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Chen B, Li Y, Sun Y, Sun H, Wang Y, Lyu J, Guo J, Bao S, Cheng Y, Niu X, Yang L, Xu J, Yang J, Huang Y, Chi F, Liang B, Ren D. A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application. J Med Internet Res 2024; 26:e51706. [PMID: 39116439 PMCID: PMC11342006 DOI: 10.2196/51706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/30/2023] [Accepted: 05/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Temporal bone computed tomography (CT) helps diagnose chronic otitis media (COM). However, its interpretation requires training and expertise. Artificial intelligence (AI) can help clinicians evaluate COM through CT scans, but existing models lack transparency and may not fully leverage multidimensional diagnostic information. OBJECTIVE We aimed to develop an explainable AI system based on 3D convolutional neural networks (CNNs) for automatic CT-based evaluation of COM. METHODS Temporal bone CT scans were retrospectively obtained from patients operated for COM between December 2015 and July 2021 at 2 independent institutes. A region of interest encompassing the middle ear was automatically segmented, and 3D CNNs were subsequently trained to identify pathological ears and cholesteatoma. An ablation study was performed to refine model architecture. Benchmark tests were conducted against a baseline 2D model and 7 clinical experts. Model performance was measured through cross-validation and external validation. Heat maps, generated using Gradient-Weighted Class Activation Mapping, were used to highlight critical decision-making regions. Finally, the AI system was assessed with a prospective cohort to aid clinicians in preoperative COM assessment. RESULTS Internal and external data sets contained 1661 and 108 patients (3153 and 211 eligible ears), respectively. The 3D model exhibited decent performance with mean areas under the receiver operating characteristic curves of 0.96 (SD 0.01) and 0.93 (SD 0.01), and mean accuracies of 0.878 (SD 0.017) and 0.843 (SD 0.015), respectively, for detecting pathological ears on the 2 data sets. Similar outcomes were observed for cholesteatoma identification (mean area under the receiver operating characteristic curve 0.85, SD 0.03 and 0.83, SD 0.05; mean accuracies 0.783, SD 0.04 and 0.813, SD 0.033, respectively). The proposed 3D model achieved a commendable balance between performance and network size relative to alternative models. It significantly outperformed the 2D approach in detecting COM (P≤.05) and exhibited a substantial gain in identifying cholesteatoma (P<.001). The model also demonstrated superior diagnostic capabilities over resident fellows and the attending otologist (P<.05), rivaling all senior clinicians in both tasks. The generated heat maps properly highlighted the middle ear and mastoid regions, aligning with human knowledge in interpreting temporal bone CT. The resulting AI system achieved an accuracy of 81.8% in generating preoperative diagnoses for 121 patients and contributed to clinical decision-making in 90.1% cases. CONCLUSIONS We present a 3D CNN model trained to detect pathological changes and identify cholesteatoma via temporal bone CT scans. In both tasks, this model significantly outperforms the baseline 2D approach, achieving levels comparable with or surpassing those of human experts. The model also exhibits decent generalizability and enhanced comprehensibility. This AI system facilitates automatic COM assessment and shows promising viability in real-world clinical settings. These findings underscore AI's potential as a valuable aid for clinicians in COM evaluation. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000036300; https://www.chictr.org.cn/showprojEN.html?proj=58685.
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Affiliation(s)
- Binjun Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yike Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yu Sun
- Department of Otorhinolargnology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haojie Sun
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yanmei Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jihan Lyu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jiajie Guo
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Shunxing Bao
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, United States
| | - Yushu Cheng
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xun Niu
- Department of Otorhinolargnology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghong Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Juanmei Yang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yibo Huang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Fanglu Chi
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongdong Ren
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
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Kapoor AA, Kapoor A, Nimkar NU, Soni HD, Ojha VS, Biswas R. High-Resolution Computed Tomography and Intraoperative Correlation in Cholesteatoma: Enhancing Preoperative Evaluation and Surgical Management. Cureus 2023; 15:e44333. [PMID: 37779786 PMCID: PMC10538802 DOI: 10.7759/cureus.44333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Cholesteatoma, a hazardous non-neoplastic lesion of the temporal bone, is prevalent in socio-economically disadvantaged groups in developing nations like India. Timely detection and surgical intervention are essential for effective management. High-resolution computed tomography (HRCT) has revolutionized the assessment of temporal bone pathology, though its role in preoperative evaluation remains debated. This study aimed to validate HRCT's utility in diagnosing cholesteatoma, compare its findings with intraoperative observations, and assess sensitivity and specificity. METHODS This diagnostic accuracy study was conducted at a tertiary care center in Western India, from March 2021 to November 2022. HRCT findings of 54 cholesteatoma patients were evaluated and compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient were calculated. RESULTS HRCT demonstrated a sensitivity exceeding 90% in identifying scutum erosion, mastoid sclerosis, and abnormalities in the tympanic membrane, along with a specificity surpassing 90% in detecting various conditions, including facial canal erosion, sinus plate erosion, lateral semicircular canal erosion, erosion of the posterior wall of the external auditory canal, and abnormalities in the tympanic membrane. Furthermore, HRCT exhibited an accuracy of over 90% in detecting most pathologies. There was a perfect or near-perfect agreement observed for abnormal tympanic membrane, sinus plate erosion, mastoid sclerosis, and erosion of the posterior wall of the external auditory canal (with kappa values > 0.8). Moderate to fair agreement was noted for other pathologies. CONCLUSION HRCT offered precise detection of the majority of pathologies, thereby facilitating surgical planning. However, the presence of limitations in distinguishing specific abnormalities highlights the significance of utilizing HRCT in tandem with other diagnostic modalities to ensure meticulous diagnosis and effective treatment planning.
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Affiliation(s)
- Abha A Kapoor
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Abhay Kapoor
- Department of Internal Medicine, B.J. Medical College, Ahmedabad, Ahmedabad, IND
| | - Nimisha U Nimkar
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Hiren D Soni
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Vishnu S Ojha
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Ratnadeep Biswas
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
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Yang S, Li H, Gao J, Han Z, Tang X, Wu R, Kang H, Zhang F, Xu J, Peng Y. CT and MRI Features of Hairy Polyps in Neonates and Infants: A Retrospective Study of 14 Patients. Diagnostics (Basel) 2023; 13:diagnostics13071328. [PMID: 37046546 PMCID: PMC10093516 DOI: 10.3390/diagnostics13071328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Background: The typical imaging findings of hairy polyps have been described mostly in case reports. This study was conducted to describe the CT and MRI features of hairy polyps and their common associated abnormalities. Methods: Medical records of 14 patients with pathological diagnosis of hairy polyps were collected for this study. For each patient, the medical records, including demographics, clinical manifestations, and imaging findings were reviewed. Results: The female-to-male ratio was 3.7:1. The age at first episode varied from birth to 2.7 years. The masses were derived from the back side of the soft palate in seven (50.0%) cases, from the lateral pharyngeal wall in four (28.6%) cases, from the soft palate in one (7.1%) case, from the nasal vestibule in one (7.1%) case, and from the parapharyngeal space in one (7.1%) case. A total of 11 (78.6%) cases presented with pedicled masses containing fat and a central core of soft tissue, there were 3 (21.4%) cases whose imaging findings were atypical, and there were 6 (42.9%) patients who had other pathologies. Conclusions: Hairy polyps typically presented as pedicled masses containing fat and a central core of soft tissue, but sometimes their imaging findings can be atypical and they can be associated with other congenital abnormalities. CT and MRI are reliable methods for the diagnosis of hairy polyps and their associated abnormalities.
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Affiliation(s)
- Shuangfeng Yang
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Hang Li
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Jun Gao
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Zhonglong Han
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Xiaolu Tang
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Rongchang Wu
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Huiying Kang
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Fengzhen Zhang
- Department of Otolaryngology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Jiatong Xu
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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Cheeney S, Wright JN, Sie KC, Chapman T. Pearls of Temporal Bone Imaging in Children with Hearing Loss. Semin Ultrasound CT MR 2022; 43:3-18. [PMID: 35164907 DOI: 10.1053/j.sult.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hearing loss is one of the most common indications for temporal bone imaging in children. Hearing loss may be congenital or acquired, and it may be conductive, sensorineural, or mixed audiologically. Temporal bone imaging plays an important role in the assessment and management of this condition. An understanding of the embryology of ear structures better enables the radiologist to interpret abnormalities on imaging of the temporal bone. Here, we provide a general review of ear development and a description of known genetic defects that contribute to congenital ear anomalies associated with hearing loss. We provide appropriate imaging techniques for the temporal bone depending on the clinical presentation and a systematic approach to imaging for children with hearing loss. Diagnostic imaging for developmental anomalies of the ear and cholesteatoma will be discussed.
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Affiliation(s)
- Safia Cheeney
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Kathleen C Sie
- Department of Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
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YURTTUTAN N, BİLAL N, KIZILDAĞ B, DOĞANER A. Could computed tomography histogram analysis add value to the diagnosis of cholesteatoma? Turk J Med Sci 2022; 52:216-221. [PMID: 34579510 PMCID: PMC10734835 DOI: 10.3906/sag-2105-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 02/22/2022] [Accepted: 09/27/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND To investigate the potential role of computed tomography (CT) histogram analysis in differentiating cholesteatoma (CHS) and non-cholesteatoma (NCHS). METHODS We evaluated 77 temporal bone CT images (from November 2016 to February 2020) that were obtained preoperatively (mean age, 37.10±17.27 years in CHS; 36.72±16.08 years in NCHS group). Histogram analyses of the resulting XML files were conducted using the R Project 3.3.2 program. ROC analysis was used to find threshold values, and the diagnostic efficiency of these values in differentiating CHS-NCHS was determined. RESULTS The CT images of 41 CHS (53.25%) and 36 NHCS cases (46.75%) were evaluated. There was a statistically significant difference between the CHS and NCHS group in terms of the mean, maximum, and median values (p = 0.036, p = 0.006, p = 0.043). When examining the ROC curve obtained from the mean of these parameters, area under the curve (AUC) is determined as 0.638, and when the threshold value is selected as 42.55, the mean value was determined to have a sensitivity of 86.50% and specificity of 56.10% in differentiating CHS-NCHS.
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Affiliation(s)
- Nursel YURTTUTAN
- Department of Radiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University Kahramanmaraş,
Turkey
| | - Nagihan BİLAL
- Department of Otorhinolaryngology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University Kahramanmaraş,
Turkey
| | - Betül KIZILDAĞ
- Department of Radiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University Kahramanmaraş,
Turkey
| | - Adem DOĞANER
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kahramanmaraş Sütçü İmam University Kahramanmaraş,
Turkey
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Middle ear status in cholesteatoma: Associations among preoperative computed tomography scans, audiological assessments, and intraoperative endoscopic findings. Am J Otolaryngol 2022; 43:103198. [PMID: 34509081 DOI: 10.1016/j.amjoto.2021.103198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022]
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Cavaliere M, Di Lullo AM, Russo C, Mesolella M, Cantone E, Di Lorenzo G, Motta G, Elefante A. Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis. Front Neurol 2021; 12:615356. [PMID: 33716923 PMCID: PMC7943916 DOI: 10.3389/fneur.2021.615356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery. Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery. Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube. Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.
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Affiliation(s)
- Michele Cavaliere
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonella Miriam Di Lullo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy.,CEINGE-Centro di Ingegneria Genetica e Biotecnologie Avanzate, Naples, Italy
| | - Camilla Russo
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mesolella
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Elena Cantone
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Di Lorenzo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Elefante
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Gafford J, Freeman M, Fichera L, Noble J, Labadie R, Webster RJ. Eyes in Ears: A Miniature Steerable Digital Endoscope for Trans-Nasal Diagnosis of Middle Ear Disease. Ann Biomed Eng 2021; 49:219-232. [PMID: 32458223 PMCID: PMC7688494 DOI: 10.1007/s10439-020-02518-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/24/2020] [Indexed: 01/17/2023]
Abstract
The aim of this work is to design, fabricate and experimentally validate a miniature steerable digital endoscope that can provide comprehensive, high-resolution imaging of the middle ear using a trans-nasal approach. The motivation for this work comes from the high incidence of middle ear diseases, and the current reliance on invasive surgery to diagnose and survey these diseases which typically consists of the eardrum being lifted surgically to directly visualize the middle ear using a trans-canal approach. To enable less-invasive diagnosis and surveillance of middle ear disease, we propose an endoscope that is small enough to pass into the middle ear through the Eustachian tube, with a steerable tip that carries a 1 Megapixel image sensor and fiber-optic illumination to provide high-resolution visualization of critical middle ear structures. The proposed endoscope would enable physicians to diagnose middle ear disease using a non-surgical trans-nasal approach instead, enabling such procedures to be performed in an office setting and greatly reducing invasiveness for the patient. In this work, the computational design of the steerable tip based on computed tomography models of real human middle ear anatomy is presented, and these results informed the fabrication of a clinical-scale steerable endoscope prototype. The prototype was used in a pilot study in three cadaveric temporal bone specimens, where high-quality middle ear visualization was achieved as determined by an unbiased cohort of otolaryngologists. This is the first paper to demonstrate cadaveric validation of a digital, steerable, clinical-scale endoscope for middle ear disease diagnosis, and the experimental results illustrate that the endoscope enables the visualization of critical middle ear structures (such as the epitympanum or sinus tympani) that were seldom or never visualized in prior published trans-Eustachian tube endoscopy feasibility studies.
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Affiliation(s)
- Joshua Gafford
- Vanderbilt University Engineering Department, Nashville, TN, USA.
| | | | | | - Jack Noble
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert Labadie
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert J Webster
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
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Eissa L, Mahmoud W. Distribution of different morphological types of anterior epitympanic plate “cog” and Köerner’s septum in CT images of cholesteatomatous and non-cholesteatomatous CSOM: is it really significant? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The anterior epitympanic plate (cog) and Köerner’s septum are gaining more importance since the introduction of transcanal mastoidectomy as these anatomical structures are serving landmarks for the attic. Moreover, different morphological types of cog and Köerner’s septum revealed embryological relation to the development of the isthmic membrane; the latter is linked to aeration of the attic and thus affects the pathological development of the cholesteatoma.
Results
A retrospective review of CT images of 86 patients proved by surgical biopsies revealed: 49 cholesteatomas and 37 non-cholesteatomatous CSOM. The type-I “cog” had a higher incidence (n = 40) and was statistically more prevalent in non-cholesteatomatous CSOM (n = 30, 81.1%). Type-II was the second commonest and was statistically more prevalent in cholesteatomatous CSOM (n = 22, 44.9%). Type-III was the third commonest, seen in (n = 18, 20.9%) and was statistically more prevalent in cholesteatomatous CSOM (n = 17, 34.7%). Köerner’s septum was more prevalent in non-cholesteatomatous CSOM (70.3%) with statistical significance (p value = 0.002).
Conclusions
The difference in the distribution of different morphological types of anterior epitympanic plate “cog,” as well as the difference in Köerner’s septum existence amongst cholesteatomatous and non-cholesteatomatous CSOM are suggested as risk factors for the development of cholesteatoma and may predict a cholesteatoma on CT images.
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Newsted D, Rosen E, Cooke B, Beyea MM, Simpson MTW, Beyea JA. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e279-e286. [PMID: 33208438 PMCID: PMC8302412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objectif Fournir aux médecins de famille une approche pratique et fondée sur des données probantes pour la prise en charge de la perte auditive. Sources d’information Une recherche dans les bases de données MEDLINE et PubMed a relevé les revues de synthèse, recherches et lignes directrices publiées en anglais de 1980 à 2020. Les données probantes étaient de niveau II ou III dans la plupart des articles relevés. Message principal La perte auditive est l’une des déficiences sensorielles les plus fréquentes dans le monde, et elle est grandement préjudiciable au bien-être général du patient, affectant sa santé physique, ses finances, son inclusion sociale et sa santé mentale. Une solide évaluation clinique de la perte auditive comprend une anamnèse et un examen physique qui caractérisent efficacement la perte auditive comme étant de transmission, neurosensorielle ou mixte. Les patients qui présentent des signes alarmants (comme une perte auditive neurosensorielle unilatérale soudaine) doivent être aiguillés d’urgence en oto-rhino-laryngologie et chirurgie cervico-faciale ou être évalués immédiatement au service des urgences. Beaucoup de cas non urgents de perte auditive nécessitent également une évaluation audiologique plus poussée, un diagnostic et la prise en charge. Conclusion À titre de fournisseurs de soins de première ligne, les médecins de famille sont bien placés pour gérer les préoccupations psychologiques liées à la perte auditive et pour renforcer les stratégies thérapeutiques prudentes. Il est fréquemment nécessaire d’aiguiller le patient ou d’effectuer un bilan urgent, dont l’imagerie, pour confirmer le diagnostic et instaurer la prise en charge afin de prévenir d’autres complications.
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Affiliation(s)
- Daniel Newsted
- Candidat au doctoral et étudiant en médecine au département d'oto-rhino-laryngologie à l'Université Queen's à Kingston, en Ontario
| | - Emily Rosen
- Audiologistes cliniques agréées au département d'audiologie et d'orthophonie à l'Hôpital Hotel Dieu à Kingston
| | - Bonnie Cooke
- Audiologistes cliniques agréées au département d'audiologie et d'orthophonie à l'Hôpital Hotel Dieu à Kingston
| | - Michael M Beyea
- Urgentologue au département de médecine d'urgence au Hamilton Health Sciences, en Ontario
| | - Matthew T W Simpson
- Professeur adjoint et directeur de la formation des enseignants au département de médecine familiale à l'Université Queen's
| | - Jason A Beyea
- Professeur adjoint et directeur de la recherche à la division d'oto-rhino-laryngologie et chirurgie cervico-faciale à l'Université Queen's et scientifique auxiliaire à l'ICES de l'Université Queen's.
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Newsted D, Rosen E, Cooke B, Beyea MM, Simpson MTW, Beyea JA. Approach to hearing loss. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:803-809. [PMID: 33208419 PMCID: PMC8302436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide family physicians with a practical evidence-based approach to the management of patients with hearing loss. SOURCES OF INFORMATION MEDLINE and PubMed databases were searched for English-language hearing loss research, review articles, and guidelines published between 1980 and 2020. Most of the retrieved articles provided level II or III evidence. MAIN MESSAGE Hearing loss is one of the most common sensory impairments worldwide and causes great detriment to a patient's overall well-being by affecting physical health, finances, social inclusion, and mental health. A robust clinical assessment of hearing loss includes a history and physical examination that effectively characterizes the deficit as conductive, sensorineural, or mixed. Patients presenting with red flags (such as sudden unilateral sensorineural hearing loss) must be urgently referred to otolaryngology-head and neck surgery or immediately assessed in the emergency department. Many nonurgent presentations of hearing loss will also require referral for further audiological assessment, diagnosis, and management. CONCLUSION As primary care providers, family physicians are well equipped to manage the psychological concerns associated with hearing loss and to reinforce conservative treatment strategies. Frequently, referral or urgent workup, including imaging, is necessary to confirm a patient's diagnosis and initiate management in order to prevent further complications.
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Affiliation(s)
- Daniel Newsted
- Doctoral candidate and medical student in the Department of Otolaryngology at Queen's University in Kingston, Ont
| | - Emily Rosen
- Registered clinical audiologists in the Department of Audiology and Speech-Language Pathology at Hotel Dieu Hospital in Kingston
| | - Bonnie Cooke
- Registered clinical audiologists in the Department of Audiology and Speech-Language Pathology at Hotel Dieu Hospital in Kingston
| | - Michael M Beyea
- Emergency physician in the Department of Emergency Medicine at Hamilton Health Sciences in Ontario
| | - Matthew T W Simpson
- Assistant Professor and Faculty Development Director in the Department of Family Medicine at Queen's University
| | - Jason A Beyea
- Assistant Professor and Research Director in the Division of Otolaryngology-Head and Neck Surgery at Queen's University and Adjunct Scientist with ICES Queen's.
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Benson JC, Carlson ML, Lane JI. MRI of the Internal Auditory Canal, Labyrinth, and Middle Ear: How We Do It. Radiology 2020; 297:252-265. [PMID: 32960730 DOI: 10.1148/radiol.2020201767] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
MRI is firmly established as an essential modality in the imaging of the temporal bone and lateral skull base. It is used to evaluate normal anatomic structures, evaluate for vestibular schwannomas, assess for inflammatory and/or infectious processes, and detect residual and/or recurrent cholesteatoma. It is also extensively used in pre- and postoperative evaluations, particularly in patients with vestibular schwannomas and candidates for cochlear implantation. Nevertheless, despite the widespread use of MRI for these purposes, many radiologists remain unfamiliar with the complex anatomy and expected imaging findings with such examinations. The purpose of this review is to provide an overview of the most useful MRI sequences for internal auditory canal and labyrinthine imaging, review the relevant anatomy, and discuss the expected appearances of the most commonly encountered pathologic entities. In addition, the features at pre- and postprocedural MRI will be discussed to help ensure that diagnostic radiologists may be of greatest use to the ordering physicians. © RSNA, 2020.
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Affiliation(s)
- John C Benson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Matthew L Carlson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John I Lane
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Singh P, Singh R, Rai R, Sethi S, Ahluwalia AS, Choudhary G. High-resolution computed tomography (HRCT) in pediatric and adult patients with unsafe chronic suppurative otitis media (CSOM) and its surgical correlation. J Family Med Prim Care 2020; 9:4067-4073. [PMID: 33110811 PMCID: PMC7586635 DOI: 10.4103/jfmpc.jfmpc_455_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 06/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aim: Atticoantral, alias unsafe type of CSOM affects the posterosuperior part of the middle ear cleft and is frequently coupled with complications and bony erosions. This study aimed to correlate the high-resolution computed tomography (HRCT) temporal bone and intraoperative findings in the patients with the unsafe type of CSOM. Methods: This prospective study included 50 patients (28 males: 22 females; mean age 24 ± 14 years) who presented with clinically suspected unsafe CSOM. All patients underwent HRCT of the temporal bone and subsequent surgical procedure. The intraoperative and histopathological findings were compared with HRCT findings. Descriptive statistics, sensitivity, specificity, and positive and negative predictive value for HRCT were calculated. Student's t-test and Chi-square test were performed. Results: Out of 50 patients, left, right, and bilateral ear involvement were seen in 42% (21/50), 38% (19/50), and 20% (10/50) patients, respectively. Ear discharge was the most common symptom (100%) followed by earache (66%), vertigo (16%), and tinnitus (14%), respectively. Cholesteatoma was reported in 82% (49/60) of ears on HRCT while histopathological and intraoperative evaluation confirmed the diagnosis in 40 out of 49 ears. In 18% (11/60) ears, the cholesteatoma was not diagnosed on HRCT evaluation; however, the intraoperative and histopathological assessment revealed cholesteatoma in six patients while the rest had granulation tissue. For detection of ossicular erosions, tegmen erosions, erosions of facial nerve canal, erosions of sigmoid sinus plate, and erosions of lateral/posterior semicircular canals; HRCT had high sensitivity (86.44%–100%) and specificity (93.33%–100%). Conclusion: HRCT has a superb correlation with intraoperative findings and is a valuable tool for preoperative assessment of temporal bone pathologies.
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