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Background: Vertigo is a common presenting symptom in clinical practice, predominantly of vestibular etiology, and often medicated with betahistine, despite the lack of knowledge concerning its mechanism of action. This paper's objective was to review the scientific evidence regarding the efficacy of betahistine on peripheral vertigo. Methods: A systematic search of articles written in English, published within the past 10 years, was conducted in April 2024, on online evidence-based medicine databases, using the MeSH terms "betahistine," "ménière disease," "acute vestibular neuritis," "paroxysmal vertigo," "acute peripheral vestibulopathy," and "labyrinthitis." The Strength of Recommendation Taxonomy of the American Academy of Family Physicians was used to evaluate the level of evidence and strength of recommendation. Results: This review included 12 articles for evidence analysis. Concerning Menière's disease, despite contradictory results, three of the articles analyzed showed a positive effect of betahistine, which is in line with the recommendations of the European Academy of Otology and Neurotology and NICE guidelines, while the American Academy of Otorhinolaryngology guidelines suggest offering betahistine as maintenance therapy. For benign paroxysmal positional vertigo, the established treatment is repositioning maneuvers, and three of the five studies analyzed proved the addition of betahistine to be beneficial. In regard to peripheral vertigo from other causes, two out of three articles revealed a positive recommendation for the use of betahistine. Conclusion: There is a potential benefit to the utilization of betahistine for various etiologies of peripheral vertigo. However, additional studies are required to establish more robust evidence. [ABSTRACT FROM AUTHOR]

Background and Purpose: Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in improving cancer survival, radiation therapy has long been recognized to have various negative effects, ranging from mild to severe. In this manuscript, we review several intracranial manifestations of therapeutic radiation, with particular attention to those that may be encountered by radiologists. Methods: We conducted an extensive literature review of known complications of intracranial radiation therapy. Based on this review, we selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications, focusing only on patients who had a history of intracranial radiation therapy. We then selected cases that best exemplified expected imaging findings in these entities. Results: Based on our initial literature search and imaging database review, we selected cases of radiation-induced meningioma, radiation-induced glioma, cavernous malformation, enlarging perivascular spaces, leukoencephalopathy, stroke-like migraine after radiation therapy, Moyamoya syndrome, radiation necrosis, radiation-induced labyrinthitis, optic neuropathy, and retinopathy. Although retinopathy is not typically apparent on imaging, it has been included given its clinical overlap with optic neuropathy. Conclusions: We describe the clinical and imaging features of selected sequelae of intracranial radiation therapy, with a focus on those most relevant to practicing radiologists. Knowledge of these complications and their imaging findings is important, because radiologists play a key role in early detection of these entities. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the underlying pathophysiology and the patterns of disease spread is crucial in accurate image interpretation. In this pictorial review, the common and important inflammatory processes of the temporal bone in children will be discussed, and key computed tomography (CT) and magnetic resonance imaging (MRI) features described. Methods: Inflammatory processes are categorized by anatomical location: the petrous apex and the inner, middle and outer ear. A complete review of the literature is provided. Results: Cholesteatoma, cholesterol granuloma and mucoceles are inflammatory processes that occur across the anatomical subsites of the temporal bone, whilst site-specific inflammatory processes include labyrinthitis ossificans in the inner ear and keratosis obturans in the external ear. Infection is a key cause of inflammation in the temporal bone, and specific infections include petrous apicitis, otitis media and necrotizing otitis externa. Finally, important mimics and do-not-touch lesions are considered. CT and MRI are complementary in assessing these disorders, as two of the most important diagnostic clues are the presence of bone erosion, best appreciated on CT, and true diffusion restriction as seen on MRI. Flow charts to assist in the diagnosis of paediatric temporal bone inflammatory disease are also provided. Conclusion: Paediatric temporal bone inflammatory processes are common and can have severe clinical sequelae. Timely intervention, facilitated by correct radiological diagnosis, can often prevent progression of disease, loss of hearing and systemic illness. [ABSTRACT FROM AUTHOR]

Issues of complete disease clearance and hearing preservation in cholesteatoma induced labyrinthine fistula cases has been discussed and updated in this article. Successful disease clearance and hearing preservation in a case of cholesteatoma induced isolated cochlear promontory fistula encouraged us to retrospectively analyse 13 more cases of cholesteatoma induced labyrinthine fistula who presented in emergency service as complicated chronic suppurtive otitis media. Pre-operatively nine patients experienced vertigo, two had profound sensori neural hearing loss and radiology was suggestive of labyrinthine fistula in 12 patients. Lateral semicircular canal was involved in 13 cases. In all cases cholesteatoma matrix was completely removed from the fistula site irrespective of the fistula size and hearing status. Hearing was preserved in 11 out of 12 patients. Gentle and meticulous removal of the matrix and careful repair of labyrinthine fistula delivers significant hearing preservation rate along with a safe and dry ear which avoids a second look surgery. [ABSTRACT FROM AUTHOR]

Acute vertigo with sudden sensorineural hearing loss (SSNHL) is a rare clinical emergency. Here, we report the audio-vestibular test profiles of 27 subjects who presented with these symptoms. The vestibular test battery consisted of a three-dimensional video head impulse test (vHIT) of semicircular canal function and recording ocular and cervical vestibular-evoked myogenic potentials (oVEMP, cVEMP) to test otolith dysfunction. Unlike vestibular neuritis, where the horizontal and anterior canals with utricular function are more frequently impaired, 74 % of subjects with vertigo and SSNHL demonstrated impairment of the posterior canal gain (0.45 ± 0.20). Only 41 % showed impairment of the horizontal canal gains (0.78 ± 0.27) and 30 % of the anterior canal gains (0.79 ± 0.26), while 38 % of oVEMPs [asymmetry ratio (AR) = 41.0 ± 41.3 %] and 33 % of cVEMPs (AR = 47.3 ± 41.2 %) were significantly asymmetrical. Twenty-three subjects were diagnosed with labyrinthitis/labyrinthine infarction in the absence of evidence for an underlying pathology. Four subjects had a definitive diagnosis [Ramsay Hunt Syndrome, vestibular schwannoma, anterior inferior cerebellar artery (AICA) infarction, and traction injury]. Ischemia involving the common-cochlear or vestibulo-cochlear branches of the labyrinthine artery could be the simplest explanation for vertigo with SSNHL. Audio-vestibular tests did not provide easy separation between ischaemic and non-ischaemic causes of vertigo with SSNHL. [ABSTRACT FROM AUTHOR]

The aim of this paper was to evaluate prospectively, in a group of patients affected by VN, a diagnostic protocol employing C-VEMPs, O-VEMPs and vHIT together. The diagnosis of vestibular neurolabyrinthitis was based on the clinical history, absence of associated auditory or neurological symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function using the Fitzgerald-Hallpike caloric vestibular test and ice test. Our series revealed an incidence of 55 % of superior and inferior vestibular neurolabyrinthitis, 40 % of superior vestibular neurolabyrinthitis and 5 % of inferior vestibular neurolabyrinthitis. These data, however, comprised different degrees of vestibular involvement considering the evaluation of each single vestibular end-organ with potential different prognosis. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. The implementation of C-VEMPs, O-VEMPs and vHIT in a vestibular diagnostic protocol has made possible to observe patients with ampullary VN, unidentifiable with other types of vestibular exams. The effect of age seems to have some impact on the recovery. When recovery firstly involves the utricular and saccular nerves and subsequently the ampullary nerves, it may be reasonable to expect a more favorable and successful outcome. [ABSTRACT FROM AUTHOR]

Background: Meningitis is the most common cause of acquired sensorineural hearing loss (SNHL) in children. Labyrinthitis ossificans develops in a significant number of patients with meningitis-related SNHL. Reduced T2 signal on MRI within the membranous labyrinth is often noted in the fibrous and ossifying stages of labyrinthitis ossificans. Objective: The purpose of this study is to demonstrate the distribution and extent of involvement of the cochlea in children being evaluated for labyrinthitis ossificans; using high-resolution 3-D T2-weighted imaging, and to evaluate for subtle involvement of the scala tympani within the basal turn of the cochlea. Materials and methods: A retrospective review from 2002 to 2012 was performed using a cochlear implant database and PACS search function. Twenty-four patients were found to have MR findings consistent with labyrinthitis ossificans, 13 previously reported. Axial 3-D T2-weighted sequences were obtained in all patients. The presence of abnormal decreased T2 signal within the scala tympani and vestibuli of the cochlea was noted and graded according to the extent. The electronic medical record was reviewed for audiometry and risk factors as well as correlative operative findings. Results: The average age at imaging was 4.2 years. M:F ratio = 5:1. Eighty-eight percent (21/24) of patients had bilateral SNHL. The most common risk factor for labyrinthitis ossificans was meningitis (19/24 or 79%). Eighteen (75%) patients had a history of bacterial meningitis. The mean age for the onset of labyrinthitis was 1.2 years with an average of 2.2-year interval to imaging. Nineteen patients (79%) underwent placement of a cochlear implant. Cochlear obstruction was documented in 83% (40/48) of the ears. Lower grade (1) cochlear obstruction was present in 14 ears and limited to the scala tympani. Statistical analysis was performed correlating MRI imaging and surgical findings. Conclusion: Subtle, isolated involvement of the scala tympani within the proximal basal turn is a common finding in labyrinthitis ossificans and history typical for meningitis is not uniformly present. The extent of cochlear obstruction is important and has surgical implications. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inner ear decompression sickness (IEDCS) in scuba divers is increasingly observed, but epidemiological data are limited to small case series and the pathogenesis remains elusive. We report our experience over a 13-year period. We also thought to demonstrate that the development of this injury is mainly attributed to a mechanism of vascular origin. Diving information, clinical data, presence of circulatory right-to-left shunt (RLS), and laboratory investigations of 115 recreational divers were retrospectively analyzed. A follow-up study at 3 months was possible with the last 50 consecutive cases. IEDCS (99 males, 44 ± 11 years) represented 24 % of all the patients treated. The median delay of onset of symptoms after surfacing was 20 min. Violation of decompression procedure was recorded in 3 % while repetitive dives were observed in 33 %. The median time to hyperbaric treatment was 180 min. Pure vestibular disorders were observed in 76.5 %, cochlear deficit in 6 % and combination of symptoms in 17.5 %. Additional skin and neurological disorders were reported in 15 % of cases. In 77 %, a large RLS was detected with a preponderant right-sided lateralization of IEDCS (80 %, P < 0.001). Incomplete recovery was found in 68 % of the followed patients. Time to recompression did not seem to influence the clinical outcome. IEDCS is a common presentation of decompression sickness following an uneventful scuba dive, but the therapeutic response remains poor. The high prevalence of RLS combined with a right-sided predominance of inner ear dysfunction suggests a preferential mechanism of paradoxical arterial gas emboli through a vascular anatomical selectivity. [ABSTRACT FROM AUTHOR]

The presence of spontaneous nystagmus in darkness with a strong horizontal component has been taken to indicate that there is asymmetrical function of the horizontal semicircular canals. If this horizontal spontaneous nystagmus can be suppressed by vision, then it is regarded as due to peripheral horizontal canal dysfunction. However, we report evidence from one patient (61-year-old male), who visited the MSA ENT Clinic, Cassino (FR) Italy, reporting acute, severe vertigo, postural unsteadiness, nausea and vomiting associated with right sudden hearing loss. The patient received instrumental audiovestibular testing to obtain objective measurements of his inner-ear receptors. At the time of the attack, the patient showed spontaneous nystagmus, mainly with horizontal and vertical components (3D infrared video-oculography). Video head-impulse tests of dynamic horizontal canal function showed that the functional status of both horizontal canals was within the normal range. Cervical VEMPs to 500 Hz bone-conducted vibration at Fz showed normal results; ocular VEMPs to the same stimulus showed a reduced n10 amplitude beneath the left eye, corresponding to the right ear. For this reason, the patient was diagnosed as having right unilateral selective utricular macula lesion due to labyrinthitis. There is considerable evidence of convergence of neural input from the otoliths onto horizontal canal neurons in the vestibular nuclei. The firing of such neurons could reflect either asymmetrical horizontal canal function or asymmetrical utricular function. The problem with this patient was not due to asymmetrical horizontal canal function, but only to asymmetrical utricular function, demonstrated by the results of the oVEMP test. [ABSTRACT FROM AUTHOR]

The diagnosis of vertigo syndromes in childhood is considered a difficult challenge. A correct diagnosis, however, makes successful therapy possible, prevents unnecessary investigations and alleviates the worries of parents. Migraine-associated forms of vertigo are very common in children (benign paroxysmal vertigo of childhood, vestibular migraine) and account for about 50% of diagnoses. Acute unilateral vestibular failure in the course of infectious and para-infectious labyrinthitis is also more common in children than in adults. Motion sickness is a frequent and relevant problem in children aged 4-10 years old. A number of rare congenital syndromes can occur with bilateral vestibular failure. Because of the relatively high frequency of brainstem and cerebellar tumors in children, MRI should be considered in all patients presenting with subacute central vestibular signs. In principle, all forms of vertigo known in adult patients can also occur in children; however, they must gradually be included in the diagnostic spectrum of the primary care physician (e.g., vestibular paroxysm). [ABSTRACT FROM AUTHOR]

The otogenic cerebellar abscess still is one of the most dangerous complications of otitis media and implicates a high risk of mortality. Early diagnosis and therapy are decisive factors for the chances of rehabilitation. Radiologic imaging (CT/MRI) plays an important role. A broad-spectrum antibiotic according to antibiogram is indispensable. The type of surgical intervention depends on the cause and localization of the abscess. In this case the cerebellar abscess was a complication resulting from labyrinthitis, which was propagated through the endolymphatic duct and sac to the posterior fossa dura. Consequently, it could be cured ultimately only after petrosectomy and abscess drainage toward the mastoid cavity. It is mandatory to completely sanitize the infection surgically in order to avoid lethal complication especially in case of a delayed clinical course or recurrent symptoms of labyrinth involvement. Close interdisciplinary collaboration between ORL, neurosurgery and neuroradiology is desirable for successful therapy. [ABSTRACT FROM AUTHOR]

The inner ear is capable of rapidly mounting an immune response that can ultimately lead to cochlear degeneration and permanent hearing loss. The role of the endolymphatic sac in this immune process is not clear. In order to investigate the cytokine expression of cells within the endolymphatic sac, a secondary inner ear immune response to keyhole limpet hemocyanin (KLH) was created in mice. The animals were sacrificed 3-48 h and 7 days following initiation of the immune response. The cochleas and endolymphatic sacs were assayed by immunocytochemistry for IL-1beta, TNFalpha, and IL-6. Three hours after KLH challenge of the scala tympani, the perisaccular tissue of the endolymphatic sac contained more inflammatory cells than the scala tympani or endolymphatic sac lumen. Only a few of these cells, however, expressed the proinflammatory cytokines IL-1beta and TNFalpha between 3 and 12 h after KLH injection. On the other hand, TNFalpha, which plays an important role in the cochlear secondary immune response, was expressed in cells in the endolymphatic sac lumen. The maximum percentage of cells expressing TNFalpha was seen later than in the scala tympani. Animals treated with systemic injection of the TNF blocker, etanercept, showed a reduction in the number of cells in the endolymphatic sac lumen. It is concluded that the cells in the endolymphatic sac lumen contribute to the amplification of the adaptive immune response by expressing TNFalpha, while the infiltration of cells into the perisaccular connective tissue is part of the nonspecific, innate, cochlear immune response. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

For the evaluation of functional inner ear lesions caused by an autoimmune-induced labyrinthitis, transiently evoked otoacoustic emissions (TEOAEs) were detected in guinea pigs before and after transfer of sensitized lymphocytes from animals suffering from a labyrinthitis induced by the foreign protein keyhole limpet hemocyanin (KLH). Initially TEOAEs were detectable from 47 of 62 ears (76%) in healthy guinea pigs. These animals then were used as recipients for sensitized lymphocytes from donors exclusively. Three months after cell transfer the incidence of TEOAEs was reduced to 48% in animals receiving lymphocytes from donors sensitized with KLH intradermally and intracochlearly. In recipients of lymphocytes from donors sensitized only intradermally and in untreated animals no significant alteration of the TEOAE incidence was found. These findings showed strong correlation with those from scanning electron microscopy of the organ of Corti, indicating that the measurement of TEOAE is a useful, time-saving tool for the detection of cochlear dysfunction caused by sensitized lymphocytes in experimental animal. The present findings also show that the migration of sensitized lymphocytes actually leads to functional lesions in the cochlea. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is the gram-negative bacterial rod which is often isolated from chronic aural discharge. This microorganism may also cause necrotizing infection of the external auditory canal in certain patients with impaired host-defense mechanisms. Involvement of the inner ear by this microbe is extremly rare. In this communication, we report a case of pseudomonas labyrinthitis which resulted from traumatic middle ear injury. Infection produced massive granulations and extensive bone destruction of the otic capsule. This case shows that while P. aeruginosa is usually an avirulent opportunistic pathogen, it may also cause a highly destructive labyrinthitis if the inner ear is entered. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Oto-rhino-laryngology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Oto-rhino-laryngology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Manifest fungal infection of the middle ear, fungal mastoiditis, is a very rare entity, which is almost exclusively seen in immunocompromised patients. The authors present a case of fungal mastoiditis in a 52-year-old woman without immunocompromise. The patient presented with acutely progressing symptoms of hearing loss and dysequilibrium. Bony fistula of the semicircular canal was noted on CT scans and a marginal perforation of the tympanic membrane was also seen. Her hearing recovered following the surgery, which revealed massive granulations and proliferation of fungi but no cholesteatoma in the mastoid cavity. Fungal infection of the middle ear is rare, but can cause serious complications. The possibility should be considered even in immunocompetent patients. [ABSTRACT FROM AUTHOR]

We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semicircular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation. [ABSTRACT FROM AUTHOR]