneal shunt was reluctantly inserted. The shunt was successful in relieving her symptoms. One week after surgery, her vertigo gradually diminished and her hearing threshold in the right ear had improved from 55 to 40 dB PTA. One month postoperatively, the patient was discharged from the hospital.
Three days after discharge, the patient returned to the emergency room complaining of hemiparesis and severe headache on the right. CT revealed the presence of a subdural hemorrhage. A craniotomy was performed and a ventriculoperitoneal shunt revision was successfully performed. The patient recovered, and conservative measures eventually stabilized the cochleovestbular symptoms. To date, she remains asymptomatic.
Cases of concomitant DEH and hydrocephalus are undoubtedly caused by meningitis. However, the relationship between the symptoms of DEH and hydrocephalus has not yet been satisfactorily explained.
Case 5 (contralateral). A 42-year-old woman had been completely deaf in her left ear since the age of 8 years. The cause of her deafness was unknown. During the previous year, she began experiencing episodic vertigo, tinnitus, and fullness in her right ear.
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