Alessandro Stasolla

Detection of postoperative relapsing/residual cholesteatomas with diffusion-weighted echo-planar magnetic resonance imaging.

Purpose: To assess the capability of echo-planar diffusion-weighted magnetic resonance imaging (MRI) (EPI-DWI) in diagnosing relapsing/residual cholesteatomas after canal wall-up mastoidectomy. Materials and Methods: In a blinded study design, we investigated with MRI, including standard spin-echo sequences, 18 patients evaluated with clinical examination and computed tomography (CT) suspected for relapsing/residual cholesteatoma 7 to 19 months after a canal wall-up mastoidectomy. Images were evaluated by two radiologists blinded to patients’ identities, CT findings, and clinical data set, who decided in a consensus agreement whether there was a pathologic signal increase in the petrous bone in a single-shot EPI-DWI sequence. All the patients underwent a second tympanoplasty or revision surgery of the mastoidectomy cavity within 15 days after magnetic resonance investigation. Sensitivity, specificity, and predictive values were evaluated separately for standard sequences and EPI-DWI. Results: In EPI-DWI, five of six patients with cholesteatoma showed a bright signal, whereas those patients with a noncholesteatomatous tissue showed no anomalies. The only misdiagnosed cholesteatoma was a pearl 2 mm in diameter. Sensitivity, specificity, and positive predictive values, and negative predictive values of EPI-DWI in diagnosing relapsing/residual cholesteatomas were 86, 100, 100, and 92%, respectively. Conclusion: EPI-DWI may be a useful tool in differentiating between cholesteatomatous and noncholesteatomatous tissues after closed cavity mastoidectomy. Further investigations are, however, required to establish the practical utility of EPI-DWI on larger series as a screening modality in the follow-up after closed cavity mastoidectomies.

Modified translabyrinthine approach and hearing preservation.

Objectives/Hypothesis: In 1991, the translabyrinthine approach was modified by sealing the vestibule with bone wax, which allowed preservation of the hearing function in one patient. The present study aimed specifically at evaluating the effectiveness of the modified translabyrinthine approach in preserving hearing function in a group of patients with vestibular schwannoma that involved the internal auditory canal.

Preoperative imaging assessment of chronic otitis media: what does the otologist need to know?

The aim of this paper is to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in managing chronic otitis media (COM), with special attention to the key information required by the otologist for effective preoperative planning.RiassuntoScopo del presente lavoro è puntualizzare l’importanza dell’imaging integrato con tomografia computerizzata (TC) ed risonanza magnetica (RM) nella gestione dell’otite media cronica, con particolare riguardo alle informazioni chiave necessarie all’otoiatra per una corretta pianificazione della terapia chirurgica.

Susac syndrome and vestibular-evoked myogenic potentials.

Susac syndrome is a rare disease with fewer than 100 reported cases. It is characterized by encephalopathy, retinal arteriolar branch occlusions, and deafness. The hearing loss is often associated with vertigo or dizziness and caloric testing has demonstrated the presence of vestibular disturbances. This report describes a patient with Susac syndrome whose first symptom was vestibular dysfunction. Although the patient underwent complete audiovestibular testing, only the vestibular-evoked myogenic potentials (VEMPs), measured with an Amplaid MK-12, gave abnormal results. A 24-year-old woman presented in October 2006 with acute onset dizziness. Otoscopy was normal. Audiometry, impedance tests, and auditory brain stem responses were within normal limits. The Hallpike-Fitzgerald test was normal. She had a left-sided VEMP deficit, with delayed latency and reduced amplitude (Fig 1). Magnetic resonance imaging (MRI) showed multiple foci of high T2 signal intensity in both the white and gray matter and leptomeningeal enhancement (Fig 2A and B). A few days after the MRI, the patient complained of hearing loss and neurologic deterioration that consisted of disorientation and incoherent speech. Audiometry revealed a left sensorineural hearing loss that was more pronounced at high frequencies. An initial presumptive diagnosis of viral encephalitis was made. The patient was hospitalized and antiviral therapy was administered. Nevertheless, visual dysfunction developed. Retinal fluorescein angiography disclosed retinal arteriolar branch occlusions in the left eye. Susac syndrome was diagnosed. The antiviral treatment was stopped and prednisone was given. The neurologic deterioration resolved within 10 days. She was discharged with a recommendation that she continue the corticosteroid treatment. She regained a satisfactory quality of life with no particular limitations. MRI done at the last follow-up showed that the hyperintense lesions had disappeared. This case report was approved by Institutional Review Board of University La Sapienza of Rome, Italy.

Enlarged internal auditory canal and sudden deafness

OBJECTIVES We report a young man with bilateral enlarged internal auditory canals who developed sudden sensorineural hearing loss following weight-lifting exercise. METHODS We present a detailed clinical history, including the patients high resolution computed tomography and magnetic resonance imaging scans. RESULTS The patient reported left-sided hearing loss immediately following weight-lifting exercise. He had no vestibular disturbance. He was treated with a combined regimen of steroids and an antiviral drug, but his profound hearing loss did not resolve. During another session of weight-lifting exercise, he suffered another episode of sudden hearing loss. CONCLUSIONS To the best of our knowledge, this is the first report of a patient with patulous internal auditory canals, with no other anomalies, who developed bilateral sudden hearing loss after weight-lifting exercise. Although no definitive conclusions can be drawn, close surveillance and lifestyle warnings should be considered in such patients, even if they are clinically asymptomatic.

MRI and Muscle Signal Intensities in Alcoholics Compared With Control Subjects

OBJECTIVE To evaluate by magnetic resonance imaging (MRI) the difference in muscle signal intensities between alcoholics and control subjects. METHODS Thirty-four healthy subjects and 46 alcohol-dependent individuals were assessed. MRI was carried out using a low-field magnet (0.2 Tesla) and a limb-dedicated coil. The presence of muscle changes was evaluated by measuring signal intensities at the medial (MG) and lateral heads of the gastrocnemius muscle by T1-/T2-weighted and gradient-echo short tau inversion recovery sequences. The mean signal intensities of the two sample groups were compared by ANCOVA with age as a covariate. In the alcohol-dependent group, correlations between signal intensities and plasma levels of muscular and hepatic enzymes, in addition to years of high-risk consumption and lifetime dose of ethanol consumed, were assessed. The mean signal intensities were also compared with the different degrees of pain by ANOVA. RESULTS Compared with healthy subjects, the alcohol-dependent group had mean higher signal intensities in both gastrocnemius heads in all sequences. The difference in the MG in T2-weighted sequences was significant (F = 48.28, p < 0.01). A modest correlation between the years of high-risk consumption and the signal intensity was found in T2-weighted sequences in the MG (r = 0.288, p = 0.057), whereas a correlation with the lifetime dose consumed was not found. Significant correlations between signal intensities and plasma levels of muscular and hepatic enzymes were not found. There were also no significant group differences on different degrees of pain. CONCLUSION MRI was shown to be a sensitive, well-tolerated, and inexpensive procedure capable of detecting changes in signal intensities in the muscles of alcoholics. This technique could be included among other diagnostic tools for alcoholic myopathy with further improvements and if the signal alterations can be corroborated by biopsy evidence.

Tympanomastoid cholesterol granuloma: radiological and intraoperative findings of blood source connection

The hypothesis that the close contiguity between the cholesterol granulomas and some rich blood sources provided the trigger to the aggressive nature of tympanomastoid cholesterol granulomas has been recently reported. To corroborate this new etiopathogenetic theory we retrospectively reviewed a series of 14 patients with primary middle ear and mastoid cholesterol granulomas and investigated the temporal bone marrow invasion and its hematopoietic potentialities and a possible cholesterol granulomas contiguity with relevant vascular structures such as the carotid artery, sigmoid jugular system, mastoid or dural vein. Eight cases did not show radiological sign of bone marrow invasion or hematopoietic potentialities visible in MRI. Besides no intraoperative vascular connections that could explain an initial bleeding source were found. Cholesterol granulomas bone marrow invasion was present in six patients. A bone marrow hematopoietic potentiality was showed in four of these patients, whereas, an evident anatomical contiguity of the cholesterol granuloma with some important temporal bone vascular structures was visible in five cases. Analysis of cardiovascular risk factors showed that four patients presented one or more of the risk factors analysed.