Contralateral hearing loss in children with a unilateral enlarged vestibular aqueduct

OBJECTIVE

To evaluate the long-term ipsi- and contralateral hearing of patients with a unilateral enlarged vestibular aqueduct (EVA).

STUDY DESIGN

Multicenter retrospective cohort study.

SETTING

Three tertiary otology and audiology referral centers.

PATIENTS AND DIAGNOSTIC INTERVENTIONS

A total of 34 children with a unilateral enlarged vestibular aqueduct as identified on CT and/or MR imaging were evaluated with pure tone and speech perception audiometry.

MEAN OUTCOME MEASURES

Radiologic measurements of the vestibular aqueduct, ipsi- and contralateral hearing loss, ipsi- and contralateral hearing loss progression over time and DNA test results.

RESULTS

All patients in this cohort with unilateral EVA presented with hearing loss. Hearing loss was progressive in 38% of the ipsilateral ears. In 29% of the children, hearing loss was also found in the contralateral ear without EVA. In 90%, the contralateral hearing was stable, with a mean follow up of 4.2 years. We found a significant correlation between the severity of the hearing loss and the size of the EVA. A genetic diagnosis associated with EVA and/or SNHL was found in only 7%.

CONCLUSION

About a third of the children with unilateral EVA are at risk of developing hearing loss in the contralateral ear. This indicates that at least in some patients with a unilateral EVA, a bilateral pathogenic process underlies the hearing loss, in contrary to what the imaging results suggest. These findings are important for counseling of EVA patients and their parents and have implications for follow up.

Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease

BACKGROUND AND PURPOSE

Ménière disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing Ménière disease. This study evaluates the presence of endolymphatic hydrops and perilymphatic enhancement in patients with Ménière disease and with other vertigo-associated inner ear pathology.

MATERIALS AND METHODS

A 3D-FLAIR sequence 4 hours after intravenous gadolinium injection was performed to visualize the endolymph and perilymph in 220 patients suspected of having Ménière disease. Patients' ears were retrospectively categorized as having Ménière disease (probable or definite) or other vertigo-associated inner ear pathology not attributable to Ménière disease. Endolymphatic hydrops was evaluated using a visual classification system, and perilymphatic enhancement was scored both visually and quantitatively.

RESULTS

Endolymphatic hydrops was present in 137 (91.9%) of the definite Ménière disease ears and in 9 (7.0%) of the ears with other vertigo-associated inner ear pathology (P < .001). The combination of endolymphatic hydrops and visually increased perilymphatic enhancement was present in 122 (81.9%) definite Ménière disease ears compared with 4 (3.1%) ears with other vertigo-associated inner ear pathology (P < .001). This combination increases the positive predictive value from 0.94 for endolymphatic hydrops and 0.91 for perilymphatic enhancement to 0.97. The addition of measured perilymphatic enhancement leads to a moderate decrease in sensitivity from 0.92 for endolymphatic hydrops to 0.86.

CONCLUSIONS

The combination of perilymphatic enhancement and endolymphatic hydrops in patients suspected of having Ménière disease increases the positive predictive value in the diagnosis of definite Ménière disease.

Induction chemotherapy with docetaxel/cisplatin/5-fluorouracil followed by randomization to two cisplatin-based concomitant chemoradiotherapy schedules in patients with locally advanced head and neck cancer (CONDOR study) (Dutch Head and Neck Society 08-01): A randomized phase II study

PURPOSE

To study the feasibility of induction chemotherapy added to concomitant cisplatin-based chemoradiotherapy (CRT) in patients with locally advanced head and neck cancer (LAHNC).

PATIENTS AND METHODS

LAHNC patients were treated with 4 courses of docetaxel/cisplatin/5-fluorouracil (TPF) followed by randomization to either cisplatin 100 mg/m(2) with conventional radiotherapy (cis100 + RT) or cisplatin 40 mg/m(2) weekly with accelerated radiotherapy (cis40 + ART). Primary endpoint was feasibility, defined as receiving ≥ 90% of the scheduled total radiation dose. Based on power analysis 70 patients were needed.

RESULTS

65 patients were enrolled. The data safety monitoring board advised to prematurely terminate the study, because only 22% and 41% (32% in total) of the patients treated with cis100 + RT (n = 27) and cis40 + ART (n = 29) could receive the planned dose cisplatin during CRT, respectively, even though the primary endpoint was reached. Most common grade 3-4 toxicity was febrile neutropenia (18%) during TPF and dehydration (26% vs 14%), dysphagia (26% vs 24%) and mucositis (22% vs 57%) during cis100 + RT and cis40 + ART, respectively. For the patients treated with cis100 + RT and cis40 + ART, two years progression free survival and overall survival were 70% and 78% versus 72% and 79%, respectively.

CONCLUSION

After TPF induction chemotherapy, cisplatin-containing CRT is not feasible in LAHNC patients, because the total planned cisplatin dose could only be administered in 32% of the patients due to toxicity. However, all but 2 patients received more than 90% of the planned radiotherapy. Clinical Trials Information: NCT00774319.

Visualization of human inner ear anatomy with high-resolution MR imaging at 7T: initial clinical assessment

BACKGROUND AND PURPOSE

In many centers, MR imaging of the inner ear and auditory pathway performed on 1.5T or 3T systems is part of the preoperative work-up of cochlear implants. We investigated the applicability of clinical inner ear MR imaging at 7T and compared the visibility of inner ear structures and nerves within the internal auditory canal with images acquired at 3T.

MATERIALS AND METHODS

Thirteen patients with sensorineural hearing loss eligible for cochlear implantation underwent examinations on 3T and 7T scanners. Two experienced head and neck radiologists evaluated the 52 inner ear datasets. Twenty-four anatomic structures of the inner ear and 1 overall score for image quality were assessed by using a 4-point grading scale for the degree of visibility.

RESULTS

The visibility of 11 of the 24 anatomic structures was rated higher on the 7T images. There was no significant difference in the visibility of 13 anatomic structures and the overall quality rating. A higher incidence of artifacts was observed in the 7T images.

CONCLUSIONS

The gain in SNR at 7T yielded a more detailed visualization of many anatomic structures, especially delicate ones, despite the challenges accompanying MR imaging at a high magnetic field.

Otological aspects and surgical outcome in a consanguineous family with a novel ANKH gene mutation

OBJECTIVES

To report the hearing impairment in a new autosomal recessive metabolic disorder due to a mutation in the ANKH gene and to report the outcomes of exploratory tympanotomy.

STUDY DESIGN

Retrospective chart study.

SETTING

Tertiary referral center.

PATIENTS

One large consanguineous family was examined. Three patients underwent exploratory tympanotomy.

INTERVENTION

Exploratory tympanotomies in three patients.

MAIN OUTCOME MEASURES

Medical and otological histories; postoperative hearing outcomes.

RESULTS

In the patients who received tympanotomies, a postoperative hearing gain of between 5 and 20 dB was noted, with a residual air-bone gap of between 6 and 35 dB (follow-up between 4 and 67 months). The sensorineural component of the hearing impairment varies greatly, between 4 and 23 dB, and this factor might also affect the final hearing outcome.

CONCLUSIONS

Exploratory tympanotomy might improve the hearing outcome in patients with this syndrome and therefore surgery has a limited audiometric benefit in general. Based on anatomical findings, a congenital origin for the ossicular chain anomaly seems likely. It remains unclear whether the sensorineural component of the hearing impairment is progressive and this should be investigated further.

Becker muscular dystrophy patients with deletions around exon 51; a promising outlook for exon skipping therapy in Duchenne patients

Theoretically, 13% of patients with Duchenne muscular dystrophy may benefit from antisense-mediated skipping of exon 51 to restore the reading frame, which results in the production of a shortened dystrophin protein. We give a detailed description with longitudinal follow up of three patients with Becker muscular dystrophy with in-frame deletions in the DMD gene encompassing exon 51. Their internally deleted, but essentially functional, dystrophins are identical to those that are expected as end products in DMD patients treated with the exon 51 skipping therapy. The mild phenotype encourages further development of exon 51 skipping therapy.

Detecting dysphagia in inclusion body myositis

Dysphagia is an important yet inconsistently recognized symptom of inclusion body myositis (IBM). It can be disabling and potentially life-threatening. We studied the prevalence and symptom-sign correlation of dysphagia. Fifty-seven IBM patients were interviewed using a standard questionnaire for dysphagia and 43 of these underwent swallowing videofluoroscopy (VFS). Symptoms of dysphagia were present in 37 of 57 patients (65%). Nevertheless, only 17 of these patients (46%) had previously and spontaneously complained about swallowing to their physicians. Both symptoms of impaired propulsion (IP) (59%) and aspiration-related symptoms (52%) were frequently mentioned. Swallowing abnormalities on VFS were present in 34 of 43 patients (79%) with IP of the bolus in 77% of this group. The reported feeling of IP was confirmed by VFS in 92% of these patients. Dysphagia in IBM is common but underreported by the vast majority of patients if not specifically asked for. In practice, two questions reliably predict the presence of IP on VFS: ‘Does food get stuck in your throat’ and ‘Do you have to swallow repeatedly in order to get rid of food’. These questions are an appropriate means in selecting IBM patients for further investigation through VFS and eventual treatment.

Evaluation of 4 multisection CT systems in postoperative imaging of a cochlear implant: a human cadaver and phantom study

BACKGROUND AND PURPOSE

Postoperative imaging of cochlear implants (CIs) needs to provide detailed information on localization of the electrode array. We evaluated visualization of a HiFocus1J array and accuracy of measurements of electrode positions for acquisitions with 64-section CT scanners of 4 major CT systems (Toshiba Aquilion-64, Philips Brilliance-64, GE LightSpeed-64, and Siemens Sensation-64).

MATERIALS AND METHODS

An implanted human cadaver temporal bone, a polymethylmethacrylate (PMMA) phantom containing a CI, and a point spread function (PSF) phantom were scanned. In the human cadaver temporal bone, the visibility of cochlear structures and electrode array were assessed by using a visual analog scale (VAS). Statistical analysis was performed with a paired 2-tailed Student t test with significant level set to .008 after Bonferroni correction. Distinction of individual electrode contacts was quantitatively evaluated. Quantitative assessment of electrode contact positions was achieved with the PMMA phantom by measurement of the displacement. In addition, PSF was measured to evaluate spatial resolution performance of the CT scanners.

RESULTS

VAS scores were significantly lower for Brilliance-64 and LightSpeed-64 compared with Aquilion-64 and Sensation-64. Displacement of electrode contacts ranged from 0.05 to 0.14 mm on Aquilion-64, 0.07 to 0.16 mm on Brilliance-64, 0.07 to 0.61 mm on LightSpeed-64, and 0.03 to 0.13 mm on Sensation-64. PSF measurements show an in-plane and longitudinal resolution varying from 0.48 to 0.68 mm and 0.70 to 0.98 mm, respectively, over the 4 scanners.

CONCLUSION

According to PSF results, electrode contacts of the studied CI can be visualized separately on all of the studied scanners unless curvature causes intercontact spacing narrowing. Assessment of visibility of CI and electrode contact positions, however, varies between scanners.

Clinical Evaluation of the Clarion CII HiFocus 1 with and Without Positioner

OBJECTIVE

To study the clinical outcomes concerning speech perception of the Clarion CII HiFocus 1 with and without a positioner and link those outcomes with the functional implications of perimodiolar electrode designs, focusing on intrascalar position, insertion depth, stimulation levels, and intracochlear conductivity pathways.

DESIGN

The speech perception scores of 25 consecutive patients with the Clarion CII HiFocus 1 implanted with a positioner and 20 patients without a positioner were prospectively determined. Improved multislice CT imaging was used to study the position of the individual electrode contacts relative to the modiolus and their insertion depth. Furthermore, stimulation thresholds, maximum comfort levels, and dynamic ranges were obtained. Finally, these data were associated with intracochlear conductivity paths as calculated from the potential distribution acquired with electrical field imaging.

RESULTS

Implantation with a Clarion Hifocus 1 with positioner showed significantly higher speech perception levels at 3 mos, 6 mos, and 1 yr (p < 0.05) after implantation. Basally, the positioner brought the electrode contacts significantly closer to the modiolus, whereas apically no difference in distance toward the modiolus was present. Moreover, the patients with the electrode array in a perimodiolar position showed deeper insertions. The T-levels and dynamic range were not significantly different between the positioner and nonpositioner patients. Furthermore, the intracochlear conductivity paths showed no significant differences. However, a basal current drain is present for the shallowly inserted nonpositioner patients.

CONCLUSIONS

A basally perimodiolar electrode design benefits speech perception. The combination of decreased distance to the modiolus, improved insertion depth, and insulating properties of the electrode array have functional implications for the clinical outcomes of the perimodiolar electrode design. Further research is needed to elucidate their individual contributions to those outcomes.