1
|
Shankar A, Nagururu NV, Pearl MS, Shankar A, Carey JP, Ward BK. Superior Canal Dehiscence and the Risk of Additional Dehiscences: A Retrospective CT Cohort Study. Otol Neurotol 2024; 45:e525-e531. [PMID: 38995721 DOI: 10.1097/mao.0000000000004228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Determine if superior canal dehiscence (SCD) found on flat-panel CT increases the risk for other defects in the otic capsule. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care center. PATIENTS One hundred ears (50 with SCD and 50 matched controls without SCD). INTERVENTIONS Flat-panel CT imaging. MAIN OUTCOME MEASURES (1) Prevalence of other dehiscences in SCD ears, (2) dehiscences in controls, and (3) otic capsule thickness in other reported dehiscence locations (cochlea-carotid, lateral semicircular canal [SCC] and mastoid, facial nerve-lateral SCC, vestibular aqueduct, posterior SCC-jugular bulb, posterior SCC-posterior fossa). Between-group comparisons were considered significant at p < 0.007 after applying the Bonferroni correction for multiple comparisons. RESULTS Not including the SCD, there was a mean of 0.04 additional dehiscences in the SCD group (n = 2/50, 4%) and 0.04 non-SCD dehiscences in the controls (n = 2/50, 4%, p > 0.007). In the SCD group, there was one dehiscence between the cochlea and carotid artery and one between the posterior SCC and posterior fossa. The control group had one enlarged vestibular aqueduct and one dehiscence between the facial nerve and lateral SCC. As a group, SCD ears had wider vestibular aqueducts (0.68 ± 0.20 vs 0.51 ± 0.30 mm, p < 0.007) and thinner bone between the posterior SCC and posterior fossa (3.12 ± 1.43 vs 4.34 ± 1.67 mm, p < 0.007). The bone between the facial nerve and lateral SCC was thicker in SCD ears (0.77 ± 0.23 vs 0.55 ± 0.27 mm, p < 0.007) and no different for cochlea-carotid, and lateral SCC and mastoid (p > 0.007). CONCLUSIONS SCD does not increase the likelihood of a second dehiscence in the same otic capsule. SCD patients may have congenitally thinner otic capsule bones compared to controls, particularly near the posterior SCC, where the vestibular aqueduct may be enlarged.
Collapse
Affiliation(s)
- Ahjeetha Shankar
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Monica S Pearl
- Department of Radiology, Children's National Hospital, Washington, DC
| | | | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
2
|
Ionescu EC, Reynard P, Damien M, Ltaief-Boudrigua A, Hermann R, Gianoli GJ, Thai-Van H. Why should multiple dehiscences of the otic capsule be considered before surgically treating patients with superior semicircular canal dehiscence? A radiological monocentric review and a case series. Front Neurol 2023; 14:1209567. [PMID: 37614976 PMCID: PMC10442812 DOI: 10.3389/fneur.2023.1209567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
This review aims to draw attention to the multiple ipsilateral otic capsule dehiscences (OCDs), which may cause therapeutic failure in operated patients. A series of six severely disabled patients with symptoms and signs consistent with a superior semicircular canal dehiscence (SSCD) diagnosis, confirmed by a high-resolution CT scan, is presented here. Five of the patients underwent surgery, and in four of the cases, the postoperative results were poor and/or disappointing. The ethical principles underlying modern medicine encourage medical staff to learn from past experience even when the results are modest despite the accuracy of the treatment applied to a patient. Consequently, we reviewed the radiological records of symptomatic and asymptomatic patients diagnosed or referred to our center for confirmation over the past 5 years to determine the incidence of multiple OCD in this population. Multiple localizations of suspected OCD in the ipsilateral ear did not appear to be rare and were found in 29 of 157 patients (18.47%) in our retrospective review using high-resolution thin-sliced CT scans. The decision to perform surgery for a documented symptomatic superior SSCD should be made with caution only after ruling out concomitant lesser-known variants of OCD in the ipsilateral ear.
Collapse
Affiliation(s)
- Eugen C. Ionescu
- Department of Audiology and Otoneurological Explorations, Hospices Civils de Lyon, Lyon, France
- Hearing Institute, Research Center of Pasteur Institute, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Inserm, Paris, France
| | - Pierre Reynard
- Department of Audiology and Otoneurological Explorations, Hospices Civils de Lyon, Lyon, France
- Hearing Institute, Research Center of Pasteur Institute, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Inserm, Paris, France
- Department of Physiology, Claude Bernard University, Lyon, France
| | - Maxime Damien
- Department of Audiology and Otoneurological Explorations, Hospices Civils de Lyon, Lyon, France
- Hearing Institute, Research Center of Pasteur Institute, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Inserm, Paris, France
- Department of Physiology, Claude Bernard University, Lyon, France
| | | | - Ruben Hermann
- Department of ENT, Cervico-Facial Surgery and Audiophonology, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, IMPACT Team, INSERM, Centre National de la Recherche Scientifique (CNRS), Lyon, France
| | | | - Hung Thai-Van
- Department of Audiology and Otoneurological Explorations, Hospices Civils de Lyon, Lyon, France
- Hearing Institute, Research Center of Pasteur Institute, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Inserm, Paris, France
- Department of Physiology, Claude Bernard University, Lyon, France
| |
Collapse
|
3
|
Motasaddi Zarandy M, Kouhi A, Emami H, Amirzargar B, Kazemi MA. Prevalence of otic capsule dehiscence in temporal bone computed tomography scan. Eur Arch Otorhinolaryngol 2023; 280:125-130. [PMID: 35668224 DOI: 10.1007/s00405-022-07464-x] [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: 03/28/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the radiologic prevalence of otic capsule dehiscence in temporal bone computed tomography (CT) scan. METHODS This was a cross-sectional study. The temporal bone CT scans of the patients presenting to a tertiary center were evaluated for possible dehiscence in any part of the otic capsule; then, all of the dehiscence were confirmed by a trained academic radiologist. For each type of otic capsule dehiscence, at least three planes were used with a specific type of reconstruction. When a dehiscence was present in at least two consecutive images in all planes, it was considered as a true dehiscence. RESULTS Six hundred patients (mean age: 40 ± 18.1 years) were enrolled. The prevalence of superior and posterior semicircular canal dehiscence was 6.0% and 2.7%, respectively. The prevalence of cochlear-facial dehiscence, cochlear-internal auditory canal dehiscence, and cochlear-carotid dehiscence was 6.3%, 0.7%, and 0.7%, respectively. The prevalence of vestibular aqueduct-jugular bulb dehiscence was 6.3% and the prevalence of posterior semicircular canal-jugular bulb dehiscence was 0.2%. CONCLUSIONS Considering different types of otic capsule dehiscence described, care should be taken in patients with vestibular and auditory signs and symptoms to diagnose these dehiscences.
Collapse
Affiliation(s)
- Masoud Motasaddi Zarandy
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kouhi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Emami
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Amirzargar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Fröhlich L, Curthoys IS, Kösling S, Obrist D, Rahne T, Plontke SK. Cervical and Ocular Vestibular-Evoked Myogenic Potentials in Patients With Intracochlear Schwannomas. Front Neurol 2020; 11:549817. [PMID: 33192980 PMCID: PMC7655125 DOI: 10.3389/fneur.2020.549817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) in patients with solely intracochlear localization of an intralabyrinthine schwannoma (ILS). Study Design: Retrospective analysis of a series of cases. Setting: Monocentric study at a tertiary referral center. Patients: Patients with intracochlear schwannoma (ICS) and VEMP measurements. Outcome Measures: Signed asymmetry ratio (AR) of cVEMPs and oVEMPs to air conducted sound with AR cut-offs considered to be asymmetrical when exceeding ±30% for cVEMPs and ±40% for oVEMPs with respect to the side affected by the tumor (reduced amplitudes on the affected side indicated by negative values, enhanced amplitudes by positive values); VEMP amplitudes and latencies; tumor localization in the cochlear turn and scala. Results: Nineteen patients with a solely intracochlear tumor (ICS patients) [10 males, 9 females, mean age 57.1 (SD: 13.4) years] were included in the study. On the affected side, cVEMPs were absent or reduced in 47% of the patients, normal in 32%, and enhanced in 21%. Ocular VEMPs on the affected side were absent or reduced in 53% of the patients, normal in 32% and enhanced in 15%. Latencies for cVEMPs and oVEMPs were not significantly different between the affected and non-affected side. In all patients with enhanced VEMPs, the tumor was located in the scala tympani and scala vestibuli. Conclusions: As a new and unexpected finding, VEMP amplitudes can be enhanced in patients with intracochlear schwannoma, mimicking the third window syndrome.
Collapse
Affiliation(s)
- Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
5
|
Wackym PA, Balaban CD, Zhang P, Siker DA, Hundal JS. Third Window Syndrome: Surgical Management of Cochlea-Facial Nerve Dehiscence. Front Neurol 2019; 10:1281. [PMID: 31920911 PMCID: PMC6923767 DOI: 10.3389/fneur.2019.01281] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: This communication is the first assessment of outcomes after surgical repair of cochlea-facial nerve dehiscence (CFD) in a series of patients. Pre- and post-operative quantitative measurement of validated survey instruments, symptoms, diagnostic findings and anonymous video descriptions of symptoms in a cohort of 16 patients with CFD and third window syndrome (TWS) symptoms were systematically studied. Study design: Observational analytic case-control study. Setting: Quaternary referral center. Patients: Group 1 had 8 patients (5 children and 3 adults) with CFD and TWS who underwent surgical management using a previously described round window reinforcement technique. Group 2 had 8 patients (2 children and 6 adults) with CFD who did not have surgical intervention. Interventions: The Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6) were administered pre-operatively and post-operatively. In addition, diagnostic findings of comprehensive audiometry, cervical vestibular evoked myogenic potential (cVEMP) thresholds and electrocochleography (ECoG) were studied. Symptoms before and after surgical intervention were compared. Main outcome measures: Pre- vs. post-operative DHI, HIT-6, and audiometric data were compared statistically. The thresholds and amplitudes for cVEMP in symptomatic ears, ears with cochlea-facial nerve dehiscence and ears without CFD were compared statistically. Results: There was a highly significant improvement in DHI and HIT-6 at pre- vs. post-operative (p < 0.0001 and p < 0.001, respectively). The age range was 12.8-52.9 years at the time of surgery (mean = 24.7 years). There were 6 females and 2 males. All 8 had a history of trauma before the onset of their symptoms. The mean cVEMP threshold was 75 dB nHL (SD 3.8) for the operated ear and 85.7 dB (SD 10.6) for the unoperated ear. In contrast to superior semicircular canal dehiscence, where most ears have abnormal ECoG findings suggestive of endolymphatic hydrops, only 1 of 8 operated CFD ears (1 of 16 ears) had an abnormal ECoG study. Conclusions: Overall there was a marked improvement in DHI, HIT-6 and symptoms post-operatively. Statistically significant reduction in cVEMP thresholds was observed in patients with radiographic evidence of CFD. Surgical management with round window reinforcement in patients with CFD was associated with improved symptoms and outcomes measures.
Collapse
Affiliation(s)
- P. Ashley Wackym
- Department of Otolaryngology–Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Carey D. Balaban
- Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Pengfei Zhang
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - David A. Siker
- Siker Medical Imaging and Intervention, Portland, OR, United States
| | - Jasdeep S. Hundal
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| |
Collapse
|
6
|
Wackym PA, Mackay-Promitas HT, Demirel S, Gianoli GJ, Gizzi MS, Carter DM, Siker DA. Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis. Laryngoscope Investig Otolaryngol 2017; 2:225-253. [PMID: 29094067 PMCID: PMC5654938 DOI: 10.1002/lio2.89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Patients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors. Study Design Observational analytic case-control study in a tertiary referral center. Methods Twelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms. In addition to one of the neurotologists, 2 neurologists (one specializing in migraine and the other a neuro-ophthalmologist), and a psychologist clinician-investigator completed comprehensive evaluations. Neuropsychology test batteries included: the Millon Behavioral Medicine Diagnostic; Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7); Adverse Childhood Experiences Scale; the Wide Range Assessment of Memory and Learning, including the 3 domains of verbal memory, visual memory, and attention/concentration; Wechsler Adult Intelligence Scale; and the Delis-Kaplan Executive Function System. The control cohort was comprised of 17 participants who previously underwent surgery for third window syndrome that resulted in the expected outcomes of resolution of their third window syndrome symptoms and cognitive dysfunction. Results There was a high rate of psychological comorbidity (n = 6) in the outlier cohort; multiple traumatic brain injuries were also a confounding element (n = 10). One patient had elevated cerebrospinal fluid (CSF) pressure requiring ventriculoperitoneal shunting to control the recurrence of dehiscence and one patient with a drug-induced Parkinson-like syndrome and idiopathic progressive neurological degenerative process. Conclusions Components of the Millon Behavioral Medicine Diagnostic, PHQ-9 and GAD-7 results suggest that these instruments would be useful as screening tools preoperatively to identify psychological comorbidities that could confound outcomes. The identification of these comorbid psychological as well as other neurological degenerative disease processes led to alternate clinical management pathways for these patients. Level of Evidence 2b.
Collapse
Affiliation(s)
- P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery Rutgers Robert Wood Johnson Medical School and the Ear and Skull Base Center New Brunswick New Jersey
| | | | | | | | | | | | - David A Siker
- Siker Medical Imaging and Intervention Portland Oregon
| |
Collapse
|
7
|
Blake DM, Tomovic S, Vazquez A, Lee HJ, Jyung RW. Cochlear-facial dehiscence--a newly described entity. Laryngoscope 2014; 124:283-9. [PMID: 23712934 DOI: 10.1002/lary.24223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/16/2013] [Accepted: 05/03/2013] [Indexed: 11/07/2022]
Abstract
Dehiscence of the cochlear otic capsule has recently been described as a pathologic entity. We describe two cases of cochlear-facial dehiscence, which are the first reported: a 69-year-old male who complained of hearing loss, autophony, and pulsatile tinnitus and a 41-year-old female who complained of left-sided hearing loss, pulsatile tinnitus, and vertigo. In both, computed tomography (CT) showed bony dehiscence between the facial nerve and cochlea. Cochlear-facial dehiscence is another example of otic capsule dehiscence that produces symptoms of third-window lesions. When patients present with symptoms of third-window lesions and CT does not show superior canal dehiscence, cochlear-facial dehiscence should be considered.
Collapse
|