Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 115
Filtrar
2.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31266824

RESUMO

OBJECTIVE: In this study, we determined the prevalence of hearing loss in 157 children with proven congenital cytomegalovirus (cCMV) infection. We looked at possible risk determinants for developing hearing loss and proposed recommendations for screening and follow-up in the newborn. METHODS: In a prospective 22-year study, 157 children with proven cCMV infection were evaluated for sensorineural hearing loss (SNHL). The development of SNHL was correlated with the type of maternal infection (primary versus nonprimary), the gestational age of maternal primary infection, imaging findings at birth, and the presence of symptomatic or asymptomatic infection in the newborn. RESULTS: Of all children, 12.7% had SNHL, and 5.7% needed hearing amplification because of SNHL. Improvement, progression, and fluctuations of hearing thresholds were seen in 45%, 53.8%, and 5.7% of the children, respectively. Hearing loss was more common in the case of a symptomatic infection at birth (P = .017), after a maternal primary infection in the first trimester of pregnancy (P = .029), and in the presence of abnormalities on a neonatal brain ultrasound and/or MRI (P < .001). CONCLUSION: SNHL is a common sequela in children with cCMV infection. Risk factors for SNHL were primary maternal infections before the 14th week of pregnancy, the presence of a disseminated infection at birth, and imaging abnormalities in the newborn. These children may benefit from a more thorough investigation for SNHL than children who do not present with those risk factors.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico por imagem , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Efeitos Tardios da Exposição Pré-Natal/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Gravidez , Estudos Prospectivos
3.
Neurosurgery ; 85(6): E1084-E1094, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31270543

RESUMO

BACKGROUND: Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE: To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS: We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS: The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION: Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.


Assuntos
Audição/efeitos da radiação , Neuroma Acústico/radioterapia , Doses de Radiação , Radiocirurgia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Audição/fisiologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Testes Auditivos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
4.
Funct Neurol ; 34(1): 15-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31172935

RESUMO

Auditory dysfunction observed in patients with cognitive diseases is probably due to the alteration of some brain areas involved in sound stimulus processing. The present study aimed to investigate differences in such processing and in connectivity of the primary auditory cortex in patients affected by Alzheimer's disease (AD) and in normal subjects. We examined 131 diagnosed AD patients and a control group (CG) of 36 normal subjects. After a complete clinical investigation, focused on hearing function, all subjects underwent a brain FDG PET/CT. AD subjects vs CG showed reduced glucose consumption in BA 6,7,8,39, whereas we did not find differences in the primary auditory cortex. In AD, connectivity analyses showed a positive correlation of the primary auditory cortex with BA 6,8,21,31,39,40,42 and a negative correlation with BA 19, cerebellum and basal ganglia. Our findings suggest that neurological evaluation of patients with hearing loss might allow earlier (preclinical) identification of those affected by cognitive impairment.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Perda Auditiva/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/metabolismo , Encéfalo/metabolismo , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/metabolismo , Feminino , Glucose/metabolismo , Perda Auditiva/epidemiologia , Perda Auditiva/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade
5.
PLoS One ; 14(5): e0217682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150482

RESUMO

OBJECTIVES: We hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF). METHODS: Charts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction. RESULTS: Patients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025). CONCLUSIONS: The degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.


Assuntos
Paralisia Facial/fisiopatologia , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva/fisiopatologia , Osso Temporal/fisiopatologia , Adulto , Idoso , Cóclea/fisiopatologia , Nervo Facial/diagnóstico por imagem , Nervo Facial/fisiopatologia , Paralisia Facial/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/etiologia , Humanos , Masculino , Processo Mastoide/fisiopatologia , Pessoa de Meia-Idade , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/fisiopatologia , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vertigem/diagnóstico por imagem , Vertigem/fisiopatologia
7.
Seizure ; 69: 228-234, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31112829

RESUMO

PURPOSE: To summarize the clinical features and neuroimaging changes of epilepsy associated with TBC1D24 mutations. METHODS: Genetic testing was conducted in all epilepsy patients without acquired risk factors for epilepsy. Epilepsy patients identified with TBC1D24 compound heterozygous mutations by next-generation sequencing (NGS) epilepsy panel or whole exome sequencing (WES) were enrolled. The enrolled patients were followed up to summarize the clinical features. RESULTS: Nineteen patients were identified with TBC1D24 compound heterozygous mutations. Nine patients carried the same pathogenic variant c.241_252del. The seizure onset age ranged from 1 day to 8 months of age (median age 75 days). The most prominent features were multifocal myoclonus and epilepsia partialis continua (EPC). Myoclonus could be triggered by fever or infection in 15 patients, and could be terminated by sleep or sedation drugs. Psychomotor developmental delay was presented in 11 patients. Six patients exhibited hearing loss. Brain MRIs were abnormal in eight patients. Twelve patients were diagnosed with epilepsy syndromes including one patient who was diagnosed with Dravet syndrome. Two patients died due to status epilepticus at 4 months and 19 months of age, respectively. CONCLUSION: TBC1D24 mutation related epilepsy was drug-resistant. Multifocal myoclonus, EPC, and fever-induced seizures were common clinical features. Most patients presented psychomotor developmental delay. The neuroimaging abnormality and hearing loss could exacerbate during follow-up.


Assuntos
Epilepsia/genética , Proteínas Ativadoras de GTPase/genética , Mutação , Mioclonia/genética , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/genética , Deficiências do Desenvolvimento/fisiopatologia , Deficiências do Desenvolvimento/terapia , Epilepsia Parcial Contínua/diagnóstico por imagem , Epilepsia Parcial Contínua/genética , Epilepsia Parcial Contínua/fisiopatologia , Epilepsia Parcial Contínua/terapia , Epilepsia/diagnóstico por imagem , Epilepsia/fisiopatologia , Epilepsia/terapia , Feminino , Seguimentos , Predisposição Genética para Doença , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/genética , Perda Auditiva/fisiopatologia , Perda Auditiva/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Mioclonia/diagnóstico por imagem , Mioclonia/fisiopatologia , Mioclonia/terapia , Convulsões Febris/diagnóstico por imagem , Convulsões Febris/genética , Convulsões Febris/fisiopatologia , Convulsões Febris/terapia
8.
Acta Neurochir (Wien) ; 161(7): 1457-1465, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31127373

RESUMO

BACKGROUND: Accumulated stereotactic radiosurgery (SRS) experience for large vestibular schwannomas (VSs) based on over 5 years of follow-up are as yet insufficient, and chronological volume changes have not been documented. METHOD: Among 402 patients treated between 1990 and 2015, tumor volumes exceeded 8 cc in 30 patients. We studied 19 patients with follow-up for more than 36 post-SRS months or until an event. Median tumor volume was 11.5 cc (range; 8.0 to 30.6). The target volume was basically covered with 12.0 Gy. RESULTS: The median magnetic resonance imaging and clinical follow-up periods were both 98 months (range 49 to 204). Tumor shrinkage was documented in 13 patients (72%), no change in 2 (11%), and growth in the other 3 (17%). Therefore, the crude growth control rate was 83%. All three patients with tumor enlargement needed salvage treatment. Thus, the crude clinical control rate was 84%. Actuarial further procedure-free rates were 91%, 83% and 76%, at the 60th, 120th, and 180th post-SRS month. Among six patients followed chronologically, transient tumor expansion was observed in three (43%) and two cystic VSs showed rapid tumor growth. Transient trigeminal neuropathy occurred in two patients (11%). No patients experienced facial nerve palsy. None of the six patients with useful hearing pre-SRS maintained serviceable hearing. Ventricular-peritoneal shunt placement was required in three patients. CONCLUSIONS: Long-term tumor control with SRS was moderately acceptable in large VSs. In terms of functional outcome, trigeminal neuropathies and facial palsies were rare. However, hearing preservation remains a challenge. In the long term, chronological tumor volumes were generally decreased after SRS. However, caution is required regarding rapid increases in tumor size, especially for cystic type VSs. Further studies are needed to optimize clinical positioning of SRS for large VSs.


Assuntos
Paralisia Facial/epidemiologia , Perda Auditiva/epidemiologia , Neuroma Acústico/radioterapia , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia/métodos , Doenças do Nervo Trigêmeo/epidemiologia , Adulto , Idoso , Paralisia Facial/diagnóstico por imagem , Paralisia Facial/etiologia , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiocirurgia/efeitos adversos , Resultado do Tratamento , Doenças do Nervo Trigêmeo/diagnóstico por imagem , Doenças do Nervo Trigêmeo/etiologia , Carga Tumoral
9.
Int J Pediatr Otorhinolaryngol ; 123: 123-127, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100707

RESUMO

OBJECTIVE: To evaluate the incidence of vascular canal variations in the pediatric cochlear implant (CI) candidates. METHODS: We retrospectively reviewed temporal bone computed tomography (CT) images of the CI candidates between November 2013 and November 2018. The presence of high riding jugular bulb, dehiscent jugular bulb, jugular bulb diverticulum, bulging of sigmoid sinus, mastoid emissary vein (MEV), carotid canal dehiscence, and aberrant internal carotid canal were evaluated. Findings were compared with a control group of normal-hearing subjects. RESULTS: Temporal CT images of 118 CI candidates and 119 control group participants were evaluated. The vascular canal anomalies were found in 88 (37.3%) temporal bones of the CI candidates and 49 (20.6%) of the control group (p < 0.001). In 236 temporal CT scans of the CI candidates and 238 temporal CT scans of the control group, we found MEV in 19.1% and 6.3%, high riding jugular bulb in 11.4% and 10.5%, dehiscent jugular bulb in 2.1% and 1.3%, jugular bulb diverticulum in 6.4% and 1.7%, bulging sigmoid sinus in 11.4% and 4.2%, carotid canal dehiscence in 0.8% and 1.3%, and aberrant internal carotid canal in 0 and 0.8%, respectively. Jugular bulb diverticulum (p = 0.01), bulging of the sigmoid sinus (p = 0.003), and MEV (p < 0.001) were more frequent in the CI candidates. CONCLUSION: Vascular canal variations are more common in the CI candidates and should be evaluated before CI surgery.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva/patologia , Osso Temporal/irrigação sanguínea , Adolescente , Criança , Pré-Escolar , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/patologia , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/terapia , Humanos , Incidência , Lactente , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Masculino , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia , Tomografia Computadorizada por Raios X
10.
Otol Neurotol ; 40(5): e518-e526, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31083087

RESUMO

OBJECTIVES/HYPOTHESIS: Spikes in cochlear implant impedance are associated with inner ear pathology after implantation. Here, we correlate these spikes with episodes of hearing loss and/or vertigo, with a comparison between lateral wall and peri-modiolar electrode arrays. METHODS: Seven hundred seventy recipients of Cochlear's slim-straight, lateral wall electrode (CI422), or peri-modiolar (CI512) electrode were investigated for impedance spikes. Impedance fluctuations were defined as a median rise of ≥ 4 kΩ across all intracochlear electrodes from baseline measurements taken 2 weeks after switch-on. Medical records were analyzed from 189 of the 770 patients. RESULTS: The slim straight, lateral wall electrode was found to spike in impedance at a significantly higher rate than the peri-modiolar array (17% vs 12%). The peri-modiolar electrode tended to spike in impedance earlier than the slim-straight electrode. Impedance spikes were found to significantly correlate with medical events (hearing loss, vertigo, or tinnitus). Overall, in the "spike" group, 42 of 75 patients (56%) demonstrated a clinical event during the impedance spike, whereas 26 of 114 patients (22%) of the "non-spike" group had a clinical event. This significant difference existed with both implant types. CONCLUSION: These results demonstrate a small, but significant increase in impedance spikes in lateral wall electrodes, and support the relationship between spikes in cochlear implant impedances and postoperative inner-ear events, including the loss of residual hearing and vertigo. Monitoring cochlear implant impedance may be a method for early detection, and so the prevention, of these events in the future.


Assuntos
Implante Coclear/efeitos adversos , Implantes Cocleares/efeitos adversos , Orelha Interna/lesões , Impedância Elétrica , Adulto , Idoso , Biomarcadores , Orelha Interna/diagnóstico por imagem , Eletrodos , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Zumbido/diagnóstico por imagem , Zumbido/epidemiologia , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Vertigem/diagnóstico por imagem , Vertigem/epidemiologia , Vertigem/etiologia
11.
Trends Hear ; 23: 2331216519830237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995887

RESUMO

Chronic subjective tinnitus is a widespread disorder. This perceptual anomaly is assumed to result from a dysbalance of excitatory and inhibitory mechanisms on different levels of the auditory pathways. However, the brain areas involved are still under discussion. Using resting-state functional magnetic resonance imaging, we investigate differences in cerebral regional homogeneity (ReHo) between patients with unilateral chronic tinnitus and nontinnitus control subjects. To our knowledge, our study is the first to investigate the intraregional connectivity of patients with unilateral tinnitus in relation to hearing loss. Our analyses, based on strict recruitment and characterization of the participants, showed reduced ReHo in the primary auditory cortex contralateral to the side of the perceived tinnitus percept in patients. Reduced ReHo in this same region was also correlated with increased Tinnitus Handicap Inventory and Visual Analogue Scale for loudness scores, reflecting an alteration of synchronization in this region related to the perceived loudness of the tinnitus and the related distress. Furthermore, increased ReHo in the supramarginal and angular gyri ipsilateral to the tinnitus side was correlated with increased tinnitus duration and hearing threshold at the tinnitus pitch. The correlations observed in these brain areas, which are normally related to the nontinnitus ear, could highlight compensatory mechanisms in these secondary auditory regions.


Assuntos
Encéfalo/diagnóstico por imagem , Perda Auditiva/diagnóstico por imagem , Imagem por Ressonância Magnética , Zumbido/diagnóstico por imagem , Adulto , Vias Auditivas/diagnóstico por imagem , Vias Auditivas/fisiopatologia , Mapeamento Encefálico , Feminino , Perda Auditiva/patologia , Humanos , Percepção Sonora , Masculino , Pessoa de Meia-Idade , Zumbido/fisiopatologia
12.
Hum Brain Mapp ; 40(8): 2475-2487, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715769

RESUMO

Age-related hearing loss (HL) can be related to brain dysfunction or structural damage and may result in cerebral metabolic/perfusion abnormalities. Arterial spin labeling (ASL) magnetic resonance imaging (MRI) allows investigating noninvasively brain perfusion changes. Pseudocontinuous ASL and T1-weighted MRI (at 3 T) and neuropsychological testing (Montreal Cognitive Assessment) were performed in 31 HL (age range = 47-77 years, mean age ± SD = 63.4 ± 8.4 years, pure-tone average [PTA] HL > 50 dB) and 28 normal hearing (NH; age range = 48-78 years, mean age ± SD = 59.7 ± 7.4 years) subjects. Cerebral blood flow (CBF) and gray matter volume (GMV) were analyzed in the cortical volume to assess perfusion and structural group differences. Two HL subjects showing cognitive impairment were excluded from group comparisons. No significant differences in either global or local atrophy were detected between groups but the HL group exhibited significant regional effects of reduced perfusion within the bilateral primary auditory cortex, with maximal CBF difference (-17.2%) in the right lateral Heschl's gyrus. For the whole sample of HL and NH subjects (n = 59 = 31 HL + 28 NH), the regional CBF was correlated positively to the regional GMV (p = 0.020). In HL subjects (n = 31), the regional CBF was correlated negatively to the audiogram steepness (frequency range: 2-4 kHz, right ear: p = 0.022, left ear: p = 0.015). The observed cortical pattern of perfusion reduction suggests that neuronal metabolism can be related to HL before the recognition of brain structural damage. This also illustrates the potential of ASL-MRI to contribute early functional markers of reduced central processing associated with HL.


Assuntos
Córtex Auditivo , Circulação Cerebrovascular/fisiologia , Substância Cinzenta , Perda Auditiva , Idoso , Atrofia/patologia , Córtex Auditivo/diagnóstico por imagem , Córtex Auditivo/patologia , Córtex Auditivo/fisiopatologia , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Substância Cinzenta/fisiopatologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/patologia , Perda Auditiva/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marcadores de Spin
13.
JAMA Otolaryngol Head Neck Surg ; 145(2): 109-116, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30477013

RESUMO

Importance: Cochlear implant users generally display poor pitch perception. Flat-panel computed tomography (FPCT) has recently emerged as a modality capable of localizing individual electrode contacts within the cochlea in vivo. Significant place-pitch mismatch between the clinical implant processing settings given to patients and the theoretical maps based on FPCT imaging has previously been noted. Objective: To assess whether place-pitch mismatch is associated with poor cochlear implant-mediated pitch perception through evaluation of an individualized, image-guided approach toward cochlear implant programming on speech and music perception among cochlear implant users. Design, Setting, and Participants: A prospective cohort study of 17 cochlear implant users with MED-EL electrode arrays was performed at a tertiary referral center. The study was conducted from June 2016 to July 2017. Interventions: Theoretical place-pitch maps using FPCT secondary reconstructions and 3-dimensional curved planar re-formation software were developed. The clinical map settings (eg, strategy, rate, volume, frequency band range) were modified to keep factors constant between the 2 maps and minimize confounding. The acclimation period to the maps was 30 minutes. Main Outcomes and Measures: Participants performed speech perception tasks (eg, consonant-nucleus-consonant, Bamford-Kowal-Bench Speech-in-Noise, vowel identification) and a pitch-scaling task while using the image-guided place-pitch map (intervention) and the modified clinical map (control). Performance scores between the 2 interventions were measured. Results: Of the 17 participants, 10 (58.8%) were women; mean (SD) was 59 (11.3) years. A significant median increase in pitch scaling accuracy was noted when using the experimental map compared with the control map (4 more correct answers; 95% CI, 0-8). Specifically, the number of pitch-scaling reversals for notes spaced at 1.65 semitones or greater decreased when an image-based approach to cochlear implant programming was used vs the modified clinical map (4 mistakes; 95% CI, 0.5-7). Although there was no observable median improvement in speech perception during use of an image-based map, the acute changes in frequency allocation and electrode channel deactivations used with the image-guided maps did not worsen consonant-nucleus-consonant (-1% correct phonemes, 95% CI, -2.5% to 6%) and Bamford-Kowal-Bench Speech-in-Noise (0.5-dB difference; 95% CI, -0.75 to 2.25 dB) median performance results relative to the clinical maps used by the patients. Conclusions and Relevance: An image-based approach toward ochlear implant mapping may improve pitch perception outcomes by reducing place-pitch mismatch. Studies using a longer acclimation period with chronic stimulation over months may help assess the full range of the benefits associated with personalized image-guided cochlear implant mapping.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva/diagnóstico por imagem , Nível de Percepção Sonora , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Idoso , Feminino , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Percepção da Fala
14.
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
15.
Neuroimaging Clin N Am ; 29(1): 103-115, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466635

RESUMO

Temporal bone high-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are valuable tools in the evaluation of pediatric hearing loss. Computed tomography is important in the evaluation of pediatric conductive hearing loss and is the imaging modality of choice for evaluation of osseous abnormalities. MR imaging is the modality of choice for evaluation of sensorineural hearing loss. A broad spectrum of imaging findings can be seen with hearing loss in children. HRCT and MR imaging provide complementary information and are often used in conjunction in the preoperative evaluation of pediatric candidates for cochlear implantation.


Assuntos
Orelha/diagnóstico por imagem , Orelha/patologia , Perda Auditiva/patologia , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Criança , Perda Auditiva/diagnóstico por imagem , Humanos
17.
J Am Coll Radiol ; 15(11S): S321-S331, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30392601

RESUMO

This article presents guidelines for imaging utilization in patients presenting with hearing loss or vertigo, symptoms that sometimes occur concurrently due to proximity of receptors and neural pathways responsible for hearing and balance. These guidelines take into account the superiority of CT in providing bony details and better soft-tissue resolution offered by MRI. It should be noted that a dedicated temporal bone CT rather than a head CT best achieves delineation of disease in many of these patients. Similarly, optimal assessment often requires a dedicated high-resolution protocol designed to assess temporal bone and internal auditory canals even though such a study will be requested and billed as a brain MRI. Angiographic techniques are helpful in some patients, especially in the setting of vertigo. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Perda Auditiva/diagnóstico por imagem , Neuroimagem/métodos , Tomografia Computadorizada por Raios X , Vertigem/diagnóstico por imagem , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Imagem por Ressonância Magnética , Sociedades Médicas , Estados Unidos
18.
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
19.
Otol Neurotol ; 39(10): 1264-1270, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30289847

RESUMO

OBJECTIVE: To establish whether criteria can be used to identify patients who do not need high resolution computed tomography (HRCT) scans before cochlear implant operations, by retrospectively applying a preoperative selection pathway, the Cambridge Cochlear Implant Protocol (CCIP). STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center, Queen Elizabeth Hospital, Birmingham, UK (QEHB). PATIENTS: One hundred adult patients receiving primary cochlear implantation (CI) operations from April 2015 to July 2016 performed at the QEHB who received preoperative HRCTs. MAIN OUTCOME MEASURES: Etiology of hearing loss and anatomical abnormalities were collected by reanalyzing HRCT scans. Patients were retrospectively grouped according to criteria to restrict HRCT use derived from the Cambridge Cochlear Implant Programme (CCIP). The two main outcomes, recorded management change and significant abnormalities, were compared between the two CCIP groups, scanned and not scanned. RESULTS: Twenty-six patients had significant abnormalities detected on imaging, 16 in the scanned group and 10 in the not scanned group (p = 0.152). Five patients had a recorded management change as a result of HRCT scan, four scanned group, one not scanned group (p = 0.107). Significant abnormalities and recorded management change were seen across all etiological subgroups of hearing loss. CONCLUSION: The anatomy within the temporal bone is variable amongst CI recipients. Recorded management change and significant abnormalities occurred in both CCIP groups and across many etiologies of hearing loss patients. No specific group, based on the etiology of their hearing loss could be identified that do not require preoperative HRCT. Therefore, it is recommended that all CI patients should continue to receive preoperative HRCT imaging.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Implante Coclear/estatística & dados numéricos , Orelha/anormalidades , Orelha/diagnóstico por imagem , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Período Pré-Operatório , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem , Resultado do Tratamento
20.
Otol Neurotol ; 39(9): e752-e756, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30199495

RESUMO

OBJECTIVES: This study evaluated the correlation between skull bone attenuation on temporal bone computed tomography (CT) and bone mineral density (BMD) of the central skeleton on dual-energy x-ray absorptiometry (DXA) and the correlation between bone quality and hearing level. STUDY DESIGN: Retrospective observational. SETTING: Tertiary referral center. PATIENTS/INTERVENTIONS: One hundred and one ears of 101 patients who underwent temporal bone CT and DXA with pure tone audiometry within 3 months of CT. MAIN OUTCOME MEASURES: Bone quality was measured by both bone attenuation of the clivus and petrous apex by setting a circular region of interest and by the cortical thickness of the occipital bone on CT. Partial correlation analysis was used to assess the correlation between bone quality around the skull on CT and BMD in the central skeleton after adjusting for age and sex. Partial correlations between pure tone audiometry and CT/DXA results were sought. RESULTS: There was no significant correlation between measurements on CT and BMD on DXA. The hearing level partially correlated with BMD on DXA. The average threshold of bone conduction showed a significant correlation with BMD at the femoral neck (correlation coefficient -0.241, p = 0.020) and trochanter (correlation coefficient -0.244, p = 0.018), but there was no significant correlation between the average threshold of bone conduction and BMD at the lumbar spine (p = 0.177-0.332). CONCLUSION: We could not find a relationship between hearing loss and bone quality. Hearing levels can be affected by various factors, so further studies are needed to assess regional temporal bone quality.


Assuntos
Perda Auditiva/fisiopatologia , Osso Temporal/diagnóstico por imagem , Absorciometria de Fóton , Adulto , Idoso , Audiometria de Tons Puros , Densidade Óssea/fisiologia , Feminino , Perda Auditiva/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA