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MRI showed a right CP angle mass 20x15-mm low signal on T1W and mildly hyperintense on T2W and flair images. As is the case with most other intracranial pathology, MRI is the investigation of choice for the diagnosis and characterization of meningiomas. Usually MRS does not play a significant role in diagnosis, but can help distinguish meningiomas from mimics. Die Angabe Ihrer E-Mail-Adresse dient ausschlieAYlich der Benachrichtigung des EmpfA¤ngers und wird nicht zu Werbezwecken verwendet oder an Dritte weitergeleitet. Idiopathic sudden sensorineural hearing loss is a medical emergency that requires urgent diagnosis and treatment, and the adaptation of a proper protocol for management is a priority. Idiopathic sudden sensorineural hearing loss (ISSNHL) [1] is a well-known clinical condition characterized by a sudden occurrence in one or both ears of sensorineural hearing loss of more than 30 dB in at least three contiguous audiometric frequencies over a time course of no more than 72 hours.
Hearing impairment is a common problem worldwide and even more problematic in developing countries. Sensorineural hearing loss [4-9] (or nerve-related deafness) involves damage to the ear caused by aging, prenatal and birth-related problems, viral and bacterial infections, heredity, trauma, exposure to loud noise, fluid backup, or tumor in the inner ear.
This retrospective study was conducted from January 2002 to December 2003 to identify patients with ISSNHL.
We found no age relation or significant side predilection, and the duration of improvement was variable, extending from less than 1 week to up to 6 weeks. The prognosis of tinnitus involved full recovery in all but one of the grade 4 patients; the unrecovered patient had at 8 kHz a dip that did not improve. All but three patients who developed dizziness (those with very severe hearing loss) had fully recovered in a few days; the unrecovered group had dizzy spells that lasted more than a few days. ISSNHL is a symptom of cochlear injury and is characterized by sudden onset; within a few hours, it reaches its maximum peak. Although called sudden, hearing loss seems unlikely to be abrupt but rather probably evolves over a few hours [6]. Research conducted by the Institute of Audiology in Turin documented that 5,925 cases were diagnosed over a 5-year period (1990-1995) [7].
Many causes can trigger sudden hearing loss [6-10] but, despite extensive evaluation, the majority of cases elude definitive diagnosis and, therefore, remain idiopathic. Our study revealed that the treatment protocol involving steroid therapy in Qatar resulted in hearing improvement in 57.4% of patients with ISSNHL. Tinnitus frequently accompanies hearing loss in patients with otosclerosis and has been correlated with distinct otosclerotic pathologies.
Subjective tinnitus is any abnormal noise perceived by a patient but having no existing external acoustic stimulus as its source. However, surgical repair of otosclerosis has been shown lo affect tinnitus, and the extent of this impact varies significantly across studies [2-6]. Ours was a retrospective study of 357 patients with a diagnosis of otosclerosis between the years 1993 and 2000, 40 of whom had undergone stapedectomy surgery, had documented preoperative tinnitus, and were available for interview at the time of study. Tables 2-4 show the audiometric results represented in compliance with the AAO-HNS level 1 and level 2 guidelines, respectively.
Stapedectomy for otosclerosis has been reported to have an unpredictable effect on the symptom of tinnitus [51. This study avoids potential confounding factors, such as that of having various surgeons perform stapedectomy (with possible idiosyncrasies in methodology) and differences in choice of prosthetic device.
Explanation of how successful stapedectomy may improve tinnitus remains to be completely understood. Forty patients with tinnitus and otosclerosis were retrospectively reviewed and interviewed to determine the effect of stapedectomy on their tinnitus. This manuscript was presented at the American Academy of Otolaryngology - Head and Neck Surgery Annual Meeting, San Diego, CA, September 14-16, 2002. Management of Idiopathic Sudden Sensorineural Hearing Loss: Experience in Newly Developing Qatar. A report prepared by the Department of Otolaryngology [3] at University of Texas Medical Branch documented approximately 15,000 reported cases of ISSNHL per year worldwide, with 4,000 of those cases occurring in the United States.
Therefore, we have a pressing need to study the causes of ISSNHL and suggest a treatment protocol for ISSNHL. Of the studied subjects, 81% were male and 19% were female (median age, 43 years; range, 24-67 years).
Of the seven patients (33.3%) who showed no improvement in their hearing both audiologically and clinically (grade 1), six patients had dizzy spells when first seen, four had audiometric HTLs of 65 dB or no response at 8 kHz, five had high-frequency sloping audiometric curves, and all showed no improvement at 6 weeks' duration. Incidentally that patient developed recurrence of hearing loss 12 week later but in the opposite ear, which was also treated with steroid therapy and showed remarkable improvement.

ISSNHL is the most intractable of hearing loss types, because its fundamental cause is hair cell death. The researchers concluded that sudden idiopathic hearing loss, often attributed to general vascular causes, was one of the most frequent reasons for monolateral hearing loss. Furthermore, we concluded that results can be improved if the disorder is diagnosed early in patients using proper protocols and if early treatment is undertaken. Department of Medical Statistics and Epidemiology, Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar.
The objective of our study was to evaluate the effect of stapedectomy on tinnitus in patients with otosclerosis.
Estimates indicate that in the United States, more than 35 million people experience tinnitus beyond a transient duration and that approximately 10 million people experience symptoms troubling enough to interfere with normal working and leisure life [l]. Previous examinations of the effect of stapedectomy on tinnitus in otosclerosis have proceeded without the use of a classification system that distinguishes levels of tinnitus distress. The surgeries were performed by a single surgeon at the Loyola University of Chicago, Foster McGaw Hospital. A major limitation in the study, however, was a lack of attainable, complete postoperative audiometric data.
Some have postulated that freedom from the toxic factors liberated by the otosclerotic focus into the labyrinthine fluid may be involved 110]. The aim of this study was to determine and identify as early as possible those factors that play the important role in the prognosis of the condition, to describe the experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Because of its various etiological possibilities and its prognostic characteristics, urgent attention and treatment are required, and the condition may be considered as an emergency. One in every 10,000- 15,000 people experience this condition, with the highest incidence occurring between 50 and 60 years of age. The prevalence of hearing loss increases with age; most hearing losses develop over a period of 25-30 years.
The aim of this study was to identify patients with ISSNHL as early as possible, to describe their experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Tympanometry showed a type-A curve in all patients, and acoustic reflex results were negative in the affected ear in 13 patients.
Spectacular advances have recently been made in our understanding of hair cell physiology and molecular biology, offering new hope of alleviating ISSNHL [10]. Also, we observed in our study that most patients who had ISSNHL ranged in age from 40 to 60 years, although the highest rate was found among men. Monolateral sensorineural hearing loss, which is not seriously disabling, represents a handicap from the social point of view.
The degree of hearing loss may vary from mild to severe and may involve different parts of the hearing frequency range. Suggested causes of ISSNHL include viral infections, immunologic vascular compromise, and intracochlear membrane breaks. Samson, Department of Epidemiology and Medical Statistics, Hamad Medical Cor poration, for her kind help in preparing and typing the manuscript.
Sudden hearing loss due to large vestibular aqueduct syndrome in a child: Should exploratory tympanotomy be performed?
Although the vast minority of patients complaining of tinnitus have concomitant treatable ear disorders, tinnitus frequently accompanies hearing loss as a significant presenting symptom in patients with otosclerosis. Kloekhoff and Lindblom [7] devised a classification system that can distinguish degrees of tinnitus distress.
The procedures involved use of 36 Robinson-Bucket, 1 McGee Piston, I Goldenberg, and 2 Teflon wire prosthetic devices. However, tinnitus in association with a eonductive hearing loss in ihe setting of otosclerosis may show more consistent improvement after successful stapedectomy surgery than has previously been thought [2-6]. The audiometric data that were collected demonstrated that both decrease and relief of tinnitus were statistically associated with an improved postoperative air-bone gap.
Meniere's disease and hydrochlorthiazide (Dichlotride): A critical analysis of symptoms and therapeutic effects. Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. However, because of controversies regarding etiology and the need for urgent treatment, various diagnosis and treatment protocols were advocated by different centers. Many hypotheses have been advanced to explain its etiology: viral inflammation, vascular diseases, allergic reaction, rupture of intralabyrinthine membranes, and autoimmune diseases. Audiological evaluation, including pure-tone audiometry, tympanometry, speech audiometry, and auditory brainstem-evoked response testing results were included.

All patients except one had unilateral ear involvement and revealed almost equal frequency of involvement for both left and right ears. Only three patients had speech audiometry and, for auditory brainstem response, results in nine patients were normal except for decreased HTL. Six patients of the grade 4 group had flat, basin-shaped or up-turning audiometric curves (Fig. We observed in our study that some of the causes of sudden or fluctuating sensorineural hearing loss were meningitis, multiple sclerosis, or Friedreich's ataxia. The exact cause of tinnitus in this setting has not been adequately explained, and its relation to otosclerosis is infrequently discussed in the literature. The system consists of seven grades, from 0 to 3, differing from one another with respect to prevalence or intensity (or both; Table 1).
The patients selected for study were screened for medical illnesses and use of medications known to lie associated with the presence of tinnitus. Evident from this study is that when degrees of tinnitus distress can be rendered distinguishable from one another using a standardized classification system, absolute relief of the symptom - and relative improvement in the level of distress associated with the symptom - can be frequent and marked. To elucidate further the relationship between changes in the symptom of tinnitus and additional audiometric measures, a greater sample of patients with complete audiometric data may he needed.
Recently, the predictors of tinnitus in otosclerosis were shown to be paradoxical as compared to the determinants of tinnitus in the general population [11].
It was conducted in the ear, nose, and throat outpatient clinics at Hamad General Hospital and the ear, nose, and throat wards at Rumailah Hospital. Recently, increasing interest is centered on the means of diagnosis and treatment, leading to the emergence of quite a variety of protocols adopted by different treatment centers. With respect to laboratory investigations, results of complete blood cell count, erythrocyte sedimentation rate, blood film for abnormal cells, and coagulation screening were normal in all patients. Twenty-five (62.5%) of the 40 patients were women, the range of age was 18-75 years, and the duration of their preoperative tinnitus ranged from I month to 2 years. Although the scientific understanding of the relationship between corrected conductive hearing loss and reduced tinnitus distress continues to develop, it remains of crucial importance for the etiology of tinnitus to be sought in newly presenting patients. Many studies have been carried out to assess the histopathology of the labyrinth in cases of ISSNHL and to provide a better understanding of the etiopathogenesis [10]. In ten of the twelve patients who showed improvement, the duration of onset was less than 14 days and was less than 7 days in six of eight patients in grade 4.
The incidence of tinnitus compares well with that in the literature [11,12]; however, tinnitus did not assist well in determining which patients would suffer hearing loss.
In all the studied cases, patients had an intact tympanic membrane and revealed no other ear, nose, and throat abnormality. The primary objective of this study was to examine closely the effect that stapedectomy had on tinnitus in patients with otosclerosis. As our study demonstrates, by successfully treating the cause when possible, we may attain significant measures of relief. The treatment protocol that was adopted-consisting of high-dose steroid therapy, full-dose antiviral drug (acyclovir), and a histamine analog, betahistine-resulted in hearing improvement in 57.4% of cases. Finally, most causes of ISSNHL remain unknown; thus the term idiopathic is applied to these cases. In respect to the duration of illness, 33.3% of the studied patients had the complaint for 2 weeks, and 19% had it for more than 4 weeks. However, a high incidence of associated dizziness may be responsible for poor recovery incidence in our series, so it can be considered to indicate a poor prognosis [13-15].
Postoperative air-bone gap was less for patients with decreased tinnitus than for those with no change. Using a classification system that made possible the distinction between greater and lesser degrees of tinnitus distress. Significant improvement was seen in the degree of tinnitus distress after stapedectomy for otosclerosis. The results of our study revealed that the steroid therapy protocol practiced in Qatar resulted in hearing improvement in patients with idiopathic sudden sensorineural hearing loss. Good prognostic factors include early diagnosis, marked reduction of symptoms, and improved shape of the audiometric curve.

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