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1.
Ear Nose Throat J ; 93(4-5): 168-73, 2014.
Article in English | MEDLINE | ID: mdl-24817231

ABSTRACT

We conducted a retrospective study to reexamine the value of single-photon emission computed tomography (SPECT) in the evaluation of patients with neurotologic complaints, and to assess the intra- and inter-radiologist variability of SPECT readings. Our study population was made up of 63 patients--23 men and 40 women, aged 34 to 91 years (mean: 59)--who had presented to a tertiary care otolaryngology practice and university hospital for evaluation of head trauma, sensorineural hearing loss, tinnitus, and/or vertigo. All patients had undergone brain scanning with SPECT during their evaluation, and almost all had also undergone magnetic resonance imaging (MRI) and standard computed tomography (CT). We compared the findings of all three imaging modalities in terms of their ability to detect neurotologic abnormalities. We found that detection rates were very similar among the three modalities; abnormalities were found in 24% of SPECT scans, 26% of MRIs, and 23% of CTs. Nevertheless, we did find that among 60 patients who underwent all three types of imaging, 13 (22%) exhibited areas of cerebral hypoperfusion on SPECT while their MRIs and CTs were read as either normal or nonspecific. In all, 18 of these 60 patients (30%) exhibited normal or nonspecific findings on all three types of imaging. In addition, when SPECT scans were read by the same radiologist at different times, different results were reported for 17 of the 63 scans (27%). Likewise, when SPECT scans were read by different radiologists, different results were reported for 21 of 63 scans (33%). We conclude that SPECT may be a valuable complementary diagnostic modality for making a comprehensive neurotologic evaluation and that it may detect abnormalities in some patients whose other imaging is read as normal. However, we did not find that SPECT was the most sensitive of the three modalities in neurotologic evaluation, as we had previously found in a preliminary study that the senior author (R.T.S.) published in 1996. In addition, with respect to our radiologists, both their intra- and inter-reader reliability was low, and we recommend additional study on this matter.


Subject(s)
Craniocerebral Trauma/diagnostic imaging , Hearing Loss, Sensorineural/diagnostic imaging , Tinnitus/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Vertigo/diagnostic imaging , Adult , Aged , Aged, 80 and over , Cerebrovascular Circulation , Craniocerebral Trauma/physiopathology , Female , Hearing Loss, Sensorineural/physiopathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Observer Variation , Radiology , Reproducibility of Results , Retrospective Studies , Tinnitus/physiopathology , Tomography, X-Ray Computed , Vertigo/physiopathology
2.
J Voice ; 26(2): 262-6, 2012 Mar.
Article in English | MEDLINE | ID: mdl-21839610

ABSTRACT

OBJECTIVES: The objective of this study was to evaluate the factors predictive of postoperative laryngeal nerve paresis (LNP) in patients undergoing thyroid surgery. We also assess the implications of preoperative LNP on postoperative vocal fold status. STUDY DESIGN: Case series with retrospective chart review. METHODS: Charts of 17 patients who underwent thyroid surgery and had pre- and postoperative laryngeal electromyography (LEMG) were reviewed. LEMGs were ordered routinely in all patients undergoing thyroid surgery, not just in those with clinical findings suggestive of paresis. We collected data relating to pre- and postoperative laryngeal and thyroid evaluations and the details of the surgical procedure. We analyzed the prevalence of preoperative LNP and relationship of thyroid diagnoses, size of thyroid mass, and type of surgery performed with respect to the outcome of the LNP. RESULTS: All the 17 patients had a mild to moderate degree of unilateral or bilateral LNP preoperatively. However, only seven (41.2%) had vocal symptoms. After surgery, only five of these seven patients had voice complaints, and there were no patients with voice complaints among the group that had been asymptomatic preoperatively. Thyroid diagnoses included 11 cases of benign disease (64.7%) in which LNP improved in two, worsened in four, and remained the same in five; and six cases of malignant disease (35.3%) in which LNP improved in none, worsened in two, and remained the same in four. Predictors of worsening postoperative LNP on LEMG included the diagnosis of goiter (P=0.0005) and size of mass greater than 5cm (0.032). CONCLUSIONS: This study supports the notion that there is an intrinsic relationship between benign thyroid diseases and LNP that is probably related to local effects of the disease on the laryngeal nerves. All patients with the postoperative diagnosis of goiter worsened, and all patients with the postoperative diagnosis of adenoma showed no change on postoperative electromyography (EMG). Similarly, all patients with the diagnosis of thyroiditis alone improved, and there were no cases of improvement outside this group. Of the six cases of malignancy, four exhibited no change on EMG and only two worsened. The only reliable predictors of worsening paresis postoperatively are mass size greater than 5cm and diagnosis of goiter.


Subject(s)
Laryngeal Nerve Injuries/etiology , Postoperative Complications/etiology , Thyroid Gland/surgery , Thyroidectomy/adverse effects , Vocal Cord Paralysis/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Laryngeal Nerves/physiology , Male , Middle Aged , Pilot Projects , Predictive Value of Tests , Retrospective Studies , Vocal Cords/physiology
3.
J Voice ; 25(4): 496-500, 2011 Jul.
Article in English | MEDLINE | ID: mdl-20728306

ABSTRACT

OBJECTIVE: Vocal fold paresis has a multifactorial etiology and is idiopathic in many individuals. The incidence of thyroid-related neuropathy in the larynx has not been previously described. The purpose of this study was to evaluate the prevalence of previously undiagnosed thyroid disease in patients with laryngeal neuropathy and to compare this prevalence with that in a cohort of patients with a neurotologic neuropathy. STUDY DESIGN AND SETTING: Case series with chart review; tertiary care, otolaryngology practice. SUBJECTS AND METHODS: Charts of 308 consecutive patients with dysphonia and vocal fold paresis and 333 consecutive patients with sensorineural hearing loss, who presented for evaluation during a 3-year period, were reviewed. RESULTS: One hundred forty-six of 308 (47.4%) patients with vocal fold paresis were diagnosed with concurrent thyroid disease, whereas 55 of 333 (16.5%) patients with sensorineural hearing loss were diagnosed with concurrent thyroid disease (P<0.001, Pearson chi-square = 92.896; degrees of freedom = 5). Thyroid diagnoses among those with vocal fold paresis included benign growths (29.9%), thyroiditis (7.8%), hyperthyroidism (4.5%), hypothyroidism (3.6%), and thyroid malignancy (1.6%). CONCLUSIONS: Thyroid abnormalities are more prevalent in patients with dysphonia and vocal fold paresis than in patients with symptomatic sensorineural hearing loss, suggesting a greater association between previously undiagnosed thyroid abnormalities and laryngeal neuropathy than that between neurotologic neuropathy and thyroid disease.


Subject(s)
Dysphonia/epidemiology , Thyroid Diseases/epidemiology , Vocal Cord Paralysis/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Comorbidity , Female , Hearing Loss, Sensorineural/epidemiology , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , United States/epidemiology , Young Adult
4.
Otol Neurotol ; 31(4): 574-9, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20631499

ABSTRACT

HYPOTHESIS: The purpose of this histopathological study is to examine temporal bones of patients with cochlear otosclerosis adjacent to the round window or adjacent to the oval window as compared with healthy controls. BACKGROUND: It is unclear if the extent and site of otosclerosis affects the extent of damage to cochlear structures and hearing loss. METHODS: Twelve temporal bones from 10 patients with cochlear otosclerosis adjacent to the round window, 11 temporal bones from 8 patients with cochlear otosclerosis adjacent to the oval window, and 12 bones of healthy age-matched controls were selected for study. We calculated the number of spiral ganglion cells, changes in cochlear structures, the extent and site of cochlear otosclerosis, and audiometric data. RESULTS: The loss of spiral ganglion cells and the absence of outer hair cells in patients with cochlear otosclerosis adjacent to the round window were significantly higher than those in patients with cochlear otosclerosis adjacent to the oval window and healthy controls. The area of the spiral ligament in patients with cochlear otosclerosis adjacent to the oval window was significantly smaller than that in healthy controls. However, no significant difference was found in the spiral ligament of patients with cochlear otosclerosis adjacent to the round window and healthy controls. There was no significant difference between patients with cochlear otosclerosis and age-matched controls in audiometric data. CONCLUSION: Cochlear otosclerosis adjacent to the round window caused significantly more damage to spiral ganglion cells and outer hair cells than cochlear otosclerosis adjacent to the oval window without loss of spiral ligament.


Subject(s)
Hair Cells, Auditory/pathology , Otosclerosis/pathology , Oval Window, Ear/pathology , Round Window, Ear/pathology , Temporal Bone/pathology , Adult , Aged , Aged, 80 and over , Audiometry , Auditory Threshold , Bone Conduction , Hearing Loss, Sensorineural/pathology , Humans , Middle Aged , Spiral Ganglion/pathology , Spiral Ligament of Cochlea/pathology
5.
Otol Neurotol ; 30(7): 956-60, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19672205

ABSTRACT

OBJECTIVES: To compare the incidence of deposits in the semicircular canals between the temporal bones with Ménière's disease and normal controls and to investigate the relationship between the incidence of deposits and the symptoms of positional vertigo, often seen in patients with Ménière's disease. STUDY DESIGN: Retrospective histopathologic human temporal bone study. METHODS: Twenty-two temporal bones from 11 patients with bilateral Ménière's disease, 28 from 14 with unilateral and 50 age-matched normal temporal bones from 30 individuals were histopathologically examined. Medical records were reviewed for clinical history of positional vertigo and duration of disease. RESULTS: Significant differences were found in the incidence of cupular and free-floating deposits in the posterior semicircular canals between temporal bones with and without Ménière's disease. The incidence of free-floating deposits in the lateral semicircular canals was significantly higher in cases with unilateral Ménière's disease compared with controls. The incidence of these deposits was associated with the duration of disease rather than with aging. All 5 patients with positional vertigo (3 of 11 patients of bilateral Ménière's disease and 2 of 14 of unilateral) had free-floating deposits in at least 1 semicircular canal. CONCLUSION: Our findings suggest a possible causative relationship between cupular and free-floating deposits in the semicircular canals and the symptom of positional vertigo in patients with Ménière's disease.


Subject(s)
Meniere Disease/pathology , Vertigo/etiology , Aged , Aged, 80 and over , Aging , Histological Techniques , Humans , Meniere Disease/complications , Meniere Disease/physiopathology , Middle Aged , Retrospective Studies , Semicircular Canals/pathology , Temporal Bone/pathology , Time Factors , Vertigo/pathology , Vertigo/physiopathology
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