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The Epidemiology of Meniere‘s Disease and the Problems of Diagnosis. (Abstract of ARO Meeting Denver, Colorado) George Gates University of Washington

MD is a common disorder of unknown etiology that causes episodic vertigo with hearing loss, tinnitus, and ear fullness. Stress is a commonly cited co-factor in the pathogenesis of MD. MD affects both genders equally and is most common in 40-55 year olds. Some women have symptoms in relation to their menstrual cycle; whether this is hormonal or a reflection of stress is unclear. The overall prevalence of MD is estimated from 17/100,000 population in the U.S. To 46/100,000 in Sweden. The clinical course is variable and unpredictable. About 70% of patients respond to conservative treatment, such as low salt diet, diuretics and symptom suppressants, however 30% get progressively worse and often require surgical therapy. Although the long-term treatment results are acceptable, selection of cases for medical and surgical therapy varies widely.

Imaging of pulsatile tinnitus: a review of 74 patients. Clin Imaging. 2007 Mar-Apr;31(2):102-108. Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E Department of Radiology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey.

Objective: Our aim was to assess the effectiveness of imaging modalities in detecting the underlying pathologies in patients with pulsatile tinnitus. Materials and methods: Seventy-four patients with pulsatile tinnitus were radiologically evaluated. All patients except two are evaluated on a thin-section bone algorithm computed tomography scan covering the temporal bone and skull base, 14 patients with or without contrast-enhanced brain computed tomo- graphy, 7 patients with magnetic resonance imaging and magnetic resonance angiography, 5 patients with digital subtraction angiography, and 12 patients with Doppler ultrasonography. Results: The underlying pathology of tinnitus was detected in 50 patients (67.6%), and 24 patients were normal with radiologic studies. The most common cause was high jugular bulbus (21%) followed by atherosclerosis, dehiscent jugular bulbus, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum, and glomus tumor. Conclusion: It was concluded that radiologic imaging methods are effective in detecting the underlying pathology of pulsatile tinnitus.

Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula. L Laryngol Otol. 2007 Feb 13;:1-5. Lerut B, De Vuyst C, Ghekiere J, Vanopdenbosch L, Kuhweide R Department of Otolaryngology, Az St Jan Hospital, Bruges, Belgium.

Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxys- mal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure.The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsati- le tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.

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