Treatment of persistent middle ear effusion in cleft palate patients

Objectives

The goals of the research project are to learn how to individualize otologic care for cleft palate patients and to be able to counsel families of children with cleft palate on the benefit of tympanostomy tubes, hearing issues and risks of multiple sets of tubes.

Methods

The study is a retrospective chart review. Patients with a cleft palate with or without a cleft lip born between 1 January 2000 and 31 December 2005 referred to the Connecticut Children's Medical Center Craniofacial Department were included in the study. The patients were offered individualized ear surgery (PE tube placement) only if persistent middle ear fluid was present for over 3 months with a conductive hearing impairment. The primary outcome measures included the newborn hearing screening results, number of ear tube surgeries, and complications of PE tube insertion.

Results

There were 86 patients with cleft palate spectrum with or without cleft lip (45 females and 41 males). Twelve had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. By 5 years old, 84 (98%) patients received at least one set of ear tubes for persistent middle ear fluid with conductive hearing impairment, while 2 received no tubes (2%). Of those who received ear tubes, the range was 1-6 with a mean of 1.7. Twelve patients (14%) had tympanosclerosis. Eight patients (9%) had eardrum perforation. One patient had myringoincudopexy. Of the 86 patients, 12 had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive.

Conclusions

(1) The majority of children born with cleft palate do not have middle ear fluid at birth. (2) Most children with cleft palate will likely develop persistent middle ear fluid with conductive hearing loss. Risks of complications from ear tubes in cleft palate patients are few and manageable using standard sized ear tubes.     

Computed tomography demonstrates abnormalities of contralateral ear in subjects with unilateral sensorineural hearing loss

Purpose

Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT.

Materials and methods

IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as “normal” based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 “normal” temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group.

Results

Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls.

Conclusion

Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from “normal” and/or a lateral semicircular canal bony island central lucency disparity of >5% from “normal” may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss.     

Cochlear changes in presbycusis with tinnitus

Objectives

The pathophysiology of tinnitus is obscure and its treatment is therefore elusive. Significant progress in this field can only be achieved by determining the mechanisms of tinnitus generation, and thus, histopathologic findings of the cochlea in presbycusis with tinnitus become crucial. We revealed the histopathologic findings of the cochlea in subjects with presbycusis and tinnitus.

Material and methods

The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects. We quantitatively analyzed the number of spiral ganglion cells, loss of cochlear inner and outer hair cells, and areas of the stria vascularis and spiral ligament.

Results

There was a significantly greater loss of outer hair cells in the tinnitus group compared with the control group in the basal and upper middle turns. The stria vascularis was more atrophic in the tinnitus group compared with the control group in the basal turn.

Conclusions

Tinnitus is more common in patients with presbycusis who have more severe degeneration of outer hair cells and stria vascularis.     

Myringoplasty in children with cleft palate and craniofacial anomaly

Objectives

Analyze the anatomical and audiological success rates of myringoplasty in children with craniofacial anomaly, cleft palate and compare them to a control group.

Methods

Retrospective review of medical records for all children who underwent myringoplasty between 1997 and 2007. The following data was recorded: sex, age, perforation side, size, location and etiology, surgical approach, type of myringoplasty, graft material, season of surgery, preoperative status of the operated and contralateral ear, history of previous otologic surgery, and adenoidectomy or tonsillectomy.

Results

Myringoplasty outcomes of 22 craniofacial anomaly patients (15/22 were cleft palate patients) were compared to 144 controls. Children in the craniofacial anomaly group demonstrated a tendency towards surgery at an older age. Children in the craniofacial anomaly and cleft palate groups had a significant positive history of previous otologic procedures to both operated and contralateral ears. Peroperative subannular ventilation T-tubes were more frequently recorded in patients with craniofacial anomaly than patients in the control group. The craniofacial anomaly, cleft palate and control group had comparable mean preoperative and postoperative ABG and their ABG improvement was statistically significant. Children with craniofacial anomaly, cleft palate and control group shared similar anatomical and audiological success rates (ABG < 20 dB) at 6, 12 and 24 months.

Conclusions

Although children in the craniofacial anomaly and cleft palate groups are predisposed to middle ear disease, their disease responds well to surgical intervention. Their audiological and anatomical success rates were equivalent to the ones observed in the control group. In light of our results, we recommend that myringoplasty in children with craniofacial anomaly and cleft palate be performed after the age of 12.     

The role of audiological diagnostics in children with cleft lip & palate (CLP)

Objective

To assess the otologic and audiologic status of patients with cleft lip and palate (CLP) operated in the Department of Pediatric Surgery attached to the Advanced Pediatric Centre, Post Graduate Institute of Medical Education & Research (PGIMER), India. The main idea of carrying out this study was to know the incidence of middle ear pathologies in a group where no complaints have been noticed.

Setting

Research study was carried in Post Graduate Institute of Medical Education & Research (PGIMER) which is one of the tertiary care institutions in India.

Participants

55 children (Mch: 28; Fch: 27) in the age range of 4-13 years constituted the study group. These children were operated upon by the same surgeon (JKM) during the period 1996-1998 and were attending the speech clinics at PGIMER. None of these children/parents had complained of any ear problem and were taken up for the study to find out the middle ear pathology. The ontological and audiological evaluation was done for all the children.

Results

53 of 110 ears had normal hearing status. None of the ears had severe or profound hearing loss. The air conduction thresholds ranged from 20.2 to 29.63 dB across the frequencies whereas the bone conduction thresholds varied from 7.13 to 12.41 dB. Only 42% of the right (R) ears and 47% of the left (L) ears had a normal tympanic membrane.

Conclusion

On the basis of this finding, investigation of the benefits of early and routine follow-up for otologic and audiologic status is warranted. Patients with cleft lip and palate should have an intense and detailed otologic and audiologic follow-up to identify any ME pathology/hearing loss so that timely intervention can be taken.     

International consensus on Vibrant Soundbridge implantation in children and adolescents

Objective

Active middle ear implants augment hearing in patients with sensorineural, conductive, and mixed hearing losses with great success. However, the application of active middle ear implants has been restricted to compromised ears in adults only. Recently, active middle ear implants have been successfully implanted in patients younger than 18 years of age with all types of hearing losses. The Vibrant Soundbridge (VSB) active middle ear implant has been implanted in more than 60 children and adolescents worldwide by the end of 2008. In October 2008, experts from the field with experience in this population met to discuss VSB implantation in patients below the age of 18.

Methods

A consensus meeting was organized including a presentation session of cases from worldwide centers and a discussion session in which implantation, precautions, and alternative means of hearing augmentation were discussed. At the end of the meeting, a consensus statement was written by the participating experts. The present consensus paper describes the outcomes and medical/surgical complications: the outcomes are favourable in terms of hearing thresholds, speech intelligibility in quiet and in noise, with a low incidence of intra- and postoperative complications.

Conclusions

Taken together, the VSB offers another viable treatment for children and adolescents with compromised hearing. However, other treatment options should also be taken into consideration. The advantages and disadvantages of all possible treatment options should be weighed against each other in the light of each individual case to provide the best solution; counseling should include a.o. surgical issues and MRI compatibility.     

Middle ear volume as an adjunct measure in congenital aural atresia

Objective

To examine middle ear volume in patients with aural atresia and investigate the role of middle ear volume as an adjunct measure in determining surgical candidacy.

Methods

We performed a retrospective review of children with aural atresia in a tertiary academic pediatric otolaryngology practice. High resolution multiplanar CT scans of the temporal bones were analyzed for middle ear volume and staged according to existing clinical grading scales. Atretic ears were compared to the nonatretic ears of the same patient as well as to ears of a control population.

Results

The average age of patients at the time CT was performed was 4.7 years (range <0.1-13.8 years). The average middle ear volume of the atretic ears was 0.34 cc compared to an average of 0.51 cc for the nonatretic ears. The mean ratio of the atretic to nonatretic volume was 0.67. In patients who underwent serial scans, no statistically significant difference in rates of growth existed between atretic and nonatretic ears. Finally, measures of middle ear volume correlated well with clinical grading scales.

Conclusions

Both middle ear volume and the ratio of the atretic volume to nonatretic volume serve as useful adjunct measurements in determining surgical candidacy. The practitioner may be better able to assess surgical candidacy by supplementing classic atresia classification systems with middle ear volume measurements.     

Pediatric myringoplasty: a study of factors affecting outcome

Objectives

To analyze the success rates of myringoplasty in children, to assess prognostic factors and to evaluate their interactions in the evolution of myringoplasty.

Methods

Charts of patients who had undergone a myringoplasty between 1997 and 2007 were reviewed for: patient age, sex, perforation side, etiology, size, type and location of perforation, season of surgery, type of myringoplasty, surgical technique, graft material, preoperative status of the operated and contralateral ear, history of otologic surgery to the operated and/or contralateral ear, number of prior surgeries to the operated and contralateral ear, time elapsed between the last otologic procedure and this myringoplasty, history of adenoidectomy or tonsillectomy, time elapsed between the adenoidectomy or tonsillectomy and this myringoplasty. Anatomical success was defined as postoperative intact tympanic membrane(TM). Audiological success was defined as air bone gap less than 20 dB and a postoperative difference of no more than 10 dB in the mean bone conduction (BC) threshold.

Results

A total of 201 cases of myringoplasty were operated between 1997 and 2007. Anatomical success rates were 94.9%, 84.9% and 70.1% at 6, 12 and 24 months, respectively. The type of previous otologic surgery in the operated ear was found statistically significant for anatomical success. Audiological success rates were attained in 97.4%, 93.4% and 84.9% of patients at 6, 12 and 24 months, respectively. A mean reduction of 9.1 dB of the air bone gap was achieved postoperatively. No sensorineural hearing loss occurred. Children 12 years and older presented with statistically poorer preoperative BC at frequencies ≥2000 Hz when compared to their younger counterparts. These results suggest that the chronicisation of the TM perforation can result in long-term irreversible damage to the inner ear.

Conclusion

The type of previous otologic surgery in the operated ear was found to have an impact on anatomical success. The outcome for myringoplasty was more favourable when the etiology of the previous surgery was a benign one. We advocate early myringoplasty, preferably above the age of 6. Delaying surgery can cause permanent damage to the inner ear. All other factors evaluated were not found to be statistically significant for anatomical or audiological success.     

Inner ear anatomy in Waardenburg syndrome: Radiological assessment and comparison with normative data

Objective

As patients with Waardenburg syndrome (WS) represent potential candidates for cochlear implantation, their inner ear anatomy is of high significance. There is an ongoing debate whether WS is related to any inner ear dysplasias. Our objective was to evaluate radiologically the inner ear anatomy in patients with WS and identify any temporal bone malformations.

Methods

A retrospective case review was carried out in a tertiary, referral center. The high resolution computed tomography (HRCT) scans of the temporal bone from 20 patients (40 ears) with WS who were managed for deafness in a tertiary referral center from 1995 to 2012 were retrospectively examined. Measurements of 15 different inner ear dimensions, involving the cochlea, the vestibule, the semicircular canals and the internal auditory meatus, as well as measurements of the vestibular aqueduct, were performed independently by two neuroradiologists. Finally, we compared the results from the WS group with a control group consisting of 50 normal hearing subjects (100 ears) and with previously reported normative values.

Results

Inner ear malformations were not found in any of the patients with WS. All measured inner ear dimensions were within the normative values compiled by our study group as well as by others.

Conclusions

Inner ear malformations are not characteristic for all types of WS; however, certain rare subtypes might be related to inner ear deformities. Normative cochleovestibular dimensions that can help in assessing the temporal bone anatomy are provided.     

Histopathological morphometric study of cochleosaccular dysplasia in Dalmatian dogs

Objective

To analyze temporal bones of deaf Dalmatian dogs from 5 days after birth to adulthood to better understand the pathogenesis of cochleosaccular dysplasia.

Methods

This is an experimental animal histopathological temporal bone study that included two groups of temporal bones. Group I consisted of 41 temporal bones from deaf Dalmatian dogs and group II of 25 temporal bones from 15 “normal” aged-matched, hearing Black Labradors. Morphometric analysis included: stria vascularis and spiral ligament area measurements, and cell counts of spiral ganglion, Scarpa's ganglion, and hair cells of saccular macula.

Results

The following findings were significantly less in deaf Dalmatian group compared to hearing Labradors: (1) cellular area of the stria vascularis in all cochlear turns; (2) cellular area of spiral ligament in the inferior part of the basal turn; (3) cellular density of spiral ganglion cells within segments III and IV; (4) number of Scarpa's ganglion cells; and (5) density of saccular hair cells types I and II. A borderline negative correlation was found between average density of spiral ganglion cells of segments III and IV and age in group I. Young deaf animals showed some cochlear hair cells, however in adult dogs all hair cells were replaced by supporting cells.

Conclusion

General pattern of cochleosaccular dysplasia is variable, even when only one etiology, the genetic one, is involved. The gradual degeneration of inner ear elements in the cochleosaccular degeneration might indicate that early intervention might be crucial to stop the progression of cochleosaccular dysplasia.     

Biofilms in chronic suppurative otitis media and cholesteatoma: scanning electron microscopy findings

Background

Biofilms play a role in the pathogenesis of a variety of otorhinolaryngologic diseases, including otitis media and cholesteatoma. Despite this, relatively few studies have undertaken to demonstrate the presence of biofilms tissues from patients with chronic otitis media or infected cholesteatoma.

Objective/hypothesis

Our objective is to detect evidence of biofilms human chronic ear infections with scanning electron microscopy (SEM). We hypothesized that bacterial biofilms are present in patients with chronic otitis media.

Study design

We performed prospective collection of tissue collected during middle ear surgery from 16 patients undergoing middle ear or mastoid surgery with chronic ear infections.

Methods

A total of 31 middle and mastoid tissue samples were harvested at the time of surgery and processed with critical point drying for SEM analysis. Samples were then searched for evidence of biofilms.

Results

Bacterial-shaped objects were identified that displayed both surface binding and the presence of a glycocalyx in 4 patients, findings consistent with bacterial biofilms. Most of these (3 of 4) were in patients with infected cholesteatoma, and biofims were identified in 60% of cholesteatoma cases (3 of 5). On the other hand, only 1 of 7 cases with chronic suppurative otitis media had evidence of biofilms.

Conclusion

SEM supports the hypothesis that bacterial biofilms are common in chronic infections associated with cholesteatoma and are present in some cases of chronic suppurative otitis media without cholesteatoma.     

Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy

Purpose

The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy.

Design

This is a prospective, randomized, controlled, single-blind study.

Settings

Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population.

Patients

Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered.

Methods

A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result.

Results

The success rate was 82.3% when MMC was used and 85.7% among the controls (P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group.

Conclusion

Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.     

Congenital incudostapedial anomalies in adult stapes surgery: a case-series review

Objectives

The management of developmental anomalies of the ossicular chain and otic capsule in stapes surgery tests the otologist's diagnostic skills and flexibility in technique and prosthesis choice. We review our experience in managing various incudostapedial developmental anomalies discovered during middle ear exploration for suspected otosclerosis in adult patients.

Design

A retrospective case-series review was used.

Setting

The study was set at a military tertiary referral center.

Patients and other Participants

A review of 185 stapes procedures yielded 8 cases of identified congenital anomalies of the stapes or incudostapedial complex including congenital absence of the oval window with malformed incus and stapes, columellar-type stapes with promontory fixation, stapes superstructure fixation to the fallopian canal, and malformed incus with stapes superstructure fixation to the promontory.

Interventions

The developmental anatomy and surgical technique in each case were reviewed. The surgical technique used in each case varied depending on the specific ossicular abnormality found and whether both the stapes and incus were affected.

Main outcome measures

Comparison of preoperative and postoperative audiometric testing results was performed.

Results

All 8 ears (7 patients) that underwent a stapes procedure for either an isolated congenital stapes anomaly or a combined incudostapedial anomaly had a favorable hearing outcome, with 7 ears improving to within 10-dB and 1 ear to within 13-dB air-bone gap on postoperative audiometry.

Conclusions

Despite unanticipated findings of congenital anomalies of the stapes and incus during middle ear exploration for conductive hearing loss, a flexible management approach can lead to successful hearing outcomes.     

Study of systemic lupus erythematosus in temporal bones

Despite some reports of sensorineural hearing loss with systemic lupus erythematosus (SLE), its pathologic correlate has remained unidentified due to the scarcity of human temporal bone studies. We here present findings in 14 temporal bones from 7 patients with SLE, examined histologically and immunohistochemically for pathologic conditions in the cochlea that might relate to their otologic histories. Blue-staining concretions were seen in the stria vascularis of 6 ears. Most of the cases showed a loss of spiral ganglion cells, with various degrees of hair cell loss and atrophy of the stria vascularis. One ear demonstrated formation of fibrous tissue and bone throughout the cochlea, with complete loss of the membranous labyrinth. Cochlear hydrops was found in only 1 ear. These findings in temporal bones from patients with SLE are discussed in relation to autoimmune disease of the inner ear.     

Colchicine prolongs patency of myringotomy in an animal model

Objective

Chronic otitis media with effusion (COME) is a frequently observed condition in childhood. The most common and effective surgical therapy for COME is myringotomy with insertion of a ventilation tube (VT). Our aims were to investigate the combined effect of myringotomy and the topical application of Colchicine solution to the external ear canal for the prolongation of patency in the treatment of patients with COME and to evaluate the ototoxicity of Colchicine applied directly to the middle ear.

Methods

A prospective study on 47 ears in 26 fat sand rats was fashioned. In the first phase, solutions of different concentrations of Colchicine were applied to the middle ear cavity in order to determine the drug's ototoxicity, assessing inner ear function with ABR. In the second phase myringotomy was performed and a non ototoxic concentration of Colchicine applied to 12 external ear canals, while saline was applied to nine.

Results

In the first phase, Colchicine concentration of 0.1% and higher applied to the middle ear cavity caused an ABR threshold elevation. In the second phase, the mean closure time after 0.01% Colchicine application was prolonged to >2.14 weeks (P < 0.05).

Conclusion

Colchicine has a proven potential for prolongation of myringotomy patency when applied as a solution to the external ear as a 0.01% solution. Further investigations are required to validate these results in humans and to study the potential effect of repetitive Colchicine application on the duration of myringotomy patency for the treatment of COME.     

Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus: a retrospective study of 94 patients

Objectives

Studies suggest that hypercholesterolemia promotes the development of inner ear disorders such as tinnitus. However, the underlying pathomechanisms are still not clearly defined.

Methods

A retrospective study was performed to assess whether a reduction of serum cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors may result in a relief of subacute tinnitus. Remission rates of 58 patients were investigated after 4 months of treatment with simvastatin (40 mg). Results were compared to treatment with Ginkgo biloba (120 mg; n = 36) as control group. Differences between tinnitus score at the day of first treatment and after 4 months were used as main outcome measure.

Results

After treatment with simvastatin or G biloba, tinnitus score decreased from 41.3 ± 10.4 to 37.4 ± 17.3 and from 44.7 ± 11.2 to 41.2 ± 8.7, respectively. However, independently of the treatment regimen, differences of tinnitus scores were considered not significant.

Conclusions

After administration of simvastatin over 4 months, this retrospective study has shown no significant efficacy in treatment of subacute tinnitus. For a more conclusive answer, further prospective, double-blind, and placebo-controlled studies with a larger number of patients are needed.     

Prognostic indicators for sensorineural hearing loss in temporal bone histiocytosis

Objective

Our review aims: (1) to highlight the suspicion of sensorineural hearing loss (SNHL) in temporal bone Langerhans’ cell histiocytosis (LCH); (2) to assess the evolution of SNHL in this pathology; (3) to identify radiologic findings of the otic capsule invasion by LCH; (4) to determine prognostic factors for SNHL in temporal bone LCH.

Methods

We performed a literature review through MEDLINE for SNHL in temporal bone LCH related articles that were published between 1954 and 2008. We identified 12 related studies of which 18 patients were noted. We also added our case to this series. The information from the reports was analyzed to characterize the clinical and demographic data and to focus on the sensorineural hearing aspect of the disease and on the damage of the semicircular canals (SCC) and the cochlea.

Results

Ten percent of patients with temporal bone LCH presented SNHL. The mean age of patients is 3.5 years among children and 35.5 years among adults. Male to female ratio is 1:1.14. There were 13 unilateral cases, 6 bilateral cases and 1 case of multisystemic histiocytosis. Cochlea and SSCs were involved in 4 and 20 temporal bones, respectively. The lateral SCC is the most frequently eroded canal. In 23 ears hearing level was reported: 15 ears had a SNHL and the remaining was a mixed or a conductive hearing loss type. 10 ears suffered from a profound hearing loss and none of them improved after treatment regardless otic capsule affected structures. In all cases of normal hearing, moderate hearing loss and severe hearing loss before treatment cochlea have not been affected. However a single or two semicircular canals invasions have been noted. Where it is reported (15 out of 25 temporal bone) there was a radiological healing of the otic capsule lesion after treatment. Remineralization occurs 6 months after treatment.

Conclusion

In LCH, hearing loss level before treatment can be considered as a prognostic indicator for hearing in response to treatment. Even though bone mineralization is essential for a hearing improvement, radiological healing is not a prognostic factor for better hearing level after treatment.     

Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs

Objective

Povidone-Iodine preparation is used as a disinfectant in otological surgeries. The ototoxicity of Povidone-Iodine preparation was evaluated using infant, young and adult guinea pigs. The effects of different concentrations and of different exposure durations on compound action potentials were also studied.

Materials & methods

Povidone-Iodine was used to fill one middle ear cavity of the guinea pig, and the compound action potential (CAP) was measured from the round window membrane at 24 h, 7 days, and 28 days. The contralateral side was filled with saline as control. Test sounds used were clicks and tone bursts of 2, 4, and 8 kHz.

Results

At 24 h, Povidone-Iodine solution showed a significant toxic effect in the infant group. In the young animal group, no toxic effect was seen. In the adult group, a mild degree of deafness for 2 kHz was found.At 7 days, the young group showed significant hearing loss for all frequencies, but the adult group did not show any hearing loss. With a half strength solution, both young and adult group did not show hearing loss.At 28 days, with a full strength solution, hearing loss became prominent for all sound stimulation. With 1/8th dilution, the young group showed a moderate hearing loss, but the adult group did not.

Conclusion

The thicker round window membrane in human is expected to provide more protection to the human cochlea than in the guinea pig model that we have studied. Mild hearing loss at 24 h and 7 days using 10% solution, but no hearing loss with 5% solution at 7 days may indicate that rinsing of the middle ear cavity with saline during surgery should minimize the ototoxic effect of this product.The age of the animals does influence the outcome of the ototoxicity experiment.From this experiment, Povidone-Iodine preparations in the infant should be used with caution. Povidone scrub should not be used for otologic surgery.     

Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas

Objective

To compare the efficiency of diffusion-weighted MR imaging (MRI) vs. high resolution CT in predicting recurrent or residual cholesteatoma in children who underwent prior middle ear surgery.

Design

Prospective study.

Setting

Tertiary care university hospital.

Patients

Seventeen patients (4 with 2 recurrences) aged 5-17 years (mean 11.4) previously surgically treated for a cholesteatoma of the middle ear, were included for follow-up with systematic CT scan and MRI, between 2005 and 2007.

Methodology

CT scan was performed on a Siemens Somaton 64 (0.5/0.2 mm slices reformatted in 0.5/0.3 mm images), parallel and perpendicular to the lateral semi-circular canal for each ear (100 mm × 100 mm FOV). MRI was undertaken on a Siemens Avanto 1.5 T unit, with an adapted protocol for young children. Diagnosis of recurrent cholesteatoma was based on the evidence of a hyperintense image at B1000 on diffusion-weighted images. Results of CT scan and MRI were compared with operative diagnosis.

Results

Nine patients had a positive MRI, among which 8 had cholesteatoma confirmed during revision surgery. In the 12 negative MRI cases, 5 were positive on revision surgery. None of these lesions was over 3 mm. Two of them were diagnosed on the CT scan. CT scan alone had a positive predictive value of 75%, and a negative predictive value of 58%.

Conclusion

Diffusion-weighted MRI is associated with a high positive predictive value for the detection of recurrent cholesteatoma. CT scan remains the first choice imaging technique. In case of doubtful CT scan, diffusion-weighted MRI could confirm a recurrence or, when negative, avoid second-look surgery.