Cochlear implant outcomes in patients with superior canal dehiscence

OBJECTIVE

To determine whether adult cochlear implant (CI) users with superior canal dehiscence syndrome (SCDS) or asymptomatic superior semicircular canal dehiscence (SCD) have different surgical, vestibular, and audiologic outcomes when compared to CI users with normal temporal bone anatomy.

METHODS

A retrospective single institution review of CI users with either superior semicircular canal dehiscence syndrome or asymptomatic superior semicircular canal dehiscence identified eight post-lingually deafened adults with unilateral or bilateral cochlear implantation between 2006 and 2010. Preoperative and postoperative speech perception scores as well as medical and epidemiological data were recorded and analyzed.

RESULTS

One patient with superior canal dehiscence syndrome and seven patients with asymptomatic superior semicircular canal dehiscence were identified, representing 7% or 8/113 of CI patients that fulfilled selection criteria. Average dehiscence length was 3.3 mm ± 0.79 SEM. Three patients received bilateral implants and five patients received a unilateral implant. Among asymptomatic superior semicircular canal dehiscence patients, subjective rates of post-operative dizziness were similar to those seen in patients with normal temporal bone anatomy (12.5 % vs. 15.9%, respectively). Speech perception abilities after surgery were poorer in SCD patients compared to the non-SCD cohort (Consonant Nucleus Consonant 33.7 ± 7.78 SEM vs. 56.7 ± 2.15 SEM P = 0.011), although both groups improved substantially relative to pre-operative performance. We also completed detailed analyses of auditory and vestibular outcomes in one patient with SCDS who underwent CI surgery in the symptomatic ear, which demonstrated preservation of vestibular function post-operatively, improved quality-of-life measures, and reduced dizziness symptomatology.

CONCLUSIONS

Our data suggest that patients with asymptomatic superior canal dehiscence at the time of CI surgery have similar albeit decreased speech perception scores compared to non-SCD adult CI users. Subjective rate of dizziness or vertigo following CI surgery was similar in both asymptomatic SCD and non-SCD cohorts, with detailed analyses of a single symptomatic SCD patient revealing improved vestibular function and reduced SCD symptoms following CI.

Gouty tophi on the ear: a review

Although the classic location of gouty tophi is the great toe (podagra), gouty tophi of the ear also is common and is worth including in the differential diagnosis in patients presenting with ear lesions. Other entities presenting as papules or nodules on the ear include chondrodermatitis nodularis helicis (CNH), actinic keratosis, basal cell carcinoma, squamous cell carcinoma, verruca vulgaris, amyloids, rheumatoid nodules, and elastotic nodules. If tophaceous gout is suspected, alcohol fixation of the biopsy specimen is preferable, as it enables visualization of characteristic needle-shaped urate crystals.

Multislice computed tomography overestimates superior semicircular canal dehiscence syndrome

OBJECTIVES

We assessed the prevalence of superior semicircular canal dehiscence (SSCD) through examination of ultrahigh-resolution computed tomography (CT) scans of the temporal bone and attempted to verify the correspondence between a radiologic diagnosis of SSCD and clinical signs of SSCD syndrome.

METHODS

A prospective study was carried out on 191 consecutive patients who underwent temporal bone ultrahigh-resolution CT scans. Cases that matched the radiologic diagnosis of SSCD were subsequently referred for a comprehensive audiological evaluation that might enable a final diagnosis of SSCD syndrome.

RESULTS

Among the 191 patients, 17 had a radiologic diagnosis of SSCD, which was bilateral in 5 cases, for a total of 22 SSCD cases, with a prevalence rate of 5.8%. In 2 of the 17 patients, the audiological examination revealed signs and symptoms indicative of SSCD syndrome, with a total prevalence rate of 0.5%.

CONCLUSIONS

Our data confirm that the radiologic diagnosis of SSCD, performed by mean thin-section CT scans reformatted in the plane of the superior semicircular canal, is not necessarily related to the clinical presentation of SSCD syndrome. Our study also showed a prevalence rate of SSCD syndrome that was similar to the prevalence of SSCD reported from studies of histologic specimens.

Ototoxicity of cisplatin administered to guinea pigs via the round window membrane

Animal models of ototoxicity represent an elementary tool in otolaryngologic research. Such models are usually created via the consecutive injection of ototoxic drugs or the co-administration of ethacrynic acid and low-dose ototoxic drugs. Injection via the round window membrane (RWM) is one approach that allows for local drug delivery into the inner ear. In this study, 47 guinea pigs received an injection of varying doses of cisplatin via the RWM, and data concerning the animals' auditory brainstem responses, hair cells, and spiral ganglion neurons were analyzed. Our results indicate the high efficiency and generally small reaction of the subjects, suggesting that the application of cisplatin via the RWM is an effective animal model for ototoxicity research.

Hereditary hidradenitis suppurativa restricted to the auricular region

Hidradenitis suppurativa (HS) is part of the follicular occlusion tetrad, which typically presents as recurrent deep-seated nodules, abscesses, and communicating sinus tracts with a predilection for the axilla and genital region. There is only one prior report of HS restricted to the auricular region. Herein the first familial case of HS restricted to the auricular region is reported.

Juvenile xanthogranuloma of the tympanic membrane: a case report

Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.

External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

INTRODUCTION

Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development.

CASE REPORT

A 16-year-old boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease.

CONCLUSION

There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

Pseudocyst of the auricle: an uncommon entity of the ear

A 48-year-old white man presented with a 2-month history of a lump on his right ear following purported exposure to the cold. The patient denied any history of trauma, rubbing, insect bite, or inflammation at the site. The patient was otherwise healthy and was not taking any medications. The lesion was completely asymptomatic, as the patient denied any pain, tenderness, or change in size since the lesion appeared. Physical examination revealed a 1.1-cm x 1-cm skin-colored, slightly fluctuant, rubbery, nonmobile dermal nodule on the right scaphoid fossa (Figure 1). No erythema, warmth, tenderness, or drainage was noted. A review of systems was noncontributory. A punch biopsy performed at the site of the cyst yielded clear, serous drainage. The cystic lesion was drained completely and decompressed. Histological examination revealed the surface of an intracartilaginous cystic space lined by degenerated cartilage, consistent with a diagnosis of pseudocyst of the auricle (Figure 2 and Figure 3). The lesion, although much smaller than at the time of presentation, persisted at the 3-week follow-up visit. It remained asymptomatic, without pain or irritation. At that time, the patient declined re-excision with bolster dressing. At 7-month follow-up, he reported the lesion to be stable.

Inflammatory myofibroblastic tumor involving ear lobule

We present herein an extremely rare case of an inflammatory myofibroblastic tumor (IMT) of the ear lobule with its management. A 50-year-old woman presented with a wart-like mass between the ear lobule and the facial skin. She had been accidentally lacerated her left ear lobule and visited our clinic. The mass had been incidentally found by the patient 1 year before the trauma and growing slowly without pain. Surgical excision and primary closure was performed. Histopathologic examination demonstrated ill-defined margined nodular proliferation of spindle cells in deep dermis with focal stromal hyalinization and lymphoplasmacytic infiltration compatible with the IMT. The patient showed no evidence of recurrence 6 months after surgery. To our knowledge, this is the first report of an IMT occurred in the external ear. Auricular IMT of our case was not aggressive in clinical nature and treated optimally with surgical excision.

Ear diseases in children presenting at Nepal Medical College Teaching Hospital

Ear diseases are a common presentation in the ENT out-patient department. These diseases can have sequelae if not treated early which may cause increased morbidity, hearing disability and even mortality. Identifying these conditions early and treating them can reduce these unwanted sequelae. A prospective study over a period of three years was undertaken in a tertiary care hospital in Kathmandu. All children presenting with ear diseases consecutively in the ENT out-patients were included and their data was recorded in a pro forma. The data was analysed for frequency and cross-tabulated. The study included 2218 children with ear diseases among which 868 (39.1%) were pre-school and 1350 (60.9%) were school going children. The male to female ratio was 1.5:1. The most common otological problem was wax impaction (40.2%), followed by acute otitis media (AOM) with 24.3%, chronic suppurative otitis media (CSOM) with 17.7% and acute otitis externa (AOE) with 7.5% of the total cases. The other conditions were otitis media with effusion (2.8%), foreign bodies in the ear (2.3%), otomycosis (1.7%), preauricular sinus (1.1%), sensorineural hearing loss (0.8%), trauma to the ear (0.7%), keloids (0.3%), microtia (0.2%) and perichondritis (0.2%).The three year olds had the highest number of otological diseases with 9.2% of the total among the ages studied. It is felt that proper education of health care providers regarding ear diseases and also awareness in the community can prevent and reduce the disability and complications of these conditions.

Congenital primary cholesteatoma of external auditory canal

A 2-year-old female child is reported with congenital cholesteatoma of the right external auditory canal. We describe the clinical features, computed tomography finding and surgical treatment. Congenital cholesteatomas can occur within the temporal bone. Congenital cholesteatoma of the external auditory canal is rare. Generally, it appears in the canal floor. Treatment consists of the resolution of granulation and removal of debris.

[Effect of different concentration of tamoxifen ointment on the expression of TGF-beta2 of hypertrophic scar at rabbit ears]

OBJECTIVE

To observe the effect of different concentration of Tamoxifen ointment on the fibroblasts and transforming growth factor (TGF-beta2) of hypertrophic scar at rabbit ears, so as to explore the possibility of treatment of hypertrophic scar with Tamoxifen.

METHODS

The hypertrophic scar model was established in 96 New Zealand rabbits' ears. The wounds were divided into four groups (A, B, C and D), with 144 wounds in each group. Different concentration of tamoxifen ointment (0.5%, 1%, 2%) was topically administered in groups A, B and C respectively, and blank ointment in group D. On postoperative day 30, 60 and 90, the scar samples were harvested. The scar thickness, scar histological change and the content of TGF-beta2 were detected.

RESULTS

(1) On the 30th day after operation, the difference of scar tissue thickness among groups A, D and B, C reached statistical significance (group A, D < group B < group C). However, there was a contrary tendency in fibroblasts density and TGF-beta2 content of the scar tissue simultaneously. (2) On 60th, 90th day after injury, there was statistical difference in scar thickness, fibroblasts density and the content of TGF-beta2 in scar of four groups (P < 0.05). The content of TGF-beta2 in group A, B, C, D was (43.97 +/- 3.63) microg/L, (41.92 +/- 3.91) microg/L, (36.69 +/- 4.15) microg/L, (54.90 +/- 4.71) microg/L, respectively, on 60th day; and (45.69 +/- 2.63) microg/L, (40.43 +/- 3.87) microg/L, (38.76 +/- 3.24) microg/L, (52.59 +/- 4.92) microg/L, respectively, on 90th day. The fibroblasts density of scar in groups A, B, C, D was (4392.07 +/- 327.84) point/mm2, (4208.57 +/- 329.76) point/mm2 (4 033.44 +/- 427.91) point/mm2, (4863.03 +/- 387.98) point/mm2, respectively, on 60th day; and (4418.41 +/- 432.52) point/mm2, (4077.65 +/- 386.70) point/mm2, (3844.53 +/- 354.29) point/mm2, (4838.64 +/- 390.52) point/mm2, respectively, on 90th day. The content of TGF-beta2 and fibroblasts density of scar were lined up as group D > group A > group B > group C (P < 0.05).

CONCLUSIONS

Topical Tamoxifen can reduce the content of TGF-beta2 and fibroblast, decrease fibroblasts density and the formation of hypertrophic scar at rabbit ears. It offers a new way for the treatment of the hypertrophic scar.

[Cutaneous horn of the pinna]

The cutaneous horns are uncommun lesion, asymptomatic affecting the face and extremities with a large variability in their shapes and dimensions. They can be isolated or associated with malignant skin while forming a revealing fashion. The wide excision carrying the base of implantation with anatomopathological verification is the usual treatment.

[Anatomical and morphological peculiarities of endonasal structures in children with allergic rhinitis]

The paper considers the current concepts of diagnostics and treatment aspects of allergic rhinitis in children. Both conservative and surgical methods of treatment are presented. Personal data is presented. Practical issues discussed in the paper concern pediatric allergists as well as pediatric ENT-specialists. A joint tactic to management of these patients is outlined.

Inner ear anomalies in congenital aural atresia

OBJECTIVES

To define the prevalence of inner ear anomalies in aural atresia patients and to recognize patterns of developmental anomalies in aural atresia patients.

STUDY DESIGN

Retrospective review.

SETTING

Academic medical center.

INTERVENTION

Physical exam, audiometry, and temporal bone CT in selected patients.

PATIENTS

Pediatric patients with aural atresia.

MAIN OUTCOME MEASURE

Prevalence of inner ear anomalies and coexisting facial paralysis or sensorineural hearing loss.

RESULTS

In this series of 118 patients with aural atresia, associated facial palsy was seen in 13%, whereas inner ear anomalies were present in 22%, including all patients with facial palsy. Interestingly, the inner ear anomalies often did not display a significant sensorineural hearing loss. Bilateral inner ear anomalies were frequently encountered despite unilateral atresia. Most anomalies involved the semicircular canals including several uncommon variants of posterior semicircular canal anatomy.

CONCLUSION

Inner ear anomalies are common in the presence of aural atresia, especially when there is concurrent congenital facial palsy. The presence of inner ear anomalies should be recognized as a common feature of craniofacial microsomia.

Sonotubometry with perfect sequences: First results in pathological ears

CONCLUSION

Sonotubometry with perfect sequences (PSEQ) was able to detect eustachian tube (ET) openings in both normal and pathological ears. Impaired ears showed ET openings in almost all cases; however, these proved to be not only less frequent, but also with lower amplitude and shorter duration.

OBJECTIVES

To investigate the function of impaired ET under physiological conditions, using a novel kind of sound stimulus for sonotubometry – the PSEQ.

METHODS

Twenty otologically healthy subjects (40 normal ears) and 32 patients with ear diseases (40 pathological ears) were examined sonotubometrically using noise signals with an ideally flat spectrum (PSEQ). Dry swallowing, water swallowing, and Toynbee maneuver were used to induce ET openings. Analysis was performed regarding the frequency of occurrence, duration, amplitude, and form of the ET openings.

RESULTS

PSEQ allowed the detection of an ET opening in all 40 normal ears (91% of the performed maneuvers) and in 87.5% of the ears with impaired ET function (but only 47% of the maneuvers). The average amplitude of the openings in healthy ears was 16.86 dB, the average duration was 363 ms. In diseased ears these values were significantly lower: 9.73 dB, p < 0.001 and 280 ms, p < 0.05.

Thyroxine treatments do not correct inner ear defects in tmprss1 mutant mice

Complete deficiency of a member of the type II transmembrane serine protease family, tmprss1 (also known as hepsin), is associated with severe to profound hearing loss in mice and a gross enlargement of the tectorial membrane in the cochlea. Levels of thyroxine in these mice have been shown to be significantly lower when compared with wild-type controls. As thyroxine is critical for inner ear development, we delivered thyroxine to these mice during the prenatal or postnatal stage of development. Both the treatments could not ameliorate hearing loss or correct deformities in the tectorial membrane of these mutant mice, suggesting that a deficiency in tmprss1 affects thyroxine responsiveness in the inner ear in vivo.

Extensive external auditory canal cholesteatoma in the infratemporal area without mastoid involvement: use of a new surgical technique

The external auditory canal (EAC) is an unusual location for a cholesteatoma. We present the cases of 2 patients with EAC cholesteatoma who experienced extensive damage that extended from the inferior EAC wall to the infratemporal area; there was no mastoid involvement. In both cases, the cholesteatomas were removed under local anesthesia and the inferior canal wall was reconstructed with a technique that involved the placement of a pedicled musculoperiosteal flap, a cartilage graft, and a full-thickness skin graft. This simple procedure preserves a normal EAC contour, middle ear space, and mastoid cavity.