Semicircular Canal Dehiscence

  • 文章类型: Journal Article
    目的:确定在平板CT上发现的上管裂开(SCD)是否会增加耳胶囊中其他缺陷的风险。
    方法:回顾性队列研究。
    方法:三级护理中心。
    方法:一百只耳朵(50只患有SCD,50只没有SCD的对照组)。
    方法:平板CT成像。
    方法:(1)SCD耳朵中其他开裂的患病率,(2)控制装置的开裂,和(3)其他报告的裂开位置的耳囊厚度(耳蜗-颈动脉,外侧半规管[SCC]和乳突,面神经外侧SCC,前庭水管,后SCC-颈静脉球,后SCC-后颅窝)。在应用Bonferroni校正进行多重比较后,组间比较在p<0.007时被认为是显著的。
    结果:不包括SCD,SCD组(n=2/50,4%)和对照组(n=2/50,4%,p>0.007)。在SCD组中,耳蜗和颈动脉之间有一个裂开,后SCC和后颅窝之间有一个裂开.对照组有一个扩大的前庭水管和一个在面神经和外侧SCC之间的裂开。作为一个群体,SCD耳朵的前庭水管较宽(0.68±0.20vs0.51±0.30mm,p<0.007),后SCC和后窝之间的骨骼较薄(3.12±1.43vs4.34±1.67mm,p<0.007)。SCD耳中面神经与外侧SCC之间的骨较厚(0.77±0.23vs0.55±0.27mm,p<0.007),耳蜗颈动脉没有差异,外侧SCC和乳突(p>0.007)。
    结论:SCD不会增加同一耳胶囊中第二次开裂的可能性。与对照组相比,SCD患者的先天性耳囊骨可能更薄,特别是在后SCC附近,前庭导水管可能会扩大。
    OBJECTIVE: Determine if superior canal dehiscence (SCD) found on flat-panel CT increases the risk for other defects in the otic capsule.
    METHODS: Retrospective cohort study.
    METHODS: Tertiary care center.
    METHODS: One hundred ears (50 with SCD and 50 matched controls without SCD).
    METHODS: Flat-panel CT imaging.
    METHODS: (1) Prevalence of other dehiscences in SCD ears, (2) dehiscences in controls, and (3) otic capsule thickness in other reported dehiscence locations (cochlea-carotid, lateral semicircular canal [SCC] and mastoid, facial nerve-lateral SCC, vestibular aqueduct, posterior SCC-jugular bulb, posterior SCC-posterior fossa). Between-group comparisons were considered significant at p < 0.007 after applying the Bonferroni correction for multiple comparisons.
    RESULTS: Not including the SCD, there was a mean of 0.04 additional dehiscences in the SCD group (n = 2/50, 4%) and 0.04 non-SCD dehiscences in the controls (n = 2/50, 4%, p > 0.007). In the SCD group, there was one dehiscence between the cochlea and carotid artery and one between the posterior SCC and posterior fossa. The control group had one enlarged vestibular aqueduct and one dehiscence between the facial nerve and lateral SCC. As a group, SCD ears had wider vestibular aqueducts (0.68 ± 0.20 vs 0.51 ± 0.30 mm, p < 0.007) and thinner bone between the posterior SCC and posterior fossa (3.12 ± 1.43 vs 4.34 ± 1.67 mm, p < 0.007). The bone between the facial nerve and lateral SCC was thicker in SCD ears (0.77 ± 0.23 vs 0.55 ± 0.27 mm, p < 0.007) and no different for cochlea-carotid, and lateral SCC and mastoid (p > 0.007).
    CONCLUSIONS: SCD does not increase the likelihood of a second dehiscence in the same otic capsule. SCD patients may have congenitally thinner otic capsule bones compared to controls, particularly near the posterior SCC, where the vestibular aqueduct may be enlarged.
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  • 文章类型: Journal Article
    上半规管裂开(SSCD)是最近定义的发育缺陷,可能与几种颅面异常有关,例如唇裂/腭裂(CLP)。本研究旨在比较受试者与单侧和双侧CLP和正常对照的上半规管(SSC)骨厚度和模式。
    共收集了52例单侧唇腭裂(UCLP)受试者(104例颞骨)和38例双侧唇腭裂(BCLP)受试者(76例颞骨)和148例健康对照(296例颞骨)的238例锥束计算机断层扫描(CBCT)图像。SSC骨厚度测量两次,并由颌面放射科医生进行验证。然后根据骨厚度将样品分为五类:纸莎草纸或薄,正常,厚,气动,和裂开。毕竟,UCLP,BCLP,与正常对照组比较SSC模式和厚度。
    结果显示,根据性别,在SSC模式和厚度方面,三组之间没有显着差异。SSC模式(P值=.001)和SSC厚度(0.01)与裂隙类型密切相关。在BCLP患者中,骨厚度最薄,SSCD发生率最高。
    结果显示SSC模式和SSC厚度与研究组之间存在显著关联。
    Superior Semicircular Canal Dehiscence (SSCD) is a recently-defined developmental defect may be associated with several craniofacial anomalies such as Cleft Lip/Palate (CLP). The present study aimed to compare subjects with unilateral and bilateral CLP and normal controls in terms of Superior Semicircular Canal (SSC) bone thickness and pattern.
    A total of 238 Cone Beam Computed Tomography (CBCT) images were collected from 52 unilateral Cleft Lip and Palate (UCLP) subjects (104 temporal bones) and 38 Bilateral Cleft Lip and Palate (BCLP) (76 temporal bones) subjects and 148 healthy controls (296 temporal bones). The SSC bone thickness was measured twice and validated by a maxillofacial radiologist. The samples were then classified into five categories based on bone thickness: papyraceous or thin, normal, thick, pneumatized, and dehiscence. After all, the UCLP, BCLP, and normal control groups were compared concerning the SSC pattern and thickness.
    The results revealed no significant difference among the three groups regarding the SSC pattern and thickness based on gender. The SSC patterns (P value = .001) and SSC thickness (0.01) were strongly correlated to the cleft type. The thinnest bone thickness and the highest incidence of SSCD were observed among the subjects with BCLP.
    The results showed a significant association between the SSC patterns and SSC thickness and the study groups.
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  • 文章类型: Journal Article
    报告有无阻塞性睡眠呼吸暂停(OSA)患者的影像学上半规管裂开(SSCD)和被膜裂开的频率。
    回顾性配对队列研究。
    三级护理中心。
    患有OSA的成年人和包括颞骨的精切计算机断层扫描与没有OSA的患者年龄相匹配,性别,和计算机断层扫描的类型(协议,扫描仪类型,切片厚度)。排除耳科手术或颞骨肿瘤。
    由两名独立评审员评估的SSCD和tegmen裂开的患病率。
    OSA患者的平均体重指数为29.2kg/m2,平均呼吸暂停低通气指数为36.8。对照组的平均体重指数为26.2kg/m2。在352块颞骨中,OSA队列中有34例(9.7%)患有SSCD,而对照组中有37例(10.5%)(p>0.05)。7名OSA患者(占SSCD患者的25.6%)患有双侧SSCD,而8名对照(占SSCD患者的27.6%;p>0.05)。大多数(87.3%)的裂隙涉及颞叶,其余累及岩上窦或两者。在352只OSA耳朵中,对照组90例(25.6%)的tegmen裂开,对照组95例(27.0%)(p>0.05)。两组都不倾向于SSCD或被膜开裂。
    与年龄和性别匹配的对照相比,OSA患者的影像学SSCD和被膜开裂的患病率没有显著差异。这与先前的病例对照研究相反,发现有症状的SSCD患者的OSA发生率更高。这可能表明,尽管OSA是颅内压升高的危险因素,但OSA对SSCD患病率的影响大小可能有限。
    To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA).
    Retrospective matched cohort study.
    Tertiary care center.
    Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded.
    Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers.
    The average body mass index of the OSA patients was 29.2 kg/m 2 with an average apnea-hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m 2 . Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group ( p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group ( p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence.
    The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from age- and sex-matched controls. This is in contrast to a previous case-control study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.
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  • 文章类型: Case Reports
    一名73岁的女性因持续的左前良性阵发性位置性眩晕而无法接受多种重新定位程序和训练物理治疗师练习而被转诊到我们部门。前庭听觉评估和岩骨的高共振计算机断层扫描证实存在5.4毫米大的无症状左前半规管裂开。同一患者中两个明显不同的神经实体之间的联系通过其他图像进一步维持。T2加权和3维迷宫序列证实存在部分“自动堵塞”的上半规管开裂,该开裂逐渐捕获了靠近上半规管杯的更大耳石颗粒。
    A 73-year-old female was referred to our department for persistent left anterior benign paroxysmal positional vertigo refractory to multiple repositioning procedures and training physiotherapist exercises. The audiovestibular assessment and high resonance computed tomography of the petrosal bone confirmed the presence of a 5.4 mm large paucisymptomatic left anterior semicircular canal dehiscence. The connection between the 2 apparently distinct neurotological entities in the same patient was further sustained by additional imagery. T2-weighted and 3-dimensional labyrinthine sequences confirmed the presence of a partially \"auto-plugged\" superior semicircular canal dehiscence which progressively entrapped greater otolith particles proximal to the cupula of the superior semicircular canal.
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  • 文章类型: Journal Article
    To determine which clinical factors have the strongest impact on determining diagnosis and decision for surgical repair for superior semicircular canal dehiscence syndrome (SCDS).
    A total of 81 patients presented with a suspicion for SCDS between October 2017 and October 2018. 38 patients ultimately were diagnosed with SCDS, and 28 chose surgical repair.
    Clinical factors of subjective patient symptoms (autophony, sensitivity to loud sounds, vertigo induced by loud sounds, dizziness, hearing their own heartbeats or other visceral organs) and audiogram findings (low frequency conductive hearing loss [CHL], bone-conduction hyperacusis, low cVEMP threshold [<80 db nHL], increased oVEMP [>17 μV] amplitudes) were analyzed with logistic regression to identify factors that predicted those who would ultimately be diagnosed with SCDS and those who would have surgical repair. Preoperative high-resolution CT imaging was performed on all patients.
    Significant predictors of presence of SCDS from logistic regression included low frequency CHL and increased oVEMP amplitude (p = 0.002 [OR 40, 95%CI 3.8-413], p = 0.001 [OR 93, 95%CI 6.8-1267], respectively). These were also significant predictors of individuals who chose to have surgical repair (p = 0.004 [OR 47, 95%CI 3.5-620], p = 0.001 [OR 126, 95%CI 8.2-1941], respectively). Area under the receiver operating characteristic curve (ROC curve) for these two variables are 93% for diagnosing SCDS and 94% for predicting choice for surgical repair.
    Low frequency CHL and increased oVEMP amplitude are the strongest predictive factors for making a diagnosis of SCDS and for choosing surgical repair.
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  • 文章类型: Journal Article
    OBJECTIVE: To explore the usefulness of the responses of video head impulse testing (vHIT) in assessing symptomatic patients with superior semicircular canal dehiscence (SSCD).
    METHODS: This was a prospective case-control study performed in a tertiary skull base referral Centre in the UK. It included all patients ¬diagnosed with SSCD from January 2015 to January 2019 and compared to a control group of age and gender-matched unaffected indi¬viduals. The main outcome of the study was semicircular canal vestibule-ocular reflex (VOR) gains during vHIT assessment and link to patients\' symptoms.
    RESULTS: A total of 28 patients were diagnosed with SSCD during the study period and completed the vHIT assessment. Reduced VOR gains (<0.8) were noted in 57% of patients (n = 16). Half of these (n = 8) were in canals other than the superior semicircular (posterior only: n = 5; lateral and posterior: n = 3). Three patients (10.7%) had abnormal responses in 2 canals. The canals in the contralateral side were affected in 56.5% of the cases. There was no correlation with the patients\' symptoms. Results were directly comparable with the control group vHIT results with no identifiable statistically significant differences on comparison of the ipsilateral SSCD side with a randomly selected side from the control group (all comparisons: P > .05).
    CONCLUSIONS: SSCD can affect the vestibular responses from all 3 semicircular canals; not necessarily the superior one. Similar responses were found in a control group of normal subjects. Although the use of vHIT in the assessment of SSCD is not diagnosis-specific, it can still help with identifying the impact of surgery on all canals prior to any intervention in order to avoid bilateral vestibular failure.
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  • 文章类型: Journal Article
    To assess for any association between the presence of superior semicircular canal dehiscence (SSCD) and temporal bone pneumatization and the height of middle fossa in symptomatic patients.
    Retrospective case-control study.
    Tertiary, university referral center.
    Symptomatic patients with SSCD and a matched group of non-SSCD patients.
    High-resolution computed tomography of the temporal bones.
    We graded the temporal bone pneumatization using the Virapongse classification and measured the distance between the middle fossa and the lateral semicircular canal on coronal plane at the most anterior aspect of the lateral and superior semicircular canals. We statistically compared all parameters (level of significance 0.05).
    We enrolled 30 patients with SSCD, (males = 13, females = 17) with mean age of 47 years (SD: 26). The matched control group had similar baseline characteristics (p > 0.05). Grade 4 pneumatization was noted in 83.3% (n = 25) of SSCD patients with the remainder having grade 3. In the control group, 46.6% (n = 14) had a grade 4 pneumatization, 36.6% (n = 11) grade 3 and 16.6 5 (n = 5) grade 2. This difference was statistically significant (p = 0.003). The difference in the height of the middle cranial fossa between the two groups was also statistically significant (mean 3.80 [SD: 0.84] in SSCD group and 4.68 mm [SD: 0.85] in the control group; p < 0.0001).
    We found better-pneumatized mastoids in patients with SSCD, indicative of a direct association between temporal bone pneumatization and SSCD. Additionally, the middle fossa dura is lying significantly lower in patients with SSCD, factor of surgical importance.
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