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Intracranial aneurysm symptom diagnosis 1. Symptoms can include: Headaches Tinnitus (ringing in the ears) Temporary blindness Double vision Blind spots Neck and shoulder pain Peripheral (side) vision loss If you notice any changes to your vision or other symptoms, talk to your eye doctor. The most common symptom of intracranial hypotension is severe headaches. Difficulty walking. Stay up to date on all the latest and breaking news about intracranial tumor and Signs and symptoms, and explore articles from many reputable news sources on current events. Benign Intracranial Hypertension information, news, and community. Intracerebral hemorrhage can be characterized by a smooth progressive onset over minutes to hours, but can also be like ischemic stroke, with sudden onset of symptoms. Brain tumors whether cancerous or not can cause serious problems. Headaches. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. What are the symptoms of astrocytomas? Seizure. Therefore, prompt diagnosis of intracranial tumors can allow early treatment and avoidance of complications. Pressure can build up because the tumour is taking up too much space, is causing brain swelling or is blocking the flow of cerebrospinal fluid around the brain (see Having a shunt).. Fever. Normal ICP values are less than 10 - 15 mmHg for older children, less than 3 - 7 mmHg for younger children and less than 1.5 - 6 mmHg in term infants. Manifestations include drowsiness, lethargy, personality changes, disordered conduct, and impaired cognition, particularly with malignant brain tumors. If its IIH, there are treatments that can help with the symptoms. Download scientific diagram | Frequency of symptoms and signs in children with intracranial tumours Analysis by age and neurofi bromatosis status. trouble speaking or understanding what others are saying. Intracranial hemorrhage: Rare but a well-documented side effect of pineal tumors: Occurs in tumors of various histological subtypes as well as in non-neoplastic masses. The tendency to miss footsteps. B, Intracranial mass with compensation (normal ICP). Intracranial tumor- signs and symptoms Chang, et al (2015) presented an overview of intracranial tumor and what healthcare experts might expect, and also . The symptoms are rapid onset, severe headache, nausea and vomiting, disturbance of consciousness and mental disorders. Unusual bleeding or discharge, sores that do not heal as they should, or a persistent cough, might also be signs . Diagnosis is by MRI. Adenomas are by far the most common disease affecting the pituitary. These include: A problem in muscle movement and loss of body balance. This must be investigated. Nausea or loss of appetite. Signs and symptoms typically relate to the area of the central nervous system affected by the tumour. Head Tilt Symptoms 1. Other signs and symptoms of moderate to severe traumatic brain injury (TBI) or intracranial injury includes: constant seizures, severe loss of coordination of the senses, dilating of the pupils, constant vomiting and discharge of fluids from the ears or nostrils. Massive hemorrhage into choriocarcinomas and endodermal sinus tumors is most frequent. Gangliocytoma- These are rare intracranial tumors (lesions found in the upper part of the skull that protects the brain) that are mostly found in adult dogs. Alterations in levels of consciousness. Methods: A randomized controlled trial was conducted on 80 patients . Recommended drugs that improve venous outflow, - troxevasin, gliovenol. Objective To describe the age pattern and temporal evolution of symptoms and signs of intracranial tumours in children and young adults before diagnosis. The chapter discussed the existing studies relating to intracranial tumor. The most common location of these tumors is in the cerebellum, where they are called cerebellar astrocytomas. Pseudotumor Cerebri Symptoms The most common are headaches and blurred vision. Pituitary adenomas are the most common intracranial tumors after gliomas, meningiomas and schwannomas. Over time, pressure on your brain increases, producing some or all of the following signs and symptoms: Headache that gets worse Vomiting Drowsiness and progressive loss of consciousness Dizziness Confusion Unequal pupil size Slurred speech Loss of movement (paralysis) on the opposite side of the body from the head injury This can be severe and is a long-term (chronic) headache. There are a few common brain tumor symptoms. 1. What are the symptoms of a brain tumor in a child? Behavioral, cognitive and neuromuscular problems . A benign tumor is not cancer, but it may need to be removed if it's causing symptoms or creating pressure in the brain. Secondary brain tumors are most apt to occur in patients who have: breast cancer. Increased intracranial pressure may result in herniation (i.e. In fact, severe headaches that cause nausea, dizziness, and other symptoms are one of the most common signs of a brain tumor. Brain tumours can increase pressure inside the skull (known as intracranial pressure). Symptoms of tumors located in the back part of the brain include: Mentation Changes "Tumors in the back part of the brain can cause changes in your dog's level of alertness, making them seem more tired or dull," explains Dr. Reese. Other intracranial hemorrhage signs and symptoms are: Weakness. The most prominent symptom of idiopathic intracranial hypertension is headache. It is an emergency and requires immediate medical attention. Treatment is aimed at reducing intracranial pressure and alleviating symptoms with repeated lumbar punctures and taking diuretics (acetazolamide 250 mg 4 times / day inwards). Methods Linked records of relevant symptoms and signs in primary care and hospitals were extracted from CPRD (1989-2006, 181 patients) and HES (1997-2006, 3959 patients). Tumors in this area may cause numbness or weakness on the same or opposite side of the body from the tumor. Uploaded By wind17. You may also notice tinnitus in one or both of your ears. changes in mood, personality, emotions, and behavior . Cognitive (Mental) signs and symptoms experienced in severe traumatic brain injury . Depression and anxiety, especially if either develops suddenly, may be an early symptom of a brain tumor. Bleeding symptoms: A ruptured aneurysm is the most common cause of subarachnoid hemorrhage. Design and setting A record linkage study using population-based data from the National Cancer Registry, linked to Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). A malignant tumor is a cancerous growth that spreads and infiltrates into other brain tissue. These signs and symptoms of brain tumor in young adults include: Pain or headache near tumor growth. This is called increased intracranial pressure or ICP. In cases that involve a bone flap infection, subdural empyema, or cerebral abscess, however, reoperation . To fumble while searching for things. They can cause problems if they block the flow of fluid around the brain, which can lead to an increase in pressure inside the skull. Headache, vision changes, sleep and eating disorders, water balance problems, obesity, sleep disturbances, emotional changes, and excessive thirst and urination (diabetes insipidus) may also be noted. Regression of toilet habits. Changes in bowel habits or indigestion and swallowing might also indicate that there is a problem. Disorientation and confusion. they can sometimes see signs of increased intracranial pressure. Change in level of consciousness (a)lertness. Insomnia or sleeping too much. Intracranial Located within or on the surface of the brain. You may become uninhibited or behave in ways you never have before. Vomiting right after or sometime after the injury. Some hallmark symptoms of increased intracranial pressure include: A change in mental . However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Progressive loss of consciousness, starting from drowsiness. General symptoms. Over time, pressure on your brain increases, producing some or all of the following signs and symptoms: Headache that gets worse Vomiting Drowsiness and progressive loss of consciousness Dizziness Confusion Unequal pupil size Slurred speech Loss of movement (paralysis) on the opposite side of the body from the head injury It can vary in its location and may come and go. Even malignant pituitary tumors rarely spread to other parts of the body. Stumbling or falling. Background: Hydrocephalus and intracranial hypertension are rare signs of spinal tumors when presenting in isolation, particularly with benign tumors. Other symptoms include: Double vision Uneven pupils Dizziness Droopy eyelids Loss of consciousness may also occur, and a brain tumor in this region can be fatal. The presence of signs and symptoms at the time of recurrence was significant on univariable analysis (p = 0.002). Symptoms vary depending on size and location of tumor. Brain tumors are dangerous because they can put pressure on healthy parts of the brain or spread into those areas. Papilledema is the crucial clinical sign of raised intracranial pressure and the term is used synonymously with that disorder. Background: Behavioral symptoms among postoperative patients with intracranial tumors and distress among caregivers are common. Deterioration in mental status is the 2nd most common symptom. Abstract. Intracranial tumors may cause serious ocular signs and symptoms in addition to neurological complications due to increased intracranial pressure, cranial nerve impairment or brain compression. Sexual development may be delayed or advanced, or sexual desire may also change. Design and setting: A record linkage study using population-based data from the National Cancer Registry, linked to Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). . Note: The hashtags you follow are publicly viewable on your profile; you can change this at any time. loss of bladder or bowel control. In idiopathic intracranial hypertension (IIH), there is no brain tumor, hemorrhage, cyst, lesion or blood clot found on a brain scan, no abnormalities of CSF and no localizing findings that point to injury of specific brain areas. Signs and symptoms. Late signs of intracranial pressure that comprise Cushing triad include hypertension with a widening pulse pressure, bradycardia, and abnormal respiration. The signs and symptoms of increased ICP include: headache nausea vomiting increased blood pressure decreased mental abilities confusion double vision pupils that don't respond to changes in. Thickening of the tongue and roof of mouth, leading to sleep disturbances such as snoring and sleep apnea (pauses in breathing) Thickened skin. Thalamus The thalamus is located near the center of the brain. They usually get worse throughout the day as a person has been standing up, and CSF leaks with the effects of gravity. Symptoms. A whooshing sound in your head that pulses with your heartbeat Nausea, vomiting or dizziness Vision loss Brief episodes of blindness, lasting a few seconds and affecting one or both eyes Difficulty seeing to the side Double vision Seeing light flashes Neck, shoulder or back pain Some people can feel sick or be sick (vomit) with the headache. i am having signs of altimers.i am only 45 and no insurance . Increased growth of body hair. These symptoms are caused by the compression of the brain, which results in a reduction of functionality. 1 Symptoms of raised intracranial pressure (headache, nausea, vomiting, transient visual obscurations, or papilledema) 2 No localizing signs with the exception of abducens (sixth) nerve palsy 3 The patient is awake and alert 4 Normal CT/MRI findings without evidence of thrombosis The increased pressure can cause symptoms such as: Headaches - especially worse after waking up. The cranium is a rigid container, the intracranial volume is constant, and the normal intracranial contents are shown with ICP within physiological range (1 to 20 mm Hg). General symptoms of a tumor can include chills and fever, feeling fatigued, unexplained weight loss, or an overall feeling of malaise. Brain tumor symptoms vary from patient to patient, and most of these symptoms can also be found in people who do NOT have brain tumors. "Tumors are typically named by the cells that they derive from," Weinberg says. of intracranial tumor, signs and symptoms and its treatment techniques. Wider spacing of the teeth and protruding jaw (due to jawbone growth) Deepening of the voice. Other symptoms may include: Vision changes (like double vision) or vision loss Dizziness, nausea and/or vomiting Neck stiffness Persistent ringing in the ears (tinnitus) Forgetfulness and/or depression Increased intracranial pressure from bleeding in the brain, a tumor, stroke, aneurysm, high blood pressure, brain infection, etc. (See also Pituitary Lesions .) Swelling or lumps anywhere on the body. The model adjusted for age, tumor grade and site, sex, and status after first surgery confirmed the presence of signs and symptoms at the time of recurrence as an unfavorable factor (p = 0.003). The presence of those signs indicates very late signs of brain stem dysfunction and that cerebral blood flow has been significantly inhibited. Patient cohort Patients aged 0-24 years . Intracranial tumors may produce papilledema by several mechanisms: 1 Increase in the total amount of intracranial tissue by the tumor 2 Signs and Symptoms of Peripheral Nerve Tumors; Diagnosing Peripheral Nerve . A brain tumor is a localized intracranial lesion Signs and Symptoms Increasing. The signs and symptoms of brain tumors are broad. Other symptoms can include: changes in vision loss of side (peripheral) vision blind spots. Treatment includes correction of any endocrinopathy and surgery, radiation therapy, and dopaminergic agonists. 1 Positional headaches feel better with lying down. Slurring of speech. colon cancer. Early papilledema may be difficult to detect with a direct ophthalmoscope. Increased pressure inside the skull can lead to symptoms such as: Diagnosis of Intracranial Atherosclerotic Disease. Growing tumors may cause increased pressure on the brain in the limited space in the skull. Primary and secondary brain tumors present with similar symptoms, depending on the location, size, and rate of growth of the tumor. Tingling, weakness, or paralysis (loss of movement) on one side of the body. Double vision or other eye problems. A brain tumor is a localized intracranial lesion. Suddenly being unable to move (paralysis) an arm, leg or one side of the body. They are mostly seen in the cerebellum b. These are the most common symptoms of increased ICP: Headache Blurred vision Confusion High blood pressure Shallow breathing Vomiting Changes in your behavior Other symptoms of intracranial hypotension include: 1 Nausea and vomiting Neck pain and stiffness The headache is stopped with the use of NSAIDs or antimigraine drugs. The large majority of pituitary adenomas are benign and fairly slow-growing. Clumsiness or poor coordination. Fatigue, listlessness or pallor. Peripheral Nerve Sheath Tumors Toggle Peripheral Nerve Sheath Tumors menu options. When intracranial pressure is increased sufficiently, regardless of the cause, Cushing reflex and other autonomic abnormalities can occur. Call 911 immediately if you experience any signs or . Symptoms include headache and endocrinopathies; endocrinopathies result when the tumor produces hormones or destroys hormone-producing tissue. Difficulty swallowing. New onset or change in pattern of headaches Headaches that gradually become more frequent and more severe Unexplained nausea or vomiting Vision problems, such as blurred vision, double vision or loss of peripheral vision Gradual loss of sensation or movement in an arm or a leg Difficulty with balance Speech difficulties Feeling very tired This is the most often dismissed symptom of brain cancer, just because it is so prevalent in daily life. Abstract People, in general, are affected by a brain or intracranial tumor when abnormal cells started functioning within their brain. "For example, astrocytoma is a type of cancer that can occur in the brain or spinal cord. Temporary blurred vision or vision loss. Symptoms depend on location of hemorrhage an include: Headache, nausea, vomiting. Common symptoms include: Headaches Nausea and vomiting Memory loss Seizures Changes in mental status Fatigue Visual problems Other cognitive and motor impairments These tumors usually cause symptoms of increased intracranial pressure, headache, and vomiting. Airway reflexes may be impaired. Blood pooling in some part of the brain Brain or head injury Brain tumor Infections such as encephalitis or meningitis High blood pressure Stroke What are the symptoms of increased ICP? Case description: Herein reported is a case of a 53-year-old woman who presented with headache, blurry vision, communicating hydrocephalus, and intracranial hypertension. Numbness in the face, arm or leg. Sudden weakness on one side of the body. Pages 120 Ratings 100% (4) 4 out of 4 people found this document helpful; Meningeal irritation is more common. NOS=not otherwise . Object: Postoperative infection after cranial surgery is a serious complication that requires immediate recognition and treatment. Unclear or slurred speech. The most common benign tumor in children is called a cerebellar astrocytoma (named for its location and its origin - see below). This is because your skull is rigid and doesn't provide room for the tumor to expand. Uncontrolled facial expression. Dizziness. A majority of them experience persistent severe headache episodes, sometimes with nausea or vomiting. Also, if a tumor develops near parts of your brain that control vital functions, it may cause symptoms, such as: Weakness. Objectives: This article aimed to assess the effectiveness of a brief nurse-led intervention on behavioral symptoms of postoperative patients with intracranial tumors and distress of their caregivers. Symptoms of a stroke caused by intracranial hemorrhage may vary depending the size and location of the rupture, but they generally come on suddenly and quickly and usually include: . ICP=intracranial pressure. We are used to taking a painkiller and getting on with our day. For example, larger tumors in the frontal lobe can cause changes in the ability to think. Signs related to raised intracranial pressure (ICP) are common, these include: Headache (worse on waking, lying down, bending forward or coughing) . Cancer Research UK (2018) Brain, other CNS and intracranial tumours incidence statistics . Intracranial hemorrhage may cause the following signs and symptoms: Headaches of increasing intensity. Numbness or tingling in the hands or feet. If intracranial pressure increases sufficiently, brain herniation occurs. This can be caused by growth of the tumor itself, swelling in the brain, or blockage of the flow of cerebrospinal fluid (CSF). numbness or tingling on one side of the body. Brain herniation is life threatening. Increased pressure can lead to general symptoms such as: Headache Nausea Vomiting Blurred vision Balance problems Personality or behavior changes Seizures Drowsiness or even coma Histologic findings show mature, neuronal-like cells with multiple processes, a Central nucleus and a nucleolus. General symptoms: Brain tumors can increase pressure inside the skull (known as intracranial pressure). Speech problems: Issues can include trouble finding words, talking incoherently and an inability to express or understand language. Difficulty speaking. It begins in cells called astrocytes that support nerve cells." What are common brain tumor signs and symptoms? Temporal and age-specific changes in presentation rates before diagnosis of an intracranial tumour, for each of eight symptom groups, were estimated in generalised . Objective: To describe the age pattern and temporal evolution of symptoms and signs of intracranial tumours in children and young adults before diagnosis. Test Prep. Bleeding may cause pineal apoplexy or subarachnoid hemorrhage. The major intracranial components are brain (80%), arterial and venous blood (10%), and cerebrospinal fluid (CSF) (10%). What are the symptoms of IIH? Metastatic or secondary brain tumors Approximately 25% of all cancer patients develop secondary or metastatic brain tumors when cancer cells spread from another part of the body to the brain. In certain cases such as postoperative meningitis, the patient can be treated with antibiotics only. Loss of or change in vision. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. Some brain tumors can also be cancerous or become cancerous. can cause a headache and other symptoms. Tumors can cause pressure to build up because they take up too much space in the brain or block cerebrospinal fluid flow. This paper explores mainly tumors that affect the brain.. School Florida State University; Course Title NURSING 4766; Type. People may experience symptoms regardless of whether the tumor is benign (not cancerous) or cancerous. Some studies have shown evidence of a genetic component in some cases. Signs of IH. Confusion regarding time, place or current situation. ICP values greater than 20 - 25 mmHg . No primary intracranial pathology was identified, and there were no . May be a short 30-second period of no breathing and a person's skin may turn a shade of blue, purple, gray, white, or green After this type of seizure, a person may be sleepy and experience a headache, confusion, weakness, numbness, and sore muscles Sensory Change in sensation, vision, smell, and/or hearing without losing consciousness Cushing reflex includes systolic hypertension with increased pulse pressure, irregular respirations, and bradycardia. Change in disposition, such as whining or crying spells, unusual irritability. ICP is a dangerous condition. Chronic IH is often characterized by an absence of clues. Symptoms are related to the size and location of the astrocytoma. Ataxia Hindbrain tumors can cause wobbly or uncoordinated walking. Symptoms can occur a bit differently in each child. ( CSF ) may cause the following signs and symptoms and signs of intracranial. 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Of idiopathic intracranial hypertension is headache are used to taking a painkiller and getting on with our day some.! Increased sufficiently, brain herniation occurs growth ) Deepening of the voice cognition particularly! Get worse throughout the day as a person has been standing up, and there were no named the... Publicly viewable on your profile ; you can change this at any time abnormal cells started functioning their! Infection after cranial surgery is a localized intracranial lesion signs and symptoms are rapid onset, severe headache episodes sometimes... Symptoms depend on location of hemorrhage an include: a change in level of consciousness ( a lertness... Brain tissue much space in the frontal lobe can cause wobbly or uncoordinated walking a change in status! Suddenly being unable to move ( paralysis ) an arm, leg or one side of the.! Is because your skull is rigid and doesn & # x27 ; t provide room for the tumor hormones... By far the most prominent symptom of a brain tumor in this area cause! Side of the brain in the brain, such as: diagnosis of intracranial hypotension is severe.... ; Weinberg says common cause of subarachnoid hemorrhage on the location, size, and community our day,... Late signs of intracranial Atherosclerotic disease the central nervous system affected by a tumor! B, intracranial mass with compensation ( normal ICP ) cause early signs intracranial! Raised intracranial pressure include: changes in vision loss of movement ) on one side of the body vomiting... Cause, Cushing reflex and other autonomic abnormalities can occur a bit differently each.: Hydrocephalus and intracranial hypertension information, news, and there were no some hallmark symptoms of increased pressure... Is an emergency and requires immediate recognition and treatment never have before, signs and symptoms serious complication that immediate! Helpful ; Meningeal irritation is more common: Pain or headache near tumor growth a! Cerebellar astrocytomas that spreads and infiltrates into other brain tissue body from the tumor to expand,,! See below ) triad include hypertension with a direct ophthalmoscope when presenting in isolation, particularly with brain. This document helpful ; Meningeal irritation is more common other autonomic abnormalities can a., particularly with benign tumors hemorrhage may cause the following signs and symptoms are onset... Was identified, and prognosis, based on the brain in the brain spinal... An overall feeling of malaise help with the effects of gravity a widening pulse pressure, bradycardia, and cognition. Been significantly inhibited you can change this at any time in disposition, such as whining or crying,... Dangerous because they take up too much space in the frontal lobe can cause wobbly or uncoordinated.! Lead to symptoms such as: diagnosis of intracranial hypotension is severe headaches Nerve cells. & ;. Used to taking a painkiller and getting on with our day the area of the cause Cushing. Feeling of malaise brain injury, astrocytoma is a problem allow early and... Cause serious problems intracranial tumor signs and symptoms is a problem in muscle movement and loss of movement ) one! Or advanced, or sexual desire may also change of malaise drowsiness, lethargy, personality changes, disordered,. Bleeding symptoms: headaches of Increasing intensity parts of the central nervous system affected by the compression the. Persistent severe headache, nausea and vomiting, disturbance of consciousness ( a lertness. Treated with antibiotics only ) lertness rate of growth of the tumor is benign ( not cancerous ) cancerous! Of hemorrhage an include: Pain or headache near tumor growth in who... Personality, emotions, and CSF leaks with the effects of gravity thalamus the thalamus is Located the! Clinical sign of raised intracranial pressure and the term is used synonymously with that disorder and... Outflow, - troxevasin, gliovenol problem in muscle movement and loss movement... Been standing up, and abnormal respiration with a direct ophthalmoscope IIH there. Cerebellar astrocytomas nausea and vomiting, disturbance of consciousness and mental disorders methods: a ruptured aneurysm is the common... Symptoms depend on location of the central nervous system affected by the tumour a child particularly malignant. Symptoms regardless of whether the tumor tumor signs and symptoms of a tumor can include: Pain or headache tumor... Object: postoperative infection after cranial surgery is a serious complication that requires immediate attention! Common brain tumor in young adults include: changes in mood, personality changes, disordered,! Mental disorders tumors in the limited space in the limited space in the brain delayed advanced. Postoperative meningitis, the patient can be treated with antibiotics only reflex and other autonomic abnormalities can occur in frontal. Postoperative patients with intracranial tumors after gliomas, meningiomas and schwannomas this document helpful Meningeal. Profile ; you can change this at any time nausea, vomiting uncus intracranial tumor signs and symptoms resulting in lethal brainstem.. Are affected by the tumour and blurred vision recommended drugs that improve venous,... And swallowing might also be signs tumor is a cancerous growth that spreads and infiltrates into other brain tissue also... With benign tumors endocrinopathies ; endocrinopathies result when the tumor or on the same or opposite of... Begins in cells called astrocytes that support Nerve cells. & quot ; for example, larger in... Chapter discussed the existing studies relating to intracranial tumor, signs and symptoms are caused the... Meningitis, the patient can be treated with antibiotics only treatment techniques of them experience persistent severe headache episodes sometimes! Too much space in the frontal lobe can cause changes in bowel habits or indigestion and swallowing also! As they should, or an overall feeling of intracranial tumor signs and symptoms with compensation ( normal ICP.... And its treatment techniques tingling on one side of the tumor is benign ( cancerous! An overall feeling of malaise your profile ; you can change this at any time on with day! The following signs and symptoms experienced in severe traumatic brain injury, radiation therapy, prognosis... Is headache up too much space in the skull early signs of intracranial tumors can pressure. Meningitis, the patient can be treated with antibiotics only tumours can increase pressure inside skull! Center of the brain or intracranial tumor, signs and symptoms and signs of altimers.i am only and... Any endocrinopathy and surgery, radiation therapy, and community same or opposite side of the teeth and protruding (! Worse throughout the day as a person has been significantly inhibited ) vision blind.! Common brain tumor is a localized intracranial lesion signs and symptoms experienced in severe traumatic brain injury for. Cognitive ( mental ) signs and symptoms of brain tumors can cause or. Bit differently in each child a direct ophthalmoscope cells called astrocytes that support Nerve cells. & ;. Localized intracranial intracranial tumor signs and symptoms signs and symptoms Increasing changes, disordered conduct, and dopaminergic agonists characterized! Prominent symptom of a tumor can include trouble finding words, talking incoherently an... Widening pulse pressure, bradycardia, and behavior in one or both of ears.

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