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Xun M, Liu X, Sha Y, Zhang X, Liu JP. The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis. Laryngoscope Investig Otolaryngol 2023; 8:627-635. [PMID: 37342121 PMCID: PMC10278117 DOI: 10.1002/lio2.1032] [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] [Received: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The purpose of this meta-analysis was to compare the efficiency of high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (DWI) in guiding the diagnosis of middle ear cholesteatoma in clinical practice. Materials and methods Cochrane Library, Medline, Embase, PubMed, and Web of Science were searched for studies that evaluated the sensitivity and specificity of HRCT or DWI in detecting middle ear cholesteatoma. A random-effects model was used to calculate and summarize the pooled estimates of sensitivity, specificity, and diagnostic odds ratios. Postoperative pathological results were considered as the diagnostic gold standard for middle ear cholesteatoma. Results Fourteen published articles (860 patients) met the inclusion criteria. The sensitivity and specificity of DWI when diagnosing cholesteatoma (regardless of type) were 0.88 (95% confidence interval [CI], 0.80-0.93) and 0.93 (95% CI, 0.86-0.97), respectively, while those of HRCT were 0.68 (95% CI, 0.57-0.77) and 0.78 (95% CI, 0.60-0.90), respectively. Notably, the sensitivity and specificity levels of DWI were similar to those of HRCT (p = .1178 for sensitivity, p = .2144 for specificity; pair-sampled t tests). The sensitivity and specificity of DWI or HRCT for the diagnosis of primary cholesteatoma were 0.78 (95% CI, 0.65-0.88) and 0.84 (95% CI, 0.69-0.93), respectively, while that for recurrent cholesteatoma were 0.93 (95% CI, 0.61-0.99) and 0.94 (95% CI, 0.82-0.98), respectively. Conclusion DWI and HRCT have similar levels of high sensitivity and specificity in detecting various cholesteatomas. Also, the diagnostic efficiency of HRCT or DWI for recurrent cholesteatoma is identical to that of primary cholesteatoma. Therefore, HRCT may be used in clinical settings to reduce the use of DWI and save clinical resources. Lay summary Data on the use of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography in the diagnosis of cholesteatoma were obtained through a literature search. They were analyzed to guide the clinical diagnosis and treatment of cholesteatoma. Level of evidence NA.
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Affiliation(s)
- Mengzhao Xun
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xu Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Yongfang Sha
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xin Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Jian Ping Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
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Pierce C, Ginat DT. Postsurgical and Postradiation Findings in the Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:299-313. [DOI: 10.1016/j.nic.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Bhatt PR, Alyono JC, Fischbein NJ, Penta M. Imaging of the Postoperative Temporal Bone. Neuroimaging Clin N Am 2021; 32:175-192. [PMID: 34809837 DOI: 10.1016/j.nic.2021.08.006] [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: 10/19/2022]
Abstract
Evaluation of the postoperative temporal bone can be difficult given the complex anatomy of this region and the myriad surgical approaches for management of a variety of conditions. This article provides an understanding of common postsurgical changes of the temporal bone and their typical imaging appearances. Ultimately, greater radiologist knowledge of postoperative temporal bone imaging findings will help to serve patients and referring clinicians with prompt diagnosis and recognition of expected postintervention changes compared with postoperative complications and/or disease recurrence.
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Affiliation(s)
- Paraag R Bhatt
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA.
| | - Jennifer C Alyono
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, MC 5739, Stanford, CA 94305, USA
| | - Nancy J Fischbein
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA
| | - Mrudula Penta
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA
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4
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Mazón M, Pont E, Castellá-Malonda J, Jacome-Torres O, Carreres-Polo J. Radiological evaluation of the postsurgical middle ear. RADIOLOGIA 2021; 63:436-444. [PMID: 34625199 DOI: 10.1016/j.rxeng.2021.04.006] [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: 01/30/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used iin middle ear surgery. Knowledge of these factors will enable normal postsurgical changes to be differentiated from complications. This article describes the most common surgical procedures in the middle ear, their indications, and the normal radiological appearance after these procedures. It reviews the most common causes of failure in stapes surgery, in surgery for chronic otitis media, and in surgery for cholesteatoma, suggesting the best imaging method to assess the middle ear in each case. CONCLUSION Computed tomography enables the evaluation of prostheses and the aeration of the cavities, whereas magnetic resonance imaging makes it possible to characterize the possible occupation of the cavities and is the technique of choice for the follow-up of closed mastoidectomy for cholesteatomas.
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Affiliation(s)
- M Mazón
- Área clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - E Pont
- Servicio de Otorrinolaringología, Hospital de Manises, Valencia, Spain
| | - J Castellá-Malonda
- Área clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - O Jacome-Torres
- Área clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Carreres-Polo
- Área clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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5
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Radiological evaluation of the postsurgical middle ear. RADIOLOGIA 2021. [PMID: 34116861 DOI: 10.1016/j.rx.2021.04.005] [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: 11/18/2022]
Abstract
OBJECTIVE The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used iin middle ear surgery. Knowledge of these factors will enable normal postsurgical changes to be differentiated from complications. This article describes the most common surgical procedures in the middle ear, their indications, and the normal radiological appearance after these procedures. It reviews the most common causes of failure in stapes surgery, in surgery for chronic otitis media, and in surgery for cholesteatoma, suggesting the best imaging method to assess the middle ear in each case. CONCLUSION Computed tomography enables the evaluation of prostheses and the aeration of the cavities, whereas magnetic resonance imaging makes it possible to characterize the possible occupation of the cavities and is the technique of choice for the follow-up of closed mastoidectomy for cholesteatomas.
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6
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Tames HLVC, Padula M, Sarpi MO, Gomes RLE, Toyama C, Murakoshi RW, Olivetti BC, Gebrim EMMS. Postoperative Imaging of the Temporal Bone. Radiographics 2021; 41:858-875. [PMID: 33739892 DOI: 10.1148/rg.2021200126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The anatomy of the temporal bone is complex, and postoperative imaging evaluation of this bone can be challenging. Surgical approaches to the temporal bone can be categorized didactically into tympanoplasty and ossicular reconstruction, mastoidectomy, and approaches to the cerebellopontine angle and internal auditory canal (IAC). In clinical practice, different approaches can be combined for greater surgical exposure. Postoperative imaging may be required for follow-up of neoplastic lesions and to evaluate unexpected outcomes or complications of surgery. CT is the preferred modality for assessing the continuity of the reconstructed conductive mechanism, from the tympanic membrane to the oval window, with use of grafts or prostheses. It is also used to evaluate aeration of the tympanic and mastoid surgical cavities, as well as the integrity of the labyrinth, ossicular chain, and tegmen. MRI is excellent for evaluation of soft tissue. Use of a contrast-enhanced fat-suppressed MRI sequence is optimal for follow-up after IAC procedures. Non-echo-planar diffusion-weighted imaging is optimal for detection of residual or recurrent cholesteatoma. The expected imaging findings and complications of the most commonly performed surgeries involving the temporal bone are summarized in this review. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hugo L V C Tames
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Mario Padula
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Maíra O Sarpi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Regina L E Gomes
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Carlos Toyama
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Rodrigo W Murakoshi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Bruno C Olivetti
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Eloísa M M S Gebrim
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
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7
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Ziąbka M, Malec K. Polymeric middle ear prosthesis enriched with silver nanoparticles – first clinical results. Expert Rev Med Devices 2019; 16:325-331. [DOI: 10.1080/17434440.2019.1596796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Magdalena Ziąbka
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Ceramics and Refractories, Krakow, Poland
| | - Katarzyna Malec
- 5th Military Hospital with Polyclinic, Department of Otolaryngology, Head and Neck Surgery, Krakow, Poland
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8
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Nguyen T, Pulickal G, Singh A, Lingam R. Conductive hearing loss with a "dry middle ear cleft"-A comprehensive pictorial review with CT. Eur J Radiol 2019; 110:74-80. [PMID: 30599877 DOI: 10.1016/j.ejrad.2018.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/07/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022]
Abstract
Conductive hearing loss (CHL) commonly results from middle ear fluid and inflammation (otitis media). Less commonly in patients with CHL, the middle ear cleft is well aerated or 'dry' with absence of soft tissue or fluid clinically and on imaging. There are numerous causes for this but they can be clinically challenging to diagnose. This pictorial review aims to illustrate and discuss the CT features of both common and less common causes of CHL in patients with a "dry middle ear cavity".
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Affiliation(s)
- Thi Nguyen
- Benson Radiology, 120 Greenhill Road, Unley, South Australia, 5061, Australia; Department of Medical Imaging, Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia.
| | - Geoiphy Pulickal
- Department of Diagnostic Radiology at Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore.
| | - Arvind Singh
- Department of ENT Surgery, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, United Kingdom.
| | - Ravi Lingam
- Department of Radiology, Northwick Park Hospital, Watford Road, London, HA1 3UJ, United Kingdom.
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9
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Salata TM, Ribeiro BNDF, Muniz BC, Antunes LDO, Rosas HB, Marchiori E. Hearing disorders - findings on computed tomography and magnetic resonance imaging: pictorial essay. Radiol Bras 2019; 52:54-59. [PMID: 30804617 PMCID: PMC6383528 DOI: 10.1590/0100-3984.2016.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hearing disorders are usually unilateral and are more common in women. They can be congenital or acquired, and hearing loss is categorized as sensorineural, conductive, or mixed. The onset of hearing loss can be progressive or sudden, and it is a common reason for seeking medical attention. In this context, computed tomography and magnetic resonance imaging have assumed critical roles in the search for an etiological diagnosis and in guiding the therapeutic approach. In this pictorial essay, we illustrate the common causes of hearing loss, discussing the possible differential diagnoses and highlighting the most relevant imaging findings.
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Affiliation(s)
- Tiago Medina Salata
- Hospital Casa de Portugal / Clínica 3D Diagnose, Rio de
Janeiro, RJ, Brazil.,Correspondence: Dr. Tiago Medina Salata. Hospital Casa de Portugal
/ Clínica 3D Diagnose. Rua do Bispo, 72, Rio Comprido. Rio de Janeiro,
RJ, Brazil, 22262-064.
| | | | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
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10
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Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication. Otol Neurotol 2018; 38:1500-1504. [PMID: 29065085 DOI: 10.1097/mao.0000000000001596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis. PATIENTS A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded. INTERVENTIONS All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started. MAIN OUTCOME MEASURE Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution. RESULTS Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments. CONCLUSIONS Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo.
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11
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Shama SA. MDCT assessment of recurrent cholesteatoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Neudert M, Zahnert T. Tympanoplasty - news and new perspectives. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc07. [PMID: 29279725 PMCID: PMC5738936 DOI: 10.3205/cto000146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Techniques and biomaterials for reconstructive middle ear surgery are continuously and steadily developing. At the same time, clinical post-surgery results are evaluated to determine success or failure of the therapy. Routine quality assessment and assurance is of growing importance in the medical field, and therefore also in middle ear surgery. The exact definition and acquisition of outcome parameters is essential for both a comprehensive and detailed quality assurance. These parameters are not the audiological results alone, but also additional individual parameters, which influence the postoperative outcome after tympanoplasty. Selection of patients and the preoperative clinical situation, the extent of the ossicular chain destruction, the chosen reconstruction technique and material, the audiometric frequency selection and the observational interval are only some of them. If these parameters are not well documented, the value of comparative analyses between different studies is very limited. The present overview aims at describing, comparing, and evaluating some of the existing assessment and scoring systems for middle ear surgery. Additionally, new methods for an intraoperative quality assessment in ossiculoplasty and the postoperative evaluation of suboptimal hearing results with imaging techniques are available. In the area of implant development, functional elements were integrated in prostheses to enable not only good sound transmission but also compensation of occurring atmospheric pressure changes. In combination with other components for ossicular repair, they can be used in a modular manner, which so far show experimentally and clinically promising results.
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Affiliation(s)
- Marcus Neudert
- Technical University of Dresden, Germany.,Medical Faculty "Carl Gustav Carus", Dresden, Germany.,Department of Otolaryngology, Head and Neck Surgery, University Hospital of Dresden, Germany
| | - Thomas Zahnert
- Technical University of Dresden, Germany.,Medical Faculty "Carl Gustav Carus", Dresden, Germany.,Department of Otolaryngology, Head and Neck Surgery, University Hospital of Dresden, Germany
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13
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Actualización en el diagnóstico radiológico de la otosclerosis. RADIOLOGIA 2016; 58:246-56. [DOI: 10.1016/j.rx.2016.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 12/28/2022]
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Gredilla Molinero J, Mancheño Losa M, Santamaría Guinea N, Arévalo Galeano N, Grande Bárez M. Update on the imaging diagnosis of otosclerosis. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Otologic disorders causing dizziness, including surgery for vestibular disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:279-93. [PMID: 27638078 DOI: 10.1016/b978-0-444-63437-5.00020-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter will focus on vertigo/dizziness due to inner-ear malformations, labyrinthine fistula, otosclerosis, infectious processes, and autoimmune inner-ear disorders. Inner-ear malformation due to dehiscence of the superior semicircular canal is the most recently described inner-ear malformation. Vertigo/dizziness is typically induced by sound and pressure stimuli and can be associated with auditory symptoms (conductive or mixed hearing loss). Labyrinthine fistula, except after surgery for otosclerosis, in the context of trauma or chronic otitis media with cholesteatoma, still remains a challenging disorder due to multiple uncertainties regarding diagnostic and management strategies. Otosclerosis typically manifests with auditory symptoms and conductive or mixed hearing loss on audiometry. Vertigo/dizziness is rare in nonoperated otosclerosis and should draw clinical attention to an inner-ear malformation. Computed tomography scan confirms otosclerosis in most cases and should rule out an inner-ear malformation, avoiding needless middle-ear surgical exploration. Labyrinth involvement after an infectious process is unilateral when it complicates a middle-ear infection but can be bilateral after meningitis. Labyrinth involvement due to an inflammatory disease is a challenging issue, particularly when restricted to the inner ear. The diagnosis relies on the bilateral and rapid aggravation of audiovestibular symptoms that will not respond to conventional therapy but to immunosuppressive drugs.
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Abstract
Post stapedectomy vertigo is most often a self-limiting postoperative complication. Sometimes vertigo occurs years after operation and different etiologies, non-surgically as well as related to previous surgery, have to be excluded. High resolution CT of the temporal bone can be of help, as in this case report, in which the images showed intravestibular stapes prosthesis protrusion.
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17
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Juliano AF, Ginat DT, Moonis G. Imaging Review of the Temporal Bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplastic Conditions. Radiology 2015; 276:655-72. [PMID: 26302389 DOI: 10.1148/radiol.2015140800] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The first part of this review of the temporal bone discussed anatomy of the temporal bone as well as inflammatory and neoplastic processes in the temporal bone region (1). This second part will first discuss trauma to the temporal bone and posttraumatic complications. The indications for common surgical procedures performed in the temporal bone and their postoperative imaging appearance are then presented. Finally, a few noninflammatory nonneoplastic entities involving the temporal bone are reviewed. They are relatively uncommon diagnoses compared with infectious or inflammatory diseases. However, because patients present with symptoms that are either common (hearing loss) or distinctive (sensorineural hearing loss in a child), they are important for the radiologist to be aware of and recognize.
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Affiliation(s)
- Amy F Juliano
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Daniel T Ginat
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Gul Moonis
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
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18
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Thomson S, Madani G. The windows of the inner ear. Clin Radiol 2014; 69:e146-52. [DOI: 10.1016/j.crad.2013.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 10/22/2013] [Accepted: 10/30/2013] [Indexed: 12/01/2022]
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19
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CT Virtual Endoscopy in Assessing Ossicular Chain Disruption Csused by Temporal Bone Fracture and Ear Trauma. J Otol 2013. [DOI: 10.1016/s1672-2930(13)50021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Usefulness of Cone-Beam Computed Tomography in Determining the Position of Ossicular Prostheses. Otol Neurotol 2011; 32:1358-63. [DOI: 10.1097/mao.0b013e31822e8683] [Citation(s) in RCA: 11] [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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21
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Kontorinis G, Giesemann AM, Witt T, Goetz F, Schwab B. Controlling the position and the dislocation of the middle ear transducer with high-resolution computed tomography and digital volume tomography: implications for the transducers' design. Eur Arch Otorhinolaryngol 2011; 269:1103-10. [PMID: 21938527 DOI: 10.1007/s00405-011-1772-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/09/2011] [Indexed: 11/26/2022]
Abstract
A minimal tip dislocation of the middle ear transducer (MET(®), Otologics Ltd) may result in poor hearing performance. Our objective was to examine if a defined MET dislocation can be diagnosed by high-resolution computed tomography (HRCT) or digital volume tomography (DVT). A human cadaver head was sequentially implanted with different MET tips (incus application) including a ceramic tip (T 1c), a titanium tip (T 1t), a new, thinner titanium tip (T 2), and a spherical titanium tip (Ts). HRCT and DVT studies were performed. Afterward, the tips were pulled back 0.5 mm, so that they were not attached to the incus. HRCT and DVT scans were repeated to identify the dislocation. Using the best plain in HRCT images, the dislocation of the transducer could be measured reliably and reproducibly in half of the cases. In particular, the precise positioning and the dislocation could be identified when T 1t and Ts were implanted, with the Ts showing the best visibility. DVT failed in recognizing the dislocation in all cases. The identification of MET tip's dislocation with HRCT depends on the shape, size, and material of the tip. This knowledge is useful for the design of the implants, as determination of the right position of the middle ear transducer may be proven important for the hearing outcome. In some cases, however, surgical exploration may still be required. Although DVT represents a promising imaging method for the otologists, it can barely help when MET dislocation is suspected.
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Affiliation(s)
- Georgios Kontorinis
- Department of Otorhinolaryngology, Hanover Medical University, Carl-Neuberg-Str. 1, 30625 Hanover, Germany.
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Blanco Cabellos JA, Ossaba Vélez S, Alba De Cáceres I, Soler Lluch E, Galobardes Monje J. CT and MRI Correlations in Patients with Suspected Cholesteatoma after Surgery. Neuroradiol J 2011; 24:367-78. [PMID: 24059659 DOI: 10.1177/197140091102400305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/16/2022] Open
Abstract
The study of postoperative ear cavities in patients who underwent surgery for cholesteatoma is a difficult challenge for radiologists. In our study we make a correlation between CT and MRI findings, useful tools in patients with suspected residual or recurrent cholesteatoma. The use of different MRI sequences especially DWI can help radiologists to discriminate between cholesteatoma and other different processes.
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Affiliation(s)
- J A Blanco Cabellos
- Department of Radiology, Unidad Central de Radiodiagnostico (UCR), Hospital Infanta Cristina; Parla, Madrid, Spain -
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Offergeld C, Kromeier J, Merchant SN, Lasurashvili N, Neudert M, Bornitz M, Laszig R, Zahnert T. Experimental investigation of rotational tomography in reconstructed middle ears with clinical implications. Hear Res 2010; 263:191-7. [PMID: 19969056 PMCID: PMC2866829 DOI: 10.1016/j.heares.2009.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/09/2009] [Accepted: 12/02/2009] [Indexed: 11/24/2022]
Abstract
A large air-bone-gap after ossiculoplasty may be due to a malpositioned or displaced prosthesis. Rotational tomography (RT) has the potential to provide high-resolution images of implants without artifacts and with less radiation dosage than CT scan. Twenty-seven temporal bone specimens underwent measurements of middle ear transfer function using Laser-Doppler-Vibrometry (LDV) before and after placement of ossicular replacement prostheses (PORPs, TORPs) made of titanium. RT was performed on all specimens. RT allowed 3-dimensional viewing of the temporal bone, accurate localization of implants within the reconstructed middle ear and determination of angles between the inserted prostheses and the tympanic membrane (TM) and/or the malleus handle (MH). Presence or absence of contact between the implant and the TM, malleus or stapes could be clearly visualized. Displaced prostheses were readily identified. The functional LDV-measurements for TORPs showed a trend favoring coupling to the malleus handle, while for PORPs, coupling to the TM was favored. For PORPs, sound transmission was worse with increasing angles between the PORP and stapes superstructure (p<0.05). Following our experimental results RT is an innovative, relevant and useful imaging technique to obtain immediate postoperative feedback after ossicular reconstruction and to precisely determine the position of middle ear implants.
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Affiliation(s)
- Christian Offergeld
- Dept. of ORL, HNS; University of Freiburg; Killianstrasse 5; 79106 Freiburg; Germany
| | - Jan Kromeier
- Dept. of Radiology; St. Josef’s Hospital; Sautierstrasse 1; 79104 Freiburg; Germany
| | - Saumil N. Merchant
- Dept. of Otology and Laryngology; Harvard Medical School, MEEI; 243 Charles Street; Boston, MA 02114; USA
| | - Nicoloz Lasurashvili
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Marcus Neudert
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Matthias Bornitz
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Roland Laszig
- Dept. of ORL, HNS; University of Freiburg; Killianstrasse 5; 79106 Freiburg; Germany
| | - Thomas Zahnert
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
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Imaging of the Mastoid, Middle Ear, and Internal Auditory Canal After Surgery: What Every Radiologist Should Know. Neuroimaging Clin N Am 2009; 19:307-20. [DOI: 10.1016/j.nic.2009.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Röösli C, Hoffmann A, Treumann T, Linder TE. [Significance of computed tomography evaluation before revision stapes surgery]. HNO 2008; 56:895-900. [PMID: 18330533 DOI: 10.1007/s00106-008-1670-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stapedectomy and, more recently, stapedotomy have been widely accepted as the primary surgical techniques to improve conductive hearing in patients suffering from otosclerosis. Unsuccessful outcomes are infrequent, but revision surgery may become necessary. We have analyzed the value of computed tomography (CT) scanning following unsuccessful stapes surgery. PATIENTS AND METHODS In a total of 37 CT scans, the depth of insertion, angle between prosthesis and footplate, location of prosthesis within the oval niche, visibility of the prosthesis, dehiscence of the superior semicircular canal, and extent of otospongiotic foci were evaluated and compared with the audiometric results. RESULTS There was no significant correlation between CT parameters and audiologic results, except for patients with cochlear otosclerosis or lateral dislocation of the piston. One previously unknown dehiscence of the superior semicircular canal was diagnosed. Otospongiotic foci were seen in 13 ears (35%). CONCLUSION Displacements of the stapes piston and rare causes for an insufficient result, such as a dehiscence of the superior semicircular canal, can be diagnosed accurately by CT. However, correlation between the audiologic results and the findings on CT scans was possible in only a few cases. Nevertheless, CT scans provide additional information for surgical planning in revision stapes surgery and may become increasingly important to reduce unanticipated intraoperative risks; they may even guide the surgeon not to perform unnecessary revision surgeries.
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Affiliation(s)
- C Röösli
- Klinik für Hals-Nasen-Ohren-Heilkunde, Hals- und Gesichtschirurgie, Kantonsspital Luzern, Spitalstrasse, 6000, Luzern, Schweiz.
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Three-dimensional imaging of active and passive middle ear prostheses using multislice computed tomography. J Comput Assist Tomogr 2008; 32:304-12. [PMID: 18379323 DOI: 10.1097/rct.0b013e318074d9cf] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined the explanatory power of 3-dimensional visualization of middle ear prostheses and to introduce this method as a supplementary diagnostic tool. METHODS Various prostheses were examined in vitro. Surface rendering and perspective volume-rendering techniques were compared with axial, curviplanar, and maximum intensity projection images. One hundred three patients with hearing difficulty underwent high-resolution computed tomography scanning. The 3-dimensional images of 41 patients after nonspecific middle ear surgery were compared with the tympanoscopic findings. RESULTS The PVR technique allowed the depiction of the smallest individual substructures of the prostheses. The evaluation of the prostheses' localization using PVR was significantly better than using maximum intensity projection (P < 0.001). Surface rendering showed no advantages over 2-dimensional imaging. Diagnostic findings of high-resolution computed tomography were comparable to tympanoscopy (specificity 100%, sensitivity 95.1%). CONCLUSION The 3D depiction facilitates the evaluation of middle ear prostheses fitting.
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Abstract
Chronic otitis media (COM) can be divided into two subtypes: COM with cholesteatoma (including precholesteatomatous states) is an aggressive form of otitis. Surgical treatment is mandatory because of the risk for labyrinthine or cerebromeningeal complications. CT is very important in the preoperative work-up (extension of cholesteatoma, anatomic variants). In patients who have undergone middle ear surgery, CT and presently MRI play an increasing role in the detection of recurrent or relapsing cholesteatoma. COM without cholesteatoma does not have an osteolytic potential, but may leave auditive sequelae that in selected cases may warrant surgical treatment to improve hearing. CT is useful in the etiological work-up of patients with severe hypoacusis. CT also plays an important role in cases of surgical failure, to detect a dislocation of the ossiculoplasty or impairment of the middle ear caused by fluid effusion. The objective of this paper is to specify the indications, the results and the limits of pre- and postoperative imaging in COM.
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Affiliation(s)
- M T Williams
- Service d'Imagerie Médicale, Fondation Ophtalmologique Adolphe de Rothschild, 25-29, rue Manin, 75940 Paris Cedex 19, France.
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Offergeld C, Kromeier J, Aschendorff A, Maier W, Klenzner T, Beleites T, Zahnert T, Schipper J, Laszig R. Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study. Eur Arch Otorhinolaryngol 2006; 264:345-51. [PMID: 17047976 DOI: 10.1007/s00405-006-0180-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 09/21/2006] [Indexed: 10/24/2022]
Abstract
Imaging is an essential diagnostic tool in reconstructive middle ear surgery, especially in pre-operative planning. Due to ongoing improvement of imaging quality and development of new imaging techniques like e.g. rotational tomography (RT) post-operative follow-up and immediate evaluation of surgical results may become more important. The aim of this experimental study was to evaluate RT as a new tool for postoperative determination of middle ear anatomy and implant position in temporal bones. RT was performed in ten temporal bone specimen after insertion of different middle ear prostheses concerning material, shape and length (PORP; TORP; Stapes piston). An implantable hearing device (Symphonix Soundbridge) was also implanted and visualized. For comparison some specimen additionally underwent conventional computed tomography (CT), including the newest technology. Characterization of anatomical structures of the temporal bone using RT was of comparable quality to conventional CT-scans in all investigated specimen while requiring approximately 30% of the CT's irradiation exposure. Unlike CT the RT showed almost no problems due to metallic artefacts of the implanted prostheses. Furthermore RT enabled a 3-dimensional view of the temporal bone and angle determination of inserted prostheses towards the tympanic membrane and/or the malleus handle. Detailed imaging of the prostheses allowed determination of shape, material and localization within the specimen's reconstructed middle ear. The new imaging technique of RT allows precise presentation of anatomical structures and middle ear implants in temporal bones. Following these experimental results it will be our future work to evaluate this method in clinical practise.
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Affiliation(s)
- Ch Offergeld
- Department of ORL, HNS, University of Freiburg, Freiburg, Germany.
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Powitzky ES, Hayman LA, Chau J, Bartling SH, Gupta R, Shukla V. High-Resolution Computed Tomography of Temporal Bone. J Comput Assist Tomogr 2006; 30:548-54. [PMID: 16778637 DOI: 10.1097/00004728-200605000-00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200 micro isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this, the fourth part, and the third part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same coronal (article IV) and axial (article III) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.
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Powitzky ES, Hayman LA, Bartling SH, Chau J, Gupta R, Shukla V. High-resolution computed tomography of temporal bone: Part III: Axial postoperative anatomy. J Comput Assist Tomogr 2006; 30:337-43. [PMID: 16628060 DOI: 10.1097/00004728-200603000-00034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200-mu isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this and the subsequent part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same axial (article III) and coronal (article IV) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.
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Naggara O, Williams T, Ayache D, Heran F, Piekarski JD. Imagerie des échecs et complications post-opératoires de la chirurgie de l’otospongiose. ACTA ACUST UNITED AC 2005; 86:1749-61. [PMID: 16333224 DOI: 10.1016/s0221-0363(05)81519-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Otosclerosis (OS) is a dysplasia of the otic capsule located in most cases on the anterior margin of the oval window or fissula ante fenestrum. Progressive conductive hearing loss is the major clinical symptom, due to stapedovestibular ankylosis. Stapes surgery is the only effective treatment of OS, with excellent functional results in more than 90% of cases. However, failures and complications of the surgery may be observed. In theses cases, the etiologic work-up includes imaging evaluation (CT and MRI). Imaging findings are extremely useful in the therapeutic decision. Surgical failure represents 80% of the causes for surgical revision. The main causes of failure are: displacement of the prosthesis, fibrosis of the oval window, erosion of the long process of the incus, incudo-mallear dislocation, obliterative otosclerosis. CT is essential for diagnosis. MR imaging is rarely indicated in the work-up of surgical failures. Labyrinthine complications account for less than 20% of surgical revisions. Etiologies of labyrinthine complications are: intravestibular penetration of the prosthesis, perilymphatic fistula, intra-vestibular granuloma, labyrinthitis and intravestibular bleeding. CT and MRI are complementary for the work up of these complications.
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Affiliation(s)
- O Naggara
- Département d'Imagerie Morphologique et Fonctionnelle, CH Sainte Anne, Paris.
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Williams MT, Ayache D. Imaging of the postoperative middle ear. Eur Radiol 2004; 14:482-95. [PMID: 14749948 DOI: 10.1007/s00330-003-2198-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Revised: 09/19/2003] [Accepted: 11/03/2003] [Indexed: 12/16/2022]
Abstract
The aim of this article is twofold: (a) to present the principles and the indications of surgical treatment of middle ear pathologies; and (b) to review the imaging findings after middle ear surgery, including the normal postoperative aspects and imaging findings in patients presenting with unsatisfactory surgical results or with suspicion of postoperative complications. This review is intentionally restricted to the most common diseases involving the middle ear: chronic otitis media and otosclerosis. In these specific fields of interest, CT and MR imaging play a very important role in the postoperative follow-up and in the work-up of surgical failures and complications.
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Affiliation(s)
- Marc T Williams
- Department of Medical Imaging, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75940 Paris, France.
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Hunter TB, Yoshino MT, Dzioba RB, Light RA, Berger WG. Medical Devices of the Head, Neck, and Spine. Radiographics 2004; 24:257-85. [PMID: 14730051 DOI: 10.1148/rg.241035185] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are many medical devices used for head, neck, and spinal diseases and injuries, and new devices are constantly being introduced. Many of the newest devices are variations on a previous theme. Knowing the specific name of a device is not important. It is important to recognize the presence of a device and to have an understanding of its function as well as to be able to recognize the complications associated with its use. The article discusses the most common and important devices of the head, neck, and spine, including cerebrospinal fluid shunts and the Codman Hakim programmable valve; subdural drainage catheters, subdural electrodes, intracranial electrodes, deep brain stimulators, and cerebellar electrodes; coils, balloons, adhesives, particles, and aneurysm clips; radiation therapy catheters, intracranial balloons for drug installation, and carmustine wafers; hearing aids, cochlear implants, and ossicular reconstruction prostheses; orbital prostheses, intraocular silicone oil, and lacrimal duct stents; anterior and posterior cervical plates, posterior cervical spine wiring, odontoid fracture fixation devices, cervical collars and halo vests; thoracic and lumbar spine implants, anterior and posterior instrumentation for the thoracic and lumbar spine, vertebroplasty, and artificial disks; spinal column stimulators, bone stimulators, intrathecal drug delivery pumps, and sacral stimulators; dental and facial implant devices; gastric and tracheal tubes; vagus nerve stimulators; lumboperitoneal shunts; and temperature- and oxygen-sensing probes.
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Affiliation(s)
- Tim B Hunter
- Department of Radiology, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067, USA.
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Rao AG, Weissman JL. Imaging of postoperative middle ear, mastoid, and external auditory canal. Semin Ultrasound CT MR 2002; 23:460-5. [PMID: 12597094 DOI: 10.1016/s0887-2171(02)90036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Anil G Rao
- Department of Radiology, Rush-Presbyterian Medical Center, Chicago, IL, USA
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Maroldi R, Farina D, Palvarini L, Marconi A, Gadola E, Menni K, Battaglia G. Computed tomography and magnetic resonance imaging of pathologic conditions of the middle ear. Eur J Radiol 2001; 40:78-93. [PMID: 11704355 DOI: 10.1016/s0720-048x(01)00376-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Computed tomography (CT) is an excellent technique for demonstrating even small abnormalities of the thin and complex bony structures of the middle ear. For this reason, it is the modality of choice in the study of conductive hearing loss (CHL). However, not every patient complaining of CHL requires a CT study. In fact, established indications encompass complex conditions, such as the complications of acute and chronic otomastoiditis, the postoperative ear in chronic otomastoiditis or in the localization of prosthetic devices, and the assessment of congenital or vascular anomalies. Particularly, the precise extent of bone erosion associated with cholesteatoma is correctly demonstrated by high resolution CT. Conversely, although fistulization through the tegmen tympani or the posterior wall of temporal bone is usually detectable by CT, the actual involvement of meninges and veins are better assessed by magnetic resonance (MR). MR is also indicated when complicated inflammatory lesions are suspected to extend into the inner ear or towards the sigmoid sinus or jugular vein. Neoplasms arising from or extending into the middle ear require the use of both techniques as their combined data provide essential information. Most important data for surgical planning concern the destruction of thin bony structures and the relationships of the lesion with the dura and surrounding vessels. DSA and interventional vascular techniques maintain an essential role in the presurgical work-up and embolization of paragangliomas extended into the middle ear.
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Affiliation(s)
- R Maroldi
- Department of Radiology, University of Brescia, P.zzale Spedali Civili 1, I-25123 Brescia, Italy.
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Abstract
More of us suffer from hearing loss than from visual impairment, coronary artery disease, and cancer combined. Auditory dysfunction is detected in less than one third of newborns afflicted and is underdiagnosed in the elderly. Despite biomedical and technological advances, our understanding of vestibular dysfunction has grown little. Forming part of the lateral and inferior surfaces of the skull, the temporal bone contains the organs of hearing and balance. Diagnosis of diseases in these important regions requires adequate clinical information and a thorough knowledge of normal temporal bone anatomy to recognize abnormal findings when present. This article dissects the temporal bone into segments, describes the relevant radiologic anatomy of each, and discusses the imaging appropriate to specific concerns.
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Affiliation(s)
- S Nayak
- Department of Radiology, University of California School of Medicine, San Francisco, USA.
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