- Email: [email protected]
P114
P250
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
METHODS: 99 subjects complaining of chronic tinnitus (67 male and 32 female) were recruited from a tinnitus clinic and underwent a detailed neuro-otological examination including otoscopy, stapedius reflexes, middle ear pressure measurements, pure tone audiometry, tinnitus pitch and loudness matches. Tinnitus severity was assessed by the Tinnitus Questionnnaire (TQ) and subjects were genotyped for two biallelic BDNF markers, an intronic A⬎T substitution (refSNP# rs2049046), plus a functional missense variant (Val66Met, rs6265). RESULTS: When genotypes were grouped at both loci assuming dominance of the lesser alleles, no effects were observed for the intronic BDNF variant. However, carriers of the BDNF missense variant differed significantly from other subjects with regard to the prevalence of comorbid hearing impairment (p⫽.01). In addition, tinnitus symptomatology was found to be milder in male subjects carrying the missense variant (p⬍.05). CONCLUSIONS: This is the first study to address the participation of BDNF variants in the genetic susceptibility to chronic tinnitus. Pending replication in larger samples, a genotype-wise association with comorbid hearing impairment and, to a lesser extent, with tinnitus severity, argues in favour of a modifying role in defined tinnitus phenotypes.
P112 Intratemporal Facial Nerve Tumors: Management Controversies Diogo Oliveira Carmo, MD (presenter); Hugo Estibeiro, MD; Carlos Stapleton Garcia, MD; Alfredo H Luis, MD; Joao Carlos Lopes Simoes Paco, MD PhD Lisbon Portugal; Caldas da Rainha Portugal OBJECTIVES: The goal is to review and update the different strategies used in the management of intratemporal facial nerve tumors. METHODS: The authors performed a retrospective review of the world medical literature and review their experience with intratemporal facial nerve tumors management: conservative management, wide decompression, tumor remotion with preservation of uninvolved fibers, and excision associated with nerve repair (facial nerve reconstruction with hypoglossalfacial anastomosis). RESULTS: Intratemporal tumors of the facial nerve are relatively rare. Excision of a facial neuroma almost always results in some degree of permanent facial dysfunction even when primary nerve anastomoses or grafting is accomplished. Because these neoplasms are invariably slow-growing, sacrifice of facial motor function in all cases may be either unwarranted or unacceptable to some patients. CONCLUSIONS: These tumors threaten function rather than life, and thus decisions should be based largely on the long– term functional implications of each management choice. The decision on how to treat these patients should be individualized
and based on facial function, growth rate, location, age, surgical experience, and informed patient consent.
P113 High-Resolution MRI in Patients with Meniere’s Disease Robert D Silver, MD (presenter); Alok Bachuwar, BS; Frank L Rimell, MD; Samuel C Levine, MD Edina MN; Minneapolis MN OBJECTIVES: Endolymphatic hydrops is the generally accepted pathophysiologic endpoint accountable for symptoms of Meniere’s disease. Multiple factors affect endolymph production and fluid homeostasis, leading to temporary threshold shifts and possibly explaining symptomatology without radiographically observable findings. The aim of this study was to evaluate the fluid spaces of the inner ear with new, clinically available high-resolution MRI in order to assess the feasibility for inclusive radiographic findings in establishing a diagnosis of Meniere’s disease. METHODS: A prospective analysis of 10 healthy volunteers and 10 patients with unilateral Meniere’s disease was performed. A noncontrast-enhanced three-dimensional constructive interference in steady state sequence was chosen for imaging vestibulocochlear anatomy using a 3 Tesla MRI scanner. Vestibulocochlear fluid volumes, endolymphatic duct and sac measurements, and signal intensities of multiple fluid spaces were measured. RESULTS: Vestibulocochlear fluid volumes in healthy volunteers and Meniere’s patients were measured. Mean volumes were 0.242 mL and 0.227 mL (p⫽0.057), respectively. The distance from the posterior semicircular canal to the posterior fossa dura was measured and found to be shorter on the affected side in 90% of Meniere’s patients by a mean difference of 26.3% (p⬍0.002). No significant difference was observed in MRI signal intensities between affected and unaffected ears or between affected ears and healthy volunteers (all p-values ⬎ 0.05). CONCLUSIONS: The findings in this study demonstrate a new method for reliably determining vestibulocochlear fluid volumes, using MRI pixel signal intensities in patients with Meniere’s disease.
P114 Internal Carotid Artery Dehiscence Masquerading as OME Alexander Ross Anderson, MBChB (presenter); Arunachalam Perumkulam Iyer, MS (ENT) DLO FRCS Heckmondwike UK; Sheffield UK OBJECTIVES: Description of a case of total dehiscence of the internal carotid artery in the middle ear cleft that was mistaken for OME and listed for myringotomy.
METHODS: A case report in December 2005. A patient with a totally dehiscent internal carotid artery presented initially with signs of a pinna cellulitis. This settled with intravenous antibiotics and was replaced by signs and symptoms masquerading as OME. A junior member of the team decided a myringotomy and grommet insertion under general anaesthetic was needed. The patient was reviewed prior to admission by the consultant who arranged a high-resolution CT of the ear and temporal bone after otoscopic examination. RESULTS: Otoscopy revealed a highly vascular lesion pressing on the posterior-medial aspect of the tympanic membrane. No evidence of effusion was seen. CT showed a totally dehiscent internal carotid artery in the middle ear cleft, pressing on the tympanic membrane. Severe complications of a myringotomy were averted. CONCLUSIONS: An unusual pathology is described and illustrated with CT scans. Otoscopy prior to myringotomy should always be performed by clinicians with many years of practice at this difficult skill. P115 Movements of Ferro-Magnetic Prostheses in a 9.4 T MRI Ilka Charlotte Naumann, MD (presenter); Michael H Fritsch, MD Indianapolis IN OBJECTIVES: Increasing MRI resolution requires stronger magnetic fields. Otologic prostheses implanted into patients and subjected to these stronger magnetic fields could move and dislocate from their intended positions. This study looked at this phenomenon to determine if it is a matter of concern. METHODS: Twenty-three middle ear prostheses were initially place into a petri dish and exposed to a 9.4 Tesla MR field. The clinical scenario was then simulated by implanting the prostheses in cadaveric human temporal bones. Movements were recorded. Heat and vibration were not recorded. RESULTS: Nine middle ear prostheses were seen to move dramatically in-vitro in the Petri dish experiment. No extrusion or large displacement was found when placed into the temporal bone. CONCLUSIONS: Certain prostheses show large movements in-vitro. Although no large displacement was noted when the prostheses were placed at their surgical site, other factors, such as heat, voltage induction, and vibration have to be considered as potential hazards. The findings of the experimental model for ferro-magnetic movements of middle ear protheses suggest that stabililty of otological implants that are exposed to newgeneration MR scanners may be of concern. P116 Changing the Click Characteristics during the ABR Recording Mariana Lopes Favero, MD (presenter); Alfredo Tabith, Jr, MD; Fernanda Stavale Nicastro, MD; Monica Gudmon Sa˜o Paulo Brazil
P251 OBJECTIVES: Analyze the effect of click manipulations in potentials records of patients with hearing loss as a way to improve the diagnosis. METHODS: In a transversal cohort between August 2002 and February 2004, 59 patients (mean age 11.3 years, SD⫾ 8.5 years) with hearing loss underwent ABR record using a rarefaction and condensation click at a rate stimulus of 27.7 stimuli per second, and a rarefaction click at a rate stimulus of 3.3 rate stimuli per second. The records were compared to the otoacoustic-evoked emission. RESULTS: Eight (13.53%) patients showed ABR potentials record changes with the click characteristic manipulations, as an extended cochlear microphonic or a better electric potential record. Five of them did not have any otoacoustic-evoked emission. CONCLUSIONS: The manipulations of click stimuli can improve the hearing loss topographic diagnosis, mainly in that group of auditory neuropathy patients without otoacousticevoked emission–the usual way to diagnose the problem. P117 Low-Set Ear Associated with Congenital Anomalies Norberto Lopez, MD (presenter); Rodolfo Martinez Burckhardt, MD; Alfredo Nunez-Castruita, MD; Guadalupe Valentina Esparza, Jr; Carlos E. De La Garza-Gonzalez, MD; Scott M Graham, MD Monterrey Mexico; Linda Vista Guadalupe Mexico; Iowa City IA OBJECTIVES: To analyze the association of low-set ears with other congenital anomalies in human fetuses. METHODS: A retrospective and descriptive study was made using 463 human fetuses from the 8th to 24th week of morphological age. Position of the ears was determined using a horizontal line passing through the inner canthi of the eyes. For fetuses with a low-positioned ear, dissection of the thoracic and abdominal cavities was done to search for congenital anomalies. RESULTS: From 463 analyzed fetuses, 34 had low-set ears (7.4%). In thoracic and abdominal dissection, 17 fetuses (50%) were found with no anomalies; 8 fetuses (23.5%) had kidney anomalies: malrotation, polar arteries and crossed renal ectopia; 3 fetuses (8.8%) had anomalies in gastrointestinal development like terminal atressia; 2 fetuses (5.8%) presented bilateral adrenal hypoplasia; 1 fetus (2.9%) had an umbilical hernia, another one (2.9%) had ambiguous external genitalia. Another one had hallux valgus (2.9%) and 1 fetus (2.9%) had retroperitoneal cysts. CONCLUSIONS: The results obtained corroborate that the association of low-set ears with morphological anomalies is very high (50%) and as reported in literature, renal anomalies are on the top of the list (23.5%). Nevertheless, the presence of anomalies in other organs is also high, especially the ones that affect the intestinal and genital systems. Thus, the anterior
SCIENTIFIC POSTERS
Scientific Posters—Wednesday
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
METHODS: 99 subjects complaining of chronic tinnitus (67 male and 32 female) were recruited from a tinnitus clinic and underwent a detailed neuro-otological examination including otoscopy, stapedius reflexes, middle ear pressure measurements, pure tone audiometry, tinnitus pitch and loudness matches. Tinnitus severity was assessed by the Tinnitus Questionnnaire (TQ) and subjects were genotyped for two biallelic BDNF markers, an intronic A⬎T substitution (refSNP# rs2049046), plus a functional missense variant (Val66Met, rs6265). RESULTS: When genotypes were grouped at both loci assuming dominance of the lesser alleles, no effects were observed for the intronic BDNF variant. However, carriers of the BDNF missense variant differed significantly from other subjects with regard to the prevalence of comorbid hearing impairment (p⫽.01). In addition, tinnitus symptomatology was found to be milder in male subjects carrying the missense variant (p⬍.05). CONCLUSIONS: This is the first study to address the participation of BDNF variants in the genetic susceptibility to chronic tinnitus. Pending replication in larger samples, a genotype-wise association with comorbid hearing impairment and, to a lesser extent, with tinnitus severity, argues in favour of a modifying role in defined tinnitus phenotypes.
P112 Intratemporal Facial Nerve Tumors: Management Controversies Diogo Oliveira Carmo, MD (presenter); Hugo Estibeiro, MD; Carlos Stapleton Garcia, MD; Alfredo H Luis, MD; Joao Carlos Lopes Simoes Paco, MD PhD Lisbon Portugal; Caldas da Rainha Portugal OBJECTIVES: The goal is to review and update the different strategies used in the management of intratemporal facial nerve tumors. METHODS: The authors performed a retrospective review of the world medical literature and review their experience with intratemporal facial nerve tumors management: conservative management, wide decompression, tumor remotion with preservation of uninvolved fibers, and excision associated with nerve repair (facial nerve reconstruction with hypoglossalfacial anastomosis). RESULTS: Intratemporal tumors of the facial nerve are relatively rare. Excision of a facial neuroma almost always results in some degree of permanent facial dysfunction even when primary nerve anastomoses or grafting is accomplished. Because these neoplasms are invariably slow-growing, sacrifice of facial motor function in all cases may be either unwarranted or unacceptable to some patients. CONCLUSIONS: These tumors threaten function rather than life, and thus decisions should be based largely on the long– term functional implications of each management choice. The decision on how to treat these patients should be individualized
and based on facial function, growth rate, location, age, surgical experience, and informed patient consent.
P113 High-Resolution MRI in Patients with Meniere’s Disease Robert D Silver, MD (presenter); Alok Bachuwar, BS; Frank L Rimell, MD; Samuel C Levine, MD Edina MN; Minneapolis MN OBJECTIVES: Endolymphatic hydrops is the generally accepted pathophysiologic endpoint accountable for symptoms of Meniere’s disease. Multiple factors affect endolymph production and fluid homeostasis, leading to temporary threshold shifts and possibly explaining symptomatology without radiographically observable findings. The aim of this study was to evaluate the fluid spaces of the inner ear with new, clinically available high-resolution MRI in order to assess the feasibility for inclusive radiographic findings in establishing a diagnosis of Meniere’s disease. METHODS: A prospective analysis of 10 healthy volunteers and 10 patients with unilateral Meniere’s disease was performed. A noncontrast-enhanced three-dimensional constructive interference in steady state sequence was chosen for imaging vestibulocochlear anatomy using a 3 Tesla MRI scanner. Vestibulocochlear fluid volumes, endolymphatic duct and sac measurements, and signal intensities of multiple fluid spaces were measured. RESULTS: Vestibulocochlear fluid volumes in healthy volunteers and Meniere’s patients were measured. Mean volumes were 0.242 mL and 0.227 mL (p⫽0.057), respectively. The distance from the posterior semicircular canal to the posterior fossa dura was measured and found to be shorter on the affected side in 90% of Meniere’s patients by a mean difference of 26.3% (p⬍0.002). No significant difference was observed in MRI signal intensities between affected and unaffected ears or between affected ears and healthy volunteers (all p-values ⬎ 0.05). CONCLUSIONS: The findings in this study demonstrate a new method for reliably determining vestibulocochlear fluid volumes, using MRI pixel signal intensities in patients with Meniere’s disease.
P114 Internal Carotid Artery Dehiscence Masquerading as OME Alexander Ross Anderson, MBChB (presenter); Arunachalam Perumkulam Iyer, MS (ENT) DLO FRCS Heckmondwike UK; Sheffield UK OBJECTIVES: Description of a case of total dehiscence of the internal carotid artery in the middle ear cleft that was mistaken for OME and listed for myringotomy.
METHODS: A case report in December 2005. A patient with a totally dehiscent internal carotid artery presented initially with signs of a pinna cellulitis. This settled with intravenous antibiotics and was replaced by signs and symptoms masquerading as OME. A junior member of the team decided a myringotomy and grommet insertion under general anaesthetic was needed. The patient was reviewed prior to admission by the consultant who arranged a high-resolution CT of the ear and temporal bone after otoscopic examination. RESULTS: Otoscopy revealed a highly vascular lesion pressing on the posterior-medial aspect of the tympanic membrane. No evidence of effusion was seen. CT showed a totally dehiscent internal carotid artery in the middle ear cleft, pressing on the tympanic membrane. Severe complications of a myringotomy were averted. CONCLUSIONS: An unusual pathology is described and illustrated with CT scans. Otoscopy prior to myringotomy should always be performed by clinicians with many years of practice at this difficult skill. P115 Movements of Ferro-Magnetic Prostheses in a 9.4 T MRI Ilka Charlotte Naumann, MD (presenter); Michael H Fritsch, MD Indianapolis IN OBJECTIVES: Increasing MRI resolution requires stronger magnetic fields. Otologic prostheses implanted into patients and subjected to these stronger magnetic fields could move and dislocate from their intended positions. This study looked at this phenomenon to determine if it is a matter of concern. METHODS: Twenty-three middle ear prostheses were initially place into a petri dish and exposed to a 9.4 Tesla MR field. The clinical scenario was then simulated by implanting the prostheses in cadaveric human temporal bones. Movements were recorded. Heat and vibration were not recorded. RESULTS: Nine middle ear prostheses were seen to move dramatically in-vitro in the Petri dish experiment. No extrusion or large displacement was found when placed into the temporal bone. CONCLUSIONS: Certain prostheses show large movements in-vitro. Although no large displacement was noted when the prostheses were placed at their surgical site, other factors, such as heat, voltage induction, and vibration have to be considered as potential hazards. The findings of the experimental model for ferro-magnetic movements of middle ear protheses suggest that stabililty of otological implants that are exposed to newgeneration MR scanners may be of concern. P116 Changing the Click Characteristics during the ABR Recording Mariana Lopes Favero, MD (presenter); Alfredo Tabith, Jr, MD; Fernanda Stavale Nicastro, MD; Monica Gudmon Sa˜o Paulo Brazil
P251 OBJECTIVES: Analyze the effect of click manipulations in potentials records of patients with hearing loss as a way to improve the diagnosis. METHODS: In a transversal cohort between August 2002 and February 2004, 59 patients (mean age 11.3 years, SD⫾ 8.5 years) with hearing loss underwent ABR record using a rarefaction and condensation click at a rate stimulus of 27.7 stimuli per second, and a rarefaction click at a rate stimulus of 3.3 rate stimuli per second. The records were compared to the otoacoustic-evoked emission. RESULTS: Eight (13.53%) patients showed ABR potentials record changes with the click characteristic manipulations, as an extended cochlear microphonic or a better electric potential record. Five of them did not have any otoacoustic-evoked emission. CONCLUSIONS: The manipulations of click stimuli can improve the hearing loss topographic diagnosis, mainly in that group of auditory neuropathy patients without otoacousticevoked emission–the usual way to diagnose the problem. P117 Low-Set Ear Associated with Congenital Anomalies Norberto Lopez, MD (presenter); Rodolfo Martinez Burckhardt, MD; Alfredo Nunez-Castruita, MD; Guadalupe Valentina Esparza, Jr; Carlos E. De La Garza-Gonzalez, MD; Scott M Graham, MD Monterrey Mexico; Linda Vista Guadalupe Mexico; Iowa City IA OBJECTIVES: To analyze the association of low-set ears with other congenital anomalies in human fetuses. METHODS: A retrospective and descriptive study was made using 463 human fetuses from the 8th to 24th week of morphological age. Position of the ears was determined using a horizontal line passing through the inner canthi of the eyes. For fetuses with a low-positioned ear, dissection of the thoracic and abdominal cavities was done to search for congenital anomalies. RESULTS: From 463 analyzed fetuses, 34 had low-set ears (7.4%). In thoracic and abdominal dissection, 17 fetuses (50%) were found with no anomalies; 8 fetuses (23.5%) had kidney anomalies: malrotation, polar arteries and crossed renal ectopia; 3 fetuses (8.8%) had anomalies in gastrointestinal development like terminal atressia; 2 fetuses (5.8%) presented bilateral adrenal hypoplasia; 1 fetus (2.9%) had an umbilical hernia, another one (2.9%) had ambiguous external genitalia. Another one had hallux valgus (2.9%) and 1 fetus (2.9%) had retroperitoneal cysts. CONCLUSIONS: The results obtained corroborate that the association of low-set ears with morphological anomalies is very high (50%) and as reported in literature, renal anomalies are on the top of the list (23.5%). Nevertheless, the presence of anomalies in other organs is also high, especially the ones that affect the intestinal and genital systems. Thus, the anterior
SCIENTIFIC POSTERS
Scientific Posters—Wednesday