Thirty patients with temporo-mandibular joint dysfunction were selected to investigate the changes in otoacoustic emissions before and after conservative treatment of their temporo-mandibular joints. Pure tone audiometry, transient-evoked otoacoustic emissions (TEOAE), distortion-product otoacoustic emissions (DPOAE) as well as a tinnitus questionnaire were administered to all patients before and after therapy. Therapy was conservative in the form of counselling, physiotherapy, anti-inflammatory agents, muscle relaxants, and occlusal splints. Results indicated insignificant changes in the TEOAEs, whereas there were significant increases in distortion product levels at most of the frequency bands. These results were paralleled to subjective improvement of tinnitus.

Ménière's disease (MD) is characterised by intermittent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus and aural pressure. Histopathologically, endolymphatic hydrops are seen initially in the cochlear duct and saccule, and with progression of the disease subsequent involvement of the utricle and semicircular canals occurs. The aims of this study are: 1) to assess the function of the saccule, utricle and three semicircular canals using cervical vestibular evoked myogenic potential (cVEMP), ocular VEMP (oVEMP) and video head impulse test (vHIT) in Ménière's patients, and 2) to correlate the findings with the different stages of MD. Forty patients diagnosed with unilateral definite MD according to the AAO-HNS (1995) criteria were tested. They were divided into four subgroups according to the stage of MD using the average of 500, 1000, 2000 and 3000 Hz pure tone thresholds of the worst documented audiogram during the 6-month interval before examination. A control group of 40 healthy age-matched adults was equally divided into four corresponding subgroups according to their pure tone average. 500 and 1000 Hz tone burst air conduction cVEMP and oVEMP tests, bithermal caloric test and video HIT for all semicircular canals were recorded for both groups. The results of this study showed that the highest prevalence of abnormalities in Ménière's patients were seen in the PTA (85%), followed by cVEMP (72.5%) and oVEMP (67.5%). Caloric test abnormalities followed with a lower prevalence of 32.5%. The vHIT presented the lowest prevalence of abnormalities with 20% in the lateral canal, 7.5% in the anterior and 5% in the posterior. This pattern of abnormality agrees with the histopathological pattern of hydrops formation in the vestibular system. The findings of the current study suggest that with the advancement in the stage of MD, abnormal cVEMP, oVEMP, caloric and vHIT responses occur following the histopathological evidence of progression of the disease from the saccule up to the semicircular canals. Based on these findings, the authors suggest a new staging scheme for MD. KEY WORDS: Cervical vestibular evoked myogenic potential • Ocular vestibular evoked myogenic potential • Video head impulse test • Ménière's disease • Staging of Ménière's disease RIASSUNTO La malattia di Ménière (MD) è caratterizzata da episodi intermittenti di vertigine, ipoacusia neurosensoriale fluttuante, tinnito e sensazione di ovattamento auricolare. L'idrope endolinfatica è inizialmente osservata a livello istopatologico nel dotto cocleare e nel sacculo, ma con la progressione della malattia anche l'utricolo e i canali semicircolari possono venire interessati. Lo scopo dello studio è duplice: 1) definire la funzione del sacculo, dell'utricolo e dei tre canali semicircolari per mezzo di potenziali evocati vestibolari miogeni cervicali e oculari (cVEMP, oVEMP) e del video-Head Impulse Test (vHIT) nei pazienti affetti da MD; 2) correlare i risultati ottenuti con i diversi stadi di malattia. Quaranta pazienti con diagnosi di MD m...

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Objective: Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. Study Design: Retrospective review. Setting: University Hospital. Patients: Patients with small-or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). Interventions: SRS or observation. Main Outcome Measure: Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. Results: Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 AE 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 AE 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. Conclusion: Based on our data we conclude that patients with small-and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.

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