Inner ear malformations in patients with sensorineural hearing loss: detection with gradient-echo (3DFT-CISS) MRI.

The sensitivity of different MRI sequences in the detection of inner ear malformations in patients presenting with sensorineural hearing loss (SNHL) and/or vertigo was evaluated. We studied 650 patients presenting with SNHL and/or vertigo, clinically not suspected of having inner ear malformations. The sensitivity of T1-weighted, Gd-enhanced T1-weighted and (when available) T2-weighted spin-echo images, and three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) gradient-echo images, to unexpected malformations was assessed. Inner ear malformations were found in 15 (2.3%) of these patients. Enlargement of the endolymphatic duct and sac was the most frequent malformation, found in 11 patients. The 3DFT-CISS images showed all lesions; the other sequences were less sensitive and the pathology was missed, partially or only retrospectively seen in 11 of the 15 patients. Therefore, in addition to the routine unenhanced and Gd-enhanced T1-weighted and T2-weighted images, thin gradient-echo (3DFT-CISS) images are necessary to detect all clinically unexpected inner ear malformations in patients presenting with vertigo and/or SNHL.

Magnetic resonance examination of the inner ear and cerebellopontine angle in patients with vertigo and/or abnormal findings at vestibular testing.

The inner ears of 167 patients with vertigo and/or abnormal findings at vestibular testing were studied using magnetic resonance (MR). Pathology potentially explaining vertigo was found in 54 patients, and was detected in the posterior fossa (28%), the internal auditory canal (28%) and the membranous labyrinth (44%). The overall percentage of pathology and the percentage of pathology found in the membranous labyrinth was high and was probably influenced by the referral pattern in our hospital where high resolution MR of the inner ear (three dimensional Fourier transformation-constructive interference in steady state sequence; 3DFT-CISS sequence) is available. Unenhanced, and especially gadolinium (Gd)-enhanced T1-weighted spin-echo images, are needed to detect most of the pathology inside the internal auditory canal, and some of the lesions inside the membranous labyrinth. 3DFT-CISS images are the only images that can show fibrous obliteration of the intralabyrinthine fluid spaces, and are therefore necessary to recognise most of the intralabyrinthine pathology. Finally, T2-weighted spin-echo images are best suited to demonstrate cerebellar or brain stem infarction. An additional MR-angiography sequence (three dimensional Fourier transformation-fast imaging with steady precession; 3DFT-FISP) is used when vascular compression of the cochleovestibular nerve is suspected. MR is the method of choice to look for pathology in patients with vertigo, and allows detection of pathology that remains invisible with other imaging techniques. However, well adapted sequences are needed to detect these lesions.

[Hearing loss following lumbar puncture: case report and literature study]. / Gehoorsdaling na lumbaal punctie: gevalsbespreking met litteratuurstudie.

This report describes a patient with permanent hearing loss after spinal anesthesia. The literature is reviewed, particularly concerning incidence and possible causes. The incidence is surprisingly high and related to the size of the needle. The role of the cochlear aqueduct as a transmitter of a decreased fluid pressure in the subarachnoid space to the perilymph of the labyrinth is discussed.

Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle.

PURPOSE: To assess the value of a three-dimensional Fourier transformation MR technique "CISS" (constructive interference in steady state) in imaging the inner ear. SUBJECTS: We studied 50 normal inner ears (40 axial, 10 coronal) and 10 pathologic inner ears in 60 patients. RESULTS: The cochlea, semicircular canals, and vestibulum were visualized in detail. Cranial nerve VII and the cochlear, superior vestibular, and inferior vestibular branch of cranial nerve VIII were identified in 90%, 94%, 80%, and 88% of the cases, respectively. A vascular loop was recognized inside the internal auditory canal in 6%, and in the porus in 30%, of the cases. The high signal of the cerebrospinal fluid and labyrinthine fluids (perilymph and endolymph) on the CISS images made excellent delineation of tumors in the cerebellopontine angle and internal canal possible and allowed detection of tumoral labyrinth involvement. The thin sections, high resolution of the images, and capability of producing multiplanar and three-dimensional reconstructions often offered additional information. CONCLUSIONS: The CISS sequence allows detailed study of the normal and pathologic inner ear and promises to be highly valuable in the demonstration of the vascular loop.

Pathology of the membranous labyrinth: comparison of T1- and T2-weighted and gadolinium-enhanced spin-echo and 3DFT-CISS imaging.

PURPOSE: To assess the value of unenhanced T1-weighted images, T2-weighted images, gadolinium-enhanced T1-weighted images, and three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) images in depicting lesions of the membranous labyrinth. METHODS: Six patients were studied using 1-T MR; both enhanced (gadolinium-tetraazacyclododecane tetraacetic acid) and unenhanced images were obtained and different sequences compared to determine which provided the most information. RESULTS: A combination of gadolinium-enhanced T1-weighted and 3DFT-CISS images could depict all membranous labyrinth pathology. Unenhanced T1-weighted images were necessary to exclude spontaneous hyperintensity in the membranous labyrinth. Gadolinium-enhanced T1-weighted images were needed to detect enhancing pathology such as labyrinthitis and tumors inside the membranous labyrinth. In these cases, 3DFT-CISS images allowed immediate differentiation between inflammation and tumor. In temporal bone tumors involving the bony and membranous labyrinth, unenhanced and enhanced T1-weighted images often sufficed to suggest the correct diagnosis. Only 3DFT-CISS images were able to demonstrate small structures (as fistulas) and to help us confirm or rule out obliteration of the labyrinthine fluid spaces. 3DFT-CISS images were necessary to detect small congenital malformations of the membranous labyrinth when only MR was performed. Uncalcified obliteration of the labyrinth fluid spaces could be reliably detected only on 3DFT-CISS images. Here also gadolinium-enhanced T1-weighted images had to be obtained because enhancement of the soft tissues inside the membranous labyrinth had been observed. CONCLUSION: The CISS sequence and enhanced T1-weighted sequence formed the best sequence combination for diagnosis of membranous labyrinth lesions; additional, unenhanced T1-weighted images can help one differentiate labyrinthitis, proteinaceous fluid, subacute hemorrhage, or tumor inside the labyrinth.

[Medial maxillectomy in transitional papilloma]. / Mediale maxillectomie bij transitional papilloma.

Transitional Papilloma, the formerly inverted papilloma, is a rather rare neoplasm of the nasal cavity. Its origin is still debated. The only constant symptom is unilateral nose obstruction. This lesion is of considerable interest because of the recurrence tendency and its association with malignancy. Although a benign tumor, radical aggressive surgery is advocated. A medial maxillectomy is the treatment of choice. A sublabial incision gives excellent exposure without external facial scar.

[Orbital involvement of sinusitis]. / Orbitale verwikkelingen van een sinusitis.

Sinusitis can spread to the orbital tissues. 'Preseptal' soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy they usually resolve quickly. 'Orbital' soft-tissue infections, in contrast, are relatively rare and frequently cause serious morbidity. Four cases are presented. Symptomatology and pathogenesis are reviewed. Diagnostic procedures, especially CT-scan, are discussed and recommendations are given for medical and surgical management.

[Nasal endoscopic approach to sinus diseases]. / Nasale endoscopische benadering van sinusaandoeningen.

The endoscopical endonasal surgery is in vogue. Today it has become a functional surgery. A thorough knowledge of the endonasal anatomy is difficult but essential. The antral ostium is reached after infundibulotomy, from which starts the inspection of the locoregional pathology.

[Mesenchymal chondrosarcoma]. / Mesenchymaal chondrosarcoma.

A case is presented of mesenchymal chondrosarcoma. This extremely rare tumor has a characteristic histology. The prognosis is poor. Radical surgery is essential. A lifelong follow-up is recommended.

[Ototopic agents]. / Ototopica.

In treating ear disease every otolaryngologist is familiar with topical medications. The choice of the ideal agent for a given clinical situation may be difficult. In order to make this decision more easy, we overlook the composition of ear-drops. The most important disadvantages are ototoxicity, allergy and pain. The place of ototopical agents in otitis externa, otitis media and otomycosis is discussed.

Vascular tinnitus and arteriovenous meningeal fistula.

With the development of improved angiographic techniques, arteriovenous meningeal fistulas are being recognized more and more as an important cause of vascular tinnitus. Vascular tinnitus is generally considered to be objective and pulse-synchronous. This report concerns three cases of vascular tinnitus due to arteriovenous meningeal fistulas. They all could not or only hardly be objectified by auscultation and in one of them any pulse-synchronism was denied. The pathophysiology of vascular tinnitus is reviewed, followed by a more detailed discussion about the pathogenesis, the symptomatology and the radioanatomical aspects of arteriovenous meningeal fistulas. Finally, the report deals with the treatment of those fistulas.

[The CO2 laser in otorhinolaryngology. Advantages as opposed to conventional surgery and current possibilities]. / De CO2-laser in de otorhinolaryngologie. Voordelen ten opzichte van conventionele chirurgie en nieuwe mogelijkheden.

The future of lasers in medicine in general and in otorhinolaryngology in specific appears to be bright. It's use is very simple, but may not weaken the wakefulness of its user. Skill and experience remain very important. The role of the laser is clearly defined. The laser is not the only surgical tool to be used for any given operative procedure.

Nodular thyroid disease and cancer.

Different possibilities of solitary or multinodular involvement of the thyroid gland are described. Because of the broad spectrum of malignancy there exists a controversy and widespread divergence of opinion regarding the incidence, malignancy, classification and treatment of thyroid cancer.

Spontaneous cerebrospinal fluid otorrhea.

A case of spontaneous cerebrospinal fluid otorrhea due to a congenital tegmen tympani defect is reported. The etiology and pathogenesis of cerebrospinal fluid otorrhea and of the spontaneous congenital form in particular is discussed, together with the clinical picture and the methods of diagnosis. Reviewing the literature, a middle ear exploration is considered to be the procedure of choice to ascertain the presence and determine the exact locus of the cerebrospinal fluid leak.

A survey of electro-oculography.

The vestibulometric examination in the ORL office is done by means of the registration of eye movements of vestibular origin, the electro-nystagmography. With the ENG-equipment one can perform electro-oculography, examining eye movements in general. EOG is quite helpful in neurologic diagnosis and important in ORL practice too. The adjustment of the ENG-equipment to EOG is explained, after some words on the physiology and the clinical examination of ocular motor function. Than a short survey is given of the abnormalities that may be met in EOG.

[Wegener's granulomatosis in the ORL area]. / Wegener's granulomatosis in het ORL-gebied.

Overlooking the literature, Wegener's granulomatosis often seems to have manifestations in the ear-nose-throat region, especially in the beginning. The usual clinical findings are mentioned, to put the attention of the ENT-surgeon on this affection. Indeed, by early recognition and proper treatment of this disease, the prognosis is clearly improving. A case-history is illustrating the clinical picture.

[Role of air-CT-meato-cisternography in the diagnosis of acoustic neuroma]. / De plaats van de luchtmeatocisternografie met CT-scan in de diagnose van acousticusneurinoma.

The CT-meato-cisternography with air is at the moment the examination of choice in the diagnosis of the intra-canalicular acoustic neuroma. Every time there is a possibility of acoustic neuroma the air-CT-meato-cisternography has to be performed after the CT-scan was negative. The air-CT-meato-cisternography is easily performed on an outpatient basis and complications are never seen. Filtrated air seems to be the best contrast material.

[The Noonan syndrome]. / Het Noonan-syndroom.

Two cases of Noonan syndrome are observed. The Noonan syndrome is a Turner-like syndrome with normal chromosomal constitution. Essential criteria in diagnosing the syndrome are the facial expression (hyper-telorisme, low-set and malformed ears, micrognathie, fish-like mouth). The short webbed neck and the cubitus valgus. These children are rather small and mental retardation can be present, especially in comparison with their siblings. Associated cardiac malformations occur in approximately 50% of the cases. We insist on audiologic findings. One case has a hearing impairment due to a malformation of the middle ear, recognised radiologically. The other has a deafness of perception type. Yet, the familial occurrence of last patient makes it doubtful whether this hearing loss can be linked to the Noonan-syndrome.