1262 Audit of MRI IAM (Internal Auditory Meatus) Requests at Darlington Memorial Hospital and Review of The Literature

Aim To assess if the MRI IAM scans are being requested as suggested in NICE guidelines Draft 2017 for consultations. Educate and implement any changes if needed to minimise unnecessary investigations. Method Retrospective data collection of 1000 data. Variables included hearing loss (HL), tinnitus (T), dizziness (D) and other lateralized symptoms. Audiograms assessed for asymmetrical HL at decibel level ≥20 Db at a frequency of 0.5 kHz, 1.0 kHz, 2.0 kHz. MRI of IAM assessed if a cerebellar pontine angle (CPA) lesion was presented. Results 853 (85.3%) met criteria. 16/1000 (1.6%) MRI showed CPA lesion. All 16 cases had unilateral sensorineural hearing loss (SNHL) and met NICE guidelines criteria. Discussion Limited value in the scanning of asymptomatic patients, those who do not fit audiometric guidelines, those bilateral symptoms or those with unilateral tinnitus without audiometric asymmetry. Very few studies were found in the literature in relation to symptoms associated with positive findings of CPA lesion. Our results indicate unilateral SNHL were linked with positive findings of MRI and it is similar findings in the literature. We recommend that patients who present with asymmetrical SNHL with this audiometric asymmetrical characteristic of 20Db or more will need an urgent MRI IAM as part of their diagnostic workup.

The use of magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss

Background Tinnitus is a common condition presenting to the ENT out-patient clinic. Vestibular schwannomas are benign cerebellopontine angle tumours that usually present with unilateral sensorineural hearing loss. Magnetic resonance imaging of the internal auditory meatus is the definitive investigation in their detection. The current recommendation is for unilateral tinnitus patients to undergo magnetic resonance imaging of the internal auditory meatus to exclude vestibular schwannoma. Objective To evaluate magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Method A retrospective case series was conducted of all patients who underwent magnetic resonance imaging of the internal auditory meatus to investigate unilateral non-pulsatile tinnitus without asymmetrical hearing loss, from 1 January 2014 to 1 January 2019. Results Of 2066 scans, 566 (27 per cent) were performed to investigate patients (335 female, 231 male) with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Three vestibular schwannomas were detected on imaging, and 134 incidental findings were discovered. Conclusion The detection rate of vestibular schwannoma in this group was just 0.3 per cent. This paper questions the utility of magnetic resonance imaging evaluation in these patients.

Management of advanced cholesteatoma: Madras ENT Research Foundation experience

<p class="abstract"><strong>Background:</strong> Cholesteatoma is a common condition encountered by the otolaryngologist in the Indian subcontinent. Due to absence of pain in most patients, they may have advanced disease at presentation. Lack of awareness, long distance between the patient’s home and the treatment centre are also reasons for late presentation. Surgical management is the mainstay of treatment. The aim of this study was to retrospectively analyze the number of patients with advanced cholesteatoma, the extent of disease, and associated complications.</p><p class="abstract"><strong>Methods:</strong> Fifty one patients out of a total of 1132 patients with cholesteatoma presented with advanced disease in a tertiary referral centre between January 2010 to January 2020. The surgical issues in the management of the disease and the outcomes were studied. </p><p class="abstract"><strong>Results:</strong> Fifty one patients presented with extensive cholesteatoma in a tertiary referral centre. There were 33 males and 18 females in the study. Of fifty one patients, pediatric cholesteatoma was seen in 6 patients. Hearing loss was the most common presentation. Facial palsy, labyrinthine fistula, dural involvement, internal auditory meatus involvement was noted in some patients. All patients underwent surgical management with good outcomes.</p><p class="abstract"><strong>Conclusions:</strong> Advanced cholesteatoma is a dreaded disease that can result in various complications. Involvement of the facial canal, labyrinth, cochlea, dura, internal auditory meatus, internal carotid artery, jugular bulb, and sigmoid sinus involvement in the presence of extensive disease should be identified before surgery. Appropriate treatment with complete disease clearance can result in good outcomes.</p>

The Spectrum and Frequency of Inner Ear Anomalies in Patients with Congenital Hearing Impairment in Yakutia

Objective. To analyze the spectrum and frequency of inner ear anomalies in patients with congenital hearing impairment in Yakutia.Material and methods. A total of 165 patients with congenital hearing impairment were surveyed. All the patients were examined by an audiologist, an educational audiologist, and a neuropsychiatrist. All the patients underwent X-ray computed tomography (X-ray CT) of temporal bone structures (which was supplemented by magnetic resonance imaging (MRI) in some cases).Results. Based on modern ideas about inner ear anomalies and their classification, the authors first analyzed the spectrum and frequency of inner ear anomalies in patients with congenital hearing impairment in Yakutia. Inner ear malformations were identified in 16 (9.7%) of the 165 patients with hearing impairment, which corresponds to that in the previously studied samples of deaf people in different countries (from 3% to 35%). Of the inner ear structures, the cochlea and vestibule were more commonly affected. Abnormalities of the internal auditory meatus, semicircular canals, and vestibular aqueduct were less common. In general, the spectrum of anomalies was represented by 7 different malformations. Incomplete partition type II (IP-II) (34.3%) came first in incidence among all the abnormalities. Incomplete partition type III (IP-III) (18.7%) ranked second in incidence. The expansion of the internal auditory meatus (12.5%) and vestibular aqueduct (12.5%) occupied the third place. Inner ear anomalies occurred as concurrences that are difficult to interpret and classify in half (50%) of all the cases.Conclusion. Analysis of the spectrum and frequency of temporal bone abnormalities in Yakutia suggests that every 10 patients with congenital hearing impairment have one or another inner ear structural malformation (9.7%) and require accurate and timely diagnosis using up-to-date X-ray CT and MRI techniques.

Effectiveness of using electromagnetic navigation system in surgical treatment of temporal bone tumors

Purpose of the work: Increasing the efficiency of surgical treatment of patients with destructive pathology of the temporal bones through intraoperative use of an electromagnetic navigation system. The article showed the results of using the electromagnetic navigation system for surgical treatment of patients with temporal bone paraganglioma types B and C, facial neuromas and chronic otitis media with an unfavourable form in which radical mastoidectomy was previously performed. The features of preoperative preparation for surgical treatment of patients, surgical approaches (retrofacial, infratemporal, transcochlear) are described. For retrofacial access, the reference points were: a horizontal semicircular canal, the bone wall of the internal carotid artery and the jugular vein bulb. For infratemporal access, the reference points were the wall of the carotid artery, the jugular vein bulb and the internal auditory meatus. For transcochlear access, the carotid artery wall, jugular fossa and internal auditory meatus are considered landmarks. The use of the navigation system made it possible to navigate the complex anatomy during the operation and avoid injury to vital structures (internal carotid artery canal, jugular vein bulb, semicircular canals, facial nerve). The need to use navigation systems especially increases with anomalies in the development of the ear and when the boundaries between anatomical structures are destroyed by an inflammatory process or a neoplasm.

Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing

A 45-year-old male patient with reduced hearing in the right ear was diagnosed with a medium-sized (T3a) acoustic neuroma. The operation was performed through an individually tailored retrosigmoid mini-craniotomy. Endoscope-assisted microsurgical technique was applied to early detect the location of the facial and cochlear nerves as well as to look around the hidden corners during the surgery. The entire operation was performed without using brain retractors. The moderate intrameatal extension of the tumor and the use of angled endoscopes allowed to avoid the drilling of the internal auditory meatus. The lesion could be completely removed and the patient showed a satisfactory hearing recovery in the follow-up examinations 3 months after the surgery.The link to the video can be found at: https://youtu.be/dAYLakih924.