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A case of intractable suspected perilymph fistula with severe depression.

Goto F, Oishi N, Tsutsumi T, Ogawa K - Psychiatry Investig (2014)

Bottom Line: Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative.However, her dizzy symptom did not improve.Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. ; Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT
A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient's finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment.

No MeSH data available.


Related in: MedlinePlus

Pure tone audiometry (PTA) upon first presentation to our hospital. The PTA revealed that the patient had bilateral mixed hearing loss. The patient had undergone a left tympanoplasty 42 years previously. She reported a 2-month history of acute sensorineural hearing loss in the right ear.
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Figure 1: Pure tone audiometry (PTA) upon first presentation to our hospital. The PTA revealed that the patient had bilateral mixed hearing loss. The patient had undergone a left tympanoplasty 42 years previously. She reported a 2-month history of acute sensorineural hearing loss in the right ear.

Mentions: A 68-year-old woman presented with frequent vertigo spells and long-standing dizziness accompanied by right-sided tinnitus after acute sensorineural hearing loss in the right ear several months before. When the patient was 24 years old, her left ear was surgically treated for chronic otitis media. Her pure tone audiometry (PTA) score as measured on her first visit revealed bilateral mixed hearing loss (Figure 1). An otoscopic examination of her left ear revealed the finding of postoperative tympanic membrane without any evidence of active inflammation and the enlargement of external auditory canal. The right ear was normal in appearance. However, when an otoscope was inserted in her right ear, the patient immediately complained of dizziness. She then admitted to feeling dizzy whenever she put her finger in her right ear. It was assumed that insertion of the otoscope exerted positive pressure to the external auditory canal and thereby provoked subjective dizziness. A charge-coupled device (CCD) camera was used to record all subsequent observations. The application of negative air pressure to the patient's right external auditory canal induced nystagmus toward the right side as well as a dizzy sensation. The patient also felt dizzy when changing her body position, but this sensation was not associated with apparent nystagmus.7 The patient also complained of tinnitus, which she characterized as similar to the sound of water streaming. The caloric test with ENG indicated canal paralysis of 35% in right ear with 20 degree water irrigation. Temporal bone CT did not reveal any findings of pneumolabyrinth or aerolabyrinth. There were no traumatic events to cause perilymph fistula, e.g., excessive pressure changes to the inner ear such as in deep-water diving, head trauma, or an extremely loud noise, etc. From these clinical findings we could not completely rule out the possibility of underlying idiopathic perilymph fistula.


A case of intractable suspected perilymph fistula with severe depression.

Goto F, Oishi N, Tsutsumi T, Ogawa K - Psychiatry Investig (2014)

Pure tone audiometry (PTA) upon first presentation to our hospital. The PTA revealed that the patient had bilateral mixed hearing loss. The patient had undergone a left tympanoplasty 42 years previously. She reported a 2-month history of acute sensorineural hearing loss in the right ear.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225218&req=5

Figure 1: Pure tone audiometry (PTA) upon first presentation to our hospital. The PTA revealed that the patient had bilateral mixed hearing loss. The patient had undergone a left tympanoplasty 42 years previously. She reported a 2-month history of acute sensorineural hearing loss in the right ear.
Mentions: A 68-year-old woman presented with frequent vertigo spells and long-standing dizziness accompanied by right-sided tinnitus after acute sensorineural hearing loss in the right ear several months before. When the patient was 24 years old, her left ear was surgically treated for chronic otitis media. Her pure tone audiometry (PTA) score as measured on her first visit revealed bilateral mixed hearing loss (Figure 1). An otoscopic examination of her left ear revealed the finding of postoperative tympanic membrane without any evidence of active inflammation and the enlargement of external auditory canal. The right ear was normal in appearance. However, when an otoscope was inserted in her right ear, the patient immediately complained of dizziness. She then admitted to feeling dizzy whenever she put her finger in her right ear. It was assumed that insertion of the otoscope exerted positive pressure to the external auditory canal and thereby provoked subjective dizziness. A charge-coupled device (CCD) camera was used to record all subsequent observations. The application of negative air pressure to the patient's right external auditory canal induced nystagmus toward the right side as well as a dizzy sensation. The patient also felt dizzy when changing her body position, but this sensation was not associated with apparent nystagmus.7 The patient also complained of tinnitus, which she characterized as similar to the sound of water streaming. The caloric test with ENG indicated canal paralysis of 35% in right ear with 20 degree water irrigation. Temporal bone CT did not reveal any findings of pneumolabyrinth or aerolabyrinth. There were no traumatic events to cause perilymph fistula, e.g., excessive pressure changes to the inner ear such as in deep-water diving, head trauma, or an extremely loud noise, etc. From these clinical findings we could not completely rule out the possibility of underlying idiopathic perilymph fistula.

Bottom Line: Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative.However, her dizzy symptom did not improve.Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. ; Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT
A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient's finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment.

No MeSH data available.


Related in: MedlinePlus