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Visually-induced dizziness (visual vertigo) is a core symptom of Persistent Perceptual Postural Dizziness (PPPD) and occurs in other conditions and general populations. It is difficult to treat and lacks new treatments and research. We incorporated the existing rehabilitation approach of visual desensitisation into an online game environment to enhance control over visual motion and complexity. We report a mixed-methods feasibility trial assessing: Usage and adherence; rehabilitation potential; system usability and enjoyment; relationship with daily dizziness. Participants played online with (intervention, N = 37) or without (control, N = 39) the visual desensitisation component for up to 5-10 min, twice daily for 6 weeks. Dropout was 45%. In the intervention group, N = 17 played for the recommended time while N = 20 played less. Decreases in visual vertigo symptoms, anxiety and depression correlated with playtime for the intervention but not control. System usability was high. Daily symptoms predicted playtime. Qualitative responses broadly supported the gamified approach. The data suggest gamified visual desensitisation is accessible, acceptable and, if adherence challenges can be overcome, could become a useful addition to rehabilitation schedules for visually-induced dizziness and associated anxiety. Further trials are needed., (© 2024. The Author(s).)

A young man with cystic fibrosis in his early 30s presented to accident and emergency with acute onset unilateral lower motor neuron facial palsy, hearing loss and impaired balance following Mycobacterium abscessus eradication induction therapy. The hearing loss and impaired balance developed over a 3-day period prior to the onset of facial palsy. Further investigation with a CT scan and MRI scan led to a diagnosis of vestibular schwannoma. The facial palsy resolved with steroid treatment; however, the hearing loss is irreversible, which has had a profound impact on his life and career. This case is intriguing as the cause and association of events are unclear. A working diagnosis of incidental Bell's palsy and unilateral hearing loss caused by the vestibular schwannoma was applied. However, the onset of these symptoms in relation to M. abscessus eradication induction therapy promotes discussion., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The general consensus on the roles of hearing loss in triggering tinnitus seems not applicable in patients with normal hearing thresholds. The absence of hearing loss on the audiogram in this group of patients poses a serious challenge to the cochlear theories in explaining tinnitus generation in this group of patients., Objective: To scrutinize auditory functioning in a sample of tinnitus subjects with normal hearing thresholds and non-tinnitus normally hearing control participants using transient evoked and distortion product otoacoustic emission (TEOAE and DPOAE) and Threshold Equalising Noise (TEN) test., Methods: Twenty-seven tinnitus adult patients with normal hearing thresholds and 27 normally hearing volunteers were tested with TEOAE, DPOAE and TEN test., Results: Abnormal TEOAE was significantly more in tinnitus group than in controls. No significant difference was observed in DPOAE and TEN test. Only one patient was found with a positive TEN test result, who was confirmed by Magnetic Resonance Imaging to have acoustic neuroma on the affected ear., Conclusion: These results suggest the possible existence of subtle auditory deficit in normally hearing tinnitus patients, which may be an early sign of diseases that are only diagnosed after the onset of hearing loss.

Objective: We present an interesting case of superior and posterior semicircular canal dehiscence in pregnancy., Method: We present a case report and a review of the world literature concerning semicircular canal dehiscence., Case Report: A 34-year-old woman presented with sound and pressure induced vertigo at 22 weeks gestation. A thinly sliced computed tomography (CT) scan of the petrous temporal bones viewed with coronal reconstructions was performed post-partum. This showed the presence of both left superior canal and posterior canal dehiscence., Conclusion: To our knowledge this is the first reported case of semicircular canal dehiscence in pregnancy. The diagnosis of semicircular canal dehiscence should be suspected in pregnant patients with sound induced vertigo.

Twenty cases which presented with proptosis during the period of 1 year at the Madras Medical College & Govt. General Hospital, Madras, India were taken up for this prospective study. After a detailed ENT and ophthalmological examination, exophthalmometric readings were done on all cases. The etiological causes and other factors were analysed. Malignancies and benign tumours and tumour like lesions were found to be the commonest cause of proptosis. Infections which were once responsible for most cases of proptosis formed only a very small proportion. A person presenting with protosis as the only sign is most likely to suffer from a benign tumour or tumour like lesion while presence of other eye signs should raise the possibility of malignancies. The direction of proptosis was found to be more useful than exophthalmometric readings in determining the site of lesion.

The Noise measurements done during peak traffic hours in Chennai city in 1985, is compared with the levels prevailing in 1993 and the density of vehicles plying enumerated. The intensity of noise produced was found to be proportionate to the density of the vehicles. Noise levels at all points studied have shown a significant increase in the last eight years, varying from 2 dB to 10 dB. In most of the places the levels were found to be above 80 dB.A sample study of 100 individuals, selected from a survey comprising of 1100 traffic policemen, showed a high incidence (21 %) of noise induced hearing loss. Incidence of high frequency sensorineural hearing loss (18%) was also found to be high in these personnel.Possible causes for these findings are discussed and some remedial measures suggested.