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Reynard P, Idriss S, Ltaief-Boudrigua A, Bertholon P, Pirvan A, Truy E, Thai-Van H, Ionescu EC. Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities. Front Neurol 2022; 12:792545. [PMID: 35087471 PMCID: PMC8786803 DOI: 10.3389/fneur.2021.792545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants. Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities. Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed. Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.
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Affiliation(s)
- Pierre Reynard
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Samar Idriss
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | | | - Pierre Bertholon
- Department of Otorhinolaryngology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Andreea Pirvan
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France
| | - Eric Truy
- Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Department of Otorhinolaryngology, Lyon University Hospital, Lyon, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Eugen C Ionescu
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
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Salvinelli F, Bonifacio F, Beccaria C, Greco F, Frari V, Iafrati F, Trivelli M. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac241. [PMID: 35665379 PMCID: PMC9156001 DOI: 10.1093/jscr/rjac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
The superior semicircular canal dehiscence is a vestibular disease recognized condition in recent years, and surgical therapy has been modeling itself over the years to ensure the control of vestibular symptoms and auditory symptoms. In this case series, the authors have experienced an intervention aimed at closing the superior semicircular canal dehiscence through the insertion of bone paté between the meninx and the residual middle cranial fossa bone wall. Seven patients underwent this intervention, they reported an improvement in all vestibular and auditory symptoms, and hearing threshold remained stable. Despite the small sample size, the difference was significant in the control of dizziness and the reduction of pulsatile tinnitus. The technique described in this article allows the control of symptoms in superior semicircular canal dehiscence, and it is a type of surgery familiar to the otosurgeon and easily replicable as it involves a modified mastoidectomy. More data are needed.
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Affiliation(s)
- Fabrizio Salvinelli
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Bonifacio
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Correspondence address. Unit of Otolaringology, Campus Bio-Medico University, via Alvaro del Portillo 21, Rome 00128, Italy. E-mail: ; Tel: 3384706537; Fax: 06225411028
| | - Claudia Beccaria
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabio Greco
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Valeria Frari
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Iafrati
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Maurizio Trivelli
- Department of Otolaringology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Nieto P, Gallois Y, Molinier C, Deguine O, Marx M. Surgical treatments of superior semicircular canal dehiscence: A single-centre experience in 63 cases. Laryngoscope Investig Otolaryngol 2021; 6:1414-1420. [PMID: 34938882 PMCID: PMC8665461 DOI: 10.1002/lio2.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/16/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Different procedures have been described to treat superior canal dehiscence. The present study aims to describe the results obtained with middle fossa approach, transmastoid approach, and round window reinforcement in a large series of patients. METHODS AND DESIGN In this single-center retrospective study, we report the results of the procedures performed between 2006 and 2019 using the three main surgical approaches, middle fossa approach (MFA), transmastoid approach (TMA), and round window reinforcement (RWR). The outcome on cardinal cochlear and vestibular symptoms, audiometric results, and changes in cervical vestibular evoked myogenic potentials (cVEMPs) were analyzed. The patients were also interviewed 12 months to 13 years post-treatment to establish their overall satisfaction following surgery. RESULTS Sixty-three patients were divided into three groups: 42 MFA; 12 RWR; 9 TMA. Postsurgical control rates exceeded 80% for the majority of symptoms in the MFA and TMA groups, and ranged from 11.1% to 83.3% for the RWR group. Over 90% of MFA or TMA patients and 60% of the RWR cohort were satisfied overall with their treatment. Hearing thresholds were intact following surgery in the MFA and TMA groups. There was one case of profound postoperative deafness in the RWR group. CONCLUSION MFA and TMA are both safe and effective techniques in the treatment of disabling SSCD. Since MFA is the more invasive technique, we suggest that TMA should be proposed as first-line treatment, temporal bone anatomy permitting. RWR outcomes are more variable in term of symptomatic control, and this option could be offered to patients at risk under general anesthesia. LEVEL OF EVIDENCE Level 4 evidence.
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Affiliation(s)
- Pauline Nieto
- Service d'ORL, Otoneurologie et ORL PédiatriqueCHU Toulouse PurpanToulouseFrance
| | - Yohan Gallois
- Service d'ORL, Otoneurologie et ORL PédiatriqueCHU Toulouse PurpanToulouseFrance
- Service d'ORL, Otoneurologie et ORL PédiatriqueUniversité Toulouse III—Paul SabatierToulouseFrance
| | | | - Olivier Deguine
- Service d'ORL, Otoneurologie et ORL PédiatriqueCHU Toulouse PurpanToulouseFrance
- Brain & Cognition Research Centre, UMR 5549Université Toulouse IIIToulouseFrance
- Service d'ORL, Otoneurologie et ORL PédiatriqueUniversité Toulouse III—Paul SabatierToulouseFrance
| | - Mathieu Marx
- Service d'ORL, Otoneurologie et ORL PédiatriqueCHU Toulouse PurpanToulouseFrance
- Brain & Cognition Research Centre, UMR 5549Université Toulouse IIIToulouseFrance
- Service d'ORL, Otoneurologie et ORL PédiatriqueUniversité Toulouse III—Paul SabatierToulouseFrance
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Quantitative three-dimensional image analysis of the superior canal after surgical plugging to treat superior semicircular canal dehiscence. Sci Rep 2021; 11:16112. [PMID: 34373484 PMCID: PMC8352905 DOI: 10.1038/s41598-021-95063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/11/2021] [Indexed: 11/08/2022] Open
Abstract
Surgical plugging to treat superior semicircular canal dehiscence (SCD) has been proven to impede the effect of the third mobile window, abating cochleovestibular symptoms. Knowledge of superior semicircular canal (SC)-plugging status has been proposed to serve as a guide for adjuvant treatment. Here, we investigated disturbances in the inner ear fluid space following SC plugging using a novel three-dimensional (3D) reconstruction-based method. This approach used a semi-automatic segmentation algorithm and a direct volume rendering method derived from conventional magnetic resonance images. The variable extents of filling defects at the sites of SC plugging and the positional relation of the defect to the ampulla and common crus were identified. The success group exhibited markedly reduced volumes following surgery, whereas the failure group displayed no changes in volume. These results indicate that the success or failure of SC plugging was related to 3D volume changes in the labyrinth fluid signal. Collectively, this study presents individualized SC-plugging statuses using a novel 3D reconstruction-based method and it facilitates future work regarding easy-to-measure 3D volume changes. This current technology also aids in the exploration of pathologic changes in various targets of interest.
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Eberhard KE, Chari DA, Nakajima HH, Klokker M, Cayé-Thomasen P, Lee DJ. Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome. Front Neurol 2021; 12:638574. [PMID: 33889125 PMCID: PMC8055857 DOI: 10.3389/fneur.2021.638574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Divya A. Chari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Hideko Heidi Nakajima
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Mads Klokker
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
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Laine J, Hautefort C, Attye A, Guichard JP, Herman P, Houdart E, Fraysse MJ, Fraysse B, Gillibert A, Kania R, Eliezer M. MRI evaluation of the endolymphatic space in otosclerosis and correlation with clinical findings. Diagn Interv Imaging 2020; 101:537-545. [PMID: 32253140 DOI: 10.1016/j.diii.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to investigate the clinical features of ears with otosclerosis and their correlation with endolymphatic hydrops and blood-labyrinth barrier (BLB) impairment on 3T magnetic resonance imaging (MRI). MATERIALS AND METHODS This was a single-center retrospective imaging study. Thirty-nine ears from 29 patients (17 men, 12 women; mean age 52±12 [SD] years; range 27-74 years) with non-operated otosclerosis were included. All patients underwent three-dimensional fluid attenuated inversion recovery (FLAIR) MRI sequences performed 4hours after the intravenous administration of a single dose of gadolinium-based contrast material. MRI examinations were analyzed by two radiologists for the presence of saccular hydrops (SH) and BLB impairment. Results of MRI examinations were compared with clinical findings, hearing levels and extent of otosclerotic lesions based on high-resolution computed tomography findings. BLB impairment was evaluated using the signal intensity ratio, ratio of intensities between the basal turn of the cochlea and the medulla. RESULTS SH was observed in 1/39 (3%) otosclerotic ears and BLB impairment in 8/39 (21%) while 8/29 patients with otosclerosis (28%) had vertigo. No significant associations were found between SH or BLB impairment on MRI, and the presence of vertigo or the degree of sensorineural hearing loss. CONCLUSION Clinical manifestations of otosclerosis (sensorineural hearing loss and rotatory vertigo) were not significantly associated with MRI findings such as BLB impairment and endolymphatic hydrops. SH was only observed in one patient with obstruction of the vestibular aqueduct by an otosclerotic focus.
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Affiliation(s)
- J Laine
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France
| | - C Hautefort
- Department of Head & Neck Surgery, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France
| | - A Attye
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - J-P Guichard
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France
| | - P Herman
- Department of Head & Neck Surgery, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France; Université de Paris, Diderot-Paris 7, 75010 Paris, France
| | - E Houdart
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France; Université de Paris, Diderot-Paris 7, 75010 Paris, France
| | - M-J Fraysse
- Department of Head & Neck Surgery, Toulouse University Hospital, 31300 Toulouse, France
| | - B Fraysse
- Department of Head & Neck Surgery, Toulouse University Hospital, 31300 Toulouse, France
| | - A Gillibert
- Department of Biostatistics, Rouen University Hospital, 76000 Rouen, France
| | - R Kania
- Department of Head & Neck Surgery, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France; Université de Paris, Diderot-Paris 7, 75010 Paris, France
| | - M Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hopitaux de Paris, 75010 Paris, France; Université de Paris, Diderot-Paris 7, 75010 Paris, France.
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Nguyen T, Sheppard JP, Duong C, Ding K, Dejam D, Alkhalid Y, Romiyo P, Azzam D, Prashant G, Gopen Q, Yang I. Age and gender considerations on the symptomology in patients with superior semicircular canal dehiscence: A systematic review and case illustration. J Clin Neurosci 2019; 65:112-120. [DOI: 10.1016/j.jocn.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/11/2019] [Accepted: 04/12/2019] [Indexed: 12/16/2022]
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Eliezer M, Poillon G, Maquet C, Gillibert A, Horion J, Marie JP, Guichard JP, Magne N, Attyé A. Sensorineural hearing loss in patients with vestibular schwannoma correlates with the presence of utricular hydrops as diagnosed on heavily T2-weighted MRI. Diagn Interv Imaging 2019; 100:259-268. [PMID: 30773403 DOI: 10.1016/j.diii.2019.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to assess whether the volume of the vestibular endolymphatic space correlates with the degree of hearing loss using heavily T2-weighted fast imaging employing steady-state acquisition with cycle phase (FIESTA-C) MRI. MATERIALS AND METHODS A total of 23 patients with vestibular schwannoma, as diagnosed on typical image findings, who underwent FIESTA-C MRI were included. There were 13 women and 10 men with a mean age of 63.5±9.3 (SD) years (range: 49-88years). Two radiologists independently evaluated the volume of the utricle and saccule. Correlation between tumor volume, vestibular endolymphatic space volume and degree of hearing loss - as evaluated with the levels of pure-tone average and speech recognition threshold - were searched for. RESULTS The mean saccular, utricular and tumor volumes were 3.17±1.1 (SD) mm3 (range: 1.45-5.7mm3), 14.55±5 (SD) mm3; (range: 6.6-23.9mm3) and 17.4±5.5 (SD) mm3; (range: 8.3-25.4mm3), respectively. There was a moderate correlation between the volume of the utricle and the degree of hearing loss as evaluated with the levels of pure-tone average (rho=0.5; P=0.015) and speech recognition threshold (rho=0.58; P=0.004). There were no significant correlations between saccular and tumor volumes and the degree of hearing loss. CONCLUSION The volume of the utricle in patients with obstructive vestibular schwannoma moderately correlates with the degree of hearing loss.
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Affiliation(s)
- M Eliezer
- Department of Neuroradiology, Rouen University Hospital, 76000 Rouen, France; Department of Neuroradiology, Hôpital Lariboisière, 75010 Paris, France.
| | - G Poillon
- Department of Neuroradiology, Rouen University Hospital, 76000 Rouen, France
| | - C Maquet
- Department of Head And Neck Surgery, Rouen University Hospital, 76000 Rouen, France
| | - A Gillibert
- Department of Biostatistics, Rouen University Hospital, 76000 Rouen, France
| | - J Horion
- Department of Neuroradiology, Rouen University Hospital, 76000 Rouen, France
| | - J-P Marie
- Department of Head And Neck Surgery, Rouen University Hospital, 76000 Rouen, France
| | - J-P Guichard
- Department of Neuroradiology, Hôpital Lariboisière, 75010 Paris, France
| | - N Magne
- Department of Neuroradiology, Rouen University Hospital, 76000 Rouen, France
| | - A Attyé
- Department of Neuroradiology, Rouen University Hospital, 76000 Rouen, France; Department of Neuroradiology and MRI, Grenoble Alpes University Hospital, SFR RMN neurosciences, 38000 Grenoble, France
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