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Yang HH, Yang I, Gopen QS. Patient Sex Mediates the Influence of Patient Age on Superior Canal Dehiscence Repair Outcome. Laryngoscope 2024; 134:3363-3370. [PMID: 38381092 DOI: 10.1002/lary.31356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To investigate the independent and interactive effects of patient age and sex on superior canal dehiscence (SCD) repair outcomes. METHODS This was a cohort study of consecutive SCD repairs via the middle fossa approach at an institution between 2011 and 2022. We constructed multivariable regression models assessing surgical outcomes with age and sex as the primary predictors. Models controlled for surgery duration, follow-up duration, and relevant surgical and medical history. Subsequently, we repeated each model with the incorporation of an interaction term between patient age and sex. RESULTS Among 402 repairs, average age was 50 years, and 63% of cases were females. There was a significant interaction between patient age and sex with respect to symptom resolution score (SRS) (adj. β 0.80, 95% C.I. 0.04-1.56). Older age was associated with lower SRS among females (-0.84, -1.29 to -0.39 point per year) but not significantly associated with SRS among males (0.04, -0.65 to 0.56 point per year). Furthermore, older age independently predicted a greater magnitude of increase in air conduction at 8000 Hz following surgery regardless of sex (adj. β 2.1, 0.2-4.0 dB per 10-year increase). CONCLUSIONS This is the first study on the interactive effect between patient age and sex with respect to SCD repair outcomes. Older age predicted poorer symptomatic response among female patients but did not predict symptomatic response among male patients. Furthermore, older age predicted more severe high-frequency hearing loss following SCD repairs among both female and male patients. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3363-3370, 2024.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, U.S.A
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, California, U.S.A
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, U.S.A
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Moneir W, Darwish AY, Khafagy YW, Youssef MA, El Rakhawy MM, Hemdan A. Superior semicircular canal dehiscence: a radiological and clinical study. Indian J Otolaryngol Head Neck Surg 2024; 76:865-870. [PMID: 38440643 PMCID: PMC10908998 DOI: 10.1007/s12070-023-04299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 03/06/2024] Open
Abstract
Aim to assess radiologically the prevalence of SSCD with its clinical presentations and its relationship with age. Methods a prospective cohort study carried out on 200 consecutive patients (400 temporal bones). Radiological evaluation was performed using High Resolution Computed Tomography (HRCT) with measurement of thickness of bone covering superior semicircular canal (SCC), height and diameter of SSC. Results Two hundred patients (400 temporal bones) were involved. The mean thickness ± SD, the mean diameter ± SD and the mean height ± SD were 1.38 ± 0.80 mm, 0.94 ± 0.26 mm and 10.91 ± 2.39 mm respectively. The prevalence of SSCD and predehiscence were 1% and 14% respectively. The commonest symptom encountered was autophony (48.3%). When the SSC thickness, diameter and height were compared with the age of patients, statistically significant differences were detected. The highest diameter, lowest height and lowest thickness were found in patients aged from 54 to 72 years. Thickness of bony layer covering SSC was found to be the most validated measurement for differentiation between cases with positive and negative symptoms with the highest sensitivity and specificity. Conclusion The prevalence of SSCD and predehiscence varied among the studies. Autophony is the commonest symptom usually encountered. The condition is acquired rather than congenital. The thickness of bone covering SCC is the most validated measurement in differentiation between cases with positive and negative symptoms.
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Affiliation(s)
| | | | | | | | - Mohammed Magdy El Rakhawy
- Mansoura Faculty of Medicine, Mansoura, Egypt
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Hemdan
- Lecturer of Otorhinolaryngology, Mansoura Faculty of Medicine, Mansoura, Egypt
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-gomhoria Street, Mansoura, Egypt
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Tikka T, Mohd Slim MA, Ton T, Sheldon A, Clark LJ, Kontorinis G. Investigation of serum calcium and vitamin D levels in superior semicircular canal dehiscence syndrome: A case control study. J Otol 2023; 18:49-54. [PMID: 36820155 PMCID: PMC9937815 DOI: 10.1016/j.joto.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/22/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
Objective It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence (SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group. Methods This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period (2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups. Results A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l (SD: 20.8) compared to 47.5 nmoL/l (SD: 27.4) on the control group (p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l (SD: 0.7) for SSCD compared to 2.41 mmoL/l (SD: 0.11) for controls (p = 0.01), being within normal limits for both the SSCD and the control group. Conclusion Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.
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Evaluation of Superior Semicircular Canal Morphology and Its Relationship with Glenoid Fossa Roof Thickness Using Cone Beam Computed Tomography. Radiol Res Pract 2022; 2022:1565038. [PMID: 36573139 PMCID: PMC9789904 DOI: 10.1155/2022/1565038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to evaluate the bone thickness of the superior semicircular canal (SSC) roof and its relationship with the roof thickness of the glenoid fossa (RGF). Methods The cone beam computed tomography (CBCT) images of 280 patients (560 temporal regions) were surveyed. The lowest thickness of the SSC roof was measured and categorized based on the radiological patterns of the Cisneros et al. classification. The thickness of GF and the presence of dehiscence in this part were determined, as well. The relationship between the thickness of the GF roof and the bone thickness covering the SSC was also assessed. Results The mean thickness of the SSC roof was 0.93 ± 0.48 mm, with no significant difference among different age groups and genders (p > 0.05). However, superior semicircular canal dehiscence (SSCD) was more prevalent among females over 45 years old. Similarly, the individuals with the dehiscence of the GF roof had a 12.93-fold higher chance of SSCD development. Conclusions The results indicated that the thickness of the bone overlying the SSC was significantly related to the roof thickness of the GF. However, an increase in age resulted in no significant change in the bone thickness of the SSC roof. Gender also had no role in changing the thickness of the bone overlying the SSC. Considering the decrease in the thickness of the SSC roof among females over 45 years of age, menopause may be responsible for this occurrence as well as for the increase in the prevalence of SSCD.
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Inal M, Bayar Muluk N, Asal N, Çelik EN. Peripheric smell regions in patients with semicircular canal dehiscence: An MRI evaluation. J Clin Neurosci 2021; 94:173-178. [PMID: 34863433 DOI: 10.1016/j.jocn.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated the peripheric smell regions in patients with semicircular canal dehiscence (SCD) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 186 adult patients were included. Group 1 consisted of 83 adult patients with SCD. The control group (Group 2) consisted of 83 healthy subjects without central vertigo. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth were measured in all groups. RESULTS In group 1, SCD was detected on the right (33.7%), left (26.5%) sides and bilateral (39.8%). Localization of dehiscence was at superior SC (75.9%), posterior SC (21.7%), lateral SC (1.2%), and posterior + superior SCs (1.2%). OB volumes of the SCD group were significantly lower than the control group bilaterally (p < 0.05). There were no significant differences between OS depths of groups 1 and 2 (p > 0.05). In SCD group, there were positive correlations between OB volumes; OS depths; and OB volumes and OS depths (p < 0.05). In older patients, bilateral OS depth values got lower (p < 0.05). In females, left OB volume values were lower than males (p < 0.05). In right SCD (+) patients, left OS depth values got lower (p < 0.05). CONCLUSION We concluded that possible changes in CSF dynamics may cause the development of SCD at thin bone segments; and a decrease in the OB volume. CSF leaks into the perineural sheet of the olfactory bulb (OB) maybe responsible for the decrease in the OB volume. In addition, minor trauma, infection, and inflammation may also be responsible for both coexistences of SCD development and OB volume decrease.
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Affiliation(s)
- Mikail Inal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Neşe Asal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Enes Nusret Çelik
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
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McCrary HC, Babajanian E, Patel N, Yang S, Kircher M, Carlson ML, Gurgel RK. Superior Semicircular Canal Dehiscence Syndrome Following Head Trauma: A Multi-institutional Review. Laryngoscope 2021; 131:E2810-E2818. [PMID: 34272884 DOI: 10.1002/lary.29751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate patients who become symptomatic from superior semicircular canal dehiscence (SSCD) following head trauma. STUDY DESIGN Case series assessing patients presenting with SSCD after a trauma. METHODS A case series was completed assessing patients presenting with SSCD after trauma. Data from three academic medical centers were evaluated, including the following: imaging, videonystagmography (VNG)/vestibular evoked myogenic potential (VEMP) testing, audiometric assessment, and surgical repair. Outcome measures included the following: 1) Description of audio-vestibular symptoms, 2) mean pre- and post-operative pure tone average (PTA), word recognition score (WRS), and air bone gap (ABG). RESULTS A total of 14 patients were included; 86% were male. Approximately 43% were found to have bilateral SSCD on imaging, with 57% of patients pursuing surgical management. The most common presenting symptoms included pulsatile tinnitus (93%), autophony (79%), and hearing loss (64%). Approximately 36% of patients underwent VNG/VEMP testing, with 83.3% of those demonstrating abnormal results. The mean audiometric findings on the symptomatic side included an air-conduction PTA of 38.0 dB, bone-conduction PTA of 24.3 dB, WRS of 81%, and ABG of 17.9 dB. Among patients who underwent surgery (57%), there was no significant change in the air-conduction PTA, bone-conduction PTA, or WRS (P > .05). However, there was an improvement in the ABG (preoperative = 22.8 dB versus postoperative = 9.7 dB; P = .005). CONCLUSION Head trauma may be a potentiating event for SSCD syndrome. This study advances the hypothesis that these patients likely have underlying radiographic SSCD prior to their trauma, and a traumatic event increases in intra-vestibular or intracranial pressures, unmasking SSCD syndrome. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2810-E2818, 2021.
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Affiliation(s)
- Hilary C McCrary
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Eric Babajanian
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Neil Patel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Sara Yang
- Department of Otolaryngology-Head and Neck Surgery, Loyola University, Chicago, Illinois, U.S.A
| | - Matthew Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University, Chicago, Illinois, U.S.A
| | - Matthew L Carlson
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Preet K, Udawatta M, Mozaffari K, Ong V, Franks A, Ng E, Gaonkar B, Sun MZ, Salamon N, Gopen Q, Yang I. Relationship Between Superior Semicircular Canal Dehiscence Volume with Clinical Symptoms: Case Series. World Neurosurg 2021; 156:e345-e350. [PMID: 34562630 DOI: 10.1016/j.wneu.2021.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an osseous defect of the arcuate eminence of the petrosal temporal bone. Patients typically present with auditory and vestibular symptoms, such as hearing loss and disequilibrium. Using advanced imaging segmentation techniques, we evaluated whether the volume of SSCD correlated with preoperative symptoms and postoperative outcomes. METHODS Our laboratory previously described a novel method of quantifying the size of an SSCD via manual segmentation. High-resolution computed tomography images of the temporal bones were imported into a specialized segmentation software. The volume of the dehiscence was outlined on consecutive slices of the coronal and axial planes via a single-pixel-thick paintbrush tool and was then calculated according to the number of nonzero image voxels. RESULTS This study included 111 patients (70 women and 41 men; mean age, 55.1 years; age range, 24-87 years) with a total of 164 SSCDs. Mean postoperative follow-up time was 5.2 months (range, 0.03-59.5 months). The most common preoperative and postoperative symptoms were tinnitus (n = 85) and dizziness (n = 45), respectively. Surgery resulted in improvement of symptoms in most patients. The average volume of 164 SSCDs was 1.3 mm3. SSCD volume was not significantly associated with either preoperative symptoms or postoperative outcomes. CONCLUSIONS Advances in imaging techniques have allowed increased visualization of SSCD. Further research will be necessary to evaluate the potential correlation of volume of the dehiscence with clinical variables.
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Affiliation(s)
- Komal Preet
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Vera Ong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Alyssa Franks
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Bilwaj Gaonkar
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Quinton Gopen
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA.
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Ionescu E, Reynard P, Coudert A, Roiban L, Boudrigua AL, Thai-Van H. Superior Semicircular Canal Dehiscence by Superior Petrosal Sinus: Proposal for Classification. J Int Adv Otol 2021; 17:35-41. [PMID: 33605219 DOI: 10.5152/iao.2020.9384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study aimed to present 3 different clinical stages in patients presenting with superior semicircular canal dehiscence (SSCD) by the superior petrosal sinus (SPS). A specific 3-class classification based on clinical, radiological, and audio-vestibular arguments is proposed. MATERIALS AND METHODS We retrospectively compared clinical and radiological findings in 3 patients with different degrees of audio-vestibular dysfunction in whom the imagery evocated the diagnosis of SSCD by SPS. Imaging sensitivity was improved by combining inner ear high-resolution computed tomography (HRCT) scan and magnetic resonance imaging in fusion, allowing us to compare and corroborate clinical and audio-vestibular findings in each case with the imagery. RESULTS HRCT and 3T inner ear fusion imaging highlighted a direct contact and/or compression between SPS and the membranous superior semicircular canal (SSC). We propose a new classification of SSCD by SPS. Class "A" corresponds to an HRCT image with a "cookie bite" and thin bone still covering the SSC. Class "B" corresponds to a "cookie bite" image with confirmed contact between the SPS wall and the membranous SSC in MRI labyrinthine sequences. Class "C" type corresponds to a "cookie bite" image, contact, and obvious compression of the membranous SSC by SPS on MRI sequences. CONCLUSION Anatomical systematization is needed for daily practice. This classification of SSCD by SPS would contribute to a better understanding of the wide variety and variability in the occurrence and onset of symptoms.
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Affiliation(s)
- Eugen Ionescu
- Department of Audiology and Otoneurological Evaluation - Lyon University Hospital, Lyon, France;Paris Hearing Institute, Institut Pasteur, Paris, France
| | - Pierre Reynard
- Department of Audiology and Otoneurological Evaluation - Lyon University Hospital, Lyon, France;Claude Bernard Lyon 1 University, Lyon, France;Paris Hearing Institute, Institut Pasteur, Paris, France
| | - Aurélie Coudert
- Department of Otolaryngology - Head - Neck Surgery, Edouard Herriot Hospital - Hospices Civils de Lyon, Lyon, France;Integrative Multisensory Perception Action - Cognition Team - ImpAct, Lyon Neuroscience Research Center, Lyon, France
| | - Lucian Roiban
- Univ Lyon, INSA-Lyon, CNRS, UCBL, MATEIS, UMR 5510, Villeurbanne, France
| | | | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation - Lyon University Hospital, Lyon, France;Claude Bernard Lyon 1 University, Lyon, France;Paris Hearing Institute, Institut Pasteur, Paris, France
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Berkiten G, Gürbüz D, Akan O, Tutar B, Tunç MK, Karaketir S, Bircan HS, Berkiten E, Sarı H, Atar Y, Uyar Y. Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension. Eur Arch Otorhinolaryngol 2021; 279:2899-2904. [PMID: 34424380 DOI: 10.1007/s00405-021-07020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES The objective of the study is to evaluate a relationship between idiopathic intracranial hypertension (IIH) and superior semicircular canal dehiscence (SSCD) of bone overlying the superior semicircular canal (SSC). MATERIALS AND METHODS A total of 57 (114 ears) individuals, 20 of whom were controls and 37 of whom were IIH, were included in the study. Individuals were evaluated with 0.8 mm slice thickness computed tomography (CT) images for SSC bony roof thickness and SSCD. Thickness of the bony roof over the SSC was graded from Grade 1 to Grade 4. Grade 3 was defined as pre-dehiscence and Grade 4 as dehiscence. RESULTS Bony roof thickness was 1.25 mm in the control group and 0.76 mm in the IIH group. When bony roof thickness was compared between the groups, it was found to be significantly thinner in the IIH group (p = 0.012). In the IIH group, while dehiscence was detected in 25 of 74 ears, no dehiscence was detected in 49 ears. In the control group, while dehiscence was detected in 5 ears, no dehiscence was detected in 35 ears. The difference is statistically significant (p = 0.015). The correlation between bony roof thickness and cerebrospinal fluid (CSF) pressure in the IIH group was not statistically significant (p = 0.343; rho = 0.110). The correlation between bony roof thickness and age in the IIH group was not statistically significant (p = 0.082; rho = - 0.164). CONCLUSION Increased CSF pressure in patients with IIH may cause chronic, progressive, and irreversible damage to the bone of the SSC and, according to our study, the rate of SSCD was found to be high in IIH patients.
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Affiliation(s)
- Güler Berkiten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey.
| | - Defne Gürbüz
- Department of Radiology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Onur Akan
- Department of Neurology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Belgin Tutar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Melis Koşar Tunç
- Department of Radiology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Semih Karaketir
- Department of Otorhinolaryngology-Head and Neck Surgery, Bulanik State Hospital, Muş, Istanbul, Turkey
| | - Hasan Sami Bircan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Ertan Berkiten
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Hüseyin Sarı
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Yavuz Atar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
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10
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Evlice B, Çabuk DS, Duyan H. The evaluation of superior semicircular canal bone thickness and radiological patterns in relation to age and gender. Surg Radiol Anat 2021; 43:1839-1844. [PMID: 34241668 DOI: 10.1007/s00276-021-02797-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aims to evaluate the superior semicircular canal (SSC) bone thickness and radiological patterns in relation to age and gender in a Turkish population using cone beam computed tomography (CBCT). METHODS A total of 450 temporal bones were evaluated in the study by two examiners. The radiological patterns of SSC were categorized as follows: dehiscent, papyraceous, normal, thick and pneumatised patterns. The bone thickness of SSCs were measured. RESULTS The mean bone thickness of the SSC for females was 1.079 ± 0.8 mm. For males, the mean bone thickness was 0.952 ± 0.6 mm. There was no significant difference between males and females for the mean bone thickness of the SSC. (p > 0.05) The normal pattern was found in 258 temporal bones (57.3%). Seventy-two cases (16%) were defined as "papyraceous pattern"; 23 cases (5.1%) were defined as "thick pattern" and 42 cases (9.3%) were defined as "pneumatised pattern". SSC dehiscence was determined in 55 cases (12.2%). There was no significant difference between radiological patterns for age groups and gender (p > 0.05). CONCLUSION There was no significant relationship between SSC bone thickness with age and gender. The radiological patterns of SSC were not associated with age and gender. Radiologists evaluating the head and neck region for various reasons should be aware of these structures and report not only the SSC dehiscence but also the papyraceous pattern.
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Affiliation(s)
- Burcu Evlice
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey
| | - Damla Soydan Çabuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey.
| | - Hazal Duyan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey
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11
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Khan MZ, Jamil A, Tahir D, Sidiq R. Tension Pneumocephalus From an Eroding Cholesteatoma: A Case Report and Review of the Literature. Cureus 2021; 13:e12873. [PMID: 33633902 PMCID: PMC7898552 DOI: 10.7759/cureus.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pneumocephalus is defined as the presence of air inside the cranial vault. Benign and tension pneumocephalus are different ends of the same disease spectrum. Tension pneumocephalus leads to the formation of a pressure gradient, requiring emergent surgical decompression to prevent herniation of the intracranial structures. In this report, we present a rare case of tension pneumocephalus with essentially benign radiological findings secondary to a ruptured cholesteatoma. The patient was a 64-year-old woman with a history of end-stage renal disease on hemodialysis and hypertension. She presented to the emergency department (ED) with acute-onset weakness and decreased mentation. Physical exam findings were consistent with a cerebrovascular accident (CVA). CT scan and CT angiogram (CTA) were unremarkable for ischemia or hemorrhage but showed signs of free intracranial air, consistent with the diagnosis of pneumocephalus. After the activation of the code stroke, neurosurgery and neurology were consulted. Worsening respiratory status led to a decision to proceed with emergent intubation, but it was held based on the family’s decision to proceed with comfort measures. The patient’s status declined further within minutes and she died. Afterward, the case was discussed with the radiologist, who interpreted the cause as a cholesteatoma that had eroded through the temporal bone.
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Affiliation(s)
- Muhammad Z Khan
- Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA
| | - Abdur Jamil
- Internal Medicine, Central Michigan University, Saginaw, USA
| | - Danial Tahir
- General Medicine/Pediatrics, Ayub Medical College, Abbottabad, PAK
| | - Ramsha Sidiq
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
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Examination of the possible relation of the superior semicircular canal morphology with the roof thickness of the glenoid fossa and bone changes of the temporomandibular joint. Eur Arch Otorhinolaryngol 2020; 277:3423-3430. [DOI: 10.1007/s00405-020-06063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
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13
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'Soft reinforcement' of the round window for superior semi-circular canal dehiscence syndrome. The Journal of Laryngology & Otology 2020; 134:366-368. [PMID: 32106896 DOI: 10.1017/s0022215120000353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with superior semi-circular canal syndrome often describe vestibular symptoms elicited by loud sounds, as well as other pressure-induced symptoms. They also often report other symptoms, including autophony, hyperacusis, cognitive dysfunction, spatial disorientation, anxiety and migraine headaches. Symptoms occur due to the presence of a 'third window' created by the dehiscence of the superior semi-circular canal. This case report describes a minimally invasive technique to provide soft reinforcement of the round window. CASE REPORT Our patient underwent a permeatal procedure whereby the tympanic membrane was raised to allow inspection of the middle ear. The round window niche was identified and the round window membrane was reinforced with fat. The mucosa of the bony meatus leading to the round window was then disrupted before the application of a double layer of perichondrium to allow further reinforcement. CONCLUSION The case provides support for the use of 'soft reinforcement' as a simple and effective technique to treat the symptoms of superior canal dehiscence syndrome.
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Coelho DH, Fasulo B, Quinn K, Tang Y, Sima A, Forsthoffer B. Is the Height of the Arcuate Eminence Related to Body Mass Index? Otolaryngol Head Neck Surg 2020; 162:353-358. [PMID: 31959048 DOI: 10.1177/0194599819900342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the relationship, if any, between body mass index (BMI) and attenuation of the arcuate eminence (AE). STUDY DESIGN Case series with chart review. SETTING Tertiary neurotologic referral center. SUBJECTS AND METHODS Submillimeter distances were recorded from high-resolution temporal bone computed tomography (CT) scans of 50 patients (100 sides). The AE (defined as the superiormost location of the petrous bone over the otic capsule), the bony apex of the superior semicircular canal (SSC), and the geniculate ganglion (GG) were identified and 3-dimensional distances measured. The height of the AE relative to the bony apex of the superior semicircular canal was determined using Euclidean geometry using the fixed anatomical landmark of the GG as the origin. Correlations between AE and BMI were calculated using Pearson's, linear mixed effects, and sensitivity analysis models. RESULTS The mean (SD) BMI was 30 (8.1) kg/m2, with 16 (30%) patients falling in the underweight/normal category (BMI <25 kg/m2), 10 (20%) overweight patients (25 kg/m2≤ BMI ≤ 30 kg/m2), and 24 (48%) patients considered obese (BMI >30 kg/m2). The mean (SD) AE heights for the left and right ears were 2.5 (1.11) and 2.6 (1.09), respectively. The results of the linear mixed-effects models indicated little evidence that BMI is associated with AE height when including all patients (partial R2 = 0.040) and when using BMI categories (partial R2 = 0.025). CONCLUSION Contrary to other structures within the lateral skull base, the relative prominence of the arcuate eminence does not correlate with BMI or any other demographic variables.
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Affiliation(s)
- Daniel H Coelho
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Bradley Fasulo
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kevin Quinn
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Yang Tang
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Brielle Forsthoffer
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Nguyen T, Sheppard JP, Duong C, Ding K, Dejam D, Alkhalid Y, Romiyo P, Azzam D, Prashant G, Gopen Q, Yang I. Age and gender considerations on the symptomology in patients with superior semicircular canal dehiscence: A systematic review and case illustration. J Clin Neurosci 2019; 65:112-120. [DOI: 10.1016/j.jocn.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/11/2019] [Accepted: 04/12/2019] [Indexed: 12/16/2022]
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Mahulu EN, Fan X, Ding S, Jasmine Ouaye P, Mohamedi Mambo A, Machunde Mafuru M, Xu A. The variation of superior semicircular canal bone thickness in relation to age and gender. Acta Otolaryngol 2019; 139:473-478. [PMID: 31035843 DOI: 10.1080/00016489.2019.1595721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence syndrome (SSCD) is a current diagnosis that is due to a loss of bone covering the superior semicircular canal (SSC). This results in pressure-/sound- induced vertigo and oscillopsia. OBJECTIVE To find the variation of the thickness of the bone that covers the Superior Semicircular Canal with relation to age and gender among the Chinese descents. MATERIALS AND METHODS Three hundred and eleven temporal bone Cone Beam Computed Tomography (CBCT) images of patients who attended Otology clinic at Second Hospital of Shandong University from January, 2017 to April, 2018 were retrospectively studied. The images were reconstructed in the line of Poschl and the thinnest area of the bone covering the SSC was taken. RESULTS We included 172 (55.31%) females and 139 (44.69%) males. Mean age was 41 years. Overall mean difference in thickness was found to be -0.0210. There was no significant difference between the female and male bone thickness (p = .7113). With age the mean difference was 0.0801 (p = .1557) which was not statistically significant. CONCLUSION AND SIGNIFICANCE There was no significant change in bone thickness with advancing age. CBCT is the best method of assessing SSCD.
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Affiliation(s)
- Emmerenceana Nchama Mahulu
- Department of Otorhinolaryngology & Head and Neck Department, The Second Hospital of Shandong University, Jinan, Shandong, China
- Qilu College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xintai Fan
- Department of Otorhinolaryngology & Head and Neck Department, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Shouluan Ding
- Department of Biomedical Statistics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Pamela Jasmine Ouaye
- Department of Otorhinolaryngology & Head and Neck Department, The Second Hospital of Shandong University, Jinan, Shandong, China
- Qilu College of Medicine, Shandong University, Jinan, Shandong, China
| | - Athumani Mohamedi Mambo
- Internal Medicine Department, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Magesa Machunde Mafuru
- Pharmacy Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anting Xu
- Department of Otorhinolaryngology & Head and Neck Department, The Second Hospital of Shandong University, Jinan, Shandong, China
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Kaur T, Johanis M, Miao T, Romiyo P, Duong C, Sun MZ, Ferraro R, Salamon N, McArthur D, Yang I, Gopen Q. CT evaluation of normal bone thickness overlying the superior semicircular canal. J Clin Neurosci 2019; 66:128-132. [PMID: 31103254 DOI: 10.1016/j.jocn.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/07/2019] [Accepted: 05/07/2019] [Indexed: 11/24/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder with variable amounts of auditory and vestibular dysfunction. In addition to the absence of bone overlying the superior semicircular canal, thinning of bone in this area can also initiate the vestibulocochlear symptoms of SSCD. We evaluated normal bone thickness overlying the course of the semicircular canal using computed tomography (CT) scans and assessed correlations between bone thickness and age, gender, and location of the thinnest bone. A single-institution retrospective chart review was conducted on 133 high-resolution CT scans from 76 healthy, asymptomatic patients between ages 9 and 96 years. These CT scans of the temporal bone were obtained between January 2012 and August 2017. The superior semicircular canal dome thickness at the apex was reported with a mean of 1.25 mm for all 76 patients; the 10th percentile was 0.60 mm, and the 90th percentile was 2.08 mm. The thinnest area of bone at any location yielded a mean of 0.86 mm. The normal bone thickness overlying the superior semicircular canal does not depend on gender or age. The thinnest location was evenly distributed across the superior semicircular canal. A bone thickness of 0.40 mm or greater was present in 90% of normal patients based on CT scan measurements at the thinnest location.
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Affiliation(s)
- Taranjit Kaur
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Johanis
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Tyler Miao
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Prasanth Romiyo
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Courtney Duong
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew Z Sun
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Regan Ferraro
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David McArthur
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States; UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States; Office of the Patient Experience, University of California, Los Angeles, Los Angeles, CA, United States
| | - Quinton Gopen
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States.
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Voldřich R, Májovský M, Chovanec M, Netuka D. First Case Report of Bilateral Spontaneous Otogenic Pneumocephalus. World Neurosurg 2019; 125:179-182. [DOI: 10.1016/j.wneu.2019.01.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 12/29/2022]
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19
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Özgür A, Beyazal Çeliker F, Köksal V, Beyazal M, Özdemir D, Turan A. Radiological anatomy of superior semicircular canal and relationship to superior petrosal sinus: A study of computerized tomography. Clin Otolaryngol 2019; 44:648-651. [PMID: 30829451 DOI: 10.1111/coa.13323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulkadir Özgür
- Department of Otorhinolaryngology, University of Health Sciences- Samsun Health Practices and Research Center, Samsun, Turkey
| | - Fatma Beyazal Çeliker
- Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Vaner Köksal
- Department of Neurosurgery, University of Health Sciences- Samsun Health Practices and Research Center, Samsun, Turkey
| | - Mehmet Beyazal
- Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Doğukan Özdemir
- Department of Otorhinolaryngology, University of Health Sciences- Samsun Health Practices and Research Center, Samsun, Turkey
| | - Arzu Turan
- Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
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21
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Eggerstedt M, Hong S, Eddelman DB, Smith RM, Munoz L, Byrne RW, Wiet RM. Spontaneous Otogenic Pneumocephalus: Case Series and Update on Management. J Neurol Surg B Skull Base 2018; 80:424-430. [PMID: 31316888 DOI: 10.1055/s-0038-1676036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation, and treatment. Design Four patients underwent a middle cranial fossa approach for repair of the tegmen tympani and tegmen mastoideum. A comprehensive review of the literature regarding this disease entity was performed. Setting U.S. tertiary academic medical center. Participants: Patients presenting to the lead author's clinic or to the emergency department with radiographic evidence of SOP. Symptoms included headache, otalgia, and neurologic deficits. Main Outcome Measures Patients were assessed for length of stay, postoperative length of stay, and neurologic outcome. Three of four patients returned to their neurologic baseline following repair. Results Four patients were successfully managed via a middle cranial fossa approach to repairing the tegmen mastoideum. Conclusion The middle cranial fossa approach is an effective strategy to repair defects of the tegmen mastoideum. SOP remains a clinically rare disease, with little published information on its diagnosis and treatment.
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Affiliation(s)
- Michael Eggerstedt
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Scott Hong
- Rush Medical College, Chicago, Illinois, United States
| | - Daniel B Eddelman
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Ryan M Smith
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Lorenzo Munoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Rich W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - R Mark Wiet
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
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22
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Öhman J, Forssén A, Sörlin A, Tano K. Patients’ experiences of living with superior canal dehiscence syndrome. Int J Audiol 2018; 57:825-830. [DOI: 10.1080/14992027.2018.1487086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jenny Öhman
- Department of Clinical Science, Unit of Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Annika Forssén
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Anette Sörlin
- Department of Clinical Science, Unit of Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Krister Tano
- Department of Clinical Science, Unit of Otorhinolaryngology, Umeå University, Umeå, Sweden
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Fife TD, Colebatch JG, Kerber KA, Brantberg K, Strupp M, Lee H, Walker MF, Ashman E, Fletcher J, Callaghan B, Gloss DS. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 89:2288-2296. [PMID: 29093067 DOI: 10.1212/wnl.0000000000004690] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To systematically review the evidence and make recommendations with regard to diagnostic utility of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively). Four questions were asked: Does cVEMP accurately identify superior canal dehiscence syndrome (SCDS)? Does oVEMP accurately identify SCDS? For suspected vestibular symptoms, does cVEMP/oVEMP accurately identify vestibular dysfunction related to the saccule/utricle? For vestibular symptoms, does cVEMP/oVEMP accurately and substantively aid diagnosis of any specific vestibular disorder besides SCDS? METHODS The guideline panel identified and classified relevant published studies (January 1980-December 2016) according to the 2004 American Academy of Neurology process. RESULTS AND RECOMMENDATIONS Level C positive: Clinicians may use cVEMP stimulus threshold values to distinguish SCDS from controls (2 Class III studies) (sensitivity 86%-91%, specificity 90%-96%). Corrected cVEMP amplitude may be used to distinguish SCDS from controls (2 Class III studies) (sensitivity 100%, specificity 93%). Clinicians may use oVEMP amplitude to distinguish SCDS from normal controls (3 Class III studies) (sensitivity 77%-100%, specificity 98%-100%). oVEMP threshold may be used to aid in distinguishing SCDS from controls (3 Class III studies) (sensitivity 70%-100%, specificity 77%-100%). Level U: Evidence is insufficient to determine whether cVEMP and oVEMP can accurately identify vestibular function specifically related to the saccule/utricle, or whether cVEMP or oVEMP is useful in diagnosing vestibular neuritis or Ménière disease. Level C negative: It has not been demonstrated that cVEMP substantively aids in diagnosing benign paroxysmal positional vertigo, or that cVEMP or oVEMP aids in diagnosing/managing vestibular migraine.
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Affiliation(s)
- Terry D Fife
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - James G Colebatch
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Kevin A Kerber
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Krister Brantberg
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Michael Strupp
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Hyung Lee
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Mark F Walker
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Eric Ashman
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Jeffrey Fletcher
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Brian Callaghan
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - David S Gloss
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
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Superior Semicircular Canal Dehiscence: Pathophysiology and Surgical Outcomes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0156-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Whyte J, Tejedor MT, Monteagudo LV, Whyte A, Cisneros AI, Crovetto R, Fraile JJ, Crovetto MA. Influence of Sex and Age on Posterior Semicircular Canal Thickness. Audiol Neurootol 2017; 22:56-59. [PMID: 28668955 DOI: 10.1159/000477557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine whether sex and age influence posterior semicircular canal (PSC) thickness. METHODS This observational study was conducted in 3 tertiary hospitals. The minimal distance between the PSC and the posterior cranial fossa (PSC thickness) was estimated by thin-section multidetector row computed axial tomography (CAT) scan of the temporal bones. Nonselected consecutive patients of all ages (607 temporal bones) were considered. RESULTS A significant effect was only detected for sex (F = 5.418, p = 0.020); PSC thickness showed a higher mean value in women (mean difference ± SE: 0.224 ± 0.096 mm). A significant and negative r value was detected for males aged >45 years (-0.173, p = 0.026); in that group of patients, PSC thickness decreased as age increased (0.018 ± 0.008 mm/year). For females aged ≤45 years, a significant and positive r value was found (0.198, p = 0.022); in that group, PSC thickness increased as age increased (0.020 ± 0.008 mm/year). CONCLUSIONS PSC thickness did not significantly evolve with age in young males (≤45 years) but it decreased from age 45 years onwards. On the other hand, PCS thickness increased with age in women until the age of 45 years and it did not significantly change in older females.
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Affiliation(s)
- Jaime Whyte
- Department of Human Anatomy and Histology, School of Medicine, Zaragoza, Spain
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Ward BK, Carey JP, Minor LB. Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years. Front Neurol 2017; 8:177. [PMID: 28503164 PMCID: PMC5408023 DOI: 10.3389/fneur.2017.00177] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/13/2022] Open
Abstract
Superior semicircular canal dehiscence syndrome was first reported by Lloyd Minor and colleagues in 1998. Patients with a dehiscence in the bone overlying the superior semicircular canal experience symptoms of pressure or sound-induced vertigo, bone conduction hyperacusis, and pulsatile tinnitus. The initial series of patients were diagnosed based on common symptoms, a physical examination finding of eye movements in the plane of the superior semicircular canal when ear canal pressure or loud tones were applied to the ear, and high-resolution computed tomography imaging demonstrating a dehiscence in the bone over the superior semicircular canal. Research productivity directed at understanding better methods for diagnosing and treating this condition has substantially increased over the last two decades. We now have a sound understanding of the pathophysiology of third mobile window syndromes, higher resolution imaging protocols, and several sensitive and specific diagnostic tests. Furthermore, we have a treatment (surgical occlusion of the superior semicircular canal) that has demonstrated efficacy. This review will highlight some of the fundamental insights gained in SCDS, propose diagnostic criteria, and discuss future research directions.
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Affiliation(s)
- Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lloyd B. Minor
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Bi WL, Brewster R, Poe D, Vernick D, Lee DJ, Eduardo Corrales C, Dunn IF. Superior semicircular canal dehiscence syndrome. J Neurosurg 2017; 127:1268-1276. [PMID: 28084916 DOI: 10.3171/2016.9.jns16503] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) syndrome is an increasingly recognized cause of vestibular and/or auditory symptoms in both adults and children. These symptoms are believed to result from the presence of a pathological mobile "third window" into the labyrinth due to deficiency in the osseous shell, leading to inadvertent hydroacoustic transmissions through the cochlea and labyrinth. The most common bony defect of the superior canal is found over the arcuate eminence, with rare cases involving the posteromedial limb of the superior canal associated with the superior petrosal sinus. Operative intervention is indicated for intractable or debilitating symptoms that persist despite conservative management and vestibular sedation. Surgical repair can be accomplished by reconstruction or plugging of the bony defect or reinforcement of the round window through a variety of operative approaches. The authors review the etiology, pathophysiology, presentation, diagnosis, surgical options, and outcomes in the treatment of this entity, with a focus on potential pitfalls that may be encountered during clinical management.
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Affiliation(s)
- Wenya Linda Bi
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Ryan Brewster
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Dennis Poe
- 2Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital.,3Department of Otolaryngology, Harvard Medical School
| | - David Vernick
- 3Department of Otolaryngology, Harvard Medical School
| | - Daniel J Lee
- 3Department of Otolaryngology, Harvard Medical School.,4Department of Otolaryngology, Massachusetts Eye and Ear Infirmary; and.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - C Eduardo Corrales
- 3Department of Otolaryngology, Harvard Medical School.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian F Dunn
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
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Prevalence of Cochlear-Facial Dehiscence in a Study of 1,020 Temporal Bone Specimens. Otol Neurotol 2016; 37:967-72. [DOI: 10.1097/mao.0000000000001057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rizk HG, Hatch JL, Stevens SM, Lambert PR, Meyer TA. Lateral Skull Base Attenuation in Superior Semicircular Canal Dehiscence and Spontaneous Cerebrospinal Fluid Otorrhea. Otolaryngol Head Neck Surg 2016; 155:641-8. [DOI: 10.1177/0194599816651261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/03/2016] [Indexed: 12/29/2022]
Abstract
Objectives (1) To quantitatively assess the lateral skull base thickness in patients with superior semicircular canal dehiscense (SSCD) using a standardized and validated radiographic measure and to compare it with that of a population with spontaneous cerebrospinal fluid otorrhea (CSFO). (2) To analyze demographic and clinical factors associated with skull base thickness in the SSCD group. Study Design Case series with chart review. Setting Tertiary neurotologic referral center. Subjects and Methods Based on computed tomography imaging of the tegmen, mean skull base thickness was calculated for 16 patients with radiographic and clinical SSCD. Similar measures were performed in 4 comparison groups consisting of adults with spontaneous CSFO (n = 33), as well as 3 control groups recruited from our adult cochlear implant database: 30 obese controls (body mass index [BMI] >30 kg/m2), 11 overweight controls (BMI, 25-30 kg/m2), and 20 normal weight controls (BMI <25 kg/m2). Results The SSCD group had a significantly lower mean BMI (28.6 kg/m2) than the spontaneous CSFO group (37.7 kg/m2; P = .0007). The mean skull base thickness of SSCD patients was 17% thinner than that of the CSFO group, 31% thinner vs obese controls, 49% thinner vs overweight controls, and 45% thinner vs normal weight controls. These differences were all statistically significant ( P < .05). Conclusion Patients with SSCD have a marked thinning of the lateral skull base, more so than patients with spontaneous CSF otorrhea and control groups with different BMIs. Skull base attenuation in SSCD patients did not correlate with BMI.
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Affiliation(s)
- Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan L. Hatch
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shawn M. Stevens
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R. Lambert
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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