Variation among pre-surgical CT assessments of chronic otitis media.

OBJECTIVE: To investigate the reliability of preoperative computed tomography (CT) in patients with chronic otitis media (COM) as assessed by otologist-ENT surgeons, compared with surgical findings and respective radiological assessments, and to identify areas of the middle ear that are difficult to evaluate reliably with preoperative CT. MATERIALS AND METHODS: Fifty patients with COM underwent preoperative temporal bone CT reported by a qualified radiologist. Each operating surgeon completed a standardized questionnaire regarding the status of 10 middle-ear structures after the operation. Two otologists blindly reviewed the scans. AC1-statistics between the radiology/otology report and the intra-operative findings were calculated. RESULTS: In the attic, malleus-incus complex, tympanic cavity, and round window niche, the otologists' assessments of CT scans corresponded better to intra-operative findings than did the respective radiology report. In the lateral semicircular canal and sigmoid sinus, the otologists' assessments also outperformed those of the radiologists in cases of erosion. Radiological assessments outperformed those of otologists in only one of 10 studied areas: confirmation of an unexposed dura in the tegmen area. The scutum and oval window represent difficult areas for which to obtain a reliable preoperative CT scan report. CONCLUSION: Otologists' assessments regarding the pre-surgical status of the temporal bone in COM appear more reliable than those of radiologists. This finding has serious implications in current clinical practice, and should be considered when designing strategies for Radiology Head & Neck training. The inherent limitations of CT may necessitate modifications to imaging and operating strategies.

Cochlear implantation following temporal bone fracture.

Patients with bilateral temporal bone fractures frequently suffer profound hearing loss. These patients may benefit from cochlear implantation. Displaced fracture lines and ossification of the cochlea might complicate insertion of the electrode array. In the present paper we present a case of a failed cochlear implantation due to ossification of the cochlea, followed by a successful one on the opposite side in a patient who sustained bilateral temporal bone fractures. Preoperative imaging may identify these factors, help guide the appropriate surgical approach and choose which side to implant. We aim to highlight the necessity of imaging and discuss the reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture. Possible management options in the case of complex cochlear implantation are also described.

Prognosis of patients with idiopathic sudden hearing loss: role of vestibular assessment.

OBJECTIVE: To evaluate the correlation between caloric and vestibular evoked myogenic potential test results, initial audiogram data, and early hearing recovery, in patients with idiopathic sudden hearing loss. MATERIALS AND METHODS: One hundred and four patients with unilateral idiopathic sudden hearing loss underwent complete neurotological evaluation. Results for vestibular evoked myogenic potential and caloric testing were compared with patients' initial and final audiograms. RESULTS: Overall, abnormal vestibular evoked myogenic potential responses occurred in 28.8 per cent of patients, whereas abnormal caloric test results occurred in 50 per cent. A statistically significant relationship was found between the type of inner ear lesion and the incidence of profound hearing loss. Moreover, a negative correlation was found between the extent of the inner ear lesion and the likelihood of early recovery. CONCLUSION: In patients with idiopathic sudden hearing loss, the extent of the inner ear lesion tends to correlate with the severity of cochlear damage. Vestibular assessment may be valuable in predicting the final outcome.

The point prevalence of otitis media with effusion among school children in Greece.

Tympanometry, pneumatic otoscopy and acoustic reflex tests performed on 5121 school children aged 6-12 years old, during late spring and early autumn of 1996. Demographic, social, medical and birth related data were collected for each child separately. The study was undertaken in order to evaluate the prevalence of otitis media with effusion in a sample of the general population in Greece and to investigate the correlations with possible risk factors. A total of 6.5% had unilateral or bilateral type B or C2 tympanogramms, and negative reflex suggestive of otitis media with effusion. The finding indicates a rather low prevalence of otitis media with effusion in school children in Greece compared with other countries. This study, also has shown that there was a statistical significant relationship between secretory otitis media (SOM) and, age, sex, mother's education, parental smoking, breast-feeding, allergy and previous otitis media. No correlation was found in relation to the climate of residence, premature birth, number of siblings, mother's gestational age, birth skull circumference, birth body weight and length.

Value of Gd-DTPA-enhanced MR imaging of the labyrinth in patients with sudden hearing loss.

Recent reports describe labyrinthine enhancement on MRI as a highly specific sign of labyrinthine disease. This paper reports 44 patients with unilateral sensorineural hearing loss (SNHL) and laboratory evidence of cochlear damage investigated with Gd-enhanced MR imaging. Enhancement of the cochlea was observed in only one patient with a lesion at the fundus of the internal auditory canal (IAC) that extended into the cochlea after Gd-DTPA administration. In one more patient, MR imaging demonstrated large vestibular aqueducts as underlying cause for his hearing loss, but no enhancement of the labyrinth was observed. No abnormal signal intensity on precontrast MR scans nor pathologic enhancement of the membranous labyrinth were identified in the other 42 patients. Gd-enhanced MR imaging appears to be insensitive in demonstrating labyrinthine disease and normal examination findings in a patient with sudden SNHL cannot exclude damage at the cochlear level.