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Purpose: Imaging of the delicate inner ear morphology has become more and more precise owing to the rapid progress in magnetic resonance imaging (MRI). However, in clinical practice, the interpretation of imaging findings is hampered by a limited knowledge of anatomical details which are frequently obscured by artifacts. Corresponding review articles are as rare in journals as they are in reference books. This shortness prompted us to perform a direct comparison of imaging with anatomical whole-mount sections as a reference. It was the intention of this paper to compare the microscopic anatomy of a human inner ear as shown on anatomical whole-mount sections with high-resolution MRI and cone beam computed tomography (CBCT). Both are available in clinical routine and depict the structures with maximum spatial resolution. It was also a goal of this work to clarify if structures that were observed on MRI in a regular manner correlate with factual inner ear anatomy or correspond with artifacts typical for imaging. Methods: A fresh human anatomical specimen was examined on a clinical 3-Tesla MRI scanner using a dedicated surface coil. The same specimen was then studied with CBCT. In each imaging modality, high-resolution 3D data sets which enabled multiplanar reformatting were created. In the second step, anatomical whole-mount sections of the specimen were cut and stained. This process enabled a direct comparison of imaging with anatomical conditions. Results: Clinical MRI was able to depict the inner ear with remarkable anatomical precision. Strongly T2-weighted imaging protocols are exquisitely capable of showing the fluid-filled components of the inner ear. The macular organs, ampullar crests and cochlear aqueduct were clearly visible. Truncation artifacts are prone to be confused with the delicate membrane separating the endolymphatic from the perilymphatic compartment. However, it was not possible to directly depict this borderline. Conclusions: With the maximum resolution of magnetic resonance tomography, commonly used in everyday clinical practice, even the smallest details of the inner ear structures can be reliably displayed. However, it is important to distinguish between truncation artifacts and true anatomical structures. Therefore, this study can be useful as a reference for image analysis. [ABSTRACT FROM AUTHOR]

This report describes a patient with permanent hearing loss after spinal anesthesia. The literature is reviewed, particularly concerning incidence and possible causes. The incidence is surprisingly high and related to the size of the needle. The role of the cochlear aqueduct as a transmitter of a decreased fluid pressure in the subarachnoid space to the perilymph of the labyrinth is discussed.

Purpose: To assess the value of unenhanced T1-weighted images, T2-weighted images, gadolinium-enhanced T1-weighted images, and three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) images in depicting lesions of the membranous labyrinth., Methods: Six patients were studied using 1-T MR; both enhanced (gadolinium-tetraazacyclododecane tetraacetic acid) and unenhanced images were obtained and different sequences compared to determine which provided the most information., Results: A combination of gadolinium-enhanced T1-weighted and 3DFT-CISS images could depict all membranous labyrinth pathology. Unenhanced T1-weighted images were necessary to exclude spontaneous hyperintensity in the membranous labyrinth. Gadolinium-enhanced T1-weighted images were needed to detect enhancing pathology such as labyrinthitis and tumors inside the membranous labyrinth. In these cases, 3DFT-CISS images allowed immediate differentiation between inflammation and tumor. In temporal bone tumors involving the bony and membranous labyrinth, unenhanced and enhanced T1-weighted images often sufficed to suggest the correct diagnosis. Only 3DFT-CISS images were able to demonstrate small structures (as fistulas) and to help us confirm or rule out obliteration of the labyrinthine fluid spaces. 3DFT-CISS images were necessary to detect small congenital malformations of the membranous labyrinth when only MR was performed. Uncalcified obliteration of the labyrinth fluid spaces could be reliably detected only on 3DFT-CISS images. Here also gadolinium-enhanced T1-weighted images had to be obtained because enhancement of the soft tissues inside the membranous labyrinth had been observed., Conclusion: The CISS sequence and enhanced T1-weighted sequence formed the best sequence combination for diagnosis of membranous labyrinth lesions; additional, unenhanced T1-weighted images can help one differentiate labyrinthitis, proteinaceous fluid, subacute hemorrhage, or tumor inside the labyrinth.

Purpose: To assess the value of a three-dimensional Fourier transformation MR technique "CISS" (constructive interference in steady state) in imaging the inner ear., Subjects: We studied 50 normal inner ears (40 axial, 10 coronal) and 10 pathologic inner ears in 60 patients., Results: The cochlea, semicircular canals, and vestibulum were visualized in detail. Cranial nerve VII and the cochlear, superior vestibular, and inferior vestibular branch of cranial nerve VIII were identified in 90%, 94%, 80%, and 88% of the cases, respectively. A vascular loop was recognized inside the internal auditory canal in 6%, and in the porus in 30%, of the cases. The high signal of the cerebrospinal fluid and labyrinthine fluids (perilymph and endolymph) on the CISS images made excellent delineation of tumors in the cerebellopontine angle and internal canal possible and allowed detection of tumoral labyrinth involvement. The thin sections, high resolution of the images, and capability of producing multiplanar and three-dimensional reconstructions often offered additional information., Conclusions: The CISS sequence allows detailed study of the normal and pathologic inner ear and promises to be highly valuable in the demonstration of the vascular loop.

Sinusitis can spread to the orbital tissues. 'Preseptal' soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy they usually resolve quickly. 'Orbital' soft-tissue infections, in contrast, are relatively rare and frequently cause serious morbidity. Four cases are presented. Symptomatology and pathogenesis are reviewed. Diagnostic procedures, especially CT-scan, are discussed and recommendations are given for medical and surgical management.

Transitional Papilloma, the formerly inverted papilloma, is a rather rare neoplasm of the nasal cavity. Its origin is still debated. The only constant symptom is unilateral nose obstruction. This lesion is of considerable interest because of the recurrence tendency and its association with malignancy. Although a benign tumor, radical aggressive surgery is advocated. A medial maxillectomy is the treatment of choice. A sublabial incision gives excellent exposure without external facial scar.

Purpose: Tractography of the facial nerve based on diffusion MRI is instrumental before surgery for the resection of vestibular schwannoma, but no excellent methods usable for the suppression of motion and image noise have been proposed. The aim of this study was to effectively suppress noise and provide accurate facial nerve reconstruction by extend a fiber trajectory distribution function based on the fourth-order streamline differential equations., Methods: Preoperative MRI from 33 patients with vestibular schwannoma who underwent surgical resection were utilized in this study. First, T1WI and T2WI were used to obtain mask images and regions of interest. Second, probabilistic tractography was employed to obtain the fibers representing the approximate facial nerve pathway, and these fibers were subsequently translated into orientation information for each voxel. Last, the voxel orientation information and the peaks of the fiber orientation distribution were combined to generate a fiber trajectory distribution function, which was used to parameterize the anatomical information. The parameters were determined by minimizing the cost between the trajectory of fibers and the estimated directions., Results: Qualitative and visual analyses were used to compare facial nerve reconstruction with intraoperative recordings. Compared with other methods (SD_Stream, iFOD1, iFOD2, unscented Kalman filter, parallel transport tractography), the fiber-trajectory-distribution-based tractography provided the most accurate facial nerve reconstructions., Conclusion: The fiber-trajectory-distribution-based tractography can effectively suppress the effect of noise. It is a more valuable aid for surgeons before vestibular schwannoma resection, which may ultimately improve the postsurgical patient's outcome., (© 2024 International Society for Magnetic Resonance in Medicine.)

Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given. [ABSTRACT FROM AUTHOR]

This is the fourth of a 6-paper series which presents a descriptive narrative of the Western medical literature to identify and report evidence for each of the five principles of the Vertebral Subluxation Complex (VSC) premise as established in 1947 by Janse, Houser, and Wells (National College of Chiropractic). This literature comprises predominately medical referencing and includes Chiropractic papers in the electronic Index to Chiropractic Literature. This paper presents the evidence for Principle Three by documenting the evidence for the clinical findings of altered physiological function associated with the VSC including effects on skeletal muscle, vascular smooth muscle, sphincters and organs. This 6-part series describes the incontrovertible acknowledgement and weight of recognition of the effect of physical, biomechanical, and physiological vertebral disturbances collectively contributing to the VSC and demonstrates strong support of the chiropractic nomenclature, neurophysiological and clinical implications of the Vertebral Subluxation Complex as recorded in the medical literature. [ABSTRACT FROM AUTHOR]

Two cases of Noonan syndrome are observed. The Noonan syndrome is a Turner-like syndrome with normal chromosomal constitution. Essential criteria in diagnosing the syndrome are the facial expression (hyper-telorisme, low-set and malformed ears, micrognathie, fish-like mouth). The short webbed neck and the cubitus valgus. These children are rather small and mental retardation can be present, especially in comparison with their siblings. Associated cardiac malformations occur in approximately 50% of the cases. We insist on audiologic findings. One case has a hearing impairment due to a malformation of the middle ear, recognised radiologically. The other has a deafness of perception type. Yet, the familial occurrence of last patient makes it doubtful whether this hearing loss can be linked to the Noonan-syndrome.

Overlooking the literature, Wegener's granulomatosis often seems to have manifestations in the ear-nose-throat region, especially in the beginning. The usual clinical findings are mentioned, to put the attention of the ENT-surgeon on this affection. Indeed, by early recognition and proper treatment of this disease, the prognosis is clearly improving. A case-history is illustrating the clinical picture.

A case is presented of mesenchymal chondrosarcoma. This extremely rare tumor has a characteristic histology. The prognosis is poor. Radical surgery is essential. A lifelong follow-up is recommended.

The vestibulometric examination in the ORL office is done by means of the registration of eye movements of vestibular origin, the electro-nystagmography. With the ENG-equipment one can perform electro-oculography, examining eye movements in general. EOG is quite helpful in neurologic diagnosis and important in ORL practice too. The adjustment of the ENG-equipment to EOG is explained, after some words on the physiology and the clinical examination of ocular motor function. Than a short survey is given of the abnormalities that may be met in EOG.

The endoscopical endonasal surgery is in vogue. Today it has become a functional surgery. A thorough knowledge of the endonasal anatomy is difficult but essential. The antral ostium is reached after infundibulotomy, from which starts the inspection of the locoregional pathology.

The CT-meato-cisternography with air is at the moment the examination of choice in the diagnosis of the intra-canalicular acoustic neuroma. Every time there is a possibility of acoustic neuroma the air-CT-meato-cisternography has to be performed after the CT-scan was negative. The air-CT-meato-cisternography is easily performed on an outpatient basis and complications are never seen. Filtrated air seems to be the best contrast material.

The future of lasers in medicine in general and in otorhinolaryngology in specific appears to be bright. It's use is very simple, but may not weaken the wakefulness of its user. Skill and experience remain very important. The role of the laser is clearly defined. The laser is not the only surgical tool to be used for any given operative procedure.

In treating ear disease every otolaryngologist is familiar with topical medications. The choice of the ideal agent for a given clinical situation may be difficult. In order to make this decision more easy, we overlook the composition of ear-drops. The most important disadvantages are ototoxicity, allergy and pain. The place of ototopical agents in otitis externa, otitis media and otomycosis is discussed.

A case of spontaneous cerebrospinal fluid otorrhea due to a congenital tegmen tympani defect is reported. The etiology and pathogenesis of cerebrospinal fluid otorrhea and of the spontaneous congenital form in particular is discussed, together with the clinical picture and the methods of diagnosis. Reviewing the literature, a middle ear exploration is considered to be the procedure of choice to ascertain the presence and determine the exact locus of the cerebrospinal fluid leak.

The authors communicate the result of an inquest on 150 laryngectomized patients, members of their hospital rehabilitation center. A statistical study was made on the correlation between the different factors which may influence the results. The inquest shows that information of the patient, his family and occupational environment is not effective enough. The influence of the laryngectomized patient, working fulltime in the rehabilitation center, is of a great importance related to the difficulties during the vocal revalidation process and the social reintegration of the laryngectomized patients.

Different possibilities of solitary or multinodular involvement of the thyroid gland are described. Because of the broad spectrum of malignancy there exists a controversy and widespread divergence of opinion regarding the incidence, malignancy, classification and treatment of thyroid cancer.

With the development of improved angiographic techniques, arteriovenous meningeal fistulas are being recognized more and more as an important cause of vascular tinnitus. Vascular tinnitus is generally considered to be objective and pulse-synchronous. This report concerns three cases of vascular tinnitus due to arteriovenous meningeal fistulas. They all could not or only hardly be objectified by auscultation and in one of them any pulse-synchronism was denied. The pathophysiology of vascular tinnitus is reviewed, followed by a more detailed discussion about the pathogenesis, the symptomatology and the radioanatomical aspects of arteriovenous meningeal fistulas. Finally, the report deals with the treatment of those fistulas.