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SP342 – MRI as single early diagnostic modality for SSNHL etiology
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Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
cochlea measured in this study had good agreement with that defined by anatomy. SP339 – MF access to the IAC: 3D reconstruction and bone dissection. Maurizio Levorato, MD (presenter); Arnau Benet; Victoria Rivero de Jesus, MD; Luis Garcia-Ibanez, MD; Alberto Prats-Galino; Joan Bereguer; Jordina Rincon Torroella OBJECTIVES: 1) Learn surgical middle fossa access to internal auditory canal. 2) Standardize 3D imaging reconstruction 3) Compare radiological/anatomical measurements. METHODS: Study design: descriptive anatomical and radiological study. Period: May 2007 to December 2008. Condition studied: We analyzed the middle fossa anatomy for the access to the IAC with multislice HRCTscan (3D reconstruction Amira 3.0 program) and cadaver dissection. Subjects: seven cadavers (14 temporal bones). Setting: laboratory of surgical neuroanatomy. Interventions: seven cadavers were analyzed radiologically and six dissected through MF access. Outcome measurements: Angular relation among the axis of: internal auditory canal (IAC); arcuate eminence (AE); blue line-superior semicircular canal (BL); and greater superficial petrosal nerves (GSPN). Independent variables: AE, GSPN, BL, IAC. Statistical method: descriptive statistical method. RESULTS: Dissection: GSPN-AE mean 113, s.d. 12.3, min 94, max 133, median 110; GSPN-BL mean 94.7, s.d. 8.9, min 85, max 110, median 92.5; IAC-GSPN mean 53.7, s.d. 8.4, min 39, max 71, median 52; IAC-BL mean 41, s.d. 9.2, min 25, max 56, median 40; IAC-AE mean 60.9, s.d. 13.2, min 44, max 83, median 60. Radiology: GSPN-AE mean 129.4, s.d. 24.7, min 94, max 165; GSPN-BL mean 87.1, s.d. 5.9, min 77, max 98; IAC-GSPN mean 50.7, s.d. 5.6, min 39, max 58; IAC-BL mean 36.5, s.d. 7.5, min 19, max 46; IAC-AE mean 79.2. CONCLUSIONS: 3D reconstruction help junior otoneurologists to understand MF anatomy and to safely access the IAC. We find a big variability in the position/morphology of the AE and stability in the relation between BL and GSPN with respect to the IAC. SP332 – Morphologic change and hearing recovery in cochlea after intratympanic insulin Sang-Won Yeo, MD (presenter); Jung-Hae Cho, MD; Kyoung-Ho Park; Shi-Nae Park, MD, PhD OBJECTIVES: To investigate the effectiveness of intratympanic insulin like growth factor-1 (IGF-1) on deafened guinea pigs induced by co-administration of kanamycin and ethacrynic acid. METHODS: Co-administration of kanamycin and ethacrynic acid was applied for deafening the guinea pigs. An absorbable
gelatin sponge immersed with rhIGF-1 (recombinant human insulin like growth factor-1) was placed on the round window membrane of experimental ear while saline was applied to control-side ear. Hearing function was assessed by auditory brain stem responses. The temporal bones were collected for analyzing the histology of hair cells in the organ of corti. RESULTS: Local IGF-1 treatment significantly reduced the elevation of ABR thresholds after applying ototoxic agents. Histologic analysis revealed that local rhIGF treatment significantly could promote the repair of hair cell. CONCLUSIONS: These findings demonstrate that local IGF-1 application has the potential for repairing of outer hair cells from ototoxic agent. On the basis of this study, the clinical use of local rhIGF-1 application via gelatin sponge can be considered as a therapeutic option for the treatment of sensory neural hearing loss. SP342 – MRI as single early diagnostic modality for SSNHL etiology Alaa Ali Abou-Bieh, MB, BCh, MSc (ORL), MD (ORL), DO-HNS (RCS Eng) (presenter); Osama Kombar OBJECTIVES: To estimate the role of magnetic resonance imaging (MRI) scan with contrast and more recently FIESTA sequence as the single best imaging modality that can diagnose most sudden sensorineural hearing loss (SSNHL) cases. METHODS: A retrospective chart and data review study included 72 SSNHL cases between mid 2006 to mid 2008 in a tertiary referral hospital. Beside the imaging studies, data reviewed included history, clinical manifestations, audiological workup, and laboratory investigations. The main outcome measure of this study was the role of MRI to approach the final diagnosis. RESULTS: A final diagnosis could be approached in 19 cases (26%). The etiologies were acoustic neuroma, Me´nie`re’s Disease, vestibulocochlear neuritis, labyrinsitis, temporal bone fractures, round window fistula, cerebrovascular accidents, multiple sclerosis, temporal lobe meningioma, Wernicke’s encephalopathy, and leukemia. MRI, especially FIESTA sequence, could finalize the diagnosis except for traumatic cases. CONCLUSIONS: MRI can guide the diagnosis at the time of clinical presentation especially in cases with progressive and more importantly life threatening etiologies. The FIESTA imaging as a stand-alone protocol reduced the examination time and eliminated the need for contrast. SP285 – Myringoplasty using the autologous fibrin membrane and gel Yoichi Matsuda, MD (presenter); Tadashi Nakashima, MD OBJECTIVES: The simple underlay myringoplasty is performed more easily. However, this procedure needs fibrin glue
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
cochlea measured in this study had good agreement with that defined by anatomy. SP339 – MF access to the IAC: 3D reconstruction and bone dissection. Maurizio Levorato, MD (presenter); Arnau Benet; Victoria Rivero de Jesus, MD; Luis Garcia-Ibanez, MD; Alberto Prats-Galino; Joan Bereguer; Jordina Rincon Torroella OBJECTIVES: 1) Learn surgical middle fossa access to internal auditory canal. 2) Standardize 3D imaging reconstruction 3) Compare radiological/anatomical measurements. METHODS: Study design: descriptive anatomical and radiological study. Period: May 2007 to December 2008. Condition studied: We analyzed the middle fossa anatomy for the access to the IAC with multislice HRCTscan (3D reconstruction Amira 3.0 program) and cadaver dissection. Subjects: seven cadavers (14 temporal bones). Setting: laboratory of surgical neuroanatomy. Interventions: seven cadavers were analyzed radiologically and six dissected through MF access. Outcome measurements: Angular relation among the axis of: internal auditory canal (IAC); arcuate eminence (AE); blue line-superior semicircular canal (BL); and greater superficial petrosal nerves (GSPN). Independent variables: AE, GSPN, BL, IAC. Statistical method: descriptive statistical method. RESULTS: Dissection: GSPN-AE mean 113, s.d. 12.3, min 94, max 133, median 110; GSPN-BL mean 94.7, s.d. 8.9, min 85, max 110, median 92.5; IAC-GSPN mean 53.7, s.d. 8.4, min 39, max 71, median 52; IAC-BL mean 41, s.d. 9.2, min 25, max 56, median 40; IAC-AE mean 60.9, s.d. 13.2, min 44, max 83, median 60. Radiology: GSPN-AE mean 129.4, s.d. 24.7, min 94, max 165; GSPN-BL mean 87.1, s.d. 5.9, min 77, max 98; IAC-GSPN mean 50.7, s.d. 5.6, min 39, max 58; IAC-BL mean 36.5, s.d. 7.5, min 19, max 46; IAC-AE mean 79.2. CONCLUSIONS: 3D reconstruction help junior otoneurologists to understand MF anatomy and to safely access the IAC. We find a big variability in the position/morphology of the AE and stability in the relation between BL and GSPN with respect to the IAC. SP332 – Morphologic change and hearing recovery in cochlea after intratympanic insulin Sang-Won Yeo, MD (presenter); Jung-Hae Cho, MD; Kyoung-Ho Park; Shi-Nae Park, MD, PhD OBJECTIVES: To investigate the effectiveness of intratympanic insulin like growth factor-1 (IGF-1) on deafened guinea pigs induced by co-administration of kanamycin and ethacrynic acid. METHODS: Co-administration of kanamycin and ethacrynic acid was applied for deafening the guinea pigs. An absorbable
gelatin sponge immersed with rhIGF-1 (recombinant human insulin like growth factor-1) was placed on the round window membrane of experimental ear while saline was applied to control-side ear. Hearing function was assessed by auditory brain stem responses. The temporal bones were collected for analyzing the histology of hair cells in the organ of corti. RESULTS: Local IGF-1 treatment significantly reduced the elevation of ABR thresholds after applying ototoxic agents. Histologic analysis revealed that local rhIGF treatment significantly could promote the repair of hair cell. CONCLUSIONS: These findings demonstrate that local IGF-1 application has the potential for repairing of outer hair cells from ototoxic agent. On the basis of this study, the clinical use of local rhIGF-1 application via gelatin sponge can be considered as a therapeutic option for the treatment of sensory neural hearing loss. SP342 – MRI as single early diagnostic modality for SSNHL etiology Alaa Ali Abou-Bieh, MB, BCh, MSc (ORL), MD (ORL), DO-HNS (RCS Eng) (presenter); Osama Kombar OBJECTIVES: To estimate the role of magnetic resonance imaging (MRI) scan with contrast and more recently FIESTA sequence as the single best imaging modality that can diagnose most sudden sensorineural hearing loss (SSNHL) cases. METHODS: A retrospective chart and data review study included 72 SSNHL cases between mid 2006 to mid 2008 in a tertiary referral hospital. Beside the imaging studies, data reviewed included history, clinical manifestations, audiological workup, and laboratory investigations. The main outcome measure of this study was the role of MRI to approach the final diagnosis. RESULTS: A final diagnosis could be approached in 19 cases (26%). The etiologies were acoustic neuroma, Me´nie`re’s Disease, vestibulocochlear neuritis, labyrinsitis, temporal bone fractures, round window fistula, cerebrovascular accidents, multiple sclerosis, temporal lobe meningioma, Wernicke’s encephalopathy, and leukemia. MRI, especially FIESTA sequence, could finalize the diagnosis except for traumatic cases. CONCLUSIONS: MRI can guide the diagnosis at the time of clinical presentation especially in cases with progressive and more importantly life threatening etiologies. The FIESTA imaging as a stand-alone protocol reduced the examination time and eliminated the need for contrast. SP285 – Myringoplasty using the autologous fibrin membrane and gel Yoichi Matsuda, MD (presenter); Tadashi Nakashima, MD OBJECTIVES: The simple underlay myringoplasty is performed more easily. However, this procedure needs fibrin glue