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Whyte-Orozco J, Cisneros-Gimeno AI, García-Barrios A, Lozano-Langarita ME, Whyte-Orozco A, Rubio-Aranda E. Association of the superior semicircular canal and tegmen tympani dehiscences and its relationship with the pneumatisation of the temporal bone. Eur Arch Otorhinolaryngol 2024; 281:1267-1272. [PMID: 37777625 PMCID: PMC10858096 DOI: 10.1007/s00405-023-08243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani. MATERIALS AND METHODS We analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus. RESULTS Of the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017). CONCLUSION We have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone.
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Affiliation(s)
- J Whyte-Orozco
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, C/ Domingo Miral, S/N, 50009, Zaragoza, Spain
- Medical and Genetic Research Group (GIIS099) Aragon Health Research Institute, Zaragoza, Spain
- Antecessor B51_23D (Government of Aragon), Zaragoza, Spain
| | - A I Cisneros-Gimeno
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, C/ Domingo Miral, S/N, 50009, Zaragoza, Spain
- Medical and Genetic Research Group (GIIS099) Aragon Health Research Institute, Zaragoza, Spain
- Antecessor B51_23D (Government of Aragon), Zaragoza, Spain
| | - A García-Barrios
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, C/ Domingo Miral, S/N, 50009, Zaragoza, Spain.
- Medical and Genetic Research Group (GIIS099) Aragon Health Research Institute, Zaragoza, Spain.
- Antecessor B51_23D (Government of Aragon), Zaragoza, Spain.
| | - M E Lozano-Langarita
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, C/ Domingo Miral, S/N, 50009, Zaragoza, Spain
| | - A Whyte-Orozco
- Department of Animal Pathology, School of Veterinary, University of Zaragoza, Zaragoza, Spain
| | - E Rubio-Aranda
- Department of Microbiology, Pediatrics, Radiology and Public Health, School of Medicine, University of Zaragoza, Zaragoza, Spain
- Water and Environmental Health /B43_23R, Zaragoza, Spain
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Formeister EJ, Zhang L, Dent J, Aygun N, Carey JP. Predictive Factors for Concurrent Tegmen Dehiscence in Superior Canal Dehiscence Syndrome. Otol Neurotol 2022; 43:494-499. [PMID: 35213476 DOI: 10.1097/mao.0000000000003481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe factors predictive of tegmen dehiscence in subjects with superior semicircular canal dehiscence syndrome (SCDS). STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Subjects with SCDS who underwent middle fossa craniotomy (MFC) for plugging/resurfacing. MAIN OUTCOME MEASURES Operative and radiographic findings of tegmen dehiscences, preoperative low frequency air-bone gaps (LF-ABGs), ocular vestibular evoked myogenic potential (oVEMP) amplitudes, size of superior semicircular canal dehiscence (SCD), and history of obesity or obstructive sleep apnea (OSA). RESULTS One hundred thirty six patients (avg. age, 50.6 yr, 55.1% female) underwent MFC for repair of SCDS. Tegmen dehiscences were commonly found intraoperatively (tegmen tympani dehiscence [TTD] in 19.9% [11% with dural contact of ossicles], tegmen mastoideum dehiscence [TMD] in 28.7%). There were no differences in preoperative LF-ABGs and preoperative oVEMP amplitudes with respect to tegmen status. The sensitivity and specificity of computed tomography (CT) for predicting an intraoperatively confirmed TTD was 85 and 74%, respectively, and 44 and 79% for TMD. History of obesity and OSA did not differ between those with and without tegmen dehiscences. The presence of contralateral SCD and increasing cross-sectional area of SCD were both significantly associated with concurrent tegmen defects. CONCLUSIONS Obesity, OSA, preoperative oVEMP, and LF-ABG do not differ between those with SCD alone and those with SCD and concurrent tegmen dehiscences. Likewise, CT scans have relatively low sensitivity for identifying tegmen dehiscences. The presence of concurrent tegmen defects is more common in subjects with larger SCD cross-sectional areas and contralateral SCD.
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Affiliation(s)
| | - Lisa Zhang
- Department of Otolaryngology-Head and Neck Surgery
| | - James Dent
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nafi Aygun
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery
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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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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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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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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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Diagnosis and management of spontaneous cerebrospinal fluid fistula and encephaloceles. Curr Opin Otolaryngol Head Neck Surg 2020; 27:369-375. [PMID: 31361611 DOI: 10.1097/moo.0000000000000568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current state in the diagnosis and management of spontaneous cerebrospinal fluid (sCSF) fistula and encephaloceles. RECENT FINDINGS The increased incidence of obesity has resulted in more cases of sCSF fistula and encephaloceles. Obesity results in increased intracranial pressure and a greater chance of developing a sCSF fistula or encephalocele. Obstructive sleep apnea can also result in transient increase in intracranial pressure and has been shown to be common in patients with sCSF fistula. Treatment of CSF fistula is usually necessary because of the increased risk of meningitis. The use of hydroxyapatite bone cements to repair the temporal bone defects has been described with a high success rate of closing the fistula and a low complication rate. Concurrent superior semicircular canal dehiscent can be seen in up to 15% of cases and should be suspected during the surgical approach to avoid potential sensorineural hearing loss and chronic imbalance. SUMMARY sCSF fistula and encephaloceles are an uncommon cause of hearing loss, middle ear effusion, and otorrhea, but should be recognized and repaired because of the risk of meningitis.
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Thinning or dehiscence of bone in structures of the middle cranial fossa floor in superior semicircular canal dehiscence. J Clin Neurosci 2020; 74:104-108. [PMID: 32044131 DOI: 10.1016/j.jocn.2020.01.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder; currently, it is unknown whether the etiopathology underlying this structural irregularity affects neighboring structures. The goal is to investigate the prevalence of bone thinning in areas of the middle cranial fossa (MCF) floor in SSCD and non-SSCD patients. METHODS This retrospective study analyzed 100 patients from March 2011 to June 2017 at a tertiary referral center. 100 patients undergoing 118 SSCD repair surgeries (18 bilateral) were identified. 12 SSCD ears were excluded due to lack of pre-operative computed tomography (CT) scans or history of prior SSCD repair at an outside facility. Non-SSCD ears were identified from routinely-obtained CT scans for temporal bone fracture (fractured sides excluded) for a total of 101 ears; 26 non-SSCD ears were excluded due to lack of high-resolution imaging. RESULTS Univariate analyses reveal that SSCD diagnosis is associated with higher rates of geniculate ganglion (GG) dehiscence compared with non-SSCD controls (42.7 vs. 24%; χ2(1) = 9.69,P = 0.008). Individuals with SSCD depicted significantly thinner bone overlying the geniculate ganglion (GG) (0.23 ± 1.2 mm) compared to controls (0.28 ± 1.8 mm, (t(1 6 4)) = 2.1, P = 0.04). SSCD patients presented thinner bone overlying the internal auditory canal (IAC) (0.33 ± 1.3 mm) compared to patients without SSCD (0.46 ± 1.6 mm, (t(2 5 7) = 6.4, P < 0.001). CONCLUSIONS The increased prevalence of dehiscence of the MCF in this cohort of SSCD patients compared to non-SSCD patients suggests that the etiology underlying SSCD affects surrounding structures.
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Whyte J, Cisneros AI, Fraile JJ, Whyte A, Crovetto R, Monteagudo LV, Crovetto MA, Tejedor MT. Interaction effect of tegmen tympani and superior semicircular canal statuses on the thickness of the roof of the glenoid fossa: a cross-sectional descriptive study. Surg Radiol Anat 2019; 42:75-80. [PMID: 31641805 DOI: 10.1007/s00276-019-02358-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Homogeneous development of temporal bone structures is explained by their ontogenic origin; tegmen tympani (TT) and superior semicircular canal (SSC) are related with the glenoid fossa at the temporomandibular joint (TMJ). Therefore, our objective was to determine a possible relationship between TT status (dehiscence or integrity) and the roof of the glenoid fossa (RGF) thickness; SSC status has also been considered. METHODS This cross-sectional descriptive study was conducted in two tertiary hospitals on 95 patients (109 ears) presenting hypoacusia, facial palsy, vertigo, tinnitus, and other single or combined symptoms, and submitted to a thin-section multidetector-row computed axial tomography (CT) scan. RESULTS A significant interaction effect of TT × SSC statuses on RGF thickness was found (p = 0.049). A significant difference in RGF thickness was found only for SSC integrity status between TT integrity and TT dehiscence (p = 0.004). The TT dehiscence increased the risk for RGF dehiscence 12.047 times (p = 0.002). CONCLUSIONS There is an interaction effect of the statuses of both TT and SSC on the thickness of the RGF, instead of an independent effect of the TT status. When RGF dehiscence is found, TT and SSC statuses should be assessed, to discard associated dehiscences.
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Affiliation(s)
- Jaime Whyte
- Department of Human Anatomy and Histology, School of Medicine, Universidad de Zaragoza, Zaragoza, Spain.,Research Group B40/17D (DGA), Zaragoza, Spain
| | - Ana Isabel Cisneros
- Department of Human Anatomy and Histology, School of Medicine, Universidad de Zaragoza, Zaragoza, Spain.,Research Group B40/17D (DGA), Zaragoza, Spain
| | - Jesús José Fraile
- Servicio de Otorrinolaringología, Hospital Universitario Miguel Servet, Paseo Isabel La Católica, Zaragoza, Spain
| | - Ana Whyte
- Department of Animal Pathology, School of Veterinary Medicine, Universidad de Zaragoza, Zaragoza, Spain
| | - Rafael Crovetto
- Department of Stomatology II, University of the Basque Country (UPV EHU), Barrio Sarriena, Leioa, Vizcaya, Spain
| | - Luis Vicente Monteagudo
- Department of Anatomy, Embryology and Genetics, School of Veterinary Medicine, Universidad de Zaragoza, C/Miguel Servet 177, 50013, Zaragoza, Spain
| | - Miguel Angel Crovetto
- Department of Otorhinolaryngology, Basurto University Hospital, University of the Basque Country (UPV/EHU), Avenida de Montevideo, Bilbao, Vizcaya, Spain
| | - María Teresa Tejedor
- Department of Anatomy, Embryology and Genetics, School of Veterinary Medicine, Universidad de Zaragoza, C/Miguel Servet 177, 50013, Zaragoza, Spain. .,CIBERCV, Universidad de Zaragoza, Zaragoza, Spain.
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Clinical Implications of the Association Between Temporal Bone Tegmen Defects and Superior Semicircular Canal Dehiscence. Otol Neurotol 2018; 39:797-802. [DOI: 10.1097/mao.0000000000001814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kutz JW, Johnson AK, Wick CC. Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone. Laryngoscope 2018; 128:2170-2177. [DOI: 10.1002/lary.27208] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Joe Walter Kutz
- Department of Otolaryngology; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
| | - Andrew K. Johnson
- Department of Otolaryngology; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
| | - Cameron C. Wick
- Department of Otolaryngology; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
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Alvi SA, Jones JW, Lin J. Bilateral Ossicular Head Dehiscence Into the Middle Cranial Fossa. Ann Otol Rhinol Laryngol 2018; 127:209-212. [PMID: 29313370 DOI: 10.1177/0003489417751956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe a unique case of bilateral dehiscence of the malleus and incus heads into the middle fossa making contact with the temporal lobes, along with its clinical implications. METHODS An analysis of a patient case and review of pertinent literature were performed. RESULTS A patient with a history of right-sided mastoidectomy for cholesteatoma was evaluated for persistent conductive hearing loss. On computed tomography (CT) and magnetic resonance imaging (MRI), the patient had a complete dehiscence of the tegmen tympani on the right, with ossicular heads being located above the floor of the middle cranial fossa. A similar finding to a milder degree was noted on the left. The patient underwent revision tympanoplasty with mastoidectomy with removal of the incus and ossicular chain reconstruction and middle fossa craniotomy for repair of the right epitympanic dehiscence. CONCLUSIONS We present some of the unique imaging and operative findings involved in an unusual presentation of encephalocele in which the bilateral malleus and incus heads rise above the level of the middle fossa floor.
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Affiliation(s)
- Sameer A Alvi
- 1 Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joel W Jones
- 1 Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jim Lin
- 1 Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Crovetto-Martínez R, Vargas C, Lecumberri I, Bilbao A, Crovetto-De la Torre M, Whyte-Orozco J. Radiologic correlation between the thickness of the roof of the glenoid fossa and that of the bony covering of the superior semicircular canal. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:358-363. [PMID: 29402729 DOI: 10.1016/j.oooo.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dehiscence of the superior semicircular canal (SSC) has been associated with alteration of the temporomandibular joint, although data explaining this association are lacking. The present study examined the correlations between the presence of dehiscences and thickness of the bone covering the SSC and the roof of the glenoid fossa (RGF). STUDY DESIGN Computed tomography was used in a cross-sectional analysis of the presence of dehiscences and thickness of the bone overlying the SCC and RGF in 156 temporal bones of 78 patients. The correlations of the presence of dehiscences in the SSC and ipsilateral RGF and the thickness of bone covering the SSC and RGF were analyzed by using the χ2 or Fisher's exact test. The relationship between the thickness of the bone overlying the SCC and RGF was analyzed by using the Spearman correlation coefficient and the Kruskal-Wallis test. The relationship between the thickness of the RGF and the covering of the SCC and patient age and gender was analyzed with the general linear model. RESULTS Significant correlations were found between the presence of dehiscences and thickness of the bone overlying the SSC and RGF (P < .001). CONCLUSIONS There is a morphologic relationship between the structure of the SSC and RGF.
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Affiliation(s)
- Rafael Crovetto-Martínez
- Department of Stomatology II, Faculty of Medicine and Dentistry, University of the Basque Country/EHU, Getxo, Spain.
| | | | | | - Amaia Bilbao
- Research Unit of Basurto University Hospital, Health Services Research on Chronic Patients Network (REDISSEC), Vizcaya, Spain
| | | | - Jaime Whyte-Orozco
- Faculty of Medicine, Department of Human Anatomy and Histology, University of Zaragoza, C/ Domingo Mirall s/n, Zaragoza, Spain
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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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Castellucci A, Brandolini C, Piras G, Fernandez IJ, Giordano D, Pernice C, Modugno GC, Pirodda A, Ferri GG. Superior canal dehiscence with tegmen defect revealed by otoscopy: Video clip demonstration of pulsatile tympanic membrane. Auris Nasus Larynx 2016; 45:165-169. [PMID: 28017492 DOI: 10.1016/j.anl.2016.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/05/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
Superior canal dehiscence is a pathologic condition of the otic capsule acting as aberrant window of the inner ear. It results in reduction of inner ear impedance and in abnormal exposure of the labyrinthine neuroepithelium to the action of the surrounding structures. The sum of these phenomena leads to the onset of typical cochleo-vestibular symptoms and signs. Among them, pulsatile tinnitus has been attributed to a direct transmission of intracranial vascular activities to labyrinthine fluids. We present the first video-otoscopic documentation of spontaneous pulse-synchronous movements of the tympanic membrane in two patients with superior canal dehiscence. Pulsating eardrum may represent an additional sign of third-mobile window lesion.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Center for Clinical and Basic Research (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Cristina Brandolini
- ENT & Audiology Unit, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Via Antonio Emmanueli 42, 29121 Piacenza, Italy
| | - Ignacio Javier Fernandez
- ENT & Audiology Unit, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Davide Giordano
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Center for Clinical and Basic Research (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Carmine Pernice
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Center for Clinical and Basic Research (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Giovanni Carlo Modugno
- ENT & Audiology Unit, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Antonio Pirodda
- ENT & Audiology Unit, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Gian Gaetano Ferri
- ENT & Audiology Unit, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
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