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Objective: This study aimed to review the incidence and co-morbidity of functional ear symptoms in new referrals to an adult otology clinic and present a clinical model based on neuroscientific concepts. Method: This was a retrospective review of 1000 consecutive new referrals to an adult otology clinic. Results: Functional disorder was the primary diagnosis in 346 patients (34.6 per cent). Functional ear symptoms included tinnitus (69.7 per cent), imbalance (23.7 per cent), otalgia (22.8 per cent) and aural fullness (19.1 per cent), with more than one symptom occurring in 25.1 per cent of patients. Co-morbidities included sensorineural hearing loss (39 per cent), emotional stress (30 per cent) and chronic illness (22 per cent). Conclusion: Functional disorders commonly present to the otology clinic, often in the presence of emotional stress or chronic illness. They occur because of adaptation of brain circuitry to experience, including adverse events, chronic illness and fear learning. This study presented an experience-driven clinical model based on these concepts. An understanding of these principles will significantly aid otolaryngologists who encounter patients with functional ear symptoms. [ABSTRACT FROM AUTHOR]

Background:The postulated sites of perilymph fistulae involve otic capsule deficiencies, in particular, at the fissula ante fenestram. Histological studies have revealed this to be a channel extending from the middle ear, and becoming continuous with the inner ear medial to the anterior limit of the oval window. The relationship between a patent fissula and symptoms of perilymph fistula is contentious.Objective:The understanding of the anatomy of the fissula ante fenestram is incomplete. Histopathology is inherently destructive to the delicate ultrastructure of the middle and inner ear. Conversely, X-ray microtomography allows non-destructive examination of the otic capsule. In this study, we used X-ray microtomography to characterise the fissula ante fenestram.Materials and methods:We imaged cadaveric temporal bones with X-ray microtomography. We used the Avizo Fire (Visualization Science Group, Merignac Cedex, France) software to perform post-processing and image analysis.Results:Three-dimensional modelling of the fissula ante fenestram allowed stratification into four forms: rudimentary pit; partial fissula; complete occluded fissula; and complete patent fissula.Conclusion:X-ray microtomography showed that the fissula ante fenestram is present in various forms from rudimentary pit to complete deficiency of the otic capsule. This understanding may have implications for otologic surgery and clinical diagnosis of perilymph fistula. [ABSTRACT FROM PUBLISHER]

Objectives:This study aimed (1) to report the long-term effects of infliximab, a murine monoclonal antibody directed against tumour necrosis factor-α, on autoimmune inner ear disease, and (2) to discuss dilemmas surrounding the long-term management of autoimmune inner ear disease.Case report:A 49-year-old man presented with sudden-onset, left-sided, sensorineural hearing loss, tinnitus and vertigo. He was prescribed oral prednisolone, with benefit. Over several subsequent months, he experienced frequent relapses and progressive deterioration of high-frequency hearing bilaterally. Multiple agents failed to stabilise his condition. Following infliximab treatment, there was a documented and sustained improvement in his hearing and tinnitus. He stopped the treatment after 46 weeks, with rapid relapse of his condition. His hearing recovered quickly again after recommencing infliximab.Conclusion:The benefits of prolonged infliximab use and potential side effects must be balanced against allowing the disease to take its course, with progressive deafness. Randomised controlled trials are required to assess infliximab's optimal duration of use, long-term efficacy and safety in the treatment of autoimmune inner ear disease. [ABSTRACT FROM PUBLISHER]