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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 Comput Assist Tomogr ; 44(1): 53-58, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939882

RESUMO

OBJECTIVE: In the diagnosis of superior semicircular canal dehiscence (SSCD), computed tomography (CT) is the only imaging method. The aims of the study were to show that reformat images are more accurate than standard planes for diagnosis of SSCD and to determine the prevalence of SSCD. METHODS: The retrospective review yielded 1309 temporal CTs performed in our radiology department for any reason. Two radiologist interpreted CTs in standard planes collaboratively. Patients with SSCD were reinterpreted in Pöschl and Stenvers planes by 2 radiologists separately. RESULTS: Statistical analysis was made by accepting that 2 radiologists diagnosis were accurate in Pöschl plane. Coronal plane sensitivity 86%, specificity 64%, Stenvers plane sensitivity 96%, and specificity 52% have been found in the mean result of 2 observers (P < 0.001). CONCLUSIONS: In the diagnosis of SSCD, standard and Stenvers planes can cause false-negative and false-positive diagnoses. Interpretation in Pöschl plane can significantly increase sensitivity, specificity, negative, and positive predictive values for diagnosing dehiscence.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Canais Semicirculares/anormalidades , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares/diagnóstico por imagem , Sensibilidade e Especificidade , Adulto Jovem
3.
Eur Arch Otorhinolaryngol ; 276(12): 3267-3274, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605190

RESUMO

INTRODUCTION: Autoimmune inner disease (AIED) is an uncommon cause of sensorineural hearing loss and poses a diagnostic challenge. The present study aims to review the existing knowledge on the clinicopathological aspects, the diagnostic challenges, and therapeutic interventions in AIED. DISCUSSION: The incidence of AIED is less than five cases per 100,000 population. There are no definite seromarkers which make diagnosis of AIED difficult. Even though various markers have been studied, their sensitivity and specificity have not been replicated in the clinical scenario. The treatment of the condition is also an enigma. Corticosteroids are the drug of choice and require long-term use to prevent relapse. Various other therapeutic agents have been studied in a small cohort of patients, but the efficacy of these drugs needs to be validated in a large multicentric trial. CONCLUSION: Timely intervention can restore hearing loss in AIED patients, but the clinician has to find a delicate balance between the hearing outcome and the potential side effects resulting from long-term use of the drugs. Treatment of steroid resistant AIED is a challenge and there are no universal guidelines for the same. AIED being an uncommon diagnosis, multicentric trials and collaboration are required to formulate diagnostic criteria and therapeutic guidelines.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Orelha Interna/diagnóstico por imagem , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/imunologia , Imunossupressão/métodos , Corticosteroides/uso terapêutico , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Feminino , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Doenças do Labirinto/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Resultado do Tratamento
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
6.
Acta Otolaryngol ; 139(6): 473-478, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035843

RESUMO

BACKGROUND: Superior semicircular canal dehiscence syndrome (SSCD) is a current diagnosis that is due to a loss of bone covering the superior semicircular canal (SSC). This results in pressure-/sound- induced vertigo and oscillopsia. OBJECTIVE: To find the variation of the thickness of the bone that covers the Superior Semicircular Canal with relation to age and gender among the Chinese descents. MATERIALS AND METHODS: Three hundred and eleven temporal bone Cone Beam Computed Tomography (CBCT) images of patients who attended Otology clinic at Second Hospital of Shandong University from January, 2017 to April, 2018 were retrospectively studied. The images were reconstructed in the line of Poschl and the thinnest area of the bone covering the SSC was taken. RESULTS: We included 172 (55.31%) females and 139 (44.69%) males. Mean age was 41 years. Overall mean difference in thickness was found to be -0.0210. There was no significant difference between the female and male bone thickness (p = .7113). With age the mean difference was 0.0801 (p = .1557) which was not statistically significant. CONCLUSION AND SIGNIFICANCE: There was no significant change in bone thickness with advancing age. CBCT is the best method of assessing SSCD.


Assuntos
Densidade Óssea/fisiologia , Reabsorção Óssea/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Doenças do Labirinto/diagnóstico por imagem , Canais Semicirculares/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Reabsorção Óssea/epidemiologia , China , Feminino , Hospitais Universitários , Humanos , Incidência , Doenças do Labirinto/epidemiologia , Doenças do Labirinto/patologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Canais Semicirculares/patologia , Índice de Gravidade de Doença , Fatores Sexuais
7.
J Clin Neurosci ; 66: 128-132, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103254

RESUMO

Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder with variable amounts of auditory and vestibular dysfunction. In addition to the absence of bone overlying the superior semicircular canal, thinning of bone in this area can also initiate the vestibulocochlear symptoms of SSCD. We evaluated normal bone thickness overlying the course of the semicircular canal using computed tomography (CT) scans and assessed correlations between bone thickness and age, gender, and location of the thinnest bone. A single-institution retrospective chart review was conducted on 133 high-resolution CT scans from 76 healthy, asymptomatic patients between ages 9 and 96 years. These CT scans of the temporal bone were obtained between January 2012 and August 2017. The superior semicircular canal dome thickness at the apex was reported with a mean of 1.25 mm for all 76 patients; the 10th percentile was 0.60 mm, and the 90th percentile was 2.08 mm. The thinnest area of bone at any location yielded a mean of 0.86 mm. The normal bone thickness overlying the superior semicircular canal does not depend on gender or age. The thinnest location was evenly distributed across the superior semicircular canal. A bone thickness of 0.40 mm or greater was present in 90% of normal patients based on CT scan measurements at the thinnest location.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Canais Semicirculares/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
AJNR Am J Neuroradiol ; 40(4): 709-712, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30819770

RESUMO

BACKGROUND AND PURPOSE: Prior studies of radiologic superior semicircular canal dehiscence have suggested that CT may overcall dehiscence. However, many of those studies were performed before the advent of multichannel helical CT. Furthermore, there are limited data investigating the prevalence of radiologic superior semicircular canal dehiscence in asymptomatic individuals. The purpose of this study was to determine the rate of radiologic superior semicircular canal dehiscence in an asymptomatic population using 64-channel helical CT. MATERIALS AND METHODS: We retrospectively enrolled 500 consecutive adult patients without symptoms of superior semicircular canal dehiscence who had undergone CT of the temporal bones in the emergency department of a tertiary academic center between February 2012 and June 2017. The superior semicircular canals were evaluated bilaterally by 2 dedicated head and neck radiologists and subjectively classified as either dehiscent or nondehiscent. A secondary group of 110 scans of patients with symptoms consistent with superior semicircular canal dehiscence was similarly interpreted, and the rate of radiologic superior semicircular canal dehiscence was calculated for each group. RESULTS: Ten of the 500 asymptomatic patients (2.0%; 95% CI, 1.1%-3.6%) had CT evidence of superior semicircular canal dehiscence, compared with 15 of 110 symptomatic patients (13.6%; 95% CI, 7.8%-21.5%). There was excellent interobserver agreement (κ = 0.91). CONCLUSIONS: Only 2% of asymptomatic patients had radiologic evidence of superior semicircular canal dehiscence on 64-detector row helical CT. This is markedly lower than previous reports and approaches the postmortem rate of asymptomatic superior semicircular canal dehiscence. We therefore recommend that asymptomatic patients with CT evidence of superior semicircular canal dehiscence undergo audiologic evaluation because the rate of false-positive scans is extremely low.


Assuntos
Doenças do Labirinto/epidemiologia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/patologia , Adulto , Feminino , Humanos , Doenças do Labirinto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada Espiral , Adulto Jovem
9.
Anat Histol Embryol ; 48(3): 268-276, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868615

RESUMO

The aim of this study was to check the relevance of using in-vivo micro computed tomography (µCT) for the diagnosis of possible diseases of the middle and inner ear of the cat. Therefore, on the one hand, differences of the detail detectability between the two imaging methods conventional computed tomography (cCT) and in-vivo µCT were analyzed. Six healthy cat ears were dissected and scanned several times and the obtained images were compared with each other. On the other hand, histological slices of all ears were prepared and pictures of defined anatomical structures were taken and compared with the identical sectional plane of the µCT-images. This way it was possible to evaluate the quality and clinical limitations of the in-vivo µCT. The results show that an in-vivo µCT is suitable to analyze even the smallest osseous structures, such as the semicircular ducts, the spiral osseous lamina or the ossicles whereas with the help of cCT it is not possible to identify such small osseous structures because of their blurred and less detailed representation. Delicate soft tissue structures as the membranous labyrinth including hearing and vestibular organ cannot be differentiated with as well in-vivo µCT- as with cCT-images. In-vivo µCT represent a good possibility for more detailed diagnosis of extremely fine structures which cannot be detected with cCT. Histological slices can nonetheless not be replaced by in-vivo µCT due to a too low spatial resolution and the limitations of the in-vivo µCT with regard to the evaluation of soft tissue dense structures.


Assuntos
Doenças do Gato/diagnóstico por imagem , Doenças do Labirinto/veterinária , Otite Média/veterinária , Tomografia Computadorizada por Raios X/veterinária , Microtomografia por Raio-X/veterinária , Animais , Doenças do Gato/patologia , Gatos , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/patologia , Otite Média/diagnóstico por imagem , Otite Média/patologia
10.
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
11.
Neuroimaging Clin N Am ; 29(1): 57-92, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466645

RESUMO

Third window abnormalities are bony defects of the inner ear that enable abnormal communication with the middle ear and/or cranial cavity. Vestibular symptoms include vertigo and nystagmus induced by loud noises or increases in pressure. Auditory symptoms involve "pseudo-conductive" hearing loss with a low-frequency air-bone gap at audiometry, resulting from decreased air and increased bone conduction. High-resolution temporal bone computed tomography is the first-line imaging modality for evaluation of third window pathology and is critical for accurate diagnosis and management. This article reviews the fundamental mechanisms of the third window phenomenon and describes imaging findings and differential diagnosis.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Orelha Interna/diagnóstico por imagem , Humanos
12.
Braz J Otorhinolaryngol ; 85(1): 111-120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29980446

RESUMO

INTRODUCTION: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. OBJECTIVE: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. METHODS: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. RESULTS: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. CONCLUSION: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.


Assuntos
Perda Auditiva/etiologia , Doenças do Labirinto/complicações , Neuroma Acústico/complicações , Adulto , Audiometria , Progressão da Doença , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/fisiopatologia , Humanos , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/fisiopatologia , Imagem por Ressonância Magnética , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/fisiopatologia
13.
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
14.
Otol Neurotol ; 40(2): 213-217, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30570605

RESUMO

HYPOTHESIS: Flat panel computed tomography (FPCT) provides more accurate measurements of dimensions for superior semicircular canal dehiscence (SCD) than multislice CT (MSCT). BACKGROUND: SCD syndrome occurs when a bony defect of the superior semicircular canal causes vestibular and auditory symptoms. MSCT can overestimate the size of the canal defect, with possible over-diagnosis of SCD and suboptimal selection of surgical approach. The higher resolution of FPCT should afford more accurate measurements of these defects. METHODS: Radiographic and surgical measurements were compared in 22 patients (mean age 49.4) with clinical SCD syndrome and canal defects confirmed at surgery. Twenty second FPCT scans were acquired before surgery with parameters: 109Kv, small focus, 200 degrees rotation angle, and 0.4 degree per frame angulation step. Dehiscence dimensions were measured from orthogonal multiplanar reconstructions on a high-resolution liquid crystal display monitor and compared with actual measurements recorded during microsurgery. RESULTS: SCD dimensions by FPCT (x) were 2.8 ±â€Š1.6 mm for length and 0.72 ±â€Š0.28 mm for width. The surgical measurements (y) were 2.8 ±â€Š1.7 mm for length and 0.72 ±â€Š0.34 mm for width. Linear fits between x and y yielded R values of 0.93 (length) and 0.66 (width). Our previous study using MSCT had R values of 0.28 (length) and 0.48 (width). The average difference between each FPCT and corresponding surgical measurement was not significantly different from zero, whereas the results for MSCT were significantly different. CONCLUSION: FPCT can provide more accurate measurements of SCD than MSCT. Clinicians should consider using FPCT for imaging suspected SCD.


Assuntos
Doenças do Labirinto/diagnóstico por imagem , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Doenças do Labirinto/patologia , Masculino , Pessoa de Meia-Idade
15.
Vet Radiol Ultrasound ; 60(5): E58-E61, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29194857

RESUMO

A four-year-old female French bulldog was presented for evaluation of acute, left-sided peripheral vestibular syndrome. Computed tomographic (CT) examination of the head revealed the presence of air within the left cochlea and vestibule, consistent with pneumolabyrinth. This was concurrent with ipsilateral otitis media and externa. Pneumolabyrinth is an uncommon finding in humans and is most frequently due to head trauma and temporal bone fracture. This is the first report describing pneumolabyrinth in a dog, apparently of nontraumatic origin in this case.


Assuntos
Doenças do Cão/diagnóstico por imagem , Doenças do Labirinto/veterinária , Otite Externa/veterinária , Otite Média/veterinária , Vestíbulo do Labirinto/diagnóstico por imagem , Animais , Doenças do Cão/etiologia , Cães , Feminino , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/etiologia , Otite Externa/diagnóstico por imagem , Otite Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Vestíbulo do Labirinto/patologia
16.
Braz J Otorhinolaryngol ; 85(2): 222-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29599061

RESUMO

INTRODUCTION: Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood. OBJECTIVE: Evaluate patients with cholesteatoma, in order to identify possible risk factors or clinical findings associated with labyrinthine fistula. Secondary objectives were to determine the prevalence of labyrinthine fistula in the study cohort, to analyze the role of computed tomography and to describe the hearing results after surgery. METHODS: This retrospective cohort study included patients with an acquired middle ear cholesteatoma in at least one ear with no prior surgery, who underwent audiometry and tomographic examination of the ears or surgery at our institution. Hearing results after surgery were analyzed according to the labyrinthine fistula classification and the employed technique. RESULTS: We analyzed a total of 333 patients, of which 9 (2.7%) had labyrinthine fistula in the lateral semicircular canal. In 8 patients, the fistula was first identified on image studies and confirmed at surgery. In patients with posterior epitympanic and two-route cholesteatomas, the prevalence was 5.0%; and in cases with remaining cholesteatoma growth patterns, the prevalence was 0.6% (p=0.16). In addition, the prevalence ratio for labyrinthine fistula between patients with and without vertigo was 2.1. Of patients without sensorineural hearing loss before surgery, 80.0% remained with the same bone conduction thresholds, whereas 20.0% progressed to profound hearing loss. Of patients with sensorineural hearing loss before surgery, 33.33% remained with the same hearing impairment, whereas 33.33% showed improvement of the bone conduction thresholds' Pure Tone Average. CONCLUSION: Labyrinthine fistula must be ruled out prior to ear surgery, particularly in cases of posterior epitympanic or two-route cholesteatoma. Computed tomography is a good diagnostic modality for lateral semicircular canal fistula. Sensorineural hearing loss can occur post-surgically, even in previously unaffected patients despite the technique employed.


Assuntos
Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/epidemiologia , Fístula/epidemiologia , Fístula/etiologia , Doenças do Labirinto/epidemiologia , Doenças do Labirinto/etiologia , Adolescente , Adulto , Distribuição por Idade , Audiometria de Tons Puros/métodos , Colesteatoma da Orelha Média/diagnóstico por imagem , Feminino , Fístula/diagnóstico por imagem , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/etiologia , Humanos , Doenças do Labirinto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
17.
Otol Neurotol ; 39(10): 1319-1325, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30289844

RESUMO

OBJECTIVE: To determine the prevalence of radiographic cochlear-facial nerve dehiscence (CFD). STUDY DESIGN: Retrospective radiological study. SETTING: Two tertiary-referral centers. PATIENTS: Two hundred six temporal-bone computed tomography (CT) scans (405 total ears) of otology/neurotology patients from two academic institutions between the years 2014 and 2017. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The cochlear-facial nerve partition width (CFPW) was measured on coronal CT sections and defined as the shortest distance between the cochlear basal turn and facial nerve (FN) labyrinthine segment. We used logistics regression analyses to determine positive predictors for radiographic evidence of CFD. RESULTS: The overall prevalence of radiographic CFD was 5.4% (22/406 ears). 9.2% of patients (19/206) had CFD. Of these 19 patients, only one patient had mixed hearing loss that could not be explained by any other vestibular or auditory etiology. Three out of 206 patients had dehiscence in both ears (1.4%). The average CFPW was 0.6 ±â€Š0.2 mm, and fallopian canal width was 1.1 ±â€Š0.02 mm (n = 405). Older age, use of traditional CT scans, and thinner CT slice thickness were significant predictors for radiographic CFD. CONCLUSIONS: The radiographic prevalence of CFD is higher than what is reported in histologic studies, and may over-estimate the true prevalence of CFD. The clinician should keep this in mind when considering this as potential cause for third-window symptoms.


Assuntos
Cóclea/diagnóstico por imagem , Nervo Facial/diagnóstico por imagem , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/epidemiologia , Adulto , Fatores Etários , Idoso , Audiometria , Orelha Interna/diagnóstico por imagem , Feminino , Perda Auditiva/diagnóstico por imagem , Humanos , Doenças do Labirinto/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 37(5): 290-295, sept.-oct. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178221

RESUMO

Introducción: Evaluar la utilidad de la PET/TC con 18F-FDG en la caracterización de la enfermedad inmunomediada del oído interno primaria (EIOI) aportando datos que ayuden a valorar la actividad inflamatoria y la existencia o ausencia de enfermedad sistémica asociada. Material y métodos: Estudio prospectivo sobre 28 pacientes con sospecha de EIOI o EIOI primaria diagnosticada y 4 controles ajustados por edad y sexo, sin enfermedad ótica conocida, a los cuales se había realizado una PET con 18F-FDG por otro motivo. Dieciocho pacientes presentaban EIOI primaria y 10EIOI secundaria. A todos se les realizó una PET/TC con 18F-FDG para valorar la actividad metabólica en el oído interno y la presencia de afectación sistémica. La interpretación del resultado de la PET fue realizada por 2médicos nucleares sin conocimiento de la clínica del paciente. Para valorar la reproductibilidad de las medidas se realizaron análisis Bland y Altman y correlación de coeficientes intraclase. Resultados: Se encontraron hallazgos sospechosos de afectación sistémica en 13 pacientes. Cuatro de ellos correspondieron a pacientes diagnosticados previamente de EIOI primaria que mostraron actividad inflamatoria (tiroidea y aórtica). En cuanto al análisis semicuantitativo de la actividad metabólica en el oído interno, la variabilidad interobservador fue muy alta y no fue posible establecer diferencias adecuadas entre grupos. Conclusiones: Este estudio demuestra que la PET/TC con 18F-FDG puede tener un papel en la evaluación de pacientes con sospecha de EIOI primaria descartando la presencia de datos que sugieran inflamación sistémica. Consideramos que no es adecuado tratar de cuantificar la actividad metabólica del oído interno probablemente por el pequeño tamaño del mismo


Introduction: To evaluate the utility of 18F-FDG PET/TC as an imaging tool for the characterization of immune-mediated inner ear disease (IMIED), providing measurements of the inner ear region activity as well as detecting possible involvement of other organs. Material and methods: The study included 28 patients with IMIED and 4 sex-matched and age-matched control subjects with no history of ear disease. Eighteen patients were considered to be suffering from primary IMIED and 10 patients from secondary. PET/CT scans with 18F-FDG were performed to assess systemic involvement as well as inner ear region activity. Interpretation of PET/CT scans was performed independently by 2nuclear medicine physicians blinded to clinical history. In order to assess inter-rater agreement before performing the analysis of the inner ear, different Bland & Altman plots and the intraclass correlation coefficients were estimated. Results: Different metabolically active foci findings were reported in 13 patients. Four patients diagnosed as primary IMIED showed thyroid and aorta activity. Regarding the inner-ear semiquantitative analysis, the inter-rater agreement was not sufficiently high. Comparisons between groups, performed using Mann-Whitney test or Kruskal-Wallis tests, showed no differences. Conclusions: The study showed 18F-FDG PET/TC could be an important tool in the evaluation of IMIED as it can support the characterization of this entity providing the diagnosis of unknown or underestimated secondary IMIED. Nevertheless, we consider PET is not an adequate tool to approach the inner ear because of the small size and volume of the cochlea which makes the assessment very difficult


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia por Emissão de Pósitrons/métodos , Doenças do Labirinto/diagnóstico por imagem , Doenças Autoimunes/complicações , Sensibilidade e Especificidade , Doenças do Labirinto/imunologia , Estudos Prospectivos , Perda Auditiva/imunologia , Estudos de Casos e Controles
19.
Aerosp Med Hum Perform ; 89(10): 923-926, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30219121

RESUMO

BACKGROUND: Humans detect motion and gravity via the labyrinthine system of the inner ear, which consists of the vestibule and the semicircular canals. The vestibular system provides three major functions for maintaining balance and orientation. First, it maximizes the effectiveness of the visual system. Second, it provides orientational information necessary for performing both skilled and reflexive motor activities. Third, in the absence of vision, the vestibular system provides a reasonably accurate perception of motion and position. Although these organs provide important cues for basic orientation on the ground, they often provide misleading information during flight. A superior semicircular canal dehiscence can cause an individual to experience disorientation and vertigo-like symptoms. CASE REPORT: A 30-yr-old male student pilot experienced airsickness on his first several flights in the T-6A Texan II aircraft. Airsickness is common among student pilots in the early stages of flight training; however, the subject pilot's symptoms lasted well beyond the normal 24 h, and included vertiginous symptoms lasting days after his last flight. His persistent symptoms required he be held out of training for further evaluation. Comprehensive vestibular and audiological testing were normal; however, a CT scan of the temporal bones showed a left superior semicircular canal dehiscence, and he was diagnosed with left labyrinthine fistula as the cause of his vertigo. He was medically eliminated from pilot training and permanently disqualified from U.S. Air Force flying duties. DISCUSSION: Spatial disorientation remains one of the deadliest factors related to aircraft mishaps every year. In this case, an abnormal presentation of airsickness that prompted further evaluation may have prevented a dangerous situation in the air. In standard airsickness, the goal is to keep the pilot flying to expedite adaptation, so this case highlights the importance of distinguishing between normal airsickness and a spatially disorienting medical condition.Dreibelbis JA, Organ BE. Semicircular canal dehiscence syndrome and vestibular dysfunction disqualify a military student pilot. Aerosp Med Hum Perform. 2018; 89(10):923-926.


Assuntos
Fístula/fisiopatologia , Doenças do Labirinto/fisiopatologia , Militares , Pilotos/normas , Canais Semicirculares/diagnóstico por imagem , Estudantes , Vertigem/fisiopatologia , Adulto , Confusão , Fístula/complicações , Fístula/diagnóstico por imagem , Humanos , Doenças do Labirinto/complicações , Doenças do Labirinto/diagnóstico por imagem , Masculino , Enjoo devido ao Movimento/etiologia , Enjoo devido ao Movimento/fisiopatologia , Orientação Espacial , Tomografia Computadorizada por Raios X , Vertigem/complicações , Doenças Vestibulares/complicações , Doenças Vestibulares/fisiopatologia
20.
Otol Neurotol ; 39(9): e849-e855, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30199501

RESUMO

OBJECTIVES: To highlight superior semicircular canal dehiscence (SSCD) involving the superior petrosal sinus (SPS), and to propose a novel classification system for SPS associated SSCD with potential surgical implications. STUDY DESIGN: Multicenter retrospective review. SETTING: Three tertiary referral centers. PATIENTS: All patients diagnosed with SPS associated SSCD (1/2000 to 8/2016). Radiographic findings and clinical symptoms were analyzed. INTERVENTION: Surgical repair or observation. MAIN OUTCOME MEASURE: Radiographic findings and clinical symptoms were analyzed. RESULTS: Thirty-three dehiscences (30 patients) involving the SPS were identified. The average age at the time of presentation was 52.5 years (median, 56.9; range, 4.9-75.3 yr), and 53.3% of patients were men. Three patients had bilateral SPS associated SSCD. The most common associated symptoms at presentation were episodic vertigo (63.6%), subjective hearing loss (60.6%), and aural fullness (57.6%). Four distinct types of dehiscence were identified: class Ia. SSCD involving a single dehiscence into an otherwise normal appearing SPS; class Ib. SSCD involving a single dehiscence into an apparent venous anomaly of the SPS; class IIa. SSCD involving two distinct dehiscences into the middle cranial fossa and the SPS; class IIb. SSCD involving a single confluent dehiscence into the middle cranial fossa and the SPS. CONCLUSIONS: SSCD involving the SPS represents a small but distinct subset of SSCD cases. This scenario can create a unique set of symptoms and surgical challenges when intervention is sought. Clinical findings and considerations for surgical intervention are provided to facilitate effective diagnosis and management.


Assuntos
Cavidades Cranianas/diagnóstico por imagem , Perda Auditiva/classificação , Doenças do Labirinto/classificação , Canais Semicirculares/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cavidades Cranianas/cirurgia , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/cirurgia , Humanos , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Adulto Jovem
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