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Internal Auditory Canal (IAC) and Cerebellopontine Angle (CPA): Comparison between T2-weighted SPACE and 3D-CISS sequences at 1.5T. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Iwasaki S. Advances in auditory implants. Auris Nasus Larynx 2022; 50:321-326. [PMID: 36114071 DOI: 10.1016/j.anl.2022.09.003] [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: 08/05/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022]
Abstract
Auditory implants are classified into bone conduction (BAHA and Bonebridge; BB) and active middle ear implants (Vibrant Soundbridge; VSB) that stimulate cochlear hair cells, and cochlear implants (CIs) that stimulate neural structures. CIs should be performed as early as possible, and bilateral CIs have become popular because sound localization and speech recognition can be improved. CI is also considered a desirable treatment option for patients with single-sided deafness. VSB provides a safe and effective option for patients with conductive or mixed hearing loss and moderate to severe sensorineural hearing loss (SNHL); however, it use in patients with conductive or mixed hearing loss have only been approved in Japan. BAHA and BB implants have been approved by national insurance in Japan as bone conduction implants for patients with conductive or mixed hearing loss. Two fully implantable devices (Cochlear Carina and Envoy Esteem) are provided for patients with SNHL.
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Affiliation(s)
- Satoshi Iwasaki
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan.
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Grueninger I, Lippl L, Canis M, Simon F, Spiro JE, Spiegel JL, Hempel JM, Müller J, Volgger V. Anatomical Variations of the Epitympanum and the Usable Space for Middle Ear Implants Analyzed With CT-assisted Imaging Using a Tablet-based Software. Otol Neurotol 2022; 43:e454-e460. [PMID: 35213480 DOI: 10.1097/mao.0000000000003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate interindividual anatomical variations of the epitympanum and the usable space for implantation of active middle ear implants (AMEI) as well as the usefulness of a tablet-based software to assess individual anatomy on computed tomography (CT) scans. PATIENTS CT scans of 126 patients, scheduled for cochlea implantation (50.8% men; 0.6-90.0 yr) without middle ear malformations or previous middle ear surgery and with slice thickness ≤0.7 mm were analyzed. MAIN OUTCOME MEASURES Since no standardized measurements to assess the size of the epitympanum are available, relevant distances were defined according to anatomical landmarks. Three independent raters measured these distances using a tablet-based software. Interrater correlation was computed to evaluate the quality of the measurement process. Descriptive data were analyzed for validation and for evaluation of interindividual anatomical variations. Influence of age and sex on the taken measurements was assessed. RESULTS No relevant correlation between age or sex and the anatomy of the epitympanum was found. Interrater correlation ranged from Spearman's ρ = 0.3-0.9 and there were significant differences between individual rater results for various combinations. Descriptive data revealed high interindividual anatomical variance of the epitympanum, especially regarding the distance between incus and skull base. CONCLUSION The reported descriptive data regarding the anatomy of the epitympanum emphasizes the importance of preoperative planning, especially since the height of the epitympanum showed great interindividual variance potentially limiting implantation of AMEIs. The herein used tablet-based software seems to be convenient for preoperative assessment of individual anatomy in the hand of otosurgeons.
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Affiliation(s)
- Ivo Grueninger
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Lisa Lippl
- MED-EL Medical Electronics GmbH, Innsbruck, Austria
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Florian Simon
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - John Martin Hempel
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Joachim Müller
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Veronika Volgger
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany
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Pham N, Raslan O, Strong EB, Boone J, Dublin A, Chen S, Hacein-Bey L. High-Resolution CT Imaging of the Temporal Bone: A Cadaveric Specimen Study. J Neurol Surg B Skull Base 2022; 83:470-475. [PMID: 36091630 PMCID: PMC9462966 DOI: 10.1055/s-0041-1741006] [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: 01/19/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023] Open
Abstract
Objective Super-high and ultra-high spatial resolution computed tomography (CT) imaging can be advantageous for detecting temporal bone pathology and guiding treatment strategies. Methods Six temporal bone cadaveric specimens were used to evaluate the temporal bone microanatomic structures utilizing the following CT reconstruction modes: normal resolution (NR, 0.5-mm slice thickness, 512 2 matrix), high resolution (HR, 0.5-mm slice thickness, 1,024 2 matrix), super-high resolution (SHR, 0.25-mm slice thickness, 1,024 2 matrix), and ultra-high resolution (UHR, 0.25-mm slice thickness, 2,048 2 matrix). Noise and signal-to-noise ratio (SNR) for bone and air were measured at each reconstruction mode. Two observers assessed visualization of seven small anatomic structures using a 4-point scale at each reconstruction mode. Results Noise was significantly higher and SNR significantly lower with increases in spatial resolution (NR, HR, and SHR). There was no statistical difference between SHR and UHR imaging with regard to noise and SNR. There was significantly improved visibility of all temporal bone osseous structures of interest with SHR and UHR imaging relative to NR imaging ( p < 0.001) and most of the temporal bone osseous structures relative to HR imaging. There was no statistical difference in the subjective image quality between SHR and UHR imaging of the temporal bone ( p ≥ 0.085). Conclusion Super-high-resolution and ultra-high-resolution CT imaging results in significant improvement in image quality compared with normal-resolution and high-resolution CT imaging of the temporal bone. This preliminary study also demonstrates equivalency between super-high and ultra-high spatial resolution temporal bone CT imaging protocols for clinical use.
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Affiliation(s)
- Nancy Pham
- Department of Radiology, University of California, Los Angeles, California, United States,Address for correspondence Nancy Pham, MD Department of Radiology, University of California757 Westwood Plaza, Suite 1621D, Los Angeles, CA 90095-7532United States
| | - Osama Raslan
- Department of Radiology, University of California, Davis, Sacramento, California, United States
| | - Edward B. Strong
- Department of Otolaryngology, University of California, Davis, Sacramento, California, United States
| | - John Boone
- Department of Radiology, University of California, Davis, Sacramento, California, United States
| | - Arthur Dublin
- Department of Radiology, University of California, Davis, Sacramento, California, United States
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California, United States
| | - Lotfi Hacein-Bey
- Department of Radiology, University of California, Davis, Sacramento, California, United States
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Galal A, Caruso A, Lauda L, Eldin OG, Baki F, Sanna M. Effect of Sigmoid Sinus Position on the Difficulty and Approaches to Cochlear Implantation Surgery. J Int Adv Otol 2021; 17:23-29. [PMID: 33605217 DOI: 10.5152/iao.2020.8927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the effect of the position of the SS on CI regarding the ability to perform posterior tympanotomy, round window visibility, and mastoid pneumatization. MATERIALS AND METHODS This is a prospective study, including 65 adult patients with CI performed at our center during 2017. We used 3 methods to assess SS position using a computed tomography (CT) scan. Lee's line passing through the tympanic segment of the facial nerve. Park's line passing through the facial nerve and round window membrane. Our proposed method using a parallel line from the external auditory canal and passing through the facial nerve. Relation to mastoid pneumatization on CT and to intraoperative round window visibility were assessed in relation to intraoperative position of the SS. RESULTS The method by Park et al. was statistically significant (p<0.001); however, a cutoff point could not be set. Lee's method was statistically insignificant (p=0.091). Our proposed method was statistically significant with a cutoff point at ≤2.46 mm (p=0.001). SS position did not affect pneumatization nor round window visibility. CONCLUSION The position of SS preoperatively using a CT might suggest the inability to perform posterior tympanotomy and the need to change side or approach. However, it does not affect neither mastoid pneumatization nor visibility of the round window niche through the facial recess.
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Affiliation(s)
- Ahmed Galal
- Department of Otorhinolaryngology, Alexandria University School of Medicine, Alexandria, Egypt
| | - Antonio Caruso
- Department of Otorhinolaryngology and Neuro-Otology, Gruppo Otologico, Piacenza, Rome, Italy
| | - Lorenzo Lauda
- Department of Otorhinolaryngology and Neuro-Otology, Gruppo Otologico, Piacenza, Rome, Italy
| | - Omneya G Eldin
- Department of Radiodiagnosis, Alexandria University School of Medicine, Alexandria, Egypt
| | - Fatthi Baki
- Department of Otorhinolaryngology, Alexandria University School of Medicine, Alexandria, Egypt
| | - Mario Sanna
- Department of Otorhinolaryngology and Neuro-Otology, Gruppo Otologico, Piacenza, Rome, Italy
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Amin N, Pai I, Touska P, Connor SEJ. Utilization of SEMAC-VAT MRI for Improved Visualization of Posterior Fossa Structures in Patients With Cochlear Implants. Otol Neurotol 2021; 42:e451-e458. [PMID: 33534384 DOI: 10.1097/mao.0000000000003016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The number of cochlear implant (CI) users is ever increasing worldwide, as is the utilization of magnetic resonance imaging (MRI) as a key diagnostic modality for pathology of the brain and surrounding structures. Despite advances in MRI compatibility with CI, metal artefact remains a significant issue that needs to be addressed. We test our hypothesis that the slice encoding for metal artefact correction and view angle tilting (SEMAC-VAT) metal artefact reduction technique improves demonstration of posterior fossa structures on MRI in CI recipients. STUDY DESIGN A retrospective case review. SETTING A tertiary referral hearing implant and skull base center. INTERVENTIONS Dedicated MRI of the posterior fossa using T1 spin echo post-gadolinium sequences with and without the application of SEMAC-VAT in CI recipients. MAIN OUTCOME MEASURES Extent and severity of the artefact and visualization of surrounding anatomic structures with and without the application of SEMAC-VAT, allowing for direct comparison. RESULTS Eight CI recipients with nine CI devices were analyzed. We noted a significant reduction in signal void and improved visibility of the ipsilateral hemisphere in every case. Penumbra size increased although there was improved visibility through the penumbra. There was improved visualization of key intracranial structures, such as the ipsilateral internal auditory canal, cerebellopontine angle, cerebellar hemisphere, and brainstem. CONCLUSIONS Application of SEMAC-VAT produces a significant reduction in signal void and improved visualization of key structures within the temporal bone and posterior cranial fossa in patients with CIs without the need for removal of the internal magnet.
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Affiliation(s)
| | | | - Philip Touska
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steve E J Connor
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Abstract
OBJECTIVE To test the feasibility of image-guided Baha Attract implant surgery with mixed reality (MR) in the form of the HoloLens to visualize critical structures and facilitate precise Baha implant placement. METHODS A cadaveric case study of bilateral Baha Attract implant approaches was conducted using Star Atlas MR three-dimensional (3D) medical interaction system guidance at the Otolaryngology Department of PUMCH, Beijing, China. The accuracy of visual surface registration was determined by the target registration error (TRE) between the predefined points on the preoperative 3D holographic Baha Attract implant model and the postoperatively reconstructed 3D model. RESULTS Bilateral Baha Attract implantation was completed successfully for all four cadaveric heads using the Star Atlas MR 3D medical interaction system with the HoloLens. The preoperative 3D digital model characteristics (including bone quality and thickness and avoidance of cranial vessels, air cells, and cranial sutures) corresponded well with the 3D model of the actual implantation reconstructed postoperatively. The median TRE of our system was 2.97 mm (ranging from 1.98 to 4.58 mm) in terms of distance and 2.76 degrees (ranging from 0.59 to 6.4 degrees) in terms of angle. CONCLUSIONS Applying MR technology in the form of the HoloLens in Baha Attract implant surgery is feasible and could improve the accuracy of the surgery. The described MR system for Baha Attract implantation has the potential to improve the surgeon's confidence, as well as the surgical safety, efficiency, and precision.
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Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
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Burd C, Pai I, Connor SE. Active middle ear implantation: imaging in the pre-operative planning and post-operative assessment of the Vibrant Soundbridge TM. Br J Radiol 2020; 93:20190741. [PMID: 31944820 DOI: 10.1259/bjr.20190741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Active middle ear implants augment sound waves and directly stimulate the middle ear structures. The most frequently utilised active middle ear implant is the Vibrant Soundbridge TM (VSB).CT plays a vital role in appropriate patient selection and surgical planning of active middle ear implant surgery. The VSB TM offers a number of options for implant placement. The ideal location is influenced by the patient's middle ear and mastoid anatomy as well as the type and severity of the hearing loss. CT provides important information on the surgical access to the middle ear and helps determine the most appropriate implant site by assessing the adjacent middle ear anatomy and the continuity of the ossicular chain. Post-operative active middle ear implant imaging may be indicated in the setting of poor auditory outcomes and when revision surgery is being considered so as to assess for suboptimal implant placement or migration.This pictorial review will describe the VSB TM middle ear device and explain the role of imaging in both the pre-operative and post-operative settings.
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Affiliation(s)
- Christian Burd
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Irumee Pai
- Department of Otolaryngology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Steve Ej Connor
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, King's Health Partners, Guy's Hospital, London, United Kingdom
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The Image Fusion Technique for Cochlear Implant Imaging: A Study of its Application for Different Electrode Arrays. Otol Neurotol 2019; 41:e216-e222. [PMID: 31834210 DOI: 10.1097/mao.0000000000002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the benefits of the image fusion technique for precise postoperative assessment of intracochlear placement with six different electrode arrays. STUDY DESIGN Consecutive retrospective case study. SETTINGS Tertiary referral center. PATIENTS Analyses of imaging data of 30 patients implanted with six different electrode arrays. INTERVENTIONS Electrode reconstructions obtained from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) and/or high-resolution computed tomography (HRCT) registrations to create artefact-free images. MAIN OUTCOME MEASURES Each electrode's intracochlear position was analyzed with the image fusion reconstructions and compared with the results obtained by CBCT alone. The electrode location was classified according to its position in relation to the basal membrane at four different insertion angles. RESULTS In 40 out of 151 measurements (26.5%), the location grading obtained by CBCT alone changed after the assessment with the image fusion reconstructions. A significant association was found between deep insertions (over 360 degrees) and the effectiveness of image fusion (p = 0.019). The difference between the impact of the fusion technique for the basal turn versus the apical part was highly significant (p = 0.001). There was no significant difference between the effectiveness of the image fusion and the different electrodes. CONCLUSIONS By utilizing an image fusion technique, a more accurate assessment of electrode placement could be achieved for all types of electrodes. Image fusion was especially beneficial for insertions beyond 360 degrees.
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The Insertion Results of a Mid-scala Electrode Assessed by MRI and CBCT Image Fusion. Otol Neurotol 2019; 39:e1019-e1025. [PMID: 30444847 DOI: 10.1097/mao.0000000000002045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the results of clinical surgical insertions with a Mid-scala array (HIFocus Mid-Scala Electrode, HFms). STUDY DESIGN Consecutive retrospective case study. SETTINGS Tertiary referral center. PATIENTS Analyses of imaging data of 26 consecutive patients (31 insertions) implanted with the HFms. INTERVENTION (S) The evaluation of insertion trauma evoked by a previously validated image fusion technique. Electrode reconstructions from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) scans to create artifact-free images. MAIN OUTCOME MEASURES The electrode position was quantified in relation to the basilar membrane. Trauma scaling adopted from Eshraghi was used for evaluating insertion trauma. The results of the visual assessment of the postoperative CBCT were compared to those obtained with the fusion technique. RESULTS Three insertions had to be excluded due to incompatibility of the imaging data with the fusion software. We found consistent peri- to mid-modiolar placement of the HFms with a mean insertion depth angle of 376°. According to the medical records, a visual examination of the postoperative CBCT indicated that there had been no scala dislocations but when assessed by the image fusion technique, five scala dislocations (17.8%) were found. Additionally, one tip fold-over was detected in the postoperative CBCT even though this was not evident in any intraoperative measurements. CONCLUSION HFms showed atraumatic surgical insertion results with consistent mid-modiolar placement. Image fusion enhances the accuracy of the insertion trauma assessment. Routine postoperative imaging is recommended for identifying tip fold-over as well as for quality control and documentation.
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Abd El Aziz TT, El Fiky L, Shalaby MH, Essam A. Radiological evaluation of inner ear trauma after cochlear implant surgery by cone beam CT(CBCT). Eur Arch Otorhinolaryngol 2019; 276:2697-2703. [PMID: 31214825 DOI: 10.1007/s00405-019-05507-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cochlear implantation (CI) has been extended to involve younger age group with higher incidence of residual hearing which increases the need of minimizing surgical inner ear trauma. Radiological evaluation for electrode position has been studied yet without assessment of inner ear trauma, our objective is radiological evaluation of post cochlear implantation inner ear trauma MATERIAL AND METHODS: 20 patients with CI for pre lingual SNHL were included in this study. Cone beam CT (CBCT) was used for evaluation of electrode position and assessment of inner ear trauma. A Neuroradiologist and an implant surgeon analyzed the relation of inserted electrode to the intra-cochlear structures, with introduction of novel radiological grading for inner ear trauma. RESULTS The mean major cochlear diameter was 8.9 mm, the mean angular depth of insertion was 406.9944 (SD = 165.0559). Ten patients were with no cochlear trauma (grade 0), three patients were grade 1, two patients were grade 2 and five patients were grade 3 inner ear trauma. CONCLUSION Radiological evaluation for electrode position should extend to involve assessment of inner ear trauma using relation of the implant to cochlear internal structures which could be performed by CBCT with high resolution and least metallic artifacts.
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Affiliation(s)
| | - Lobna El Fiky
- Otorhinolaryngology Department, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Essam
- Otorhinolaryngology Department, Ain Shams University, Cairo, Egypt
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Connor S. Head and Neck Imaging. Clin Radiol 2018; 73:1-3. [DOI: 10.1016/j.crad.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
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Garin A, Benoudiba F, Ducreux D. [Techniques and progress in the imaging of the ear]. Presse Med 2017; 46:1097-1105. [PMID: 29097036 DOI: 10.1016/j.lpm.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022] Open
Abstract
Ear and temporal bone imaging is essential for the diagnostic and preoperative management of middle ear lesions. The scanner is the exam of choice to analyze the walls and the contents of the middle ear. MRI is used to characterize the opacities of the middle ear and to evaluate possible neurological complications. Modern imaging techniques allow intraoperative guidance in otological surgery. Hearing implants are not always a contraindication to MRI but require precautions according to the type of implant.
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Affiliation(s)
- Antoine Garin
- AP-HP, hôpital Bicêtre, service d'oto-rhino-laryngologie et de chirurgie cervicofaciale, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, faculté de médecine, 94275 Le Kremlin-Bicêtre, France.
| | - Farida Benoudiba
- AP-HP, hôpital Bicêtre, service de neuroradiologie, 94270 Le Kremlin-Bicêtre, France
| | - Denis Ducreux
- Université Paris-Saclay, faculté de médecine, 94275 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de neuroradiologie, 94270 Le Kremlin-Bicêtre, France; CNRS UMR 8081, IR4M, Le Kremlin-Bicêtre, France
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