Use of 3D Volume Rendering Based on High-Resolution Computed Tomography Temporal Bone in Patients with Cochlear Implants

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

PURPOSE

Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature.

METHODS

Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines.

RESULTS

The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review.

CONCLUSIONS

Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

Adenomatous Neuroendocrine Tumors of the Middle Ear in a Young Man With Conductive Hearing Loss

ABSTRACT

Neuroendocrine neoplasms of the ear pose a diagnostic challenge because clinical symptoms are no specific. Definite diagnosis is made by histopathological analysis with immunohystochemical evalutation. Therapy consists in a complete surgical resection. Controversial terminology of the neoplasm arises from the differentiation of these tumors composed of both endocrine and exocrine glands. Middle ear localization is an extremely rare presentation but less aggressive than gastrointestinal tract or lung localizations which are the most frequent. Radio-diagnostic analyses are necessary follow-up for preventing or detecting recurrence or metastasis. The authors present a case of neuroendocrine tumor of the middle ear in a young male of 37 years old who presented unilateral right hearing loss and tinnitus. A transcanal tympanoplasty was performed. There were no intraoperative complications and the postoperative period was uneventful.

Implantation of the Vibrant Soundbridge in a Case of Bilateral Malformation of the Middle and External Ear

Patient: Female, 13-year-old

Final Diagnosis: Bilateral congenital external and middle ear malformation

Symptoms: Hearing loss

Medication: —

Clinical Procedure: —

Specialty: Otolaryngology

Multimodal Imaging in Susac Syndrome: A Case Report and Literature Review

Susac syndrome (SS) is a rare microangiopathy that involves arterioles of the brain, retina, and cochlea. Diagnosis is extremely difficult because of the rarity of the disease and because the signs and symptoms often occur at different times. Multidisciplinary approaches and multimodal images are mandatory for diagnosis and prompt therapy. In this report, we describe a case of SS and the application of multimodal retinal imaging to evaluate the ophthalmologic changes and to confirm diagnosis. Early diagnosis and therapy based on the associations of steroids and immunosuppressants are necessary to limit the sequelae of the disease.

Titanium and Platinum-Fluoroplastic Stapes Prostheses Visualization on Cone Beam Computed Tomography and High-Resolution Computed Tomography

Objective: The aim of this study was to evaluate whether stapes prostheses can be visualized with less metal artifacts and therefore more accurately on cone beam computed tomography in comparison to computed tomography imaging. Recent studies have shown that cone beam computed tomography has advantages when imaging metal artifacts. Patients with hearing loss or vertigo, who have undergone stapedotomy, often present a challenge for otologic surgeons. Imaging studies can deliver crucial additional information. Methods: A retrospective analysis of imaging studies and clinical data in a tertiary care center were carried out. Forty-one patients with forty-five implanted ears were evaluated in the study. All included patients had been implanted with a platinum-fluoroplastic (n = 19) or titanium (n = 26) piston and subsequently had undergone imaging months or years after surgery for various reasons. Patients underwent computed tomography or cone beam computed tomography of the temporal bone depending on availability. Piston visualization, prosthesis length, vestibular intrusion and audiologic results were compared between the groups. Piston position on imaging studies were compared to intraoperative findings. Results: Functional length measurements of all prostheses were carried out with a mean error of -0.17 mm (±0.20). Platinum-fluoroplastic protheses were significantly underestimated in length compared to titanium prostheses. To analyze the material-dependent difference in the measurement errors of the imaging techniques the interaction was tested in an ANOVA model and showed no statistically significant result (p = 0.24). The blinded neuroradiologist viewed two implants, both platinum-fluoroplastic pistons, as located outside of the vestibule due to an underestimation of the prothesis length and the missing radiodensity of the lower end of the prosthesis. Conclusion: Surgeons and radiologists should be aware of the different types and radiologic features of stapes prostheses and the missing radiodensity of some protheses parts. Cone beam computed tomography is an imaging alternative with a potential advantage of reduced radiation in patients after stapes surgery suffering from vertigo or hearing loss to evaluate piston position.

Rhino-Orbito-Cerebral Mucormycosis in Diabetic Disease Mucormycosis in Diabetic Disease

The authors present their experience about clinical evidences that include patients with an untreated diabetes who developed rhino-orbito-cerebral mucormycosis (ROCM). They were treated with endoscopic sinus surgery and medical treatment with intravenous, intradural therapy, and sinus washes with amphotericin B. The ROCM is a disease with a rapid evolution and an increase in mortality rate, especially if the fungus enters the cranial cavity. Therefore, it would be necessary in all diabetic patients with sinus symptoms, headaches, visual changes, suspect a mucormycosis, and perform a careful radiology assessment and a nasal endoscopy. Often, despite an early diagnosis and rapid treatment for ROCM, it is not possible to stem the disease, which ends with the patient's death.

Cochlear Implant Surgery: Endomeatal Approach versus Posterior Tympanotomy

The aim of the present study was to compare the posterior tympanotomy (PT) technique to the endomeatal approach. The endomeatal approach (EMA) for Cochlear Implant (CI) surgery was performed on 98 patients with procident lateral sinus or a small mastoid cavity, on 103 ears (Group A). Conventional mastoidectomy and PT was performed on the other 104 patients, on 107 ears (Group B). Data on all patients were then collected for the following: intra- and post-operative complications, Tinnitus Handicap Inventory (THI), Vertigo Symptom Scale (VSS), duration of surgery, and postoperative discomfort. The difference in the total number of major and minor complications between the case group and the control group was not statistically significant. There was a statistically significant difference in discomfort between the two groups using the Visual Analogue Scale (VAS), both immediately postsurgery (p = 0.02) and after one month (p = 0.04). The mean duration of surgery was 102 ± 29 min for EMA and 118 ± 15 min for the PT technique (p = 0.008). EMA is a faster technique resulting in reduced postoperative patient discomfort in comparison to the PT method. The experience of the surgeon as well as the correct choice of surgical technique are fundamental to successful outcomes for cochlear implant surgery.

Real ear measurement (REM) and auditory performances with open, tulip and double closed dome in patients using hearing aids

OBJECTIVE

The aim of the study is to evaluate the importance of acoustic modifications generated by different commercially available ear-tips, focused on domes of receiver in the canal hearing aids using Real Ear Measurement (REM).

METHODS

We enrolled 110 people selecting 200 ears bearers of hearing aids. In every patient, we performed REM and audiological tests with three different dome types: Open, Tulip and Double Closed (DC). Data about real-ear occluded gain (REOG), Pure Tone Average (PTA), Word Recognition Score (WRS) with aids switched on in Free Field, Ear and Auditory Comfort were collected and analyzed.

RESULTS

REOG gain was statistically significant different between the three types of dome, with a DC that always closes the external auditory canal (EAC) (p < 0.001). There was no statistically significant difference between the PTA (p = 0.11). Regarding the WRS there were statistically significant differences between Open and DC dome (p < 0.001) and between Tulip and DC dome (p < 0.001), with worse discrimination when using DC. Both auditory and ear comfort are worse in the DC than in the other two domes (p < 0.001). From measured REOG gain values, in 135 cases Tulip dome does not occlude the EAC, with a statistically significant difference compared to DC (p < 0.001; Odd Ratio 0.0012; 95% CI 0.001-0.0196).

CONCLUSION

Our study confirms the necessity to perform REM to evaluate if the prescription target is achieved, especially when tulip domes are used, because they may not occlude the ear canal, causing in some cases the reduction of the vocal discrimination.

Application of Cervical Vestibular-Evoked Myogenic Potentials in Adults with Moderate to Profound Sensorineural Hearing Loss: A Preliminary Study

Introduction  The cochlea and the vestibular receptors are closely related in terms of anatomy and phylogeny. Patients with moderate to profound sensorineural hearing loss (MPSHL) should have their vestibular organ functions tested.

Objective  To evaluate the incidence of vestibular abnormalities in patients with MPSHL and to study the correlation between the etiology of hearing loss (HL) and a possible damage to the labyrinth.

Methods  A case-control retrospective study was performed. In the case group, 20 adults with MPSHL of known etiology were included. The control group was composed of 15 adults with normal hearing. The case group was divided into 4 subgroups based on the etiology (bacterial meningitis, virus, vascular disease, congenital). Cervical vestibular-evoked myogenic potentials (cVEMPs) were used to rate the saccular function and lower vestibular nerve.

Results  The study was performed in 70 ears, and it highlighted the presence of early biphasic P1-N1 complex in 29 (71.5%) out of 40 ears in the study group, and in all of the 30 ears in the control group ( p  = 0.001). Regarding the presence or absence of cVEMPs among the four subgroups of patients with MPSHL, the data were statistically significant ( p  < 0.001). The comparison between the latencies and amplitude of P1-N1 in case and control groups from other studies and in the four subgroups of cases in the present study did not detect statistically significant differences.

Conclusion  The present study demonstrates that patients with MPSHL have a high incidence of damage to the labyrinthine organs, and it increases the current knowledge about the etiopathogenesis of sensorineural HL, which is often of unknown nature.

Vocal cord surgery and pharmacological treatment of a patient with HPV and recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is caused by persistent infection of the respiratory epithelium by human papillomavirus (HPV), especially HPV 6 and 11. We present a case of surgically treated RRP. The main purpose of our protocol is to remove the lesions with a non-aggressive surgical technique and prevent recurrences with the use of cidofovir for local infiltrations in multiple sessions. We use low-power energy CO₂ laser, directed towards the upper part of the vocal cord, to determine a retraction of the mucosa with consequent coverage of the epithelium of the free edge. The aim of this technique is to treat and stop the formation of synechia of the anterior commissure and the free margin of the vocal cords in the anterior commissure. After 8 years follow-up, there are no signs of recurrence of the disease. The voice had a net improvement confirming the effectiveness of the protocol.

The Additional Diagnostic Value of the Three-dimensional Volume Rendering Imaging in Routine Radiology Practice

Three-dimensional volume rendering (3DVR) is useful in a wide variety of medical-imaging applications. The increasingly advanced capabilities of CT and MRI to acquire volumetric data sets with isotropic voxels have resulted in the increased use of the 3DVR techniques for clinical applications. The two most commonly used techniques are the maximum intensity projection (MIP) and, more recently, 3DVR. Several kinds of medical imaging data could be reconstructed for 3D display, including CT, MRI, and ultrasonography (US). In particular, the 3D CT imaging has been developed, improved, and widely used of late. Understanding the mechanisms of 3DVR is essential for the accurate evaluation of the resulting images. Although further research is required to detect the efficiency of 3DVR in radiological applications, with wider availability and improved diagnostic performance, 3DVR is likely to enjoy widespread acceptance in the radiology practice going forward.

Hyperbaric oxygen therapy in a case of cervical abscess extending to anterior mediastinum, with isolation of Prevotella corporis

We present a case of an odontogenic abscess, first spreading at the lateral cervical level and then in mediastinum. We isolated an anaerobic bacterium, Prevotella corporis, rarely documented in literature. The mortality rates of cervical abscesses secondary to odontogenic infections and complicated by mediastinitis vary from 10% to 40%. Treatment of descending mediastinitis involves multidisciplinary teams such as otorhinolaryngology, thoracic surgeons, infectious disease physicians, anesthetists and intensivists. Due to the combined treatment with surgical drainage within 48 hours of hospitalisation, antibiotics and subsequent hyperbaric oxygen therapy, we have achieved complete recovery of the patient.

Endoscopic treatment of a periorbital fat herniation caused by spontaneous solution of continuity of the papyracea lamina

We present a case of a 16-year-old girl with interruption of papyracea lamina and herniation of the periorbital fat covered by a bone shell. The patient presents with a history of diplopia and visual disturbances ever since she can remember. Thanks to radiological imaging and biopsy, we have done differential diagnosis with periorbital lipoma, intraosseous lipoma and intramuscular lipoma of medial rectus. Diagnostic for images is necessary for a correct operative planning. Endoscopic sinus surgery with computer-assisted navigation is the safest and most effective method to remove the lesion that was closely related to the medial rectum muscle and to the anterior ethmoidal artery. The patient after surgery and in 1 year of follow-up reports the disappearance of symptoms.