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Idiopathic intracranial hypertension in otolaryngology

European Archives of Oto-Rhino-Laryngology volume 266, pages 803–806 (2009)Cite this article

Abstract

Idiopathic intracranial hypertension (IIH) is defined as increased intracranial pressure in the absence of intracranial mass or obstructive hydrocephalus. Over 80% of patients are overweight women. IIH is usually encountered in the neurology and ophthalmology practise as headaches, visual disturbance and papilloedema are the characteristic features of this syndrome. Patients with IIH also experience tinnitus, hearing loss, balance disturbance, cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea and in some cases these otorhinological symptoms can be presenting features of this syndrome. IIH is also associated with obstructive sleep apnoea. Otolaryngologists should be familiar with this important condition as it can manifest a variety of symptoms that are more frequently seen in their clinics. Sometimes otolaryngologists may be involved in the surgical management of this condition, such as repair of CSF rhinorrhoea or otorrhoea or endoscopic optic nerve decompression. The aim of this review article is to familiarise the otolaryngologists with the important features of this unusual syndrome which may remain unrecognised in the otolaryngology practice.

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References

  1. Sismanis A (1987) Otologic manifestations of benign intracranial hypertension syndrome: diagnosis and management. Laryngoscope 97(8 part 2 Suppl 42):1–17

    Google Scholar 

  2. Friedmen DI, Corbett JJ (2005) High cerebrospinal fluid pressure. In: Olesen J, Tfelt-Hansen P, Goadsby P, Ramadan NM, Welch KMA (eds) The headaches. Chap 113. Williams & Wilkins, Baltimore, pp 925–934

  3. Corbett JJ (2000) Pseudotumour cerebri by any other name. Arch Opthalmol 118(12):1685

    CAS  Google Scholar 

  4. Radhakrishnan K, Ahlskog JE, Cross SA, Kurland LT, O’Fallon WM (1993) Idiopathic intracranial hypertension (pseudotumour cerebri): descriptive epidemiology in Rochester, Minn. Arch Neurol 50(1):78–80

    PubMed  CAS  Google Scholar 

  5. Durcan FJ, Corbett JJ, Wall M (1988) The incidence of pseudotumour cerebri population studies in Iowa and Louisiana. Arch Neurol 45(8):875–877

    PubMed  CAS  Google Scholar 

  6. Sismanis A, Butts FM, Hughes GB (1990) Objective tinnitus in benign intracranial hypertension: an update. Laryngoscope 100(1):1152–1155

    PubMed  Article  CAS  Google Scholar 

  7. Murphy TP (1991) Otologic manifestations of pseudotumour cerebri. J Otolaryngol 20(4):258–261

    PubMed  CAS  Google Scholar 

  8. Snyder DA, Frenkel M (1979) An unusual presentation of pseudotumour cerebri. Ann Opthalmol 11(12):1823–1827

    CAS  Google Scholar 

  9. Hart RG, Carter JE (1982) Pseudotumor cerebri and facial pain. Arch Neurol 39(7):440–442

    PubMed  CAS  Google Scholar 

  10. Suryadevara AC, Fattal M, Woods CI (2007) Nontraumatic cerebrospinal fluid rhinorrhea as a result of pseudotumour cerebri. Am J Otolaryngol 28(4):242–246

    PubMed  Article  Google Scholar 

  11. Kutz JW, Hussain IA, Isaacson B et al (2008) Management of spontaneous cerebrospinal fluid otorrhoea. Laryngoscope 118(12):2195–2199

    PubMed  Article  Google Scholar 

  12. Langfitt TW (1975) Clinical methods for monitoring intracranial pressure and measuring cerebral blood flow. Clin Neurosurg 22:302–320

    PubMed  CAS  Google Scholar 

  13. Sismanis A (2003) Pulsatile tinnitus. Otolaryngol Clin North Am 36:389–402

    PubMed  Article  Google Scholar 

  14. Sismanis A, Callari RH, Slomka WS, Butts FM (1990) Auditory-evoked response in benign intracranial hypertension syndrome. Laryngoscope 100(11):1152–1155

    PubMed  Article  CAS  Google Scholar 

  15. Sugita Y, Iijima S, Teshima Y et al (1985) Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep with apnoea hypersomnia syndrome. Electroencephalogr Clin Neurophysiol 60:214–219

    PubMed  Article  CAS  Google Scholar 

  16. Jennum P, Borgesen SE (1989) Intracranial pressure and obstructive sleep apnea. Chest 95:279–283

    PubMed  Article  CAS  Google Scholar 

  17. Purvin V, Kawasaki A, Yee R (2000) Papilledema and obstructive sleep apnea syndrome. Arch Opthamol 118:1626–1630

    CAS  Google Scholar 

  18. Acheson JF (2006) Idiopathic intracranial hypertension and visual function. Br Med Bull 79–80:233–244

    PubMed  Article  Google Scholar 

  19. Lessell IM, Wanger SL (1984) Pseudotumour cerebri, A not always a benign imposter. Postgrad Med 75(3):59–66

    PubMed  CAS  Google Scholar 

  20. Wall M, George D (1991) Idiopathic intracranial hypertension a prospective study of 50 patients. Brain 114(1A):155–180

    Google Scholar 

  21. Corbett JJ, Mehta MP (1983) Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumour cerebri. Neurology 33:1386–1388

    PubMed  CAS  Google Scholar 

  22. Johnston PK, Corbett JJ, Maxner CE (1991) Cerebrospinal fluid protein and opening pressure in idiopathic intracranial hypertension (pseudotumour cerebri). Neurology 41:1040–1042

    PubMed  CAS  Google Scholar 

  23. Smith JL (1985) Whence pseudotumour cerebri? J Clin Neuro-opthalmol 5:55–56

    CAS  Google Scholar 

  24. Meador KJ, Swift TR (1984) Tinnitus from intracranial hypertension. Neurology 34:1258–1261

    PubMed  CAS  Google Scholar 

  25. Quattrone A, Bono F, Oliveri RL et al (2001) Cerebral venous thrombosis and isolated intracranial hypertension without papilloedema in CDH. Neurology 57:31–36

    PubMed  CAS  Google Scholar 

  26. Farb RI, Vanek I, Scott JN et al (2003) Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:1414–1418

    Google Scholar 

  27. Higgins JNP, Gillard JH, Owler BK et al (2004) MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75:621–625

    PubMed  Article  CAS  Google Scholar 

  28. King JO, Mitchell PJ, Thompson KR et al (2002) Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology 58:26–30

    PubMed  CAS  Google Scholar 

  29. Higgins JN, Pickard JD (2004) Lateral sinus stenosis in idiopathic intracranial hypertension resolving after CSF diversion. Neurology 62:1445–1446

    Google Scholar 

  30. Kupersmith MJ, Gamell L, Turbin R et al (1998) Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology 50:1094–1098

    PubMed  CAS  Google Scholar 

  31. Gupta AK, Gupta A, Kumar S et al (2007) Endoscopic endonasal management of pseudotumour cerebri: is it effective? Laryngoscope 117:1138–1142

    PubMed  Article  Google Scholar 

  32. Michaelides EM, Sismanis A, Sugerman HJ et al (2000) Pulsatile tinnitus in patients with morbid obesity: the effectiveness of weight reduction surgery. Am J Otol 21(5):682–685

    PubMed  CAS  Google Scholar 

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Otolaryngology, University Hospital Coventry and Warwick Hospital, Coventry, UK

    Mudit Jindal & Darius Rejali

  2. University of Birmingham, Birmingham, UK

    Lucinda Hiam

  3. Department of Neurology, Hull and East Yorkshire Hospital, Kingston upon Hull, UK

    Ashok Raman

  4. Department of ENT, University Hospital Coventry and Warwick NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Mudit Jindal

Authors
  1. Mudit Jindal
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  2. Lucinda Hiam
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  3. Ashok Raman
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  4. Darius Rejali
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Correspondence to Mudit Jindal.

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Jindal, M., Hiam, L., Raman, A. et al. Idiopathic intracranial hypertension in otolaryngology. Eur Arch Otorhinolaryngol 266, 803–806 (2009). https://doi.org/10.1007/s00405-009-0973-0

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  • DOI: https://doi.org/10.1007/s00405-009-0973-0

Keywords

  • Intracranial hypertension
  • Obstructive sleep apnoea
  • Tinnitus
  • CSF
  • Otorrhoea