Volumetry improves the assessment of the vestibular aqueduct size in inner ear malformation.

OBJECTIVES: Enlarged vestibular aqueduct (EVA) is a common finding associated with inner ear malformations (IEM). However, uniform radiologic definitions for EVA are missing and various 2D-measurement methods to define EVA have been reported. This study evaluates VA volume in different types of IEM and compares 3D-reconstructed VA volume to 2D-measurements. METHODS: A total of 98 high-resolution CT (HRCT) data sets from temporal bones were analyzed (56 with IEM; [cochlear hypoplasia (CH; n = 18), incomplete partition type I (IPI; n = 12) and type II (IPII; n = 11) and EVA (n = 15)]; 42 controls). VA diameter was measured in axial images. VA volume was analyzed by software-based, semi-automatic segmentation and 3D-reconstruction. Differences in VA volume between the groups and associations between VA volume and VA diameter were assessed. Inter-rater-reliability (IRR) was assessed using the intra-class-correlation-coefficient (ICC). RESULTS: Larger VA volumes were found in IEM compared to controls. Significant differences in VA volume between patients with EVA and controls (p < 0.001) as well as between IPII and controls (p < 0.001) were found. VA diameter at the midpoint (VA midpoint) and at the operculum (VA operculum) correlated to VA volume in IPI (VA midpoint: r = 0.78, VA operculum: r = 0.91), in CH (VA midpoint: r = 0.59, VA operculum: r = 0.61), in EVA (VA midpoint: r = 0.55, VA operculum: r = 0.66) and in controls (VA midpoint: r = 0.36, VA operculum: r = 0.42). The highest IRR was found for VA volume (ICC = 0.90). CONCLUSIONS: The VA diameter may be an insufficient estimate of VA volume, since (1) measurement of VA diameter does not reliably correlate with VA volume and (2) VA diameter shows a lower IRR than VA volume. 3D-reconstruction and VA volumetry may add information in diagnosing EVA in cases with or without additional IEM.

Stapes surgery leads to significant improvement in quality of life, independently from the surgical method: evaluation of stapes surgery using different prostheses and different quality of life measurements.

OBJECTIVES: To compare quality-of-life (QoL) measurements with audiological results after stapes surgery with two different prostheses. METHODS: This is a retrospective longitudinal study. All patients required stapes surgery for otosclerosis and ossicular chain reconstruction with either a titanium band prothesis (TBP) or receiving a nitinol head prosthesis (NHP). Intervention was between January 2011 and March 2017 patients received stapes-surgery with either TBP (n = 95) or NHP (n = 50). Audiological measurements at three different time points (preoperatively, early follow up < 3 months, late follow-up > 3 months) were compared and two different QoL-inventories, the Glasgow-Benefit-Inventory (GBI) and the Stapes-Plasty-Outcome-Test-25 (SPOT-25) were investigated postoperatively. The main outcome measures were Pure tone average (PTA) at 0.5, 1, 2, 3 kHz at early and late follow up after stapes surgery were compared and correlated with the subjective benefit on the QoL inventories. The perforation method and the type of surgery were analyzed as potentially influencing factors. RESULTS: All patients showed a significantly reduced air bone gap (ABG 0.5, 1, 2, 3) at the two follow-up visits (visit 2: mean: 13.6 dB, SD 7.7; visit 3: mean: 12.7 dB SD 8.1) compared to preoperative measurements (mean: 28.9 dB, SD 9.9) and subjectively benefitted from stapes surgery (mean GBI score: 21.55; SD 20.60, mean SPOT-25 score: 28.03; SD 18.53). The outcome of the two questionnaires correlated with each other. Neither the hearing-outcome nor the subjective benefit was significantly influenced by the prosthesis, the perforation method or the type of anesthesia. CONCLUSIONS: Both prostheses were safe and led to comparable hearing results as well as to subjective benefits in the Health-related-Quality-of-Life (HrQoL). A combination of the two questionnaires is recommendable for postoperative quality control.