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7th and 8th Crainial Nerves
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7th and 8th Crainial Nerves


  This past February my son started hearing a loud sound in his left ear.  It is a rushing sound that blocks his hearing in this ear. At his time he experienced vertigo.  It came and went through March and April, but since
  May it has been continuous.  Exercise dosn't seem to help.  A CT-scan was performed on his head, and there did not appear to be any sign of a problem.  As a result of the CT-scan, the doctor concluded it was a "learn to live with".
  Talking with another doctor, we were told that sometimes blood vessels will grow around the 7th and 8th Crainial Nerves and cause pressure on the nerve, with the result being the nerve is stimulated and you hear the
  rushing of blood, which is interpreted by the brain as a loud sound.  It was suggested I contact a neuro-surgeon in Pittsburg, PA, who has performed many operations to solve this problem by isolating the nurves with some sort of Teflon
  sheild which would remain permantly in place.  This doesn't sound too swift to a lay-person.  My question is: "Is this type of operation normally performed, and what other options are there to choose from?"
  The distracting sound is effecting his ability to function.  Thank you... J. David.
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I'm not sure how quickly I'd advise you to get a surgical treatment for the sound of rushing in the ear and vertigo. But let me tell you about the operation for a couple of other conditions with which I have more direct experience.
As you might imagine, there are a lot of blood vessels in the brain (as there are elsewhere in the body). Indeed, some tiny blood vessels occasionally do lie too close to certain cranial nerves, leading to persistent irritation of those nerves. The consequence of the mechanical irritation is that the nerve fires impulses, which then have effects related to the nerve function.
One such recognized instance is a condition called trigeminal neuralgia, or tic doloreaux (I can never remember how to spell French words, I hope that's the right spelling). In this, CN5 (trigeminal nerve) is irritated, causing excruciating pain in part of the face.
Another instance is called hemifacial spasm. In this, CN7 (facial nerve) is irritated, causing twitching or sustained spasms of muscles of facial expression -> grimacing, winking, etc.
In both of these disorders, medications such as Tegretol or other anti-seizure drugs are given. These have nothing to do with seizures, because there is no abnormal electrical activity in the cerebral cortex involved in producing symptoms. But the drugs can quiet down irritable membranes, and that's why they're used.
A surgeon named Janetta pioneered the use of mechanical separation of the tiny artery and the affected cranial nerve. A piece of something is wedged between them and left in place. The Janetta procedure is quite effective, if chosen for the right patient, and the results seem to be lasting.
I don't have direct experience with use of the Janetta procedure for CN8 problems. For TN and HFS, we try medications first and then consider surgery only after failure of medications.
This may be worth a second opinion. Find a neurologist who specializes in neuro-otology or vestibular disorders. These are usually in certain large academic medical centers with strong neurology departments. If your son is very young (under 14, for example), take him to an academic pediatric neurology department. Here at CCF, we do have a neuro-otologist who just joined the faculty. You can call 800 223-2273 and ask for neurology appointments: ext 4-5559.
I hope this helps. CCF MD mdf.





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