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Purpose:Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.Materials and methods:The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively.Results:CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001).Conclusion:CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

Background Recurrent papillary thyroid carcinoma (PTC) beyond the first two decades of definitive treatment (i.e. total thyroidectomy and radioactive iodine ablation) is a rare occurrence. Case presentation We present a case of a 71-year old Caucasian female with a distant history of PTC treated with total thyroidectomy and radioactive iodine ablation who experienced recurrence of her disease 43 years following initial diagnosis and definitive treatment. She presented with palpable left-sided neck mass and subsequently underwent a level II, III, neck dissection and adjuvant iodine ablation. This case presents the latest recurrence in papillary thyroid cancer documented to date in the literature. Conclusion This case exemplifies the need for the head and neck surgeon, radiation oncologist, general practitioner and radiologist to consider new lateral neck mass as late-presenting recurrence of PTC until proven otherwise regardless of low recurrence rates beyond two decades from treatment and low prognostic risk scores.

Background Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to determine whether a newly developed sonotubometric test using clicks can reliably detect ET opening during swallowing in normal ET subjects, and patulous ET (PET) in subjects with ET dysfunction. Methods Sixteen subjects (19 normal ET ears and 6 PET ears) were individually placed in a sound-isolated audiometry booth and subjected to a 1000Hz click train stimulus, played through the nose. PET subjects were identified through the ET clinic at our institution, while healthy subjects were recruited. Transmission through the ET was recorded by a microphone in the ear ipsilateral to the presenting nostril, during no swallow and swallow states, and this was used to compute a power ratio (power in the frequency range of interest to the whole frequency range). The power transmission ratio both before and after the swallow was averaged, and represented the baseline (BaseR). The power transmission ratio during swallow represented the peak (PeakR). The same process was repeated in the absence of a stimulus to account for swallowing noise. Wilcoxon rank rum tests were performed to determine statistical significance. Results It was found that for healthy ET patients, the median difference between the PeakR and BaseR was 0.51 (p = 0.004). For the PET patients in this study, the median difference between the PeakR and the BaseR was 3.30 (p = 0.041). Comparing the baseline between groups revealed that PET patients had a median BaseR 1.05 higher than healthy ET patients. PET patients had a median PeakR of 3.84 higher than healthy ET patients. Both were deemed to be statistically significant (p = 0.003, p = 0.003 respectively). A significant difference was found between median PeakR for the stimulus and no-stimulus condition for the healthy ET group (0.59, p

12-year-old girl presents to her family physician with a 5-week history of right-sided hip pain. �怀 e pain is dull, focal, and aching in the hip and groin region. �怀 e patient has difficulty weight bearing on the affected side resulting in a limp when walking. �怀 e patient reports no recent history of physical trauma. She has a body mass index of 24 kg/m 2 , placing her above the 90th percentile for her age and sex. �怀 e patient is otherwise well with an unremarkable demeanor. Her hip is non-tender and there are no palpable abnormalities. Her physical examination reveals decreased range of motion at the hip through internal rotation, and abduction. Passive flexion of the hip causes abduction and external rotation of her right

Background Sonotubometry is a non-invasive means of assessing Eustachian tube (ET) function. Its interpretation remains a complex task with questionable results due to wide variation between trials. A study was conducted to ascertain whether the measurement of phase shift in sonotubometric signals would be a more reliable indicator of ET patency than fluctuating Sound Pressure Level (SPL). Methods The ears of six healthy participants and two participants with patulous ET (PET) were probed with a 100 Hz signal. Five recordings of SPL were performed at the external auditory canal. Cross-correlation was performed among filtered SPL signals and among extracted phase shift waveforms. Peak coefficients were averaged to provide a measure of waveform similarity between trials. Results Mean peak cross correlation coefficient for SPL signal measured 0.603 ± 0.057 Standard Error of Mean (SEM) whilst that for Phase-Shift signal measured 0.884 ± 0.027 (SEM). All normal participants demonstrated an observable phase change between the ear and nasal signal during swallowing indicating an acoustic impedance change during the event. For the PET patients tested, the phase measurements in ear and nasal signals follow one another reasonably closely, indicating little or no impedance change during swallowing. It is thought that this impedance change is indicative of opening of the ET in normal patients, and the lack impedance change indicates ET either remaining open or remaining closed throughout the swallow. Conclusions Experimental data suggest that phase-shift detection is a more consistent means of interpreting sonotubometric data than SPL analysis.