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Vestnik Otorinolaringologii 2023Cochlear implantation (CI) is currently the recognized and most promising method of rehabilitation of patients suffering from profound hearing loss and deafness. During...
Cochlear implantation (CI) is currently the recognized and most promising method of rehabilitation of patients suffering from profound hearing loss and deafness. During the surgical stage of CI, one of the most unpleasant intraoperative features is CSF leakage from the cochlea opening. Most often it occurs in patients with malformations of the inner ear, with temporal bone fractures and with cochlear otosclerosis. The difficulty of choosing the tactics of surgical intervention in these patients is caused by the large variability of the anatomical structures of the inner ear. In the period from 2017 to 2021, 1954 patients underwent CI, of which 83 were patients with cochlea malformations (65 intraoperative CSF leakages), 14 with the temporal bones fractures (2 intraoperative CSF leakage), 12 with cochlear otosclerosis (1 CSF leakage), while 3 spontaneous intraoperative CSF leakages were noted in patients with normal cochlea anatomy and hyperpnumotized temporal bone pyramid and enlarged vestibular aqueduct. The highest risk of intraoperative CSF leakage was observed in patients with inner ear malformations (common cavity - 10, incomplete partition type III - 15) and anomalies of the internal auditory canal - 5 (dilated IAC - more than 8.5 mm in diameter). Moderate risk of intraoperative CSF leakage was typical for patients with incomplete partition type I (15 patients) and type II (25 patients).
PubMed: 37767584
DOI: 10.17116/otorino2022880414 -
Diagnostic Efficacy of High-Resolution Computed Tomography Densitometry for Diagnosing Otosclerosis.Otology & Neurotology : Official... Dec 2023The purpose of this study is to evaluate the reliability of temporal bone density measurements for diagnosing otosclerosis.
OBJECTIVES
The purpose of this study is to evaluate the reliability of temporal bone density measurements for diagnosing otosclerosis.
MATERIALS AND METHODS
A retrospective case-control study is presented. Bone density was measured in Hounsfield units (HUs) by using high-resolution computed tomography in eight regions of interest (ROI) where otosclerotic foci are usually localized. The density of 113 otosclerotic ears was compared with that of 33 nonotosclerotic ears to determine sensitivity and specificity. Furthermore, the binormal receiver operating characteristic curve of each ROI's density was calculated to estimate the diagnostic value for osteosclerosis. In addition, the radiological density of seven cases-where radiological visual examination exhibited no findings but surgery confirmed stapes fixation-was compared with nonotosclerotic controls.
RESULTS
ROI densities were significantly lower in otosclerotic patients compared with nonotosclerotic controls. The area under the curve of the fissula ante fenestram (FAF) presented the highest diagnostic performance: 1,871 HU cut-off value (area under the curve = 0.986), 96.64% sensitivity, and 100% specificity. Significantly lower densities in the FAF area were observed in the seven cases with negative radiology but intraoperatively confirmed otosclerosis.
CONCLUSION
The high-resolution computed tomography density of the FAF is a reliable measurement for diagnosing otosclerosis. A value less than 1,871 HU exhibited the highest sensitivity and specificity in a European Caucasian population.
Topics: Humans; Otosclerosis; Retrospective Studies; Case-Control Studies; Reproducibility of Results; Tomography, X-Ray Computed; Densitometry
PubMed: 37733986
DOI: 10.1097/MAO.0000000000004012 -
Acta Otorhinolaryngologica Italica :... Apr 2023
Review
Topics: Humans; Hearing Loss, Conductive; Stapes Surgery
PubMed: 37698101
DOI: 10.14639/0392-100X-suppl.1-43-2023-07 -
Brazilian Journal of Otorhinolaryngology 2023To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. (Review)
Review
OBJECTIVES
To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis.
METHODS
Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
RESULTS
The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI).
CONCLUSIONS
The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
Topics: Humans; Female; Otosclerosis; Brazil; Cochlear Implantation; Cochlear Implants; Stapes Surgery
PubMed: 37647735
DOI: 10.1016/j.bjorl.2023.101303 -
The Laryngoscope Mar 2024To determine the morphologies and effect of the round window niche veil (RWNV) on local drug delivery efficacy and develop diagnostic criteria on high-resolution...
OBJECTIVES
To determine the morphologies and effect of the round window niche veil (RWNV) on local drug delivery efficacy and develop diagnostic criteria on high-resolution computed tomography (HRCT).
METHODS
Patients diagnosed with otosclerosis, bilateral profound sensorineural hearing loss or vestibular schwannoma were enrolled from 2019 to 2022, receiving temporal bone HRCT scanning, and anatomic variations of RWMV were summarized intraoperative. For patients with vestibular schwannoma, 1 mL of dexamethasone solution (4 mg/mL) was administered via facial recess during operation, and samples of perilymph were collected to analyze. The diagnostic criteria of RWNV on HRCT were developed and verified.
RESULTS
A total of 85 patients were enrolled. RWNV was observed in 54 cases intraoperatively with an incidence of 63.5% (95% CI, 52.9%-73.0%). The median perilymph concentrations were 4.86-fold higher in the group without RWNV than with RWNV (p < 0.0001). RWNV could be visualized on HRCT with a window width of 3500-4500 HU and a window level of 300-500 HU. The characteristic features were as follows: (1) a thin soft tissue shadow could be seen at the entrance of the round window niche (RWN); (2) it was visible in at least 2 consecutive layers along the upper margin of RWN from top to bottom; (3) it was discontinuous with the adjacent bone margin. The sensitivity and specificity of the diagnostic criteria were 77.8% and 93.6%, respectively.
CONCLUSION
RWNV could reduce local dexamethasone diffusion efficacy to the inner ear, which could be diagnosed on HRCT and used as a predictor of local drug delivery efficacy to the inner ear.
LEVEL OF EVIDENCE
3 Laryngoscope, 134:1396-1402, 2024.
Topics: Humans; Neuroma, Acoustic; Round Window, Ear; Ear, Inner; Hearing Loss, Sensorineural; Tomography, X-Ray Computed; Dexamethasone
PubMed: 37638702
DOI: 10.1002/lary.31006 -
The International Journal of Medical... Dec 2023Artificial intelligence (AI) techniques, especially deep learning (DL) techniques, have shown promising results for various computer vision tasks in the field of...
BACKGROUND
Artificial intelligence (AI) techniques, especially deep learning (DL) techniques, have shown promising results for various computer vision tasks in the field of surgery. However, AI-guided navigation during microscopic surgery for real-time surgical guidance and decision support is much more complex, and its efficacy has yet to be demonstrated. We propose a model dedicated to the evaluation of DL-based semantic segmentation of chorda tympani (CT) during microscopic surgery.
METHODS
Various convolutional neural networks were constructed, trained, and validated for semantic segmentation of CT. Our dataset has 5817 images annotated from 36 patients, which were further randomly split into the training set (90%, 5236 images) and validation set (10%, 581 images). In addition, 1500 raw images from 3 patients (500 images randomly selected per patient) were used to evaluate the network performance.
RESULTS
When evaluated on a validation set (581 images), our proposed CT detection networks achieved great performance, and the modified U-net performed best (mIOU = 0.892, mPA = 0.9427). Moreover, when applying U-net to predict the test set (1500 raw images from 3 patients), our methods also showed great overall performance (Accuracy = 0.976, Precision = 0.996, Sensitivity = 0.979, Specificity = 0.902).
CONCLUSIONS
This study suggests that DL can be used for the automated detection and segmentation of CT in patients with otosclerosis during microscopic surgery with a high degree of performance. Our research validated the potential feasibility for future vision-based navigation surgical assistance and autonomous surgery using AI.
Topics: Humans; Artificial Intelligence; Otosclerosis; Neural Networks, Computer; Image Processing, Computer-Assisted
PubMed: 37634074
DOI: 10.1002/rcs.2567 -
Medicina (Kaunas, Lithuania) Aug 2023Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of... (Review)
Review
Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy.
Topics: Humans; Otosclerosis; Vertigo; Stapes Surgery; Deafness; Osteogenesis
PubMed: 37629775
DOI: 10.3390/medicina59081485 -
Folia Morphologica Aug 2023Stapedotomy is the most efficient treatment for otosclerosis. The anatomical structure of the operation area is complex, but it has a great impact on the postoperative...
BACKGROUND
Stapedotomy is the most efficient treatment for otosclerosis. The anatomical structure of the operation area is complex, but it has a great impact on the postoperative effect. We measure the anatomical parameters of the stapes and its surrounding structures to provide an anatomical reference for stapes surgery in otosclerosis.
MATERIALS AND METHODS
Fifteen adult cadaver heads (30 samples) were scanned using micro-CT. The stapes, facial nerve and external auditory canal were reconstructed by image processing. The stapes parameters and relationships between the stapes and surrounding structures were measured using a three-dimensional reconstruction model.
RESULTS
The length, width and thickness of the stapes footplate were 2.93 ± 0.17 mm, 1.46 ± 0.08 mm and 0.30 ± 0.11 mm, respectively. The distance between the stapes footplate and long process of the incus was 3.79±0.39 mm. The angle of the incudostapedial joint was 88.29 ± 11.58°. The distance from the center of the stapes footplate to the facial canal was 1.60 ± 0.34 mm. In simulated stapes surgery, the minimum depth of the external auditory canal to be removed was 2.17 ± 0.91 mm, and no significant difference was found between the left and right sides and between men and women (P > 0.05).
CONCLUSIONS
A three-dimensional model of the stapes bone and its surrounding anatomical structures was established based on Micro-CT imaging. Anatomical parameters of the stapes bone and its surrounding structures were measured using the model. In stapedotomy, the implanted piston diameter should be around 0.6mm, with a length of approximately 4.6mm. Care should be taken to protect the facial nerve canal during the surgery. These data provide reference for otologists.
PubMed: 37622391
DOI: 10.5603/FM.a2023.0056 -
Cureus Jul 2023Paragangliomas are mostly benign, slow-growing, hypervascular tumors originating from neural crest derivatives. Head and neck (H&N) paragangliomas represent <1% of all...
Paragangliomas are mostly benign, slow-growing, hypervascular tumors originating from neural crest derivatives. Head and neck (H&N) paragangliomas represent <1% of all H&N tumors and <5% are malignant. They are mostly non-secreting tumors that originate from autonomous parasympathetic paraganglia. We present a case of right middle ear jugulotympanic paraganglioma, a subtype of H&N paragangliomas, which had been misdiagnosed as otosclerosis for about 10 years. The patient was suffering from worsening tinnitus along with hearing impairment. High clinical suspicion of jugular paraganglioma prevented us from taking a biopsy. Complete surgical excision after preoperative embolization was decided. Embolization resulted in facial nerve paralysis, however, facial nerve rerouting was performed during the complete surgical excision of the tumor. The patient remains disease-free three years postoperatively, with House-Brackmann III facial nerve paralysis.
PubMed: 37593266
DOI: 10.7759/cureus.41997