John Tonkin

Rupture of the round window membrane

A perilymph leak into the middle ear through a ruptured round window membrane results in the symptoms of hearing loss, tinnitus and vertigo, either singly or in combination. The case histories of thirteen patients with such a fistula are described, these patients having in common a predisposing incident which had led to a rise of C.S.F. pressure. Symptomatology and the results of investigation are analysed and operative technique and results discussed. While it appears that vertigo uniformly responds very satisfactorily to operative treatment the improvement in hearing loss and tinnitus is more difficult to predict.

An evaluation of relaxation training in the treatment of tinnitus

Abstract Thirty tinnitus patients received either relaxation training with counterdemand instructions, relaxation training with neutral demand instructions or no treatment. Assessment of subjective tinnitus severity, sleep difficulties, depression and anxiety was conducted at pretreatment, posttreatment and a 6-week follow-up. Assessment of subjective tinnitus severity and sleep difficulties was also conducted in the middle of treatment. Audiological assessment of tinnitus was conducted at pretreatment and posttreatment. No significant effects for relaxation training were found on any measure. Only the Beck Depression Inventory improved significantly from pretreatment to posttreatment, but the degree of change was equivalent for both treated and untreated groups. While this study suggests that relaxation training is not an effective treatment for tinnitus, a number of explanations for the findings are offered.

EMG biofeedback in the treatment of tinnitus: An experimental evaluation

26 tinnitus patients received either electromyogram (EMG) biofeedback with counterdemand instructions, EMG biofeedback with neutral demand instructions, or no treatment. Assessment was conducted on self-report measures of the distress associated with tinnitus, the loudness, annoyance and awareness of tinnitus, sleep-onset difficulties, depression, and anxiety. Audiological assessment of tinnitus was also conducted and EMG levels were measured (the latter only in the 2 treatment groups). No significant treatment effects were found on any of the measures. There was a significant decrease in the ratings of tinnitus awareness over the assessment occasions, but the degree of change was equivalent for treated and untreated groups. Results do not support the assertion that EMG biofeedback is an effective treatment for tinnitus.

Outcomes in the use of intra-tympanic gentamicin in the treatment of Ménière's disease.

The pathogenesis of Ménières disease is associated with a disorder of ionic homeostasis, with the pathologic correlate being endolymphatic hydrops. Despite uncertainty as to its particular mode of action, it is accepted wisdom that intra-tympanic gentamicin has a definite therapeutic role in the control of symptoms in patients who fail to respond to medical therapy. This study reports an evaluation of the efficacy of intra-tympanic gentamicin in the treatment of Ménières disease and also presents a simple, reliable, safe method of administering gentamicin for this purpose. A retrospective review of 56 patients undergoing intra-tympanic gentamicin treatment for Ménières disease was conducted. Response to treatment was analysed using a patient survey and examination of pure-tone averages. An overall significant improvement in vertigo symptoms of 81.3 per cent was found. There was a 21.4 per cent rate of significant hearing loss, defined as greater than 10 dB, with an average loss in this group of 18.5 dB. A single dose of gentamicin applied directly to the round window resulted in a high rate of control of vertigo, with acceptably low rates of hearing loss.

Non-chromaffin paraganglioma of the nasopharynx.

A case of non-chromaffin paraganglioma of the nasopharynx is presented. Previously reported cases are discussed and classified, and theories of origin are reviewed in the light of new evidence suggesting a common origin for this rare tumour and juvenile angiofibroma of the nasopharynx.

Transtemporal facial nerve schwannoma without facial nerve paralysis

Facial schwannoma is a relatively rare but well documented lesion, presenting either as a mass or with facial nerve symptoms. In this report, an extensive facial schwannoma, extending from the brain stem to the periphery with minimal facial nerve symptoms and normal facial function is presented.

Vestibular schwannoma in an only hearing ear

A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfunctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.

Treatment of Otitis Externa

 Getting water, shampoo or soap into the ear canal can irritate the skin.  Damage to the skin in the ear canal (caused by cotton buds, scratching or poking) causes inflammation and infection.  Water can get into the ear canal while you are swimming (hence the term swimmer’s ear). The stagnant water triggers an infection.  Hot humid weather makes inflammation of the ear canal more likely to develop.  Skin problems such as eczema or psoriasis can increase the chance of developing problems with the ear canal.  An increased build-up of wax in the ear canal can start to cause irritation, or water can become trapped behind the wax, causing infection.