RESUMEN

A persistent stapedial artery (PSA) is a rare embryologic remnant that typically involutes at week 10 of embryogenesis. However, if it is persistent, it may lead to conductive hearing loss and pulsatile tinnitus. It is of utmost importance to identify such an anomaly, as it leads to serious complications intraoperatively if overlooked. Proper clinical and radiological assessment helps an otologist recognize the PSA. We describe the case of a 24-year-old female presenting with a chronically discharging ear in addition to pulsatile tinnitus and conductive hearing loss with an incidental finding of a PSA upon otoscopy.

RESUMEN

Cochlear size variation was first reported in 1884, and since then, there have been various reports confirming the same. Yet, there is no single report that has displayed the wide variations in the cochlear size in a single layout capturing the cochlea in the oblique coronal view/ cochlear view. Basal turn diameter (A-value) was measured in the oblique coronal plane using the OTOPLAN® otological preplanning tool in 104 computed tomography (CT) scans of the temporal bones of cochlear implant (CI) recipients in a tertiary CI center. All CT scans with an image resolution of at least 0.5 mm and identified as having cochleae with normal anatomy were included in this study. A 3-dimensional (3D) segmentation was performed using the 3D slicer and visualized to evaluate the impact of cochlear size on the number of turns studied. The A-value was found to vary between 7.3 mm and 10.4 mm among the studied patients. Three-dimensional segmentation of the inner ear revealed only 2 turns of the cochlea in 4 ears, with A-values of 7.3, 8.8, 7.8, and 7.7 mm. One ear had only 11 /2 turns of the cochlea, with an A-value of 7.9 mm. As a further advancement in the assessment of cochlear size as determined by the A-value, 3D segmentation of the complete inner ear provides a full picture of the number of cochlear turns. Three-dimensional segmentation of the entire inner ear could help improve the preoperative planning of CI surgery and have implications for electrode array selection. Cochlear size could be a predictor of the number of cochlear turns, even in cases that look normal from the radiological findings. The findings of this study could help in improving the preoperative planning for a more successful CI surgery by differentiating between the normal and abnormal cochlea.

Asunto(s)

Cóclea , Implantación Coclear , Imagenología Tridimensional , Hueso Temporal , Tomografía Computarizada por Rayos X , Humanos , Implantación Coclear/métodos , Cóclea/diagnóstico por imagen , Cóclea/anomalías , Cóclea/anatomía & histología , Tomografía Computarizada por Rayos X/métodos , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/anatomía & histología , Masculino , Femenino , Imagenología Tridimensional/métodos , Persona de Mediana Edad , Implantes Cocleares , Anciano , Adulto , Estudios Retrospectivos , Tamaño de los Órganos , Adolescente

RESUMEN

"Allergic fungal sinusitis (AFS)" is typically diagnosed using radiologic images like computed tomography (CT) scans and magnetic resonance imaging (MRI), with the "Hounsfield unit (HU)" in CT scans and T2-weighted images (T2WI) in MRI serving as reliable objective parameters. However, diagnosing AFS might be difficult because of possible signal changes and densities caused by variations in the secretion concentration in the sinus. Few studies have compared the diagnostic performance of MRI and CT scans. This study aimed to investigate the value of MRI signal intensity in evaluating AFS compared with CT HUs. This retrospective study included 111 patients with pathologically confirmed AFS who underwent CT imaging followed by MRI evaluation at King Saud Medical City, Riyadh, Saudi Arabia, from January 2012 to December 2022. Radiographic densities of sinus opacities on CT scan, including the mean HU values, and MRI findings, including signal voids on T1-weighted images and T2WI, were gathered and analyzed. To determine the efficacy of these radiographic characteristics in predicting the disease and the best cutoff value, we employed receiver operator characteristic curves. The mean age was 31.9 ±â€…15.6 years, and most patients were 74 females (66.7%). The main symptom was nasal obstruction in 73 patients (65.8%). In comparison, between HU and signal void on T2WI, there was moderate predictive performance [area under the curve: 0.856, P = .001]. An ideal HU cutoff value of 69.50 HU was obtained with a sensitivity of 100% and a specificity of 44.7%. However, the receiver operator characteristic for T1-weighted images could not be plotted, as no signal was avoided to predict AFS and it was not statistically significant (area under the curve: 0.566; P = .287). The study found a CT HU of 69.5 can predict MRI T2WI signal values with a void signal, aiding in diagnostic workup and evaluation for AFS.

Asunto(s)

Imagen por Resonancia Magnética , Rinitis Alérgica , Sinusitis , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Sinusitis/diagnóstico por imagen , Sinusitis/microbiología , Persona de Mediana Edad , Rinitis Alérgica/diagnóstico por imagen , Adulto Joven , Micosis/diagnóstico por imagen , Micosis/diagnóstico , Adolescente , Curva ROC , Arabia Saudita , Sensibilidad y Especificidad , Sinusitis Fúngica Alérgica

RESUMEN

Objective: To report a reliable method in obtaining optimal cochlear basal turn and cross-section (c/s) of internal auditory canal (IAC) supporting Cochlear implantation (CI) procedure. Materials and Methods: Computer tomography (CT) and magnetic resonance image (MRI) scans of potential CI candidates from 2018 to 2022 from the tertiary center were considered for analysis. Slicer software was used in three-dimensional (3D) segmentation of inner ear and for capturing the cochlear basal turn. Results: A total of 1932 head scans were made available for the analysis and out of which 1866 scans had normal anatomy (NA) inner ear. Incomplete partition (IP) type-I was identified in 19 ears, IP type-II in 27 ears, IP type-III in 6 ears, cochlear hypoplasia (CH) type-I in 6 ears, CH type-II in 1 ear, CH type-III in 3 ears, and CH type-IV is 3 ears, and enlarged vestibular aqueduct syndrome in 1 ear. 3D segmented inner ear helped in successfully obtaining the cochlear basal turn and the c/s of IAC in all anatomical types. Time taken to capture the cochlear basal turn with the help of 3D segmented inner ear was <1 min. Within the NA category, five cases showed scalar ossification, and its extent was identified in the cochlear basal turn. Conclusion: The identification and the extent of ossification in the scala tympani, shape of the basal turn, and the cochlear size measurement in cochlear basal turn has high clinical relevance as this helps in surgical planning and in choosing appropriate electrode length. Level of evidence: Level 2 to the best of our understanding.

RESUMEN

Objective: We hypothesize that visualizing inner-ear systematically in both cochlear view (oblique coronal plane) and in mid-modiolar section (axial plane) and following three sequential steps simplifies, identification of inner-ear malformation types. Methods: Pre-operative computer-tomography (CT) scans of temporal bones of 112 ears with various inner ear malformation (IEM) types were taken for analysis. Images were analyzed using DICOM viewers, 3D slicer, and OTOPLAN®. The inner-ear was captured in the oblique-coronal plane for the measurement of length and width of cochlear basal turn which is also called as A-, and B-values respectively (Step 1). In the same plane, the angular-turns of lateral-wall (LW) of cochlear basal turn were measured (Step 2). As Step 3, the mid-modiolar section of inner ear was captured in the axial plane by following the A-value and perpendicular to cochlear view. From the mid-modiolar section, the outer-contour of inner ear was captured manually by following contrasting gray area between fluid filled and bony promontory and was compared to known resembling objects to identify IEM types (Step 3). Results: Following reference values have emerged from our analysis: A-, and B-values (Step 1) on average are >8 mm and >5.5 mm respectively, in normal cochleae (NA), enlarged vestibular aqueduct syndrome (EVAS), incomplete partition (IP) type-I and -II, whereas it is <8 mm and <5.5 mm respectively, in IP type-III and cochlear hypoplasia (CH). Angular-turn of LW is consistently observed in cochlear basal turn (Step 2), is 540° in NA and EVAS, 450° in IP-II, and 360° in IP types I & III. In subjects with CH type, angular-turn of LW is either 360° or 450° or 540°. In true mid-modiolar section, outer-contour of inner-ear (Step-3), other than in CH and cystic inner-ear malformations, resembles recognizable shapes of known objects. Absence of EVA is an additional characteristic that confirms diagnosis of CH when the A-, B-values, and angular-turn of LW can be similar to other anatomical types. Drawing a straight line along posterior edge of internal auditory canal (IAC) in axial view can differentiate a true common cavity (CC) from cochlear aplasia-vestibular cavity (VC). Conclusion: Three-step process proposed in this study captures inner-ear in cochlear view as well in mid-modiolar sections visualizing key features of inner-ear in identification of IEM types. Level of Evidence: Level 1.

RESUMEN

PURPOSE: The diagnostic criteria of allergic fungal rhinosinusitis focus on characteristic clinical, radiographic, histopathologic findings and immunologic characteristics of the disease. None of these are useful for a prompt outpatient diagnosis of the condition. No clear endoscopic signs (pathognomonic) of polyps in allergic fungal rhinosinusitis are mentioned in the literature. OBJECTIVE: The objective of this study is to describe and evaluate the sensitivity and specificity of an endoscopic sign the intrapolypoidal white particles for the diagnosis of allergic fungal rhinosinusitis in outpatient setting. METHODOLOGY: In a descriptive, cross-sectional study, 46 chronic rhinosinusitis patients were examined by endoscope in the outpatient clinic. The endoscopic images of the nasal polypi were captured preoperatively. During endoscopic surgery, a sample of nasal polypi was taken for fungal staining and culture. Results of histopathology were compared to the impression of rhinologist on the images of nasal polypi captured preoperatively. RESULTS: The most common endoscopic features were the expansion of sinus (24, 52.2%) and intrapolypoidal white particles (50%). Intrapolypoidal white particles were calculated to have 85.71% sensitivity, 65.63% specificity, 52.17% positive predictive value, 91.3% negative predictive value and 71.74% diagnostic accuracy. CONCLUSION: This study offers a new endoscopic sign, intrapolypoidal white particles for diagnosing allergic fungal rhinosinusitis.