Plain radiological findings in Ménière's disease

Transmastoid implantability of an active transcutaneous bone conduction implant in adults with regard to the underlying pathology: a radiological simulation study

OBJECTIVES

To compare the feasibility of transmastoid implantation of an active transcutaneous bone conduction device (BCD) in the most important pathologies of the temporal bone and the impact of implant lifts in adulthood.

METHODS

First, clinical predominant pathologies for implantation of this BCD were evaluated by a literature review. Then, high-resolution CT of 240 temporal bones with neuro-otologic diseases (NOD), chronic otitis media (COM), or cholesteatoma, respectively, were investigated regarding their implantability, using a radiological simulation program.

RESULTS

Chronic inflammatory diseases (CID) of the temporal bone with or without cholesteatoma account for most adults scheduled for an active BCD. Complete implantation was possible in almost all cases with NOD as well as COM, requiring an implant lift in 50% of COM and 20% of NOD (p = .025) cases. In contrast, in subjects with cholesteatoma, implantation required an additional tool in 92% of cases, leading to 59% implantability rate in these temporal bones.

CONCLUSION

Adult subjects with CID of the temporal bone show more limiting anatomical conditions for transmastoid placement of an active transcutaneous BCD than those with single-sided deafness. Implant lifts increase the implantability significantly in subjects with COM and particularly in those with cholesteatoma.

Ménière disease: diagnostic instrumental support

The current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery entrust the diagnosis of Ménière disease (MD) only to the clinical presentation and the pure tone audiometry. However, most otolaryngologists request a widened instrumental evaluation of the patients suspected of MD. The effective reliability of the further instrumental support for the diagnosis of MD is still debated in the literature because of nonstandardized procedures and sometimes incoherence among authors. New and more sophisticated diagnostic tests have been developed both in audiovestibology and in imaging in the last few years. A review of the recent literature on this controversial subject is provided.