It presents as unilobular or multilobular bony protrusion usually found in the midline of the hard palate. Most cases of tori is less than 2 cm, however it subjects to change throughout the life. Females are more common to get affected compare to males.
The etiology is unknown. Some studies believe that it is due to autosomal dominant trait. However, generally it is believed that tori it is more likely results from local stresses rather than genetic influence. It is more common during early adult life and may increase in size. The size may decrease later due to aging process and bone resorption.
Most of the time there is no treatment needed. In certain circumstances, the torus can be removed by small surgery to remove the excess bone if the mass causing problem to the patient (e.g.: eating, frequent ulceration) or a denture needs to be worn.
Reference:
- Robin Youngs. Nicholas D Stafford. ENT In Focus. Elsevier Churchill Livingstone. 2004.
- Available at:http://en.wikipedia.org/wiki/Torus_palatinus
Meniere’s disease is an idiopathic ear disorder that will results in balancing problem. Morphologically, there is swelling of the endolymphatic fluid compartment. This condition is also known as endolymphatic hydrops. The first symptoms usually present between the ages of 30 and 60 which peak incidence at 50 years old. Males and females are equally affected
Meniere’s disease usually affects a unilateral ear. Patient often presented with violent paroxysmal vertigo, most of the time is rotary. Due to problems with pressure within the inner ear, some may complain of tinnitus and progressive deafness. Attacks will occur in clusters with periods of remission in between the attack. During remission period, balanced is normal. The attacks often accompany by prostration, nausea and vomiting. Frequently, patients give history of sensation of pressure or fullness in the affected ear, pain in the neck, increase tinnitus or deafness before the attack start. The attack may also been preceded by otalgia or pain in the ear. Unlike benign positional vertigo which only lasted in seconds, attack in Meniere’s disease will last for several hours but rarely more than 12 hours. However, although the disease is progressive, the duration of the attacks and remissions period is highly variable.
The accompanying deafness is sensory neural hearing loss (SNHL) and involves low frequency. Audiogram findings usually show these features; inverted “V” (low and high frequency SNHL), low frequency hearing loss or flat SNHL. With the increase duration of the disease, the episodes of vertigo will usually decrease.
A test for tertiary syphilis is indicated to all patients. Audiometric assessment is essential for the diagnosis of Meniere’s disease. Vestibular function test is important to look for peripheral vestibular lesion, especially if surgical intervention is plan. MRI scan with enhancement is necessary to rule out a retrocohclear lesion. Electrocochleography (ECOG) or evoked potential audiometry will shown abnormal SP (Summating potential) / AP (Action potential) ratios. However, this tests lacks of specificity and sensitivity if done at early stage of the disease and cannot be used to diagnose or confidently rule out the disease. The SP/AP ratios are elevated in well established cases, but once the syndrome has declared itself, this test does not required any longer to “confirm” the diagnosis.
Treatment:
Treatment remains controversial.
- Salt restricted diet combined with a diuretic is the foundation of treatment. However, neither of these treatments has ever been shown to be more effective in comparison to placebo in well designed controlled clinical trials.
- Vestibular suppressants (e.g.: betahistine, meclizine, diazepam) – reserved for acute exacerbation. Avoid chronic usage of this type of medication.
Surgical treatment:
Surgical intervention is indicated to conserve hearing for patient with intractable vertigo from Meniere’s disease.
- Endolymphatic sac surgery Vestibular nerve section
- Labyrinthectomy
- Gentamycin inner ear perfusion
Reference:
- Harold Ludman and Patrick J Bradley. ABC of Ear, Nose and Throat. 5th edition. 2007.
- Michael J Ruckenstein. Comprehensive Review of Otolaryngology. Saunders. 2004.
