Roya Azadarmaki

MRI Information for Commonly Used Otologic Implants Review and Update

Objective To review information on magnetic resonance imaging (MRI) issues for commonly used otologic implants. Data Sources Manufacturing companies, National Library of Medicine’s online database, and an additional online database (www.MRIsafety.com). Review Methods A literature review of the National Library of Medicine’s online database with focus on MRI issues for otologic implants was performed. The MRI information on implants provided by manufacturers was reviewed. Results Baha and Ponto Pro osseointegrated implants’ abutment and fixture and the implanted magnet of the Sophono Alpha 1 and 2 abutment-free systems are approved for 3-Tesla magnetic resonance (MR) systems. The external processors of these devices are MR Unsafe. Of the implants tested, middle ear ossicular prostheses, including stapes prostheses, except for the 1987 McGee prosthesis, are MR Conditional for 1.5-Tesla (and many are approved for 3-Tesla) MR systems. Cochlear implants with removable magnets are approved for patients undergoing MRI at 1.5 Tesla after magnet removal. The MED-EL PULSAR, SONATA, CONCERT, and CONCERT PIN cochlear implants can be used in patients undergoing MRI at 1.5 Tesla with application of a protective bandage. The MED-EL COMBI 40+ can be used in 0.2-Tesla MR systems. Implants made from nonmagnetic and nonconducting materials are MR Safe. Conclusion Knowledge of MRI guidelines for commonly used otologic implants is important. Guidelines on MRI issues approved by the US Food and Drug Administration are not always the same compared with other parts of the world. Implications for Practice This monograph provides a current reference for physicians on MRI issues for commonly used otologic implants.

Eosinophilic Mucin Otomastoiditis and Otopolyposis A Progressive Form of Eosinophilic Otitis Media

Objective: The purpose of this study is to introduce and define a disease entity on a continuum of eosinophilic otitis media: eosinophilic mucin otomastoiditis and otopolyposis. Methods: A case of a 66-year-old woman with complicated chronic otitis media is reported. A literature review of the National Library of Medicine’s online database, with a focus on eosinophilic otitis media and eosinophilic mucin rhinosinusitis, was performed. Results: The authors report the case of a 66-year-old woman with a history of asthma, chronic rhinosinusitis, nasal polyposis, and chronic otitis media who presented with allergic middle ear mucin and otic polyps. Treatment involved a tympanomastoidectomy with removal of otic polyps and steroid therapy. Conclusion: Eosinophilic mucin otomastoiditis with otopolyposis is a disease entity on a continuum of eosinophilic otitis media. This disease process shares similarities with eosinophilic mucin rhinosinusitis. Otic polypectomy and steroids are suggested therapeutic measures.

Malignant transformation of respiratory papillomatosis in a solid-organ transplant patient: case report and literature review.

We report the case of a 77-year-old non-smoker and non-drinker with a solid-organ transplant who had malignant transformation of respiratory papillomatosis 3 years after the initial diagnosis of this benign lesion. This is the first case reported in the literature of malignant transformation of respiratory papillomatosis in a solid-organ transplant patient. Virus-associated cutaneous cancers occur more frequently and aggressively in solid-organ transplant patients. There may be a higher rate of malignant transformation of respiratory papillomatosis in immunosuppressed patients, as this is a virus-associated disease. Closer observation, airway evaluation with laryngoscopy and tracheobronchoscopy, and interval biopsies of immunosuppressed patients with respiratory papillomatosis is recommended.

Failed Tube Extrusion is Not a Random Event in Children or Their Siblings

Objectives/Hypothesis: It has been assumed that prolonged retention of tympanostomy tubes was random, with an incidence of 4% to 12% per tube. We have noticed patterns of tube retention that suggested a genetic predilection. We undertook this study to validate or disprove this impression. Such information may shed light on the physiology of tube extrusion and may help better define the risks of tympanostomy tube placement.

Feasibility of endoscopic treatment of middle ear myoclonus: a cadaveric study.

Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope.

Endoscopic treatment of middle ear myoclonus with stapedius and tensor tympani section: a new minimally-invasive approach.

Aims: We describe a new, entirely endoscopic surgical technique for treatment of middle ear myoclonus. Case Presentation: In our patient, the stapedius and tensor tympani tendons were sectioned to control chronic middle ear myoclonus. The procedure was performed using endoscopic ear surgery techniques, with the aid of rigid Hopkins rod endoscopes. Control of the pulsatile tinnitus was achieved after endoscopic tenotomy of the stapedius and tensor tympani, without any complications. Discussion and Conclusion: Endoscopic tensor tympani and stapedius tendon section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as a first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize dissection of healthy tissue for exposure. The entire operation, including raising the tympanomeatal flap and tendon section can be safely completed under visualization with a rigid endoscope with good control of the pulsatile tinnitus. Case Study British Journal of Medicine & Medical Research, 4(17): 3398-3405, 2014 3399

Progressive dysphagia in a patient with a history of cervical spine fusion.

A man in his 30s presented with a chief complaint of having coughed up a metallic screw. He reported progressive dysphagia and choking spells with liquids over the previous 6 months and had a recent admission for pneumonia. His medical history was notable for anterior cervical spine plating and fusion after a diving accident 11 years earlier with resultant paraplegia. Examination revealed a wheelchair-bound young man in no acute distress. The right aspect of the neck had a well-healed scar along the anterior border of the sternocleidomastoid muscle. Flexible laryngoscopy revealed an immobile right true vocal fold with anterior location of the arytenoid. Findings from the remainder of his head and neck examination was normal. His workup included computed tomography of the neck (Figure 1A) and a barium esophagram (Figure 1B). What is your diagnosis? A B

Hearing loss in patients with spondyloepiphyseal dysplasia congenita and tarda.

Aim: To describe hearing loss in patients with spondyloepiphyseal dysplasia congenita and tarda. Methodology: A literature review of the National Library of Medicines online database on hearing loss in patients with spondyloepiphyseal dysplasia congenita and tarda was performed. Results: Four articles were identified that reported hearing loss in subjects with spondyloepiphyseal dysplasia congenita and tarda. Including this study, a total of fourteen patients with hearing loss are reported. Eight patients with sensorineural loss and two patients with mixed hearing loss were identified. The type of hearing loss is unknown in 4 cases. Conclusion: Serial audiograms are recommended early in life in individuals with spondyloepiphyseal dysplasia congenita and when clinically indicated in patients with spondyloepiphyseal dysplasia tarda. Mini-review Article Azadarmaki et al.; BJMMR, 6(11): 1113-1120, 2015; Article no.BJMMR.2015.289 1114

Congenital Intralabyrinthine Cholesteatoma

A patient with a congenital intralabyrinthine cholesteatoma is presented. High-resolution computerized tomographic scans and intraoperative photomicrographs display features of intralabyrinthine extension. We discuss pathogenetic theories for the development of congenital intralabyrinthine cholesteatoma. The distinction of this condition from congenital cholesteatoma with labyrinthine erosion is discussed.