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1.
Rev Assoc Med Bras (1992) ; 66(1): 74-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130385

RESUMO

OBJECTIVE: This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS: 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS: 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS: MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.


Assuntos
Implante Coclear/métodos , Orelha Interna/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Orelha Interna/cirurgia , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/cirurgia , Humanos , Lactente , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Valores de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada Espiral/métodos , Adulto Jovem
2.
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
3.
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
4.
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
5.
J Int Adv Otol ; 15(2): 283-288, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257189

RESUMO

OBJECTIVES: To assess and monitor lateral semicircular canal (LSC) function over time in patients affected by chronic otitis media with cholesteatoma (CHO) complicated by fistula of LSC (LSC-F) before and after surgery using video Head Impulse Test (vHIT). MATERIALS AND METHODS: Eight patients aged 18-67 years affected by CHO with imaging-ascertained LSC-F were included in this preliminary prospective study. The following protocol has been applied: oto-microscopic diagnosis with patient's history; computed tomography scan of the temporal bone; surgery with concomitant resurfacing of LSF-F; audiological and vestibular evaluation before surgery (T0) and at 30 days (T1), 6 months (T2), and 1 year after surgery (T3). vHIT was used to assess vestibulo-ocular reflex (VOR) in LSC. RESULTS: None of the patients showed deterioration of bone conduction hearing levels during the different time of evaluation. Three patients showed a reduced VOR gain and catch-up saccades at T0, with VOR gain normalization at T2. This finding remained stable at the 1-year follow-up. The VOR gain in the nonaffected side generally experienced an increase, paralleled by the normalization on the affected side, with statistically significant correlation. The subjects with normal vHIT before surgery did not show any variation following surgery. CONCLUSION: vHIT allows the assessment of LSC function in case of fistula. The adopted surgical fistula repair did not induce deterioration of the auditory or LSC function, but indeed, it could prevent worsening and help promoting recovery to the normal function.


Assuntos
Colesteatoma da Orelha Média/complicações , Fístula/etiologia , Doenças do Labirinto/etiologia , Adolescente , Adulto , Idoso , Condução Óssea/fisiologia , Colesteatoma da Orelha Média/fisiopatologia , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Feminino , Fístula/fisiopatologia , Fístula/cirurgia , Teste do Impulso da Cabeça/métodos , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Humanos , Doenças do Labirinto/fisiopatologia , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Otite Média/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica/fisiologia , Reflexo Vestíbulo-Ocular , Canais Semicirculares/fisiologia , Osso Temporal/fisiologia , Adulto Jovem
6.
Otol Neurotol ; 40(8): e769-e773, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31348128

RESUMO

OBJECTIVE: Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center. STUDY DESIGN: Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed. SETTING: Tertiary referral center. PATIENTS: Patients with a diagnosis of LVAS who received a cochlear implant (CI). Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis. INTERVENTION(S): Therapeutic. MAIN OUTCOME MEASURE(S): Postoperative speech perception scores. RESULTS: Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford-Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98%. Smaller numbers were available for post-CI City University of New York (CUNY) and Consonant-Nucleus-Consonant (CNC) word scores yet similar excellent results were seen. CONCLUSIONS: Our study results suggest the CI should be considered when BKB scores have dropped to 85%. We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.


Assuntos
Implante Coclear/métodos , Doenças do Labirinto/cirurgia , Percepção da Fala , Aqueduto Vestibular/cirurgia , Adulto , Criança , Implantes Cocleares , Surdez/etiologia , Surdez/cirurgia , Feminino , Perda Auditiva/cirurgia , Humanos , Doenças do Labirinto/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
7.
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
8.
Otol Neurotol ; 40(4): e356-e363, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870354

RESUMO

OBJECTIVE: To analyze surgical results on hearing and vestibular symptoms in patients with barotraumatic perilymphatic fistula (PLF) according to diagnostic criteria. METHODS: A total of 39 patients (41 ears) who underwent surgery on suspicion of barotraumatic PLF from January 2005 to December 2017 were included. Pure tone audiometry and videonystagmography (VNG) recording for spontaneous nystagmus and positional tests were performed preoperatively and postoperatively at 1 week and 1 month. Surgical outcomes were analyzed based on hearing results, subjective dizziness, and change of nystagmus. RESULTS: Preoperative hearing level was 75.5 ±â€Š28.7 dB for definite PLF and 88.5 ±â€Š22.8 dB for probable PLF, and levels were not significantly different between groups. Preoperatively, subjective dizziness was present in 18 (94.7%) and 19 (95%) in each group. Among 39 patients, 24 had VNG recordings. Positional nystagmus was recorded in 87.5% (7/8) and 87.5% (14/16) of the definite and probable PLF groups, respectively. Postoperatively, hearing was improved in 65% (13/20 ears) of definite PLF and 61.9% (13/21 ears) of probable PLF. There was no significant difference between the two groups. Hearing gain was significantly correlated with the time interval between symptom onset and surgical timing. Subjective dizziness was improved immediately after surgical repair in 97.4% (17/18) of definite PLF patients and 100% (19/19) of probable PLF patients. Even though dizziness was improved in most patients, some had persistent positional nystagmus and recurrent dizziness. CONCLUSIONS: Surgical sealing of both windows in suspected barotraumatic PLF is an effective treatment to improve hearing and subjective dizziness.


Assuntos
Barotrauma/cirurgia , Fístula/cirurgia , Doenças do Labirinto/cirurgia , Perilinfa , Adolescente , Adulto , Barotrauma/complicações , Criança , Feminino , Fístula/etiologia , Audição , Humanos , Doenças do Labirinto/etiologia , Masculino , Pessoa de Meia-Idade , Janela do Vestíbulo/lesões , Janela do Vestíbulo/cirurgia , Janela da Cóclea/lesões , Janela da Cóclea/cirurgia , Resultado do Tratamento , Testes de Função Vestibular , Adulto Jovem
9.
Otol Neurotol ; 40(4): e399-e404, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870369

RESUMO

OBJECTIVE: To describe a series of patients with iatrogenic inner ear dehiscence after lateral skull base surgery and discuss treatment options. PATIENTS: Three patients with history of recent lateral skull base surgery, symptoms consistent with inner ear dehiscence, and radiographically proven bony dehiscence on postoperative imaging. INTERVENTIONS: All patients were initially managed conservatively with serial outpatient visits. Two patients with large cochlear and vestibular dehiscences had round window reinforcement procedures. One patient had transmastoid resurfacing for repair of an iatrogenic posterior semicircular canal dehiscence. MAIN OUTCOME MEASURES: Anatomical location of dehiscences; treatment options; subjective auditory and vestibular symptoms pre-dehiscence, post-dehiscence and after dehiscence repair; pre- and post-audiogram when available. RESULTS: Patient ages were 46, 52, and 60 with two of three being women. None of the patients had subjective auditory or vestibular symptoms of inner ear dehiscence before initial skull base surgery, but they all had development of these symptoms afterwards. All patients were initially managed conservatively, but all ultimately required a surgical procedure. The two patients who elected for round window reinforcements, and the one patient who required transmastoid resurfacing, had significant improvement of symptoms. CONCLUSIONS: Iatrogenic inner ear dehiscence after skull base surgery is best dealt with and repaired intraoperatively. Should intraoperative repair not be possible, transcanal round window reinforcement is a minimally invasive option for medial otic capsule dehiscence, although long-term outcomes are unclear. For lateral otic capsule dehiscence, a transmastoid approach is recommended. LEVEL OF EVIDENCE: IV.


Assuntos
Doença Iatrogênica , Doenças do Labirinto/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Base do Crânio/cirurgia , Feminino , Humanos , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos
10.
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
11.
J Laryngol Otol ; 133(2): 102-105, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30898189

RESUMO

OBJECTIVE: To measure the outcomes of laser treatment of cholesteatoma covering cochlear and vestibular fistulas. METHODS: Cholesteatoma matrix over the fistula was denatured; the power density was sufficient only to gradually heat, but not vaporise, the keratin-forming matrix. The denaturing speed was controlled so that the integrity of the fistula cover was maintained. The change in bone conduction threshold and the residual rate of cholesteatoma at the fistula were measured. RESULTS: Thirty-six fistulas were assessed. There were seven cochlear fistulas. All were 5 mm or less in maximum length. For the entire group, the average change in bone conduction threshold was -0.3 dB. For cochlear fistulas, the average change in bone conduction was + 0.2 dB. The distribution of hearing results for the entire group was Gaussian; the apparent changes in hearing could be attributed to errors associated with testing. All patients underwent second-stage surgery. In all cases, the cholesteatoma was completely cleared from the fistula site. There were no facial palsies. CONCLUSION: Laser denaturing of cholesteatoma matrix over fistulas measuring 5 mm or less of vestibular apparatus and the cochlea is effective at eliminating cholesteatoma, and is not associated with cochlear hearing loss or facial palsy.


Assuntos
Colesteatoma da Orelha Média/complicações , Cóclea , Fístula/cirurgia , Doenças do Labirinto/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Vestíbulo do Labirinto , Feminino , Fístula/etiologia , Seguimentos , Humanos , Doenças do Labirinto/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
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
13.
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
14.
World Neurosurg ; 122: 161-164, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30385359

RESUMO

BACKGROUND: Superior semicircular canal dehiscence (SSCD) is a rare bony defect in the petrosal temporal bone, creating a new opening between the inner ear and middle cranial fossa. Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder characterized by a defect in collagen synthesis. Patients with EDS are more likely to have bony abnormalities, which may predispose them to developing SSCD. CASE DESCRIPTION: We report the cases of 2 women with history of EDS hypermobility type (HT). Both patients presented with bilateral auditory and vestibular symptoms, and computed tomography scan confirmed the presence of bilateral dehiscence in their superior semicircular canals. They underwent elective surgical repair via middle fossa craniotomy and report improvement in their symptoms. CONCLUSIONS: Because of the rarity of both diseases and their pathophysiology, a history of EDS may predispose an individual to developing SSCD. Although further research is necessary, this report aims to improve clinical screening of patients with EDS HT by suggesting an auditory and vestibular evaluation and assessment of pertinent bony abnormalities.


Assuntos
Síndrome de Ehlers-Danlos/complicações , Doenças do Labirinto/complicações , Osso Temporal/anormalidades , Adulto , Craniotomia , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/diagnóstico por imagem , Feminino , Humanos , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/cirurgia , Pessoa de Meia-Idade , Canais Semicirculares , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia
15.
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
16.
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
17.
Auris Nasus Larynx ; 46(4): 630-635, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30287116

RESUMO

OBJECTIVES: The patulous Eustachian tube (PET) and superior semicircular canal dehiscence syndrome (SCDS) have similarity in their symptoms and similar effects caused by positional changes, causing difficulty in the differentiation between the two disorders. This report describes a case of both SCDS and PET that was eventually successfully treated. METHODS: A 68-year-old man presented with hyperacusis to his own footsteps and gait disturbance. He had been diagnosed as PET two years before and had been treated by insertion of a silicone plug (Kobayashi plug) at the other hospital. Clinical case records, audiological data, cervical vestibular-evoked myogenic potential (cVEMP), Eustachian tube function tests and computed tomography (CT) were taken in the sitting position. RESULTS: While the CT confirmed superior semicircular canal dehiscence, the results of cVEMP was not typical of SCD likely due to preexisting hearing impairment in the right ear with a history of middle ear surgeries for the treatment of PET. He received round window reinforcement (RWR) and achieved relief from his symptoms but six months after the surgery, he visited again with complaints of autophony of his own voice and breathing. The tympanic membrane was found to move synchronous with respiration, and Eustachian tube function tests and the sitting CT confirmed the recurrence of severe PET. He had his silicone plug exchanged (increase in size of the Kobayashi plug) and achieved relief from symptoms. CONCLUSIONS: The present case was a rare instance showing that PET and SCDS can occur simultaneously in a patient. The patient achieved relief from symptoms after treatment with RWR and insertion of the Kobayashi plug.


Assuntos
Tuba Auditiva/fisiopatologia , Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Próteses e Implantes , Janela da Cóclea/cirurgia , Canais Semicirculares/fisiopatologia , Idoso , Otopatias/complicações , Otopatias/cirurgia , Tuba Auditiva/diagnóstico por imagem , Humanos , Hiperacusia/etiologia , Doenças do Labirinto/complicações , Masculino , Canais Semicirculares/diagnóstico por imagem , Postura Sentada , Decúbito Dorsal
18.
Int J Pediatr Otorhinolaryngol ; 116: 118-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554681

RESUMO

OBJECTIVE: The purpose of this study was to investigate the development of speech skills in young children with Mondini dysplasia and age-matched deaf children with radiologically normal inner ears over a period of 5 years after cochlear implantation (CI). METHODS: In total, 700 congenitally severely to profoundly deaf children (281 girls and 419 boys) participated in this study. All of the participants had undergone unilateral CI surgery before 36 months of age. The participants were categorized into two groups based on the absence or presence of Mondini dysplasia in the implanted ear, as assessed via high-resolution, thin-slice computerized tomography or magnetic resonance imaging: group A comprised 592 children with radiologically normal inner ears and group B comprised 108 children with Mondini dysplasia. The Meaningful Use of Speech Scale (MUSS) and Speech Intelligibility Rating (SIR) were used to evaluate the speech performance of all young children at various time points: pre-surgery and at 1, 3, 6, 12, 24, 36, 48, and 60 months after switch-on programming. RESULTS: The mean scores of SIR and MUSS in children from both group A and group B showed significant improvements over time. No significant differences were found in the mean scores of SIR between the two groups at any time interval during the 5-year follow-up. The mean score of MUSS was significantly different between group A and group B at 12, 24, and 36 months after implantation, whereas no obvious differences were noted pre-surgery, and at 1, 3, 6, 48, and 60 months post-operation. CONCLUSIONS: Young children with Mondini dysplasia develop their speech skills at a fast rate and achieve similar speech acquisition compared to age-matched children with radiologically normal inner ears 5 years post-operation. Therefore, CI is an effective intervention method for young children with Mondini dysplasia.


Assuntos
Implante Coclear/métodos , Surdez/cirurgia , Orelha Interna/anormalidades , Doenças do Labirinto/cirurgia , Inteligibilidade da Fala/fisiologia , Criança , Pré-Escolar , Implantes Cocleares , Surdez/congênito , Surdez/fisiopatologia , Feminino , Humanos , Lactente , Doenças do Labirinto/complicações , Masculino , Período Pós-Operatório , Percepção da Fala , Medida da Produção da Fala/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Otol Neurotol ; 39(10): e1160-e1167, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30444849

RESUMO

OBJECTIVE: To compare postoperative hearing outcomes between transmastoid and middle fossa craniotomy (MFC) approaches for surgical repair of superior semicircular canal dehiscence syndrome (SCDS) in a tertiary referral center. STUDY DESIGN: Historical cohort study. SETTING: Tertiary referral center. PATIENTS: Twelve consecutive SCDS cases who underwent transmastoid plugging of the superior canal; "controls" were 18 audiogram-matched patients who underwent MFC plugging and resurfacing. MAIN OUTCOME MEASURES: Differences between preoperative, 7-day postoperative, and long-term (>6 wk) postoperative air and bone conduction, speech discrimination scores (SDS), and pure-tone averages (PTA) in TM cases versus MFC controls. METHODS: MFC controls were selected by matching preoperative bone conduction (BC) pure-tone thresholds from the TM cases within 10-dBs NHL in ≥80% of recorded frequencies. Wilcoxon signed-rank tests were performed to compare primary outcomes between matches, with a Bonferroni corrected p value of 0.004 (n = 13 variables measured at each time period). RESULTS: No statistically significant differences were found in long-term postoperative air conduction and BC thresholds at any frequency both during the immediate postoperative period as well as at long-term follow-up (p > 0.004). Similarly, there were no differences in long-term SDS or PTA (p > 0.004). CONCLUSIONS: In this pilot study, there were no long-term significant differences in hearing outcomes between the two repair techniques for SCDS. We recommend continuing with the established practice for recommending surgical repair based on individual patient characteristics and preferences in managing both vestibular and auditory function.


Assuntos
Craniotomia/métodos , Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Canais Semicirculares/fisiopatologia , Tomografia Computadorizada por Raios X
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