Normative inner ear volumetric measurements.

In the current study, we attempted to determine normative inner ear volumetric measurements generated from three-dimensional computed tomography (CT) images. In addition, we investigated a correlation between the axial length and the volume of the labyrinth and discussed clinical outcomes of this correlation. Amira 5.2.2 software was used to create three-dimensional isosurface images of the human labyrinth using two-dimensional CT images from 35 anatomically normal patients. With the three-dimensional labyrinths, complete dimensional analysis was performed to gain insight into both the volume and the greatest axial length of the inner ear. Paired t test and Pearson correlation were used. Our volume of the inner ear inquiry reported a mean volume of 221.5 with SD of 24.3 µL (0.228 µL for males and 0.218 µL for females). The length showed a mean of 1.713 cm with SD of 0.064 cm (1.753 cm for males and 1.695 cm for females). The length was used to estimate the volume, and the estimates were within 10% of the measured volume 74.3% of the time. Normative volumetric measurements of the inner ear can be obtained by using three-dimensional CT Imaging by Amira 5.2.2 software. There was a statistically significant positive correlation between the axial length of the labyrinth and the volume of the labyrinth. The axial length of the labyrinth could be used to estimate the volume of the labyrinth, which may be clinically important to estimate the concentration of the drug distributed in the inner ear.

Glenohumeral articular cartilage lesions: prospective comparison of non-contrast magnetic resonance imaging and findings at arthroscopy.

PURPOSE: The purpose of this study was to assess the diagnostic sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV), and test-retest reliability of magnetic resonance imaging (MRI) for detecting cartilage abnormalities of the glenohumeral joint in comparison with the gold standard of diagnostic arthroscopy. METHODS: Forty-four patients with a preoperative non-contrast MRI study of their affected shoulder underwent arthroscopy by one surgeon for rotator cuff tendinopathy from 2009 to 2010. Articular cartilage defects were prospectively recorded and graded according to the International Cartilage Repair Society classification system at the time of arthroscopy. One year after surgery, the preoperative MRI were reviewed by a board-certified radiologist and the treating surgeon for articular cartilage defects of both the humeral head and the glenoid. Sensitivity, specificity, accuracy, and test-retest reliability were calculated. RESULTS: At arthroscopy, 43% of the shoulders were found to have articular cartilage defects. When the readers' findings were combined, the sensitivity of detecting humeral lesions on MRI was 32%; specificity, 80%; accuracy, 63%; PPV, 57%; and NPV, 66%. The sensitivity of detecting glenoid lesions was 31%; specificity, 86%; accuracy, 76%; PPV, 33%; and NPV, 85%. CONCLUSIONS: This study finds that the overall accuracy of MRI in detecting articular cartilage damage in patients with the clinical diagnosis of subacromial pathology is moderate. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria based on consecutive patients with universally applied reference "gold" standard.

Transmastoid middle fossa craniotomy repair of superior semicircular canal dehiscence using a soft tissue graft.

OBJECTIVE: To describe the successful surgical treatment of 5 cases of superior semicircular canal dehiscence via a transmastoid middle fossa craniotomy using a soft tissue graft. DESIGN: Case report. SETTING: Private practice otologic referral center. RESULTS: All patients have experienced reduction in auditory and vestibular symptoms. Pulsatile tinnitus and autophony are now absent in the operated ears. Chronic disequilibrium is subjectively improved. Patients with sound evoked eye movements no longer have sound sensitivity on the operated side. Head thrust testing indicates no obstruction of the operated superior canal in all patients with normal head thrust preoperatively. Audiometry is unchanged from preoperation, and cervical vestibular-evoked myogenic potential thresholds have increased on the operated side in 4 of 4 patients. Three patients had dehiscence at the superior petrosal sinus inaccessible to standard middle fossa repair. All patients were discharged to home the morning after surgery. CONCLUSION: Transmastoid craniotomy repair of the superior semicircular canal dehiscence using a soft tissue graft offers numerous advantages over traditional surgical approaches and can be performed safely in the outpatient setting. The strategy is particularly useful in patients with dehiscence at the superior petrosal sinus. This article will review our strategy and discuss the advantages and disadvantages of the different surgical treatments used for patients with severe symptoms from superior canal dehiscence.

Otalgia associated with migraine.

OBJECTIVE: To investigate the association of otalgia and migraine. STUDY DESIGN: Retrospective survey with evaluation of otalgia response to migraine treatment. Only patients with minimum symptom duration of 3 months, who accepted migraine treatment and had a minimum follow-up of 3 months, were included. SETTING: Single neurotology practice. SUBJECTS: All patients with otalgia in whom other causes of otalgia had been excluded and who were treated with migraine therapies. INTERVENTION: Standard first-line abortive and prophylactic migraine therapies. MAIN OUTCOME MEASURES: Specific clinical data, as well as pretreatment and posttreatment severity scores, were gathered. Response to treatment was assessed by comparing pretreatment and posttreatment symptom scores using paired t test. RESULTS: A total of 26 patients were included. Ninety-two percent responded to migraine therapy with improved symptom frequency, severity, and duration (p < 0.001). Median duration of symptoms was 5 years. Mean delay to response was 2.3 weeks, and mean follow-up was 20 months. Otalgia was the chief complaint in 77%. Pain was dull in 35%, sharp in 19%, throbbing in 19%, and mixed in 27%. Sixty-five percent demonstrated triggerability of otalgia. A total of 65% had International Headache Society migraine. Patients responded to many classes of migraine preventive and abortive medications. CONCLUSION: Otalgia of unclear cause can be related to migraine mechanisms. Our group showed a high prevalence of migraine characteristics, including headache, migraine-associated symptoms, patterns of triggerability, and response to migraine treatment. Clinical criteria for diagnosis of migraine-associated otalgia are suggested for future prospective study.

Orbital floor reconstruction using porcine small intestinal submucosa.

BACKGROUND: We conducted a prospective, controlled, blinded pilot study to demonstrate that repair of induced rabbit orbital floor fractures with Surgisis ES (Cook Biotech Inc, West Lafayette, Ind) provides adequate orbital content support while promoting mucosal and bone regeneration of the fracture site. MATERIAL/METHODS: Ten New Zealand white rabbits underwent induced bilateral controlled (5mm) orbital floor fractures under anesthesia. In each rabbit, Surgisis ES, an acellular, freeze-dried soft tissue matrix derived from porcine small intestinal submucosa, was implanted subperiosteally to repair one orbital floor fracture through a transconjuntival approach. The contralateral orbital floor fracture served as a control. Histological assessment was performed at 1, 3, and 12 months post-operatively. RESULTS: All ten rabbits survived the surgery without infection, globe entrapment or implant rejection. Grossly, the orbits appeared similar in the ten rabbits. Subtle histological differences were noted between the fractures repaired with Surgisis ES and those left to heal without treatment. Eosinophilic infiltrates and connective tissue fibrosis found to varying degrees in the Surgisis ES sites were not found in the control sites. Previous Surgisis studies found a foreign body giant cell reaction that was absent in this study. Both sites were healed at all intervals. CONCLUSIONS: Surgisis ES can successfully serve as a graft in the repair of orbital floor fractures in rabbits. However, its ability to promote central bone regeneration has not been clearly established. Additional studies investigating its application in human orbital trauma are needed.

Lip augmentation with porcine small intestinal submucosa.

OBJECTIVE: To relate our initial experience using an acellular, soft tissue matrix derived from porcine small intestinal submucosa (Surgisis; Cook Biotech Inc, West Lafayette, Indiana) for lip augmentation. DESIGN: A prospective, uncontrolled case series examining the results of lip augmentation using Surgisis in patients presenting to an academic otolaryngology/facial plastic surgery office. RESULTS: Nineteen Surgisis implants were placed in 8 patients. All patients tolerated the procedure and denied unnatural sensations or complications at any interval. Adverse events included transient erythema and 1 case of local cellulitis treated effectively with oral antibiotics. Four patients were satisfied with the procedure and 4 patients requested greater augmentation. Six-month follow-up was reported, and preoperative and postoperative photography was used in all cases. CONCLUSIONS: Short-term lip augmentation was achieved in all 8 patients (4 patients had multiple strands placed). This study demonstrates technical ease and early safety. Surgisis should serve as scaffolding for ingrowth of striated muscle of the lip, potentially providing long-term augmentation. This study introduces Surgisis as a novel implant for lip augmentation.

Long-term treatment of an addictive personality.

There is infrequent discussion of long-term psychotherapy of persons with addiction, particularly in the self-psychology literature. In addition, some question whether long-term psychotherapy can be helpful in severe psychiatric disorders. The author describes the treatment of a woman with multiple diagnoses, including bulimia and alcohol and drug addiction, which took place over a period of almost 7 years. These issues are addressed from a self-psychological perspective, with progression of the treatment from early facilitation of a selfobject transference to more intense selfobject transference-countertransference states. Behavioral interventions (e.g., recommendation of inpatient chemical dependency treatment) are also discussed. The author describes the patient's dramatic progress and subsequent regression. Finally, there is a discussion of the addiction from self-psychological and biological perspectives of this woman's particular developmental and treatment issues, as well as a discussion of the confrontation and limit setting in a self-psychologically oriented treatment.