Tumors of the ear, otosclerosis, auditory syndromes of vascular origin, and their influence on driving

Tumors of the external ear

• Benign tumors are uncommon, and grow obstructing the canal, such as osteomas.
• Malignant tumors of epithelial or connective origin. They are first little painful but they infiltrate and grow with vegetation-like outgrowths that obstruct the canal.

Tips

• They are variably disabling depending on the surgery required and on the coadjuvant treatment.
• The physician will report on the hearing capacity at every time and of the possible interference with driving.

Middle ear tumors

• Benign tumors are very rare. Jugular glomic tumor causes pulsatile tinnitus, dizziness, hypoacusis and otorrhagia, making driving unfeasible.
• Malignant tumors such as epitheliomas and sarcomas are more common than benign ones, but are rare tumors.

They are associated with pain as in acute otitis, transmission hypoacusis and suppuration.

They often cause facial paralysis and labyrinth disorders. Their prognosis is very bad and they make driving unfeasible.

Tips

• Symptomatic tumors of the middle ear make driving unfeasible.
• After surgical recovery, the adequate hearing capacity must be assessed, confirming the absence of dizziness in subsequent revisions.

Otosclerosis

It is an inherited disorder of the otic capsule of the labyrinth, that leads to progressive transmission hypoacusis for blockage of the stapes in the oval window.

If the inner ear is also affected, perception hypoacusis occurs.

In some types, hypoacusis can be pure of perception.

The patient frequently hears better in environments with noise, and can show tinnitus and whistling, sometimes of such intensity that they become intolerable. Dizziness is rare.

The patient worsens in periods of fatigue, anxiety, depression, and weakness. Women worsen during pregnancy, lactation, and menopause.

It requires surgical treatment or acoustic prosthesis.

Tips

• Driving is determined by the hearing capacity and the absence of disabling tinnitus.
• The physician’s report of the specialist is advisable, specifying the limitations that can influence driving.
• After surgical recovery, the hearing capacity must be assessed in subsequent revisions, with specialist’s report that provides an adequate assessment for obtaining or extending the driving license.

Cochleovestibular syndromes of vascular origin. Vertebrobasilar insufficiency

Stenosis of the vertebral artery:

It is caused by osteoarthritis, atheromatosis, thrombosis, etc.

The blood flow of the contralateral vertebral artery is sufficient to irrigate both labyrinths.

However, in some head positions, to the back and to the sides, this flow can be blocked partially and cause a momentary vascular insufficiency, that causes in turn the crisis with dizziness, fainting, vomiting and whistling in the ears.

When the head is placed in the usual position, this returns to normal.

Drivers with this problem run the risk when making maneuvers to advance, in crossings or parking, to trigger the crisis and cause an accident.

The “subclavian steal”:

It is caused if stenosis occurs in the subclavian trunk above the origin of the vertebral artery, then the lower part of the subclavian receives a counter-current blood flow that comes from the vertebral artery.

Any excessive movement of the arm made by the driver causes ischemia of the posterior fossa and a vertebral syndrome with dizziness, fainting and weakness of legs.

In possible cases, bone or vascular surgical treatment is required to solve the problem.

Insufficiency of vertebral arteries and basilar trunk:

If the origin is an extensive thrombosis, the disorders are serious as a result of bulbar ischemia.

In mild cases, weakness of legs (“Drop Attack” due to pyramidal ischemia), dizziness, hypoacusis and whistling occur.

Diffuse atherosclerosis of the posterior fossa:

Progressive bilateral perception hypoacusis occurs, with variable episodes of dizziness, associated with instability, whistling, and buzzing sounds.

Fainting and leg weakness frequently occur. The treatment is similar to the previous condition.

Peripheral vascular insufficiency:

It is an intermittent claudication of the labyrinth by atherosclerosis of the medial cerebellar artery, with episodes of ischemia in the auditory nerve and in the labyrinth.

The crisis is of perception hypoacusis to acute, buzzing sounds like whistling and dizziness, typical and well systematized in one direction.

Tips

• Stenosis of the vertebral artery: the physician will warn the patient, if a driver, of the risk run if he must force the head and neck when making maneuvers. We should recommend him to drive in non-complex roads, with few crossings, to park square on to the kerb, and try not to advance but keep the safety distance and the adequate speed.
• The “subclavian steal”: the physician should advise on the risks for driving in each case and non-recommended movements that can be life-threatening.
• Insufficiency of vertebral arteries and basilar trunk: this disease disables significantly the driver, depending on the severity of the condition. The physician will advise against driving in the necessary cases for the safety of the patient and of all. The treatment frequently based on anticoagulants and vasodilators causes side effects and added risks in driving, that must be notified.
• Diffuse atherosclerosis of the posterior fossa: it disables significantly for driving, so the physician should establish if the improvement over time allows for driving without risk.
• Peripheral vascular insufficiency: driving is difficult, if the medical or surgical treatment applied cannot remove the symptoms. The physician will inform the patient if driving is recommended.