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Anatomy of the Approach to the Petrous Apex Through the Superior Semicircular Canal
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
R523 Evaluation of Quality of Life after Intratympanic Gentamicin for Me ´ nie ` re’s Disease Animesh Samar Banerjee, MD MS FRCSI (presenter) Newcastle Upon Tyne United Kingdom
Problem: To evaluate quality of life after Intratympanic Gentamicin for Meniere’s disease Methods: This retrospective study included all patients diagnosed of Meniere’s disease according to AAO-HNS criteria (refractory to medical management), undergoing Gentamicin labyrinthectomy in this unit over the preceding three years. Other causes of hearingloss were ruled out as all patients underwent MRI scan, ENG and Sway Magnetomety. Patients underwent gentamicin infiltration at concentration of 2mls of 30mg/ml & reviewed 6 weeks later with repeat injection if no benefit. Six months after their last follow up, they were sent GBI questionnaire. Twenty one questionnaires were posted, response rate was 81%. Results: As per the responses received, total benefit of intratympanic gentamicin injection was found to be ⫹30.3. Three components of GBI were analysed separately and it was found that general benefit was maximum (⫹33.3) followed by physical benefit (⫹28.1) and social benefit (⫹21.6) Conclusion: This study suggests that gentamicin definitely improves QoL in patients with Meniere’s disease and should be the first line of treatment if medical management fails. Significance: This study suggests that gentamicin definitely improves QoL in patients with Meniere’s disease and is relatively safe in preservation of hearing. It should be the first line of treatment if medical management fails R524 Anatomy of the Approach to the Petrous Apex Through the Superior Semicircular Canal Hamid R Djalilian, MD (presenter); Gina D Jefferson, MD; Helen Xiao-ou Xu, MD Los Angeles CA; Los Angeles CA; Los Angeles CA
Problem: The goal of this study is to use high resolution CT imaging to measure the means and ranges for the surgical approach to the petrous apex through the crura of the superior semicircular canal (SCC). Methods: High-resolution CT images of the temporal bone 1.0mm apart were obtained. Identical head position was insured using fixed landmarks. All patients were 18 years of age or older. Twenty of the 116 temporal bones had pneumatiza-
tion of the petrous apex and were examined for the study. Films were read by a neurotologist and neuroradiologist for evidence of abnormalities. Measurements were made using the standard PACS (picture archiving and communication system) measurement software. Results: Seven (35%) of the 20 temporal bones had air cells between the crura of the SSC. The mean anteriorposterior (AP) dimension of the intercrural space of the SSC was 3.67⫹/-0.31mm. The mean superior-inferior dimension of the approach was 3.59⫹/-0.31mm. When air cells were present in the intercrural space, the dimensions of the approach increased to 3.93⫹/-0.61mm for the AP dimension and 3.91⫹/-0.66mm for the superior-inferior dimension. Conclusion: Our study of 20 temporal bones provides the surgeon with the mean and ranges of the dimensions of the petrous apex approach through the crura of the SSC. These measurements show that this approach is anatomically possible for drainage of petrous apex cholesterol granulomas with minimal risk to the SSC by traversing the intercrural space. Resection of petrous apex lesions is probably not possible given the small intercrural space. Significance: This study allows the clinician to understand the dimensions and plausability of the surgical approach to the petrous apex through the crura of the superior semicircular canal. R525 Capping of the Third Window: A Five-Year Review of Superior Canal Dehiscence Syndrome Nathan Wayne Hales, MD (presenter); James E Saunders, MD Oklahoma City OK; Oklahoma City OK
Problem: Superior canal dehiscence (SCD) syndrome consists of vestibular and audiologic signs and symptoms, as well as bony dehiscence over the superior semicircular canal (SSC) on temporal bone CT. Medical and surgical treatments including SSC ablation and plugging have been reported. Nevertheless, several unresolved issues remain including the constellation of symptoms considered diagnostic, the pathophysiology of certain clinical features such as self-audible eye movements, and the optimal surgical technique. Methods: A retrospective review of eight patients with signs, symptoms, and imaging findings consistent with the diagnosis of SCD are presented. These findings will be compared with previous reports of SCD. The medical and surgical management will also be presented including a technique of capping the SSC, without ablation or plugging, intended to preserve SSC function. Results: The average age was 46 years old. No prior history of related trauma or infection was identified. No familial pattern was identified. The four most common presenting symptoms were: noise and pressure-induced dizziness, roaring tinnitus, pressure sensation, and hearing loss. A significant number of patients had self-audible eye move-
POSTERS
burden for the central vestibular nuclei in patients compared to surgical labyrinthectomy. Support: Supported by NIDCD R03 DC005700, K23 DC00196-01, R01 DC02390, T32 DC00027, P30 DC05211, grants from the Finnish Medical Foundation, Finnish Academy, and American Academy of Otolaryngology-Head and Neck Surgery Foundation.
Research Posters P133
R523 Evaluation of Quality of Life after Intratympanic Gentamicin for Me ´ nie ` re’s Disease Animesh Samar Banerjee, MD MS FRCSI (presenter) Newcastle Upon Tyne United Kingdom
Problem: To evaluate quality of life after Intratympanic Gentamicin for Meniere’s disease Methods: This retrospective study included all patients diagnosed of Meniere’s disease according to AAO-HNS criteria (refractory to medical management), undergoing Gentamicin labyrinthectomy in this unit over the preceding three years. Other causes of hearingloss were ruled out as all patients underwent MRI scan, ENG and Sway Magnetomety. Patients underwent gentamicin infiltration at concentration of 2mls of 30mg/ml & reviewed 6 weeks later with repeat injection if no benefit. Six months after their last follow up, they were sent GBI questionnaire. Twenty one questionnaires were posted, response rate was 81%. Results: As per the responses received, total benefit of intratympanic gentamicin injection was found to be ⫹30.3. Three components of GBI were analysed separately and it was found that general benefit was maximum (⫹33.3) followed by physical benefit (⫹28.1) and social benefit (⫹21.6) Conclusion: This study suggests that gentamicin definitely improves QoL in patients with Meniere’s disease and should be the first line of treatment if medical management fails. Significance: This study suggests that gentamicin definitely improves QoL in patients with Meniere’s disease and is relatively safe in preservation of hearing. It should be the first line of treatment if medical management fails R524 Anatomy of the Approach to the Petrous Apex Through the Superior Semicircular Canal Hamid R Djalilian, MD (presenter); Gina D Jefferson, MD; Helen Xiao-ou Xu, MD Los Angeles CA; Los Angeles CA; Los Angeles CA
Problem: The goal of this study is to use high resolution CT imaging to measure the means and ranges for the surgical approach to the petrous apex through the crura of the superior semicircular canal (SCC). Methods: High-resolution CT images of the temporal bone 1.0mm apart were obtained. Identical head position was insured using fixed landmarks. All patients were 18 years of age or older. Twenty of the 116 temporal bones had pneumatiza-
tion of the petrous apex and were examined for the study. Films were read by a neurotologist and neuroradiologist for evidence of abnormalities. Measurements were made using the standard PACS (picture archiving and communication system) measurement software. Results: Seven (35%) of the 20 temporal bones had air cells between the crura of the SSC. The mean anteriorposterior (AP) dimension of the intercrural space of the SSC was 3.67⫹/-0.31mm. The mean superior-inferior dimension of the approach was 3.59⫹/-0.31mm. When air cells were present in the intercrural space, the dimensions of the approach increased to 3.93⫹/-0.61mm for the AP dimension and 3.91⫹/-0.66mm for the superior-inferior dimension. Conclusion: Our study of 20 temporal bones provides the surgeon with the mean and ranges of the dimensions of the petrous apex approach through the crura of the SSC. These measurements show that this approach is anatomically possible for drainage of petrous apex cholesterol granulomas with minimal risk to the SSC by traversing the intercrural space. Resection of petrous apex lesions is probably not possible given the small intercrural space. Significance: This study allows the clinician to understand the dimensions and plausability of the surgical approach to the petrous apex through the crura of the superior semicircular canal. R525 Capping of the Third Window: A Five-Year Review of Superior Canal Dehiscence Syndrome Nathan Wayne Hales, MD (presenter); James E Saunders, MD Oklahoma City OK; Oklahoma City OK
Problem: Superior canal dehiscence (SCD) syndrome consists of vestibular and audiologic signs and symptoms, as well as bony dehiscence over the superior semicircular canal (SSC) on temporal bone CT. Medical and surgical treatments including SSC ablation and plugging have been reported. Nevertheless, several unresolved issues remain including the constellation of symptoms considered diagnostic, the pathophysiology of certain clinical features such as self-audible eye movements, and the optimal surgical technique. Methods: A retrospective review of eight patients with signs, symptoms, and imaging findings consistent with the diagnosis of SCD are presented. These findings will be compared with previous reports of SCD. The medical and surgical management will also be presented including a technique of capping the SSC, without ablation or plugging, intended to preserve SSC function. Results: The average age was 46 years old. No prior history of related trauma or infection was identified. No familial pattern was identified. The four most common presenting symptoms were: noise and pressure-induced dizziness, roaring tinnitus, pressure sensation, and hearing loss. A significant number of patients had self-audible eye move-
POSTERS
burden for the central vestibular nuclei in patients compared to surgical labyrinthectomy. Support: Supported by NIDCD R03 DC005700, K23 DC00196-01, R01 DC02390, T32 DC00027, P30 DC05211, grants from the Finnish Medical Foundation, Finnish Academy, and American Academy of Otolaryngology-Head and Neck Surgery Foundation.
Research Posters P133