We reviewed the findings in 1,220 cases of sudden sensori-neural hearing impairment encountered over a nine-year period at the Otologic Medical Group. A thorough neuro-otologic evaluation is indicated in each case. Ten patients had an acoustic tumor. A vasodilator regimen was prescribed in 380 cases and resulted in hearing improvement in 40%. Favorable prognostic findings were a low tone loss and absence of vertigo.

\s=b\Two cases suggest that long-standing recurrent otitis media contributes to delayed brain-stem evoked response wave III and V latencies persisting after resolution of the otitis media. The persistence of the delayed waves may not reflect structural damage, but rather may still reflect a slowly recovering system. (Arch Otolaryngol 1985;111:315-316) Recentl y auditory brain-stem evoked responses (BERs) in chil¬ dren with early histories of recurrent otitis media were found to differ from children with no history of middle ear disease.1 Wave I was found to be nor¬ mal, but waves III and V were found to have increased latencies resulting in increased I to III central conduction times, a pattern associated with brain stem, not cochlear, dysfunction.2 A mild conductive hearing loss, induced by the insertion of an earplug for a brief period (10 to 30 hours), also produced a lengthening of the I to III conduction time without affecting the III to V conduction time.3Historically, animal work offers only equivocal support for the conten¬ tion that conductive hearing loss has persistent effects central to the cochlea,47 however, induced perinatal unilateral conductive hearing loss had selectively influenced the size of audi¬ tory brain-stem neurons when mea¬ sured 12 to 24 days after birth.8 No changes were found when older ani¬ mals (24 to 45 days) were similarly manipulated. The volumes of the ven¬ tral cochlear nucleus, medial nucleus of the trapezoid body, and the inferior collicular nucleus were significantly impaired ipsilaterai to the ear with conductive loss when compared with the control side. The cochlear nucleus is the site of the suspected generators of wave III,9·10 the earliest evoked response component found to be aber¬ rant in children with a long history of middle ear disease.1 METHODS The case studies were two unrelated 8-year-old girls who had recurrent otitis media since infancy. Both had received several myringotomies and repeated venti¬ lating tube insertions. Otologie treatment was relatively ineffective until six months before BER testing. The BERs were recorded after the ears were clinically nor¬ mal for six months and the audiograms were normal. One child exhibited variabili¬ ty in behavioral audiometry with normal impedance studies. A normal audiogram was eventually obtained and verified by normal BER thresholds. Signals were 100-ps rarefaction clicks delivered at 83 dB equivalent sound pressure level at rates of 9/s and 33/s, and in one case 60/s. The electroencephalogram was filtered (0.15 to 3.0 kHz) and averaged in a 10-ms epoch with electrodes in the vertex-mastoid con¬ figuration. Two replications were obtained before accepting the evoked wareform. Only suprathreshold BER data were reported in the analysis of neural conduc¬ tion times.Electroencephalograms were performed prior to evoked potential testing and were interpretated as normal. Both children had experienced difficulties in school, particu¬ larly in the academic areas, and perfor¬ mance in these areas was approximately one gr...

The serpentine course of the hypoglossal nerve has been described and illustrated. Clinical and surgical correlations are reviewed.