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Anomalous cross-modal interactions along the audiovestibular, visual and soma-tosensorial pathways could be the responsible for aberrant signals, clinically expressed as phantom perceptions. This results in tinnitus that can be modified by gaze movements or somatosensorial stimulation through skin, orofacial (jaw) and cervical movements. This phenomenon has also been described in some patients with acute unilateral deafferentation of the auditory peripheral system as a result of surgery to remove a tumour in the posterior fossal. Neuroimaging preliminary studies (PET, f-MRI) describe multisensorial interactions and cortical reorganisation processes in chronic tinnitus. Treatment approaches are still unknown although counselling regarding the benignity of the process and the high percentage of habituation to the symptom is the most effective framework. We present our experience in four cases.

Susac's syndrome is an extremely rare clinical manifestation characterized by the triad of fluctuating sensorineural hearing loss, sudden visual loss and encephalopathy. Probably underdiagnosed, it affects young women who start the clinical history with headache, visual and hearing disturbances, with neurological findings in MRI. With unknown aetiology, pathogenesis is based on arteriolar microinfarcts in retina, cochlea, and grey and white matter in the brain. Treatment is, as stated in the bibliography and our experience, intravenous high doses of steroids followed by oral steroids together with hyperbaric oxygen to minimize ischaemic lesions. Aspirin associate to nimodipine has been useful to date in the treatment of our patient. We present a case and review the existing literature.

Because idiopathic sudden deafness is regarded as the result of a cochlear microcirculation disorder, its treatment has been based mainly on vasoactive therapy with little regard for the blood-flow conditions produced by these circumstances. In a group of 16 patients with sudden-onset deafness, we determined blood viscosity at different shear rates, as well as erythrocyte aggregability, deformability, and filterability, and other potentially influential parameters, such as hematobrit, fibrinogen, and leukocyte and platelet count. These values correlated with hearing loss and average recovery after conventional treatment. Our results showed a trend to high blood viscosity in patients in relation to a control group of persons with normal hearing, with a notorious increase in aggregability, which correlated significantly with recovery of hearing capacity, and a decrease in blood filterability, which correlated with average hearing loss. This suggests a potential etiopathogenic mechanism of the disease and an alternative treatment complementary to current treatment.

The aim of the rheological treatment in sudden deafness is the improvement of the microcirculation in the inner ear by hemodilution and decreased viscosity of the blood. Both parameters have been checked in two groups of patients suffering from sudden deafness; one treated with Dextran-40 and Pentoxifylline, the other with Dextran-40 only. Improvement of rheological characteristics of blood was statistically significant in the combined therapy with Dextran-40 and Pentoxifylline. Two cohorts of sudden deafness patients--one selected, one non selected--treated with Pentoxifylline and Dextran 40 have been evaluated in respect of hearing improvement under this rheological results compared with the spontaneous remission rate given by Weinaug in 1984.