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1.
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
2.
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
3.
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
4.
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
5.
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
6.
BMJ Case Rep ; 12(7)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31270089

RESUMO

Third window defects have increasingly been identified as a cause of vertigo. These defects are bony dehiscences that occur in the bony labyrinth, resulting in abnormal pressure gradient in the inner ear fluids leading to sound (Tullio's phenomenon) or pressure (Hennebert's sign) induced vertigo. The superior semicircular canal dehiscence syndrome is a well-described entity in this regard, however defects of the posterior semicircular canal are rare and may have overlapping symptomatology. We describe the history, clinical profile and management of a patient who had importunate symptoms despite being on conservative management for a year and had resolution of vestibular symptoms following surgical management.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/cirurgia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia , Humanos , Doenças do Labirinto/patologia , Masculino , Pessoa de Meia-Idade , Canais Semicirculares/patologia , Tomografia Computadorizada por Raios X/métodos , Vestíbulo do Labirinto/diagnóstico por imagem , Vestíbulo do Labirinto/patologia , Vestíbulo do Labirinto/cirurgia
7.
Otol Neurotol ; 40(5S Suppl 1): S51-S58, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225823

RESUMO

OBJECTIVE: To design and evaluate a new vestibular implant and surgical procedure that should reach correct electrode placement in 95% of patients in silico. DESIGN: Computational anatomy driven implant and surgery design study. SETTING: Tertiary referral center. PARTICIPANTS: The population comprised 81 patients that had undergone a CT scan of the Mastoid region in the Maastricht University Medical Center. The population was subdivided in a vestibular implant eligible group (28) and a control group (53) without known vestibular loss. INTERVENTIONS: Canal lengths and relationships between landmarks were calculated for every patient. The relationships in group-anatomy were used to model a fenestration site on all three semicircular canals. Each patient's simulated individual distance from the fenestration site to the ampulla was calculated and compared with the populations average to determine if placement would be successful. MAIN OUTCOME MEASURES: Lengths of the semicircular canals, distances from fenestration site to ampulla (intralabyrinthine electrode length), and rate of successful electrode placement (robustness). RESULTS: The canal lengths for the lateral, posterior, and superior canal were respectively 12.1 mm ±â€Š1.07, 18.8 mm ±â€Š1.62, and 17.5 mm ±â€Š1.23, the distances from electrode fenestration site to the ampulla were respectively 3.73 mm ±â€Š0.53, 9.02 mm ±â€Š0.90, and 5.31 mm ±â€Š0.73 and electrode insertions were successful for each respective semicircular canal in 92.6%, 66.7%, and 86.4% of insertions in silico. The implant electrode was subsequently revised to include two more electrodes per lead, resulting in a robustness of 100%. CONCLUSIONS: The computational anatomy approach can be used to design and test surgical procedures. With small changes in electrode design, the proposed surgical procedure's target robustness was reached.


Assuntos
Eletrodos Implantados , Procedimentos Cirúrgicos Otológicos/instrumentação , Procedimentos Cirúrgicos Otológicos/métodos , Desenho de Prótese/métodos , Canais Semicirculares/cirurgia , Adulto , Algoritmos , Desenho Assistido por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vestibulares/cirurgia , Vestíbulo do Labirinto/cirurgia
8.
J Clin Neurosci ; 65: 112-120, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078378

RESUMO

Superior semicircular canal dehiscence (SSCD) is caused by a fistula in the arcuate eminence, creating vestibular and auditory disturbances. We aim to determine the effects of gender and age on symptom prevalence and resolution in patients with SSCD. A Boolean search was conducted through four separate scientific databases. Full-text English articles for SSCD patients, who underwent surgery were included. Demographics and outcomes were extracted. A total of 198 patients were identified, and available for quantitative analysis. Between genders, there were no differences in the prevalence of pre- or post-operative symptomology. Both genders had statistically significant improvement in symptomatology with females experiencing significantly high rates of hearing loss improvement compared to male patients. Compared to their younger cohort, patients over 65 had similar symptom frequencies before and after surgery with similar rates of symptom resolution. SSCD repair is safe and effective for resolving auditory and vestibular symptoms. Gender and age may not be strong predictors of patient presentation or symptom resolution. Gender and age-associated factors may not influence patient outcomes.


Assuntos
Perda Auditiva/etiologia , Complicações Pós-Operatórias , Canais Semicirculares/cirurgia , Adulto , Fatores Etários , Idoso , Feminino , Transtornos da Audição , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Síndrome , Vestíbulo do Labirinto
9.
Otol Neurotol ; 40(5): e532-e541, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31083091

RESUMO

HYPOTHESIS: The choice of the material for plugging a dehiscence of the superior semicircular canal is based on the ease of use and the success of the procedure to permanently relieve symptoms without adverse side effects. BACKGROUND: Dehiscence of the superior semicircular canal can lead to autophony, conductive hearing loss, and vertigo. Surgical treatment by plugging the canal is a highly effective treatment of the symptoms in many patients, although, the procedure can be associated with some degree of hearing loss in more than or equal to 25% of the patients. The available data indicate that adverse effects may be more frequently observed with bone wax as compared with other materials. METHODS: In the present study we compare the tissue reactions induced by plugging the superior semicircular canal with autologous bone pate/bone chips, muscle, fat, artificial bone wax, and teflon in the gerbil model in an attempt to identify the material leading to successful plugging with the least adverse tissue reactions. RESULTS: Our data show that successful plugging was achieved in 100% of the ears by bone pate/bone chips, teflon, and bone wax while the success rate was significantly lower (<50%) following muscle and fat. The proportion of adverse tissue reactions was significantly more pronounced using bone wax as compared with teflon and bone pate/bone chips. CONCLUSION: The use of teflon or autologous bone as a material for plugging a dehiscent superior semicircular canal should be favored over bone wax, muscle, and fat.


Assuntos
Adesivos , Procedimentos Cirúrgicos Otológicos/métodos , Canais Semicirculares/cirurgia , Deiscência da Ferida Operatória/terapia , Adesivos/efeitos adversos , Tecido Adiposo/transplante , Animais , Transplante Ósseo , Gerbillinae , Perda Auditiva Condutiva/etiologia , Masculino , Processo Mastoide/crescimento & desenvolvimento , Músculos/transplante , Politetrafluoretileno , Ceras
10.
World Neurosurg ; 126: e1549-e1552, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928582

RESUMO

OBJECTIVE: Superior semicircular canal dehiscence (SSCD) is caused by a deformity in the arcuate eminence, leading to various vestibular and auditory symptoms that can manifest unilaterally or bilaterally. The aim of the present study was to distinguish the differences in symptoms, treatment options, and outcomes between patients with unilateral and bilateral SSCD. METHODS: A retrospective medical record analysis was conducted to identify patients with SSCD treated at a tertiary care center from March 2011 to May 2017. The patient demographic data, preoperative symptom presentation, and postoperative outcomes were extracted. Statistical analyses were performed using IBM SPSS Statistics. Fisher's exact tests were computed to investigate the relationships between binary variables, with a significance level of P < 0.05. RESULTS: A total of 99 patients with SSCD had been treated at our institution from March 2011 to May 2017. Of these 99 patients, 41 (41.4%) had a diagnosis of bilateral SSCD. Of the 41 patients with bilateral SSCD, 27 (65.9%) were women, and the mean age was 53.6 ± 10.9 years (range, 31.7-73.9). The most common presenting symptom was tinnitus (n = 33; 80.4%) and dizziness (n = 33; 80.4%). Previous trauma to the head correlated with a bilateral SSCD presentation (P = 0.04). Trends were reported between female sex and bilateral SSCD [r(35) = 0.32379; P = 0.0506]. Postoperatively, trends were also found, with greater rates of dizziness in patients with bilateral SSCD compared with those with unilateral SSCD (odds ratio, 3.81; P = 0.0659), and less improvement in dizziness (odds ratio, 0.186; P = 0.0627). No other significant differences were found between the symptoms or clinical outcomes and improvements between the bilateral and unilateral cohorts. CONCLUSION: Bilateral SSCD might result in different clinical symptoms that are more prevalent compared with unilateral SSCD. The findings from the present series of patients with bilateral SSCD suggest that patient symptoms and history are important in the diagnosis of bilateral SSCD and deciding whether 1 or both dehiscences requires surgical intervention.


Assuntos
Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Canais Semicirculares/anormalidades , Canais Semicirculares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/etiologia , Tontura/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Zumbido/etiologia , Zumbido/terapia , Resultado do Tratamento , Adulto Jovem
11.
Otol Neurotol ; 40(4): 535-542, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870372

RESUMO

OBJECTIVE: Round window (RW) occlusion or reinforcement is a less-invasive option compared with direct repair approaches to improve symptoms of superior canal dehiscence (SCD) syndrome. However, RW surgery is associated with variable outcomes. Middle fossa craniotomy or transmastoid repair is an option for SCD patients who fail RW surgery, but it is unknown whether sequential repair following RW plugging improves SCD symptoms or increases complications. The objective of this study is to evaluate outcomes of SCD repair via middle fossa craniotomy following failed RW surgery. STUDY DESIGN: Retrospective review. SETTING: Academic tertiary care center. PATIENTS: Adult patients with SCD syndrome who underwent failed RW surgery followed by sequential middle fossa craniotomy and plugging of the arcuate eminence defect. Patients with SCD associated with the superior petrosal sinus were excluded. INTERVENTION: None. MAIN OUTCOME MEASURE: Prospectively collected pre- and postoperative symptom questionnaires, threshold audiograms, and cervical vestibular evoked myogenic potentials (cVEMP). RESULTS: Seven SCD patients (out of a total of 194 surgical cases at our institution) underwent sequential middle-fossa SCD repair following failed RW surgery. Resolution of symptoms and reversal of diagnostic indicators were observed in the majority of subjects following sequential repair. Two of seven patients underwent a third procedure with plugging of the superior semicircular canal by a transmastoid approach due to the presence of residual symptoms. CONCLUSION: Middle fossa craniotomy and SCD occlusion is a safe and reasonable option for patients who fail RW surgery. Our cohort did not show increased risks of auditory or vestibular dysfunction.


Assuntos
Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Janela da Cóclea/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Doenças do Labirinto/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Potenciais Evocados Miogênicos Vestibulares
12.
Laryngoscope ; 129(11): 2580-2587, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30883762

RESUMO

OBJECTIVES/HYPOTHESIS: Compare surgical and audiometric outcomes following canal wall reconstruction (CWR) tympanomastoidectomy used as a primary versus secondary approach for treating cholesteatoma. STUDY DESIGN: Retrospective. METHODS: Patients treated for primary/secondary cholesteatoma from 2006 to 2017 via CWR were included if they had preoperative/postoperative audiograms, detailed operative note(s), and >12 months' follow-up. Patients were stratified by previous surgical history into two groups: primary CWR group (PG) and secondary CWR group (SG). Surgical outcomes measured were prevalence of recidivistic cholesteatoma, canal cholesteatoma, revision rate, and canal wall down (CWD) conversion rates. Secondary outcomes were prevalence of infection, external canal adhesions/stenoses, and retractions. Audiometric outcomes included change in pure-tone average and air-bone gap. RESULTS: We stratified 45 patients/ears into the PG and 26 into the SG. The groups did not significantly differ in age, sex, or smoking status. Overall, median follow-up was 35 months. SG patients had higher rates of cholesteatoma detected at staged surgery than did PG patients (P = .04). However, these patients exhibited lower rates of open revision surgery (4% vs.13%) and a significant improvement in air-bone gap (P = .004). Three PG patients (7%) required conversion to CWD versus zero SG patients. Secondary outcomes were similar. Patients who underwent delayed staging >12 months from CWR had increased rates of recidivism and canal adhesion/stenosis. CONCLUSIONS: CWR was effective for treating cholesteatoma as both a primary and secondary surgical approach. SG patients experienced higher rates of recidivism and secondary canal cholesteatoma. PG patients had higher rates of revision surgery. Staging of ears undergoing CWR is important regardless of prior surgical history. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2580-2587, 2019.


Assuntos
Colesteatoma da Orelha Média/cirurgia , Mastoidectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Timpanoplastia/métodos , Adolescente , Adulto , Idoso , Audiometria , Criança , Meato Acústico Externo/cirurgia , Feminino , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Otolaryngol Head Neck Surg ; 161(1): 130-136, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30832543

RESUMO

OBJECTIVE: To compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates. STUDY DESIGN: Multicenter retrospective comparative cohort study. SETTINGS: Three tertiary neurotology centers. SUBJECTS AND METHODS: All adult patients undergoing repair for superior canal dehiscence between 2006 and 2017 at 3 neurotology centers were included. Demographics and otologic history collected by chart review. Imaging, audiometric data, and vestibular evoked myogenic potential measurements were also collected for analysis. RESULTS: A total of 68 patients (74 ears) were included in the study. Twenty-one patients underwent middle fossa craniotomy repair (mean age, 47.9 years), and 47 underwent transmastoid repair (mean age, 48.0 years). There were no significant differences in age or sex distribution between the groups. The transmastoid group experienced a significantly shorter duration of hospitalization and lower recurrence rate as compared with the middle fossa craniotomy group (3.8% vs 33%). Both groups experienced improvement in noise-induced vertigo, autophony, pulsatile tinnitus, and nonspecific vertigo. There was no significant difference among symptom resolution between groups. Additionally, there was no significant difference in audiometric outcomes between the groups. CONCLUSION: Both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach.


Assuntos
Fossa Craniana Média/cirurgia , Craniotomia/métodos , Doenças do Labirinto/patologia , Doenças do Labirinto/cirurgia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Canais Semicirculares/patologia , Canais Semicirculares/cirurgia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
14.
Methods Mol Biol ; 1937: 221-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30706399

RESUMO

Inner ear gene therapy offers great potential as a treatment for hearing loss and dizziness. The surgical method used to deliver gene therapy into the inner ear is a critical step in determining the success of inner ear gene therapy. Here we describe two commonly used surgical methods for gene delivery in neonatal mouse inner ear: the round window approach and the posterior semicircular canal approach. Both of these approaches are effective at delivering gene therapy to the neonatal mouse inner ear.


Assuntos
Vetores Genéticos/administração & dosagem , Janela da Cóclea/cirurgia , Canais Semicirculares/cirurgia , Animais , Animais Recém-Nascidos , Orelha Interna/cirurgia , Técnicas de Transferência de Genes , Terapia Genética , Camundongos , Procedimentos Cirúrgicos Operatórios
16.
Laryngoscope ; 129(9): 2164-2169, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30632156

RESUMO

OBJECTIVE: Superior semicircular canal dehiscence is a well-described syndrome with potentially debilitating symptoms. We report on the audiologic and long-term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique. METHODS: Retrospective chart review and cross-sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used. Nonlinear regression curves of pre-/postoperative air and bone pure-tone audiometric data were used to evaluate postoperative changes in hearing. Surgical failure was defined as requiring revision surgery, and rates were estimated over time using a Kaplan-Meier analysis. RESULTS: Most patients reported improved symptoms postoperatively and were satisfied overall with the surgical outcomes. However, four of 12 ears (33%) had a second (revision) surgery before achieving these results. Postoperatively, hearing through air and bone conduction tended to decrease at frequencies greater than 2500 Hz. The chance of avoiding a re-operation at 36 months (and up to 120 months) was estimated to be 57.1% (95% confidence interval [confidence interval]: 100%, 32.6%). The most common surgical complication was intraoperative cerebrospinal fluid (CSF) leak, encountered exclusively during dural elevation, seen in four of 12 ears (33%). CONCLUSION: Although subjectively successful at reducing symptoms, in our small sample this surgical approach did not provide a long-term stable repair and was frequently associated with intraoperative CSF leak. Offering transmastoid resurfacing to patients should involve a detailed discussion on the potential for revision surgery and risks of diminished hearing and CSF leak. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2164-2169, 2019.


Assuntos
Cartilagem/transplante , Doenças do Labirinto/cirurgia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Canais Semicirculares/cirurgia , Audiometria de Tons Puros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Inquéritos e Questionários , Síndrome , Resultado do Tratamento
17.
Otol Neurotol ; 40(2): 204-212, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30570606

RESUMO

OBJECTIVE: To identify predictors of near dehiscence (ND) or thin rather than dehiscent bone overlying the superior semicircular canal in patients with signs and symptoms suggestive of superior semicircular canal dehiscence syndrome (SCDS), as well as postoperative outcomes. STUDY DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. PATIENTS: All 288 patients who underwent middle cranial fossa approach for repair of SCDS (1998-2018) were reviewed for cases of ND. Demographics, symptoms, and clinical signs including nystagmus, ocular vestibular-evoked myogenic potential (oVEMP) amplitude, cervical vestibular-evoked myogenic potential (cVEMP) thresholds, and low-frequency air-bone gap were compared before and after surgery. MAIN OUTCOME MEASURE: Presence of preoperative ND and postoperative symptoms and physiologic measures. RESULTS: Seventeen cases of ND (16 patients, 17 ears) and 34 cases (34 ears) of frank SCDS were identified. ND cases differed from frank dehiscence cases in that they were less likely to have nystagmus in response to ear canal pressure or loud sounds, OR = 0.05 (95% CI 0.01-0.25) and Valsalva, OR = 0.08 (0.01-0.67), smaller peak-to-peak oVEMP amplitudes, OR = 0.84 (0.75-0.95), and higher cVEMP thresholds, OR = 1.21 (1.07-1.37). Patients with ND had similar symptoms to those with frank SCDS before surgery, and after surgery had outcomes similar to patients with frank SCDS. CONCLUSIONS: In patients with symptoms consistent with SCDS, predictors of ND include absence of nystagmus in response to pressure/loud sounds, greater cVEMP thresholds, and smaller oVEMP amplitudes. We propose ND is on a spectrum of dehiscence that partially accounts for the diversity of clinical presentations of patients with SCDS.


Assuntos
Doenças do Labirinto/patologia , Doenças do Labirinto/fisiopatologia , Canais Semicirculares/patologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/epidemiologia , Nistagmo Patológico/etiologia , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Síndrome , Potenciais Evocados Miogênicos Vestibulares/fisiologia
18.
Otol Neurotol ; 40(1): 130-138, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30461526

RESUMO

OBJECTIVE: The etiology of symptoms following primary repair of superior canal dehiscence (SCD) may be due to a persistent third window. However, the extent of surgery cannot be seen on postoperative computed tomography (CT) since most repair materials are not radiopaque. We hypothesize that the extent of superior semicircular canal (SSC) occlusion following primary repair can be quantified based on postoperative magnetic resonance imaging (MRI) data. STUDY DESIGN: Retrospective series. SETTING: Tertiary care center. PATIENTS: Adult patients with a history of SCD syndrome who 1) report persistent symptoms following primary SCD repair and 2) underwent heavily T2-weighted MRI postoperatively. INTERVENTIONS: Analysis of SSC using 3D-reconstruction of CT co-registered with MRI data. MAIN OUTCOME MEASURES: Arc length of fluid void on MRI and quantification of persistent SCD based on CT/MRI co-registration. RESULTS: We identified 9 revision cases from a cohort of 145 SCD repairs at our institution (2002-2017) with CT/MRI data. A fluid void on postoperative MRI (indicating occlusion of the SSC) was observed in all cases (anterior limb: 50.1 degrees [±21.8 SD] and posterior limb 48.1 degrees [±28.5 SD]). Co-registration of CT/MRI revealed a residual defect that was most commonly found along the posterior limb in most patients with persistent symptoms. CONCLUSIONS: The extent of SCD repair can be determined using reformatted or direct T2-weighted MRI sequences in the plane of Pöschl. Co-registration of CT/MRI may be useful to determine the location of a residual superior canal defect and when present was found most commonly along the posterior limb.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Canais Semicirculares/diagnóstico por imagem , Feminino , Humanos , Doenças do Labirinto/patologia , Doenças do Labirinto/cirurgia , Imagem por Ressonância Magnética , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Canais Semicirculares/patologia , Canais Semicirculares/cirurgia , Tomografia Computadorizada por Raios X , Falha de Tratamento
19.
BMJ Case Rep ; 11(1)2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580295

RESUMO

We report the case of a 69-year-old man with a history of mastoidectomy for cholesteatoma, who developed spontaneous spinning vertigo on debridement of his cavity. Subsequent CT confirmed a lateral semicircular canal fistula, which was surgically closed with mastoid cavity obliteration. Following surgery, he developed a spontaneous, pulse-synchronous horizontal pendular nystagmus. We discuss the pathophysiology of this rare clinical sign.


Assuntos
Colesteatoma da Orelha Média/cirurgia , Mastoidectomia/efeitos adversos , Nistagmo Patológico/etiologia , Complicações Pós-Operatórias/etiologia , Deiscência da Ferida Operatória/complicações , Idoso , Humanos , Masculino , Doenças Raras/etiologia , Canais Semicirculares/cirurgia
20.
Audiol Neurootol ; 23(2): 98-104, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30173213

RESUMO

BACKGROUND: Patients with a superior canal dehiscence syndrome display symptoms of the vestibular disorder except that of hearing loss. Therefore, any type of surgery should treat those symptoms without affecting the hearing threshold. The aim of this study was to evaluate the extent to which the hearing threshold has been affected; the evaluation process was carried out by a transmastoid plugging of the superior canal. Another aim was to estimate the risk in loss of hearing due to this surgery. MATERIAL AND METHODS: In a retrospective study, 31 patients with dehiscence of the superior canal, who underwent a transmastoid plugging, were included. Additionally, 8 of them with the clinical symptoms of the Menière's disease received an endolymphatic sac surgery. A b-c threshold at 0.25, 0.5, 1, 2, and 4 kHz was observed in all patients pre and postoperatively as well as in the long-term follow-up. RESULTS: After a mean interval of 149 days, a change in the b-c threshold of 5.9 dB was detected. After 149 days, in the patient group comprising those who underwent an additional endolymphatic sac surgery, a b-c threshold change of 17.18 dB was detected. CONCLUSION: The transmastoid plugging of the superior semicircular canal can be performed with an acceptable risk of hearing affection. If the surgery was combined with other techniques, (e.g. endolymphatic sac surgery) then the risk increases.


Assuntos
Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Canais Semicirculares/cirurgia , Adulto , Idoso , Limiar Auditivo/fisiologia , Feminino , Humanos , Masculino , Doença de Meniere/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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