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2.
Ugeskr Laeger ; 183(4)2021 01 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33491628

RESUMO

Superior semicircular canal dehiscence syndrome (SCDS) is caused by a bony defect of the superior semicircular canal. The bony defect allows low-frequency acoustic stimuli of high intensity to travel to the vestibular organ. This can be induced by sound stimuli or pressure stimuli leading to vertigo, torsional nystagmus, pulsatile tinnitus, hyperacusis, hearing loss and autophony. SCDS is diagnosed with provocative testing, audiometry, CT-scan, vestibular evoked myogenic potentials and electrocochleography. Treatment is conservative, however, surgery with occlusion of the defect can be necessary for debilitating symptoms, as argued in this review.


Assuntos
Nistagmo Patológico , Deiscência do Canal Semicircular , Potenciais Evocados Miogênicos Vestibulares , Humanos , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia , Vertigem/etiologia
3.
Nat Commun ; 12(1): 697, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514733

RESUMO

Mutations in voltage-gated potassium channel KCNE1 cause Jervell and Lange-Nielsen syndrome type 2 (JLNS2), resulting in congenital deafness and vestibular dysfunction. We conducted gene therapy by injecting viral vectors using the canalostomy approach in Kcne1-/- mice to treat both the hearing and vestibular symptoms. Results showed early treatment prevented collapse of the Reissner's membrane and vestibular wall, retained the normal size of the semicircular canals, and prevented the degeneration of inner ear cells. In a dose-dependent manner, the treatment preserved auditory (16 out of 20 mice) and vestibular (20/20) functions in mice treated with the high-dosage for at least five months. In the low-dosage group, a subgroup of mice (13/20) showed improvements only in the vestibular functions. Results supported that highly efficient transduction is one of the key factors for achieving the efficacy and maintaining the long-term therapeutic effect. Secondary outcomes of treatment included improved birth and litter survival rates. Our results demonstrated that gene therapy via the canalostomy approach, which has been considered to be one of the more feasible delivery methods for human inner ear gene therapy, preserved auditory and vestibular functions in a dose-dependent manner in a mouse model of JLNS2.


Assuntos
Terapia Genética/métodos , Vetores Genéticos/administração & dosagem , Síndrome de Jervell-Lange Nielsen/terapia , Canais de Potássio de Abertura Dependente da Tensão da Membrana/genética , Canais Semicirculares/cirurgia , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Vetores Genéticos/genética , Audição/genética , Humanos , Injeções/métodos , Síndrome de Jervell-Lange Nielsen/genética , Masculino , Camundongos , Camundongos Knockout , Parvovirinae/genética , Propriocepção/genética
4.
Am J Otolaryngol ; 42(1): 102794, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33130529

RESUMO

PURPOSE: Controversy exists regarding the ideal approach for repair of lateral skull base defects. Our goal is to report the outcomes following middle cranial fossa (MCF) mini-craniotomy combined with mastoidectomy for patients with superior semicircular canal dehiscence (SSCD), spontaneous cerebrospinal fluid (CSF) leak, and cholesteatoma. MATERIALS AND METHODS: A retrospective database from chart review was formed consisting of 97 patients who met surgical criteria: SSCD, spontaneous CSF leak, and cholesteatoma. Mini-craniotomy MCF approach (<4 × 2 cm in size) combined with mastoidectomy was performed. All patients were admitted directly to the ICU postoperatively. Multiple factors were assessed, including need for revision surgery, duration of surgery, length of post-operative stay, and hospital readmission. RESULTS: Average surgery time was 110 min with no intraoperative complications. The average length of hospitalization was 2 days with an average ICU stay of 1 day. There were no neurologic complications; however, there were 3 inpatient complications (3%) which included 1 patient (1%) that had wound breakdown and 2 patients (2%) that had severe post-operative vertigo. A total of 8 patients (8%) required revision surgery and these were primarily for SSCD. The 30-day readmission rate was 3%. CONCLUSION: In the current series, all patients that underwent mini-craniotomy MCF surgery combined with mastoidectomy had minimal complications, short surgical time, limited hospital stay, low revision surgery rate and few hospital readmissions. This combined approach offers superior visualization of lateral skull base defects without the morbidity and risk typically associated with traditional, extensive MCF surgery.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Colesteatoma/cirurgia , Fossa Craniana Média/cirurgia , Craniotomia/métodos , Mastoidectomia/métodos , Deiscência do Canal Semicircular/cirurgia , Canais Semicirculares/cirurgia , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Otol Neurotol ; 42(1): 121-128, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32947492

RESUMO

OBJECTIVE: To compare the treatment outcomes and complications of single cycle versus multiple cycles of the canalith repositioning procedure (CRP). STUDY DESIGN: Randomized controlled trial. SETTING: Academic tertiary referral center; Chiang Mai University, Thailand. PATIENTS: One hundred and forty-three adults who had unilateral posterior canal benign paroxysmal positional vertigo (BPPV). INTERVENTION: Therapeutic. Patients received either a single cycle or multiple cycles of the CRP in one session. MAIN OUTCOME MEASURES: Rate of negative Dix-Hallpike test (DHT), rate of symptom improvement, dizziness handicap inventory score (DHI), and rate of complications. RESULTS: At the 1st week and the 4th week recall visits after CRP the treatment outcomes between the single-CRP group and the multiple-CRP group showed no significant difference. The outcomes included: 1) rate of negative DHT (1st week: 76.9 and 76.7%, 4th week: 89.5 and 88.2%); 2) rate of complete recovery or improved symptoms (1st week: 92.3 and 91.7%; 4th week: 96.5 and 98.0%); 3) DHI scores (1st week: 22 and 28; 4th week: 6 and 10); and 4) complication rate (1st week: 12.5 and 20%; 4th week: 20 and 0%. Rate of complications in the single-CRP group (6.9%) during the 1st treatment was lower than in the multiple-CRP groups (21.1%) (p-value = 0.013). CONCLUSION: A single cycle of CRP is as effective as multiple cycle CRP, with a lower incidence of complication and a decrease in the time for treatment. Single-cycle CRP is a more advantageous treatment for unilateral posterior canal BPPV. CLINICALTRIALS. GOV IDENTIFIER: NCT02701218.


Assuntos
Vertigem Posicional Paroxística Benigna , Posicionamento do Paciente , Adulto , Vertigem Posicional Paroxística Benigna/terapia , Meio Ambiente , Humanos , Canais Semicirculares/cirurgia , Resultado do Tratamento
6.
Otol Neurotol ; 42(1): e101-e106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026781

RESUMO

OBJECTIVE: To describe a rare case of pneumolabyrinth (PNL) and pneumocephalus (PNC) due to otogenic meningitis in a patient with superior canal dehiscence (SCD) resulting in profound sensorineural hearing loss (SNHL), semicircular canals impairment but preservation of SCD-related enhanced otolith function. PATIENT: A 65-year-old woman with otogenic meningitis. INTERVENTION: Temporal bone high-resolution computed tomography (CT) scans, brain-magnetic resonance imaging, audiometry, bedside examination, video-head impulse test, and vestibular-evoked myogenic potentials (VEMPs). MAIN OUTCOME MEASURES: Enhanced otolith function despite canal and cochlear loss. RESULTS: The patient developed right profound SNHL and acute labyrinthitis. Imaging showed middle ear inflammatory tissue, right PNL and PNC despite lack of bony fractures. Bilateral SCD and tegmen dehiscence were detected. The patient underwent mastoidectomy, drainage of effusion, and surgical repair of tegmen dehiscence. Exploratory tympanotomy was uneventful. She was treated with intravenous antibiotics and dexamethasone for 3 weeks with improvement of general condition. At 3-weeks follow-up, right profound SNHL persisted with global hypofunction for ipsilateral semicircular canals and selective impairment for left superior canal activity at video-head impulse test. Surprisingly, both cervical and ocular-VEMPs exhibited bilaterally abnormal amplitudes and reduced thresholds, consistently with preserved SCD-related macular hypersensitivity to sounds even on the affected side. CONCLUSIONS: This case report exhibits a unique clinical scenario as it offers interesting insights concerning PNL aetiology despite lack of either bony fractures or barotrauma and PNC likely conveyed intracranially by SCD. Moreover, it provides an unusual pattern of functional dissociation among inner-ear receptors showing enhanced otolith function despite severe labyrinthine damage.


Assuntos
Meningite , Pneumocefalia , Potenciais Evocados Miogênicos Vestibulares , Idoso , Feminino , Humanos , Membrana dos Otólitos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia
7.
Otol Neurotol ; 42(1): e1-e9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065596

RESUMO

OBJECTIVE: Concomitant otosclerosis (OTS) and superior semicircular canal dehiscence (SSCD) is a rare, but difficult-to-identify and treat diagnosis. A systematic review of the literature was performed to analyze the diagnostic and therapeutic approaches of concurrent OTS and SSCD cases and to identify possible factors that may help in predicting the surgical outcome. DATA SOURCES: PubMed, Scopus, Medscape, Ovid databases. STUDY SELECTION: Studies showing diagnosis of OTS documented by audiometric test with or without associated radiological signs (computed tomography), and concomitant diagnosis of SSCD, documented at least by high-resolution computed tomography (and possibly supported by neurophysiological testing) were included. Both surgically treated and untreated patients were considered for data analysis. DATA EXTRACTION: The general characteristics of each study were recorded, when available. Clinical, audiological, vestibular testing, surgical, and radiological data were extracted from the published case reports and series, and recorded on a database. For each case, the diagnostic steps that confirmed OTS and concomitant SSCD in the same ear were extracted. DATA SYNTHESIS: Twelve studies were included in the review and 18 cases affected simultaneously by the 2 conditions were extracted and analyzed. Seven of 12 ears (58.3%) undergoing stapes surgery experienced a hearing improvement. In four (33.3%) cases, vestibular symptoms (with or without associated acoustic symptoms) of SSCD were unmasked or worsened by stapes surgery. CONCLUSIONS: A reliable preoperative diagnosis of the two concomitant conditions is possible with a proper interpretation of clinical signs, audiometric, and vestibular testing, in association with the radiologic assessment. Despite that the length and the location of the dehiscence may guide the surgical decision, definitive conclusions regarding the appropriate indications for surgical treatment cannot be drawn due to the limited number of cases with adequate data reported in the literature.


Assuntos
Doenças do Labirinto , Otosclerose , Deiscência do Canal Semicircular , Tomada de Decisões , Humanos , Otosclerose/complicações , Otosclerose/diagnóstico por imagem , Otosclerose/cirurgia , Estudos Retrospectivos , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia
8.
J Clin Neurosci ; 74: 104-108, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32044131

RESUMO

BACKGROUND: Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder; currently, it is unknown whether the etiopathology underlying this structural irregularity affects neighboring structures. The goal is to investigate the prevalence of bone thinning in areas of the middle cranial fossa (MCF) floor in SSCD and non-SSCD patients. METHODS: This retrospective study analyzed 100 patients from March 2011 to June 2017 at a tertiary referral center. 100 patients undergoing 118 SSCD repair surgeries (18 bilateral) were identified. 12 SSCD ears were excluded due to lack of pre-operative computed tomography (CT) scans or history of prior SSCD repair at an outside facility. Non-SSCD ears were identified from routinely-obtained CT scans for temporal bone fracture (fractured sides excluded) for a total of 101 ears; 26 non-SSCD ears were excluded due to lack of high-resolution imaging. RESULTS: Univariate analyses reveal that SSCD diagnosis is associated with higher rates of geniculate ganglion (GG) dehiscence compared with non-SSCD controls (42.7 vs. 24%; χ2(1) = 9.69,P = 0.008). Individuals with SSCD depicted significantly thinner bone overlying the geniculate ganglion (GG) (0.23 ± 1.2 mm) compared to controls (0.28 ± 1.8 mm, (t(1 6 4)) = 2.1, P = 0.04). SSCD patients presented thinner bone overlying the internal auditory canal (IAC) (0.33 ± 1.3 mm) compared to patients without SSCD (0.46 ± 1.6 mm, (t(2 5 7) = 6.4, P < 0.001). CONCLUSIONS: The increased prevalence of dehiscence of the MCF in this cohort of SSCD patients compared to non-SSCD patients suggests that the etiology underlying SSCD affects surrounding structures.


Assuntos
Fossa Craniana Média/patologia , Canais Semicirculares/patologia , Adulto , Estudos de Coortes , Fossa Craniana Média/cirurgia , Feminino , Humanos , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Prevalência , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Tomografia Computadorizada por Raios X
9.
J Laryngol Otol ; 134(4): 366-368, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32106896

RESUMO

BACKGROUND: Individuals with superior semi-circular canal syndrome often describe vestibular symptoms elicited by loud sounds, as well as other pressure-induced symptoms. They also often report other symptoms, including autophony, hyperacusis, cognitive dysfunction, spatial disorientation, anxiety and migraine headaches. Symptoms occur due to the presence of a 'third window' created by the dehiscence of the superior semi-circular canal. This case report describes a minimally invasive technique to provide soft reinforcement of the round window. CASE REPORT: Our patient underwent a permeatal procedure whereby the tympanic membrane was raised to allow inspection of the middle ear. The round window niche was identified and the round window membrane was reinforced with fat. The mucosa of the bony meatus leading to the round window was then disrupted before the application of a double layer of perichondrium to allow further reinforcement. CONCLUSION: The case provides support for the use of 'soft reinforcement' as a simple and effective technique to treat the symptoms of superior canal dehiscence syndrome.


Assuntos
Orelha Interna/cirurgia , Janela da Cóclea/cirurgia , Canais Semicirculares/cirurgia , Orelha Interna/patologia , Orelha Interna/fisiopatologia , Orelha Média/cirurgia , Feminino , Humanos , Hiperacusia/diagnóstico , Hiperacusia/etiologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Canais Semicirculares/patologia , Síndrome , Osso Temporal/diagnóstico por imagem , Zumbido/diagnóstico , Zumbido/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Potenciais Evocados Miogênicos Vestibulares/fisiologia
10.
Audiol Neurootol ; 25(1-2): 96-108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968338

RESUMO

BACKGROUND: A combined vestibular and cochlear prosthesis may restore hearing and balance to patients who have lost both. To do so, the device should activate each sensory system independently. OBJECTIVES: In this study, we quantify auditory and vestibular interactions during interleaved stimulation with a combined 16-channel cochlear and 6-channel vestibular prosthesis in human subjects with both hearing and vestibular loss. METHODS: Three human subjects were implanted with a combined vestibular and cochlear implant. All subjects had severe-to-profound deafness in the implanted ear. We provided combined stimulation of the cochlear and vestibular arrays and looked for interactions between these separate inputs. Our main outcome measures were electrically evoked slow-phase eye velocities during nystagmus elicited by brief trains of biphasic pulse stimulation of the vestibular end organs with and without concurrent stimulation of the cochlea, and Likert scale assessments of perceived loudness and pitch during stimulation of the cochlea, with and without concurrent stimulation of the vestibular ampullae. RESULTS: All subjects had no auditory sensation resulting from semicircular canal stimulation alone, and no sensation of motion or slow-phase eye movement resulting from cochlear stimulation alone. However, interleaved cochlear stimulation did produce changes in the slow-phase eye velocities elicited by electrical stimulation. Similarly, interleaved semicircular canal stimulation did elicit changes in the perceived pitch and loudness resulting from stimulation at multiple sites in the cochlea. CONCLUSIONS: There are significant interactions between different sensory modalities during stimulation with a combined vestibular and cochlear prosthesis. Such interactions present potential challenges for stimulation strategies to simultaneously restore auditory and vestibular function with such an implant.


Assuntos
Cóclea/fisiopatologia , Implantes Cocleares , Perda Auditiva Neurossensorial/cirurgia , Audição/fisiologia , Equilíbrio Postural/fisiologia , Doenças Vestibulares/cirurgia , Vestíbulo do Labirinto/fisiopatologia , Percepção Auditiva/fisiologia , Implante Coclear/métodos , Feminino , Perda Auditiva Neurossensorial/fisiopatologia , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Canais Semicirculares/cirurgia , Resultado do Tratamento , Doenças Vestibulares/fisiopatologia
11.
Otolaryngol Clin North Am ; 53(1): 115-126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31677739

RESUMO

Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.


Assuntos
Implante Coclear/métodos , Neuroestimuladores Implantáveis , Canais Semicirculares/cirurgia , Implante Coclear/instrumentação , Estudos de Viabilidade , Fluoroscopia , Humanos , Estudo de Prova de Conceito , Canais Semicirculares/fisiologia , Nervo Vestibular/patologia , Nervo Vestibular/cirurgia
12.
Am J Otolaryngol ; 41(2): 102287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31761408

RESUMO

PURPOSE: This study was performed to evaluate the effectiveness and impact on quality of life in patients undergoing plugging of superior semicircular canal dehiscence using the transmastoid approach. MATERIALS AND METHODS: Retrospective chart review with prospective outcomes assessment, using validated quantitative scoring systems, was performed on 10 patients (23-76 years) who underwent transmastoid plugging of superior semicircular canal dehiscence between February 2014 and February 2018 at a tertiary referral center. Pre-operative and post-operative autophony and vertigo were measured by The Autophony Index and the Dizziness Handicap Index. Overall quality of life following intervention was measured by the Glasgow Benefit Inventory. Subjective improvement, audiological changes, and subjective quality of life changes were also recorded. RESULTS: A significant reduction in the total Dizziness Handicap Index was seen following transmastoid repair of superior semicircular canal dehiscence (p = 0.0078). This was also evident when subgroup analysis of the Dizziness Handicap Index was performed, as physical (p = 0.0273), emotional (p = 0.0078), and functional subgroups were all significantly reduced (p = 0.0117). Autophony was also significantly reduced following intervention (p = 0.0312). Overall quality of life was seen to be improved following surgery as measured by the Glasgow Benefit Inventory (p = 0.0345). CONCLUSION: Our data suggest that transmastoid plugging of a dehiscence in the superior semicircular canal is a safe and effective means of improving autophony, dizziness and overall quality of life in these patients. We believe that these results should be taken into consideration in discussions regarding surgical approach for patients who are contemplating this procedure.


Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Qualidade de Vida , Canais Semicirculares/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Processo Mastoide , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/prevenção & controle , Adulto Jovem
13.
Laryngoscope ; 130(4): 1023-1027, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31271445

RESUMO

OBJECTIVE: Superior semicircular canal dehiscence (SSCD) causing conductive hearing loss with present reflexes is a known reason for stapes surgery failure. However, concomitant SSCD and otosclerosis occur rarely. We present a case series of SSCD diagnosed in positively identified otosclerosis patients. METHODS: Retrospective review of clinical case series in two tertiary-referral neurotologic practices was performed. Clinical histories, operative findings, audiograms, and computed tomography (CT) images were reviewed for patients diagnosed with both SSCD and otosclerosis. Patients with present stapedial reflexes were excluded. Comprehensive literature review was performed. RESULTS: Four cases were identified. Three reported improved hearing with partial or complete closure of the air-bone gap (ABG), including one patient with far-advanced otosclerosis. One patient had no improvement in pure tone average or ABG. One patient reported worsening of preoperative autophony and pulsatile tinnitus, but none developed new postoperative third-window symptoms. CTs demonstrated both SSCD and otosclerosis. CONCLUSION: Failure to close the ABG in patients with positively identified otosclerosis intraoperatively may be due to SSCD as an occult concomitant diagnosis. SSCD should be considered as a possible cause of persistent conductive hearing loss after stapes surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1023-1027, 2020.


Assuntos
Condução Óssea/fisiologia , Perda Auditiva Condutiva/cirurgia , Otosclerose/cirurgia , Canais Semicirculares/cirurgia , Cirurgia do Estribo/métodos , Idoso , Audiometria de Tons Puros , Feminino , Seguimentos , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Pessoa de Meia-Idade , Otosclerose/complicações , Otosclerose/diagnóstico , Estudos Retrospectivos , Canais Semicirculares/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Sci Rep ; 9(1): 19397, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852932

RESUMO

This study aims to investigate the causes of vertigo relapse in patients with Meniere's disease (MD) who had undergone triple semicircular canal plugging (TSCP) and explore the morphologic changes of vestibular organ through revision surgery. Eleven intractable MD patients who underwent TSCP initially and experienced episodic vertigo recurrence later, were enrolled. All patients accepted revision surgery, including seven cases who underwent labyrinthectomy and four cases who underwent repeat TSCP. Pure tone test, caloric test and video-head impulse test (v-HIT) were used to evaluate audiological and vestibular functions. Specimens of canal plugging materials and vestibular end organs were collected from patients who underwent labyrinthectomy during revision surgery. Mineralization and other histological characteristics of canal plugging materials were evaluated by von Kossa staining. Incomplete occlusion or ossification was observed in the semicircular canals (SCs) of all eleven patients, with all three SCs affected in three, the superior SC in five patients, the horizontal SC in two and the posterior SC in one. The results of v-HIT were in accordance with findings discovered intraoperatively. Few mineralized nodules and multiple cavities were found in the von Kossa-stained canal plugging materials. Incomplete occlusion or ossification of SCs was the principal cause of vertigo recurrence in MD patients who underwent TSCP. v-HIT was helpful in determining the responsible SCs.


Assuntos
Doença de Meniere/cirurgia , Canais Semicirculares/cirurgia , Vertigem/cirurgia , Vestíbulo do Labirinto/cirurgia , Adulto , Idoso , Audiometria de Tons Puros , Feminino , Humanos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos , Reoperação , Canais Semicirculares/fisiopatologia , Vertigem/fisiopatologia , Vestíbulo do Labirinto/fisiopatologia
15.
J Vestib Res ; 29(6): 315-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31640108

RESUMO

INTRODUCTION: Meniere's disease is a common chronic inner ear disease. Because the definitive pathogenesis is still unknown, there is currently no cure for this disorder. Semicircular canal plugging (SCP), first used to treat patients with intractable benign paroxysmal positional vertigo, has since been applied to patients with intractable peripheral vertigo. This study was aimed to explore the long-term efficacy of triple semicircular canal plugging (TSCP) in the treatment of intractable Meniere's disease (MD) so as to provide a new method in the framework of treatment with MD. METHODS: Three hundred and sixty-one unilateral MD patients, who were treated with TSCP in our hospital between Dec. 2010 and Sep. 2016, were recruited in this study for retrospective analysis. Vertigo control and auditory function were monitored during a period of two-year follow-up. Seventy three patients who were subjected to intratympanic gentamicin were selected as a control group. Pure tone audiometry, caloric test, vestibular evoked myogenic potential (VEMP) were performed in two-year follow-up. RESULTS: The total control rate of vertigo in TSCP group was 97.8% (353/361) in the two-year follow-up, with complete control rate of 80.3% (290/361) and substantial control rate of 17.5% (63/361). The rate of hearing loss was 26.3% (95/361). The total control rate of vertigo in intratympanic gentamicin group was 83.6% (61/73), with complete control rate of 63.0% (46/73) and substantial control rate of 20.5% (15/73). The rate of hearing loss was 24.7% (18/73). The vertigo control rate of TSCP was significantly higher than that of chemical labyrinthectomy(χ2 = 24.798, p <  0.05). There was no significant difference of hearing loss rate between two groups. (χ2 = 0.087, p >  0.05). CONCLUSION: Triple semicircular canal plugging (TSCP), which can reduce vertiginous symptoms in patients with intractable Meniere's disease (MD), represents an effective therapy for this disorder. It might become a new important method in the framework of treatment with MD.


Assuntos
Doença de Meniere/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Canais Semicirculares/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo , Resultado do Tratamento
16.
Acta Otolaryngol ; 139(11): 939-947, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486693

RESUMO

Background: Inner gene therapy offers great promises as a potential treatment for hearing loss. Aims/objectives: One of the critical determinants of the success of inner ear gene therapy is to find a delivery method which results in consistent transduction efficiency of targeted cell types while minimizing hearing loss. Material and methods: Surgery was performed only in the right ear of each Bama miniature pig, and the left ear served as a control. The gene delivery to inner ear via round window membrane (RWM) and posterior semicircular canal (PSC) approach was performed with the viral vector AAV1-CMV-GFP. Results: The gene delivery through RWM and the PSC (canalostomy) is able to perfuse the inner ear. Conclusions and significance: The easy anatomic identification of the PSC, as to RWM, as well as minimal manipulation of the temporal bone required, make this surgical approach an attractive option for inner ear gene delivery in big animal model.


Assuntos
Técnicas de Transferência de Genes , Terapia Genética/métodos , Janela da Cóclea/cirurgia , Canais Semicirculares/cirurgia , Animais , Suínos , Porco Miniatura
17.
J Clin Neurosci ; 68: 69-72, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31383473

RESUMO

Previous studies have looked at differences in predisposing factors, symptomology, treatment options, and outcomes in patients with SSCD experiencing audiologic and vestibular symptoms, however this study utilizes data from the largest series of SSCD patients by a single pair of neurosurgeon and head and neck surgeon to date. The objective was to determine what pre-operative factors, if any, contribute to post-operative outcomes in SSCD patients. A retrospective chart review collected patient demographics, preoperative symptoms, and postoperative symptoms. Nonparametric tests were run using IBM® SPSS® Statistics. Fisher's Exact Tests, Spearman's rho, and McNemar's test for paired comparison of binary measures were performed, with a significance level of P < 0.05. A total of 156 SSCD surgeries were performed within a cohort of 119 patients. The majority of patients were female (n = 75, 63.0%). The median age was 55 years (±12.7 years) and median follow-up length was 0.46 months (range: 0.03-59.5 months). Increased postoperative dizziness and hearing loss was significantly correlated with females (P = .048, P = .041). Additionally, males reported significantly improved postoperative hearing (P = .044) with confirmatory audiometry. Serum ionized calcium levels inversely correlated with age using spearman's coefficient (rs = -.260 P = .037). Postsurgical autophony was significantly associated with bilateral SSCD (P = .01). In conclusion, differences in outcomes between patients may have to do with bilateralism of SSCD or gender effects. Proposed theories concerning a "two hit" hypothesis and about calcium feedback regulation in SSCD may play a role in these findings. Understanding differences between symptomology will help facilitate discussions with future patients.


Assuntos
Doenças do Labirinto/patologia , Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Cálcio/sangue , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Labirinto/sangue , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Fatores de Risco , Canais Semicirculares/patologia , Canais Semicirculares/cirurgia , Fatores Sexuais
18.
Otol Neurotol ; 40(9): e925-e927, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31469801

RESUMO

OBJECTIVE: To discuss an effect of transmastoid repair of superior semicircular canal dehiscence and its resolution using a mastoid titanium mesh plate. PATIENTS: A 53-year-old woman with a history of superior canal dehiscence syndrome (SCDS) and subsequent transmastoid repair experienced dizziness and a loud, drum-like sound in her repaired ear when touching the ear. Palpating the skin over the mastoid defect reproduced the symptoms and could be observed on binocular microscopy as tympanic membrane deformation synchronous with mastoid palpation. INTERVENTION (S): Surgery to place a titanium mesh cranioplasty plate over the mastoid cavity. MAIN OUTCOME MEASURE (S): Reduction in dizziness and auditory symptoms when palpating the mastoid. RESULTS: In follow-up 2 months after surgery, palpation of the left mastoid no longer results in vertigo or hearing a loud sound. Hearing and vestibular function remained unchanged. CONCLUSIONS: Despite resolution of SCDS symptoms after transmastoid plugging and resurfacing of the superior semicircular canal involving mastoidectomy, patients can be bothered by dizziness and vertigo when pressing on the mastoid soft tissue envelope. This acts like a balloon that, when compressed, changes middle ear pressure and moves the tympanic membrane and can even cause alternobaric vertigo. This can be avoided or resolved by rigidly reconstructing the defect in the mastoid bone.


Assuntos
Tontura/cirurgia , Doenças do Labirinto/cirurgia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Canais Semicirculares/cirurgia , Vertigem/cirurgia , Tontura/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Palpação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Vertigem/etiologia
19.
J Int Adv Otol ; 15(2): 209-214, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418721

RESUMO

A review of the literature is presented to consider the role of round window (RW) operations in superior semicircular canal dehiscence (SSCD). Primary (PubMed) and secondary sources (TRIP, Cochrane database, Best Practice, and PubMed Clinical Queries) were used to identify relevant studies. Four original studies (three case series and one case report) were identified. All were retrospective reviews and used a number of subjective and objective outcome measures to assess the efficacy of a minimally invasive, transmeatal approach to perform RW surgery for SSCD. The current evidence suggesting that RW operations for SSCD are unlikely to replace more established surgical procedures as first-line treatment may be appropriate in a select group of patients. Further multicenter, randomized controlled trials are required to establish their efficacy in patients with SSCD.


Assuntos
Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Janela da Cóclea/cirurgia , Canais Semicirculares/cirurgia , Métodos Epidemiológicos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
20.
Otol Neurotol ; 40(9): 1167-1177, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31318786

RESUMO

HYPOTHESIS: Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation. BACKGROUND: CI surgery often results in a loss of residual hearing. In preclinical studies, local application of controlled, mild therapeutic hypothermia has shown promising results as a hearing preservation strategy. This study investigated a suitable surgical approach to deliver local hypothermia in patients utilizing anatomical and radiologic measurements and experimental measurements from cadaveric human temporal bones. METHODS: Ten human cadaveric temporal bones were scanned with micro-computed tomography and anatomical features and measurements predicting round window (RW) visibility were characterized. For each bone, the standard facial recess and myringotomy approaches for delivery of hypothermia were developed. The St. Thomas Hospital (STH) classification was used to record degree of RW visibility with and without placement of custom hypothermia probe. Therapeutic hypothermia was delivered through both approaches and temperatures recorded at the RW, RW niche, over the lateral semicircular canal and the supero-lateral mastoid edge. RESULTS: The average facial recess area was 13.87 ±â€Š5.52 mm. The introduction of the cooling probe through either approach did not impede visualization of the RW or cochleostomy as determined by STH grading. The average temperatures at RW using the FR approach reduced by 4.57 ±â€Š1.68 °C for RW, while using the myringotomy approach reduced by 4.11 ±â€Š0.98 °C for RW. CONCLUSION: Local application of therapeutic hypothermia is clinically feasible both through the facial recess and myringotomy approaches without limiting optimal surgical visualization.


Assuntos
Implante Coclear/métodos , Hipotermia Induzida/métodos , Janela da Cóclea/cirurgia , Canais Semicirculares/cirurgia , Cadáver , Feminino , Humanos , Processo Mastoide/cirurgia , Osso Temporal/cirurgia , Microtomografia por Raio-X , Adulto Jovem
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