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Objective:To explore the clinical application value of each sequence by analyzing the characteristics of labyrinthine signal on MRI in patients with unilateral sudden deafness.Methods:Totally 52 patients of unilateral sudden deafness with inner ear MRI were analyzed retrospectively at Beijing Tongren Hospital, Capital Medical University from January 2016 to July 2019, all of which could find abnormalities in the labyrinth, including 17 cases of plain scan and 35 cases of enhanced scan, with sequences including plain T 1WI, enhanced T 1WI, plain and enhanced delayed 3D fluid attenuation inversion recovery (3D-FLAIR). The affected labyrinthine signal characteristics of each sequence were analyzed and the involvement sites were judged. The ability of each sequence to show labyrinthine abnormal signal was evaluated and scored. The Friedman test and Wilcoxon signed rank sum test were used to compare the subjective scores of the ability to show labyrinthine high signal in different sequences in plain and enhanced patients, respectively. Fisher′s exact probability method was used to analyze the relationship between the affected sites and the recovery of hearing, tinnitus and vertigo symptoms. Results:Fifty-two patients (100%, 52/52) showed labyrinthine high signal on T 1WI, 8 (15.4%, 8/52) showed higher signal and 3 (5.8%, 3/52) showed low signal on T 2WI. Thirty-five (100%, 35/35) showed high signal on enhanced T 1WI, among which 27 had enhancement (77.1%, 27/35). Fifty-two (100%, 52/52) showed significant high signal of the affected labyrinth on 3D-FLAIR (17 plain scan, 35 enhanced scan). The scores were 2 (2, 2), 3 (2, 3), 3 (3, 4) and 4 (4, 4) of T 1WI, enhanced T 1WI, plain and enhanced 3D-FLAIR respectively. The overall difference in subjective scores of plain T 1WI, enhanced T 1WI and enhanced 3D-FLAIR in enhanced patients was statistically significant (χ2=64.528, P<0.001), and the comparison between the two was statistically different (all corrected P<0.05). The plain 3D-FLAIR score was higher than the plain T 1WI in patients with a statistically significant difference ( Z=-3.729, P<0.001). Twenty-seven cases (51.9%, 27/52) exhibited high signal at the ampulla of semicircular canals, with a statistically significant difference in the distribution of hearing recovery or not ( P=0.001). Conclusions:Both T 1WI and 3D-FLAIR sequences can effectively identify the labyrinthine high signal, but the latter was better than the former of its ability to display, especially delayed enhanced 3D-FLAIR. The high signal at the ampulla of semicircular canals was a characteristic predictor of non-recovery of hearing.
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OBJECTIVE To explore the CT and MRI appearances of otogenic sigmoid sinus thrombophlebitis(SST) and abscess. METHODS The HRCT, plain MRI, magnetic resonance venography(MRV), enhanced MRI findings in 11 patients with otogenic SST were retrospectively analyzed. RESULTS On CT, the bony wall of sigmoid sinus was eroded in 10 cases (10/11), and air bubbles were found in or around sigmoid sinus in 4 cases. On plain MRI, sigmoid sinus flow void effect disappeared in all 11 cases. SST manifested as high signal on T2W1 in all 11 cases, and as low signal on T1WI in 2 cases, isointense signal on T1WI in 6 cases, high signal on T1WI in 3 cases. Contrast enhancement MRI showed enhancement in wall of venous sinus, but venous sinus thrombosis did not enhanced, but showed as irregular filling defect or empty triangle. MRV showed that involved venous sinus was not visualized. CONCLUSION CT can show the erosion of the bony wall of sigmoid sinus which may indicate the SST; and if air bubbles are found around or in the sigmoid sinus, the abscess around or in the sigmoid sinus should be doubted. Conventional MRI combined with MRV are effective and noninvasive methods in the diagnosis of SST.
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OBJECTIVE To summarize surgical treatment effects and to discuss surgical strategy for Small acoustic neuroma.METHODS The clinical data of 26 patients with small acoustic neuroma treated with surgery in our department were analyzed retrospectively.25 patients with preoperative hearing grading of C and D received the labyrinthine approach acoustic neuroma resection,and 1 patient with preoperative hearing grading of B received middle fossa approach acoustic neuroma resection.The preoperative and postoperative hearing level,incidence of tinnitus,balance disturbance and weakness of facial muscles were analyzed retrospectively.The control and recurrence of the tumor,the incidence of complications were recorded.RESULTS Total resection was achieved in 25 cases (96％),and in 1 cases achieved sub total resection due to the fact that the tumor was too adhesive to the facial nerve The follow-up time ranged from 6 months to 7 years with 7 cases lost contact.No deaths nor intracranial infection were encountered.Cerebrospinal fluid rhinorrhea was found in 1 cases after the operation and eustachian tube blockage was performed.All patients(100％) had their facial nerve reserved and 16 patients (88％) had their cochlea nerve reserved.17patients(89.5％) had intact facial nerve function and 2 patients suffered from level Ⅲ facial nerve paralysis (House-Brackmann grade) post operatively.6 patients suffered from vertigo pre-operatively and 5 of them reported disappearance of vertigo after the surgery.Of the 13 patients who did not have vertigo before the surgery,1 patient complained sense of dizziness and unsteady walking post-operatively.5 patients (33.3％) reported disappeared or alleviated tinnitus,8 patients (53％) had the same degree of tinnitus and 2 patients reported worsened tinnitus post-operatively.For patients who did not have tinnitus before the surgery,no tinnitus was reported post-operatively.CONCLUSION treatment strategy for small acoustic neuroma requires personalized setting based on the age of the patient,the combined systemic disease,the severity of the symptoms and the growth rate of the tumor.For patients without practical hearing,the tumor could be removed with labyrinthine approach,and the integrity of the cochlear nerve should be preserved as far as possible,for further reconstruction of hearing ability and cochlear implantation.
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OBJECTIVE@#To investigate the feasibility of the treatment of otosclerosis using laser stapedotomy with mini incision in the external auditory meatus.@*METHOD@#Thirteen patients(15 ears) with otosclerosis evidence on clinic history. They were all operated using the laser assisted stapedotomy by mini incision in external auditory meatus because of the wide straight canal. Laser resection the tendo musculistapedius and anterior and postrior arch, breaking the articulatioincudostapedia, removing the stapes superstructure, making a hole of 6mm diameter in the rear of stapes footplate by laser drilling, implanting the corresponding length Piston artificial ossicle.@*RESULT@#All the surgeries were successful and the operation time was about one hour. There was only one patient manifested vertigo and nausea after the operation. But the symptoms improved three days later after the expectant treatment. All the incisions were healed in the externals. There was significant difference between the preoperative and postoperative PTA. The air conduct improved in every frequent and the bone conduct improved in 1 kHz, 2 kHz and 4 kHz.@*CONCLUSION@#Laser assisted stapedotomy by mini incision in the external auditory meatus in patients having wide straight canal with otosclerosis can shorten the operation time, minimize the tissue damage, fasten the healing of the incision and reduce the complications postoperatively. In addition, the mini incision is beauty and easy to nurse.