John Xenelis

CT scan versus surgery: how reliable is the preoperative radiological assessment in patients with chronic otitis media?

The objective of the study was to evaluate the accuracy of the preoperative radiological assessment regarding 10 different middle ear structures in patients with chronic otitis media (COM). The setting of the prospective study was in a Tertiary university hospital. Fifty patients scheduled for a primary operation for COM. All patients underwent preoperative temporal bone high-resolution CT-scan (HRCT). AC1-statistics between the radiological report and the intra-operative findings were calculated. There was no correlation between the radiological assessment and the surgical findings in the scutum, attic area, and oval window. There was a poor or fair agreement on the condition of the malleus–incus complex, the status of the tympanic cavity, and the round window. There was a moderately strong agreement regarding the status of the lateral semicircular canal (LSCC) and tegmen tympani. This agreement was primarily observed, when no erosion/exposure was present in the LSCC or the dura. There was a very strong agreement in the mastoid air-cell complex and the sigmoid sinus, especially when the former was abnormal and the latter had no pathology. There are significant difficulties in radiological imaging for reliably assessing the middle ear in patients with chronic otitis media, using HRCT. The preoperative CT scan generally underestimates the actual pathology found by the surgeon in certain middle ear areas. The decision for surgical intervention should not be based on the radiological interpretation of certain middle ear structures, and ENT surgeons should be prepared to encounter conditions which are not reported by the radiologist preoperatively, and modify the operating strategy accordingly. EBM level: 2c.

Study of the Cochlear Function in Patients with Myotonic Dystrophy Type 1

Objectives: Myotonic Dystrophy type 1 is a progressive autosomal dominant multisystem disorder, the second most common form of muscular dystrophy. The disease is associated with various vestibular, oculomotor, and auditory disorders. The aim of the present study was to undertake a detailed vestibular and audiological evaluation, and specifically to analyze the cochlear function using transiently evoked otoacoustic emissions. Methods: 24 patients with genetically diagnosed myotonic dystrophy type 1 were studied during the past 4 years in Eginition hospital of Athens. Twenty-one normal subjects were used as controls. Testing included pure-tone audiometry, tympanometry, auditory brainstem responses (Abr), transiently evoked otoacoustic emissions, and nystagmography. Results: Tympanograms were normal in most patients. 15 (62.5%) patients had a varying degree of sensorineural hearing loss, with no conductive element. In 9 of them (37.5%), ABR abnormalities were found, such as absence of wave I or increased latencies of waves III and V, compatible with sensorineural hearing loss (5 patients), as well as increased I-III and I-V interpeak latencies, compatible with retrocochlear involvment of the auditory pathways (4 patients). Subclinical cochlear damage was found in all patients, as evidenced by absent otoacoustic emissions or lower otoacoustic emission amplitude. Vestibular hypersthesia was found in 9 patients (37.5%), accompanied by spontaneous nystagmus in 4 of them (15.6%). Conclusions: Audiovestibular abnormalities are quite common in patients with myotonic dystrophy type 1. We have found that subclinical cochlear damage is a common finding of the disease, as concluded from the absence or decrease of otoacoustic emissions in these patients.

Delayed Facial Nerve Palsy after Middle Ear Surgery

Objective 1) Report the incidence and outcome of delayed facial nerve palsy following middle ear surgery in our department, and 2) review the medical literature. Methods This is a retrospective chart review study of 833 patients who were operated for chronic otitis media with cholesteatoma (572 patients), otosclerosis (192 patients), and profound hearing loss who received a cochlear implant (68 patients) since 1993. Results Delayed facial nerve palsy was observed in 10 patients (1.2%). In all cases, immediate postoperative facial nerve function was normal and the palsy occurred 5 to 8 days postoperatively. Facial nerve function recovered in all patients within 6 months. Assessment and management issues are discussed. Conclusions Delayed facial nerve palsy may rarely occur following middle ear surgery and has an excellent recovery rate.