Superior semicircular canal dehiscence: congenital or acquired condition?

BACKGROUND AND PURPOSE: It remains unclear whether SSCD syndrome, characterized by onset of vestibular symptoms in the setting of loud noises, is a congenital or acquired condition. The purpose of this investigation was to assess the prevalence of SSCD on imaging among multiple age groups to determine whether this condition is more likely to be congenital or acquired. MATERIALS AND METHODS: Following approval of the institutional review board, 306 consecutive temporal bone CT examinations performed between July 2005 and March 2007 were retrospectively reviewed. Of these, 2 patients were eliminated due to destructive processes in the inner ear. Patients ranged in age from 7 months to 89 years. Images were independently evaluated by 2 neuroradiologists, and the superior semicircular canal was characterized as normal, thin, or frankly dehiscent in each temporal bone. Any discrepancies were resolved by consensus. The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group. RESULTS: Twenty-four patients were identified with SSCD, of which 6 demonstrated dehiscence bilaterally. One hundred thirty-seven subjects were identified with thinning, of which 50 demonstrated thinning bilaterally. Each successively older age category experienced a 93% increase (95% CI, 30%-187%) in the prevalence of SSCD (P = .001) and a 9% increase (95% CI, -5%-25%) in the prevalence of thinning (P = .21). Neither crude nor age-adjusted models demonstrated a significant association between thinning and contralateral dehiscence or vice versa. CONCLUSIONS: The increased radiologic prevalence of SSCD among older age groups suggests that this is more commonly an acquired rather than congenital condition.

Clinical indicators useful in predicting response to the medical management of Meniere's disease.

OBJECTIVES: To identify factors that may correlate with responsiveness to medical management of Meniere's disease. STUDY DESIGN: Retrospective chart review. METHODS: The 1995 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) Committee on Hearing and Equilibrium were used for data acquisition and measuring clinical response. New patients with 2 years' follow-up were evaluated and grouped as either medically or surgically treated. Patients were excluded for inadequate follow-up or prior otological surgery. Dietary sodium restriction (<1,500 mg/d) and a diuretic were employed initially. A compliance rating system was devised to evaluate diet adherence. Patients whose medical management failed were offered surgery. RESULTS: Of 65 patients reviewed, 29 patients qualified for analysis. Seventeen patients were treated medically (patients had either definite or possible Meniere's disease), and 12 patients required surgery. Patients with definite Meniere's disease were at a higher stage (based on audiogram) than patients with possible Meniere's disease (P = .002). Patients who required surgery for Meniere's disease were at a higher stage than patients with either definite or possible disease (P < .001). Patients with definite disease had lower compliance than patients with possible disease (P = .004), but both groups showed symptom improvement. Patients with possible disease had better control than patients with definite disease (P < .001). Hearing was stabilized in patients with possible disease and improved at 500 Hz in patients with definite disease (P = .04). CONCLUSIONS: Sodium restriction and diuretic treatment response are correlated to clinical measures of Meniere's disease. Patients with possible Meniere's disease should be treated with aggressive medical therapy to prevent disease progression.

Inhibition of human platelet function by sulfatides.

Sulfatides are glycolipid constituents of human platelet cell membranes and have been shown to interact with platelet-binding proteins involved in hemostasis. Because little is known about the physiological role of sulfatides in platelet function, the effect of sulfatide on platelet adhesion, aggregation, release, and ristocetin-induced platelet agglutination (RIPA) was studied. These processes are inhibited when exogenous sulfatide is present in vitro. Inhibition of aggregation induced by collagen, thrombin, and ristocetin by sulfatide was dose dependent. Adenosine diphosphate-mediated adhesion and aggregation were not significantly affected by sulfatide, nor was serotonin- and epinephrine-mediated aggregation. Collagen mediate release of serotonin was reduced sulfatide. RIPA demonstrated dose-dependent inhibition in response to sulfatide. These results suggest that sulfatide may play a role in modulating platelet activation.

Oral botryomycosis: a case report.

We present a 42-year-old male with botryomycosis initially presenting with left-sided proptosis due to an infraorbital mass. A biopsy through an anterior orbitotomy yielded indeterminate histopathology. The patient later developed a similar oral lesion which was biopsied and found to be botryomycosis. The oral lesion recurred after initial surgical treatment, but responded to antibiotic therapy. Discussion of this case along with a review of the literature is presented to offer guidelines for recognition and management of this rare disorder.