TUFIK SB, PASSOS UL, CEVASCO FKKI Control #: 1831, eEdE #: eEdE-157

Slides:

Advertisements

Similar presentations

IMAGING OF FAILURES AND COMPLICATIONS AFTER SURGERY FOR OTOSCLEROSIS

Advertisements

Hearing disorders of the middle ear

Chunfu Dai Otolaryngology Department Fudan University

American Academy of Otolaryngology – Head & Neck Surgery Annual Meeting Sep 29 – Oct 2, 2013 Pediatric Ossiculoplasty Should I or Shouldn’t I?

EEdE# 76. No Disclosures Taleb Almansoori, Prasad Hanagandi, Agatha Stanek, Rafael Glikstein. The value of high resolution CT images in the evaluation.

DR SUDEEP K.C.. CLASSIFICATION OF HEARING LOSS AUDITORY PATHWAYS.

Radiologic investigation of Chest and CVS diseases

OTOSCLEROSIS dr. sudeep k.c..

CASE 1/2 SURGEON: Chris ALDREN Wexham Park Hospital Berkshire (UK)

Treatment Antibiotics Antibiotics Surgery Surgery Myringotomy and suction Myringotomy and suction Mastoidectomy (if infection has spread to mastoid region)

Pseudo-conductive Hearing Losses

STAPEDECTOMY Kelsey Carter. A NATOMY Ear Stapes Tympanic membrane Ossicles Incus concha.

Evaluation of Multi-Slice Computed Tomography in Assessment of Cochlear Implant Electrode Position: A pictorial essay By:Fatemeh Nasri Tehran University.

SURGEON: Witold Szyfter Poznan University of Medical Sciences Poznan (Poland) TYPE OF SURGERY: Otosclerosis primary surgery PLANNED SURGERY: Stapedotomy.

Acoustic and Implant Driven Vibrations of the Round Window Jonathan H. Spindel 1, Richard L. Goode 2, Alex Huber 3, Geoffrey Ball 4 Department of Integrated.

Dr.Khabti Muhanna Mr.Khalid Alaqeel Department of Otolaryngology,

C OMPUTED T OMOGRAPHY - II RAD 473 Prepared By: Ala’a Ali Tayem Abed.

上海市第六人民医院 Shanghai Sixth People’s Hospital Shankai Yin Prof Dept of Otolaryngology Affiliated Sixth Hospital Otolaryngology Institute Shanghai Jiao Tong.

TYPE OF SURGERY Cochlear implant surgery PLANNED SURGERY MED EL Flex Soft cochlear implantation for Partial Deafness Treatment (left ear) SURGICAL TECHNIQUE.

1 Chapter 32 Hearing Loss in Osteogenesis Imperfecta Copyright © 2014 Elsevier Inc. All rights reserved.

Temporal bone. Left bone.

OTOSCLEROSIS SDL 22 3/14/2014. Learning Objectives Upon completion of this module the student will: 1. Define and describe otosclerosis. 2. Discuss epidemiology.

SDL 18: Otosclerosis.

Ever Heard of Third Window Hearing Loss?

2018 American Board of Oral Implantology/Implant Dentistry Case Submission template.

Imaging of fibro-osseous lesions of the temporal bone

ANATOMY THE EAR Dr. J.K. GERALD, (MD, MSc.).

Fig 2. Arrow indicating obliteration of the oval window

Neurology of The Ear.

2018 American Board of Oral Implantology/Implant Dentistry Case Submission template.

Bilateral cavitary plaques.

Fig. 3. Otologic manifestations and facial expressions of case 2

OTOSCLEROSIS (Syn. Otospongiosis)

The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma

Acquired cochlear nerve deficiency in a 14-year-old patient with hearing loss after meningococcal meningitis at the age of 6 months (patient A3). Acquired.

Mural cholesteatoma. Mural cholesteatoma. Axial (A) and coronal (B) HRCT scans show the shell of the cholesteatoma in the epitympanum (black arrow) and.

Patient with cholesteatoma on the right and chronic otitis media without cholesteatoma on the left. Patient with cholesteatoma on the right and chronic.

Ossicular connections

ANATOMY AND PHYSIOLOGY OF THE EAR

Case 1, a 76-year-old woman with low back pain

Normal progression of interbody fusion in a 28-year-old woman.

Intraosseous temporal bone meningioma in a 45-year-old woman who presented with left-sided hearing loss and tinnitus. Intraosseous temporal bone meningioma.

Fig. 2. Otologic manifestations and facial expressions of case 1

A and B, HRCT of petrous temporal bones.

2020 American Board of Oral Implantology/Implant Dentistry Case Submission template.

A, Axial CT in a 15-year-old girl with persistent conductive hearing loss poststapedectomy shows a small lucency in the left fissula antefenestrum (thin.

Axial contrast-enhanced neck CT scans and 3D reformat performed in a 59-year-old-man who underwent fibular free flap reconstruction for osteomyelitis complicating.

Case 4: 25-year-old woman with pulsatile tinnitus.

A, Axial CT in a 41-year-old man with vertigo and complete sensorineural hearing loss in the left ear after prior stapedectomy show focal hyperattenuation.

Case 1: 47-year-old woman with left TMJ swelling and pain.

High resolution bone algorithm CT scans.

Two different cases of FNS, both coronal plane bone algorithm CT images show significant enlargement of the tympanic segment of the facial nerve with the.

EACC with intramural bone fragments.

An axial T2-weighted MR image (A) reveals mixed signal intensities with minimal surrounding edema in the right posterior mobile tongue. An axial T2-weighted.

Schematic drawing (A) showing the normal appearance (a) of the malleus head (mh) and incus body (ib) and the abnormal fused dysplastic malleus-incus complex,

Figure 13b. Medium-energy injuries to the left orbital floor and zygomatic complex in a 10-year-old girl after a motor vehicle accident. (a) Axial CT.

Case 1: 52-year-old woman with buzzing in right ear.

A, The axial HRCT image of the right temporal bone in case 1 shows an erosion in the posterior temporal bone wall (arrow). A, The axial HRCT image of the.

Case 1: 9-year-old girl with profound bilateral congenital sensorineural hearing loss. Case 1: 9-year-old girl with profound bilateral congenital sensorineural.

Bone algorithm CT images from the same case, demonstrating focal enlargement of the right tympanic segment, in the axial (left) and coronal (right) planes.

A 41-year-old man with apparent thrombosis of the entire right internal jugular vein (IJV). A 41-year-old man with apparent thrombosis of the entire right.

Postoperative study of the position of electrode contacts in a patient with bilateral implantation of electrodes in the STN for the treatment of PD. Postoperative.

Patient 10. Patient 10. A 67-year-old man after radiation therapy at an outside hospital for base-of-tongue cancer. A and B, Axial contrast-enhanced CT.

A–C, Thin-section (1-mm) coronal and axial CT images of the skull base obtained with an edge-enhancing bone algorithm show enlargement (arrows) of the.

BOR syndrome. BOR syndrome. A, Axial CT image through the level of the cochlear aperture demonstrates a hypoplastic cochlea without a definable modiolus.

Noncontrast CBCT scan of a 13-year-old boy acquired with a sinus protocol (40 seconds, 600 frames, 0.4-mm pixels, 120 kVp, 48 mA). Noncontrast CBCT scan.

Case 2: 16-year-old boy, brother of girl in case 1, also with profound bilateral congenital sensorineural hearing loss. Case 2: 16-year-old boy, brother.

58 year-old man referred for SNHL and vertigo 2 days after stapedectomy with a reparative intravestibular granuloma, confirmed by surgery. 58 year-old.

A, Axial CT in an 80-year-old man with sensorineural hearing loss shows deep intrusion into the vestibule (arrow). A, Axial CT in an 80-year-old man with.

Presentation transcript:

TUFIK SB, PASSOS UL, CEVASCO FKKI Control #: 1831, eEdE #: eEdE-157 POST-OPERATORY EVALUATION OF OTOSCLEROSIS: NORMAL FINDINGS AND COMPLICATIONS THAT RADIOLOGISTS SHOULD KNOW AND REPORT TUFIK SB, PASSOS UL, CEVASCO FKKI Control #: 1831, eEdE #: eEdE-157

DISCLOSURE None of the authors has any conflict of interest to disclose.

CONTENTS Methods; Results; Introduction to otosclerosis; Normal post-operatory imaging; Complications.

METHODS 28 patients with 37 otosclerosis lesions treated with surgical procedures; Scanned on 16-channel Siemens CT and 64-channel GE CT from 2010 to 2015; Centro de Diagnósticos Brasil in Sao Paulo; Analyzed by two ENT radiologists with more than 10 years experience.

RESULTS Normal positioned prosthesis 10 Misplacement of the prosthesis 11 Labyrinthitis ossificans 8 Incus luxation 2 Incus interposition Pneumolabirinth 1 Development of reparative granulomas Proliferation of otosclerosis around the prosthesis Prosthesis fracture

RESULTS Misplacement of the prosthesis 11 Labyrinthitis ossificans 8 Incus luxation 2 Incus interposition Pneumolabirinth 1 Development of reparative granulomas Proliferation of otosclerosis around the prosthesis Prosthesis fracture

INTRODUCTION TO OTOSCLEROSIS Autosomal dominant osteodystrophy; Usually occurs in the 2nd and 4th decades of life; Progressive hearing loss (conductive, sensorineural or mixed); More common in Caucasians and women; Commonly bilateral (85%); Types: fenestral and retrofenestral.

INTRODUCTION TO OTOSCLEROSIS Stapedectomy: removal of the stapes, replacing it with a micro prosthesis. Stapedotomy: creation of a small hole in the fixed stapes and inserting a piston-like prosthesis. Main purpose: restore ossicular continuity.

EVALUATION Positioning of the prosthesis; Remaining's of the ossicular chain; Surgical access; Integrity of the membranous labyrinth; Signs indicative of fibrosis; Tympanic cavity pneumatization.

NORMAL POST-OPERATORY Case 1: Left Stapedectomy and Prosthesis Insertion Axial CT: notice that the metallic prosthesis is well inserted, in contact with the oval window, not penetrating it, and also in contact with the incus.

NORMAL POST-OPERATORY Case 1: Left Stapedectomy and Prosthesis Insertion Coronal reformat: notice that the metallic prosthesis is well inserted, in contact with the oval window, not penetrating it, and also in contact with the incus.

NORMAL POST-OPERATORY Case 1: Left Stapedectomy and Prosthesis Insertion Sagital reformat: notice that the metallic prosthesis is well inserted, in contact with the oval window, not penetrating it, and also in contact with the incus.

NORMAL POST-OPERATORY Case 2: Bilateral Stapedectomy and Prosthesis Insertion Axial CT: notice that the metallic prosthesis are well inserted bilaterally.

Case 3: Prosthesis Luxation COMPLICATIONS Case 3: Prosthesis Luxation Oblique reformat: a prosthesis like this one is making contact with the oval window, but not connecting with the ossicular chain.

Case 4: Prosthesis Luxation COMPLICATIONS Case 4: Prosthesis Luxation Axial CT: prosthesis lying on the posterior wall of the tympanic cavity (arrow), not in contact with the oval window nor the ossicular chain.

COMPLICATIONS Case 5: Artifacts Axial CT: artifacts derived from the metallic prosthesis simulate pneumolabirinth and luxation inside the right vestibule.

COMPLICATIONS Case 5: Artifacts Coronal reformat: however, it is possible to notice that the prosthesis is well placed and there is no pneumolabirinth.

COMPLICATIONS Case 5: Artifacts Sagital reformat: again, it is possible to notice that the prosthesis is well placed and there is no pneumolabirinth.

COMPLICATIONS Case 6: Strikes Artifacts derived from metallic prosthesis, such as strikes, may impact the evaluation of its relation to the oval window, leading to a false-positive of prosthesis luxation inside the vestibule.

Case 7: Luxation with Pneumolabirinth COMPLICATIONS Case 7: Luxation with Pneumolabirinth Axial CT: notice that the prosthesis is penetrating the vestibule and there is air inside it too.

Case 7: Incus Luxation with Topic Prosthesis COMPLICATIONS Case 7: Incus Luxation with Topic Prosthesis Axial CT and coronal reformat: notice that the incus is misplaced (blue arrow head) and there is labyrinthitis ossificans (red arrow head). Arrow indicating prosthesis.

Case 8: Labyrinthitis Ossificans COMPLICATIONS Case 8: Labyrinthitis Ossificans Axial CT: topic left prosthesis (arrow) with labyrinthitis ossificans (arrow head).

Case 9: Proliferation of Otosclerosis Around the Prosthesis COMPLICATIONS Case 9: Proliferation of Otosclerosis Around the Prosthesis MIP reformat: notice the hyperatenuating tissue circumscribing the prosthesis (arrow).

COMPLICATIONS Case 10: Luxation MIP reformat: bilateral stapedectomy and right prosthesis luxation (arrow). The left one is well placed (arrow head).

Case 11: Incus Interposition COMPLICATIONS Case 11: Incus Interposition Axial CT: stapedectomy with incus interposition (rotation of the incus with insertion straight to the oval window - arrow).

Case 12: Prosthesis Luxation COMPLICATIONS Case 12: Prosthesis Luxation Axial CT: non-metallic prosthesis is inserted more than 2mm into the vestibule. There is also fibrous tissue around the prosthesis.

Case 13: Topic Prosthesis COMPLICATIONS Case 13: Topic Prosthesis Coronal reformat: prosthesis replaces the entire ossicular chain.

Case 14: Prosthesis Fracture COMPLICATIONS Case 14: Prosthesis Fracture Axial CT: prosthesis fracture – discontinuation of the metallic and non-metallic segments (arrow). The prosthesis size in relation to a credit-card (arrow head).

Case 15: Reparative Granulomas COMPLICATIONS Case 15: Reparative Granulomas Oblique MIP: presence of granuloma tissue around the inferior-displaced prosthesis and obliterating the oval window.

Case 15: Reparative Granulomas COMPLICATIONS Case 15: Reparative Granulomas Oblique MIP: presence of granuloma tissue around the inferior-displaced prosthesis and obliterating the oval window.

REFERENCES Ukkola-Pons E, Ayache D, Pons Y, Ratajczak M, Nioche C, Williams M. Oval window niche height: quantitative evaluation with CT before stapes surgery for otosclerosis. AJNR Am J Neuroradiol 2013;34(5):1082-5 Purohit B, Hermans R, Op de beeck K. Imaging in otosclerosis: a pictorial review. Insights Imaging 2014;5:245-252 Révész P, Liktor B, Liktor B, Sziklai I, Gerlinger I, Karosi T. Comparative analysis of preoperative diagnostic values of HRCT and CBCT in patients with histologically diagnosed otosclerotic stapes footplates. Our Arch Otorhinolaryngol. 2015 Jan 6;273(1):63-72 Rudic M, Keogh I, Wagner R, Wilkinson E, Kiros N, Ferrary E, Sterkers O, Bozorg Grayeli A, Zarkovic K, Zarkovic N. The pathophysiology of otosclerosis: review of current research. Hear Res 2015 Dec;330(Pt A):51-6 Phillips GS, LoGerfo SE, Richardson ML, Anzai Y. Interactive web-based learning module on CT of the temporal bone: anatomy and pathology. RadioGraphics 2012;32:E85-E105