Thomas Somers - Academia.edu (original) (raw)
Papers by Thomas Somers
Advances in oto-rhino-laryngology, 2011
The headbands, the testbands and the softbands are applied for coupling of the sound processors o... more The headbands, the testbands and the softbands are applied for coupling of the sound processors of the bone-anchored devices to the patient's head before the titanium fixture/abutment can be implanted. The bands are used for acute and/or prolonged testing of the bone-anchored devices, and are able to approximate the results of postoperative amplification. Yet, whatever the type of the band coupling, the transducers interface with the bone through a layer of skin and subcutaneous tissue that damp the transmission and decrease effective amplification. Therefore, the final hearing result with the bone-anchored device after implantation is usually better than with the sound processor attached to the headband, testband or softband, especially in the high-frequency zone. The results of our studies performed in experienced Baha Compact users quantified the magnitude of the skin damping and showed significant threshold differences for frequencies 1-4 kHz (in the range of 5-20 dB) when t...
The Annals of otology, rhinology, and laryngology, 2006
A prospective randomized audiological analysis of 336 otosclerosis operations was conducted to co... more A prospective randomized audiological analysis of 336 otosclerosis operations was conducted to compare the evolution of bone conduction thresholds after primary stapedotomy with two different techniques to open the footplate: microdrill and carbon dioxide laser stapedotomy. To monitor the inner ear function, we compared the preoperative bone conduction thresholds with the postoperative levels at day 2, week 2, week 6, and month 6. Evolution of the bone conduction was compared for the two studied groups (laser versus microdrill). An average bone conduction loss of 1.8 dB was measured at day 2 for the middle frequencies (0.5, 1, and 2 kHz). At 4 kHz, a bone conduction loss of 7 dB was found. The bone conduction thresholds measured in the first and second months after surgery showed a gradual recovery with overclosure as the end result. Our results confirm the transient depression of inner ear function in the immediate postoperative period, with recovery within the first weeks after su...
AJNR. American journal of neuroradiology, 2006
Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadoliniu... more Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadolinium T1-weighted MR images and/or echo-planar (EPI) diffusion-weighted (DWI) MR images. We describe the appearance of a case of a complicated attical middle ear cholesteatoma on single-shot (SS) turbo spin-echo (TSE) DWI compared with EPI-DWI. This case suggests a higher reliability of SS TSE-DWI in the diagnosis of acquired middle ear cholesteatoma.
American Journal of Otolaryngology, 2007
PurposeThe objective of this study was to assess the value of high-resolution computed tomography... more PurposeThe objective of this study was to assess the value of high-resolution computed tomography (HRCT) and that of magnetic resonance imaging (MRI), including postcontrast T1-weighted images and echo-planar diffusion-weighted (EP-DW) images, in the detection of residual cholesteatomas after primary bony obliteration of the mastoid.
European Radiology, 2006
Our goal was to determine the value of echo-planar diffusion-weighted MR imaging in detecting the... more Our goal was to determine the value of echo-planar diffusion-weighted MR imaging in detecting the presence of primary acquired and residual cholesteatoma. One hundred patients were evaluated by preoperative magnetic resonance (MR) imaging with diffusion-weighted MR imaging. The patient population consisted of a first group of 55 patients evaluated in order to detect the presence of a primary acquired cholesteatoma.
Neuroimaging Clinics of North America, 2009
Otology & Neurotology, 2002
*University Department of Otorhinolaryngology and Department of Pathology, St. Augustinus Hospit... more *University Department of Otorhinolaryngology and Department of Pathology, St. Augustinus Hospital, Antwerp, Belgium Squamous cell carcinomas (SCC) of the external au-ditory canal are rare tumors (1). An isolated localization on the tympanic membrane has never been ...
Otology & Neurotology, 2014
Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetratin... more Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetrating trauma to the external ear canal. In this type of ossicular dislocation, disruption of the annular ligament or footplate fracture may lead to a perilymphatic fistula (PLF) presenting with cochleovestibular symptoms including (progressive) sensorineural hearing loss, tinnitus, and vestibular symptoms. The objective of this article is to define the optimal treatment of stapediovestibular luxations and review the literature on this topic. We present a case of internal stapediovestibular dislocation and pneumolabyrinth after penetrating trauma with predominantly conductive hearing loss and incapacitating vertigo. Middle ear inspection with removal of the luxated incus, repositioning of the stapes with a "stapedial strut" and closure of the tympanic membrane. Hearing outcome and vestibular symptoms of this patient are presented, and all comparable cases in the literature are reviewed. Complete resolution of the vestibular symptoms and stabilization of the bone conduction thresholds. In patients with pneumolabyrinth after middle ear trauma with mild symptoms, we recommend initial conservative treatment with close monitoring of hearing. In patients with severe, persisting, or progressive vestibulocochlear symptoms, exploratory tympanotomy should be performed to check for and treat PLF. Oval window fistula repair is reported to have variable hearing outcomes but offers complete resolution of vestibular symptoms in most cases. The stapedial strut is one of the possible surgical techniques in case of an internally luxated stapes.
Annals of Otology, Rhinology & Laryngology, 2014
An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosi... more An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosis depends on careful history taking and otoscopic examination. Different treatment options are available. Reconstruction with hydroxyapatite bone cement is a relatively new technique. The aim of this article is to review the current diagnostic work-up and treatment options and to demonstrate our method of treatment with hydroxyapatite bone cement. Three cases, repaired with hydroxyapatite bone cement in a tertiary referral otologic center, were retrospectively analyzed. A review of the literature on diagnosis and treatment procedures was performed. One fracture occurred by withdrawing a finger from the external auditory canal and 2 occurred without clear prior trauma. Our 3 cases were successfully repaired with hydroxyapatite bone cement. Diagnosis of an isolated malleus handle fracture still depends on careful clinical examination. In addition to pure tone audiometry, both low and higher frequency tympanometry may be useful. High resolution computed tomography with reformatting through the malleus handle is the most accurate imaging modality. Reconstruction with hydroxyapatite bone cement is reliable by restoring the original situation with only minimal manipulation and without additional ossicular interruption.
Skull Base, 2010
The major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality t... more The major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality to functional preservation of the facial nerve and hearing. Absence of fluid between the lateral end of the VS and the internal auditory canal fundus on magnetic resonance imaging (MRI) appeared to have a negative influence on hearing outcome. Our goal was to study the prognostic significance of fundus obliteration on facial nerve function after VS surgery in patients with clinically normal facial function. We performed a retrospective review in a tertiary referral neurotology unit or 110 consecutive patients with a surgically removed VS and normal preoperative facial nerve function. Facial nerve function was evaluated at 1 month and 1 year by using the House-Brackmann (HB) scale and correlated to fundus obliteration on MRI. Facial nerve function was intact preoperatively in 114 of 123 patients (92.7%). We noticed a statistically significant difference and worse short-term outcome when the fundus was obliterated: 29.7% had HB 3 or more versus 13.0% if no fundus obliteration was seen. This statistically significant difference disappeared at 1 year. Fundus obliteration has a negative prognostic influence on short-term facial nerve function after VS surgery in patients with clinically normal facial function preoperatively.
Radiology, 2010
To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gado... more To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gadoliniumenhanced T1-weighted magnetic resonance (MR) imaging, and the combination of both techniques in the evaluation of patients with cholesteatoma.
Otology & Neurotology, 2001
The purpose of this study was to determine whether three magnetic resonance imaging (MRI) finding... more The purpose of this study was to determine whether three magnetic resonance imaging (MRI) findings (tumor size, extension to the fundus, intralabyrinthine signal intensity) have a predictive value to hearing preservation in vestibular schwannoma surgery. A retrospective study was conducted of preoperative high-resolution MR images in a series of consecutive hearing preservation attempts for vestibular schwannomas. Twenty-six consecutive records of patients with an acoustic tumor removed via a retrosigmoid transcanal approach were analyzed, and the MR images were reviewed blindly and compared with postoperative hearing. The study took place in a tertiary referral center. Imaging Techniques: The MR sequences used in this study were unenhanced and gadolinium-enhanced T1-weighted spin-echo images and gradient echo images (3DFT-CISS). The predictive value of three MRI signs was analyzed: tumor size, lateral extension of the tumor (with and without obliteration of the fundus), and the maintenance of, or decrease in, the intralabyrinthine signal intensity on the affected side in comparison with the signal intensity on the opposite normal side as seen on 3DFT-CISS images. The tumor size in ears in which hearing was preserved averaged 15 mm and was 17 mm in those cases where hearing was not preserved. Hearing was preserved in 50% of ears when the tumor did not extend to the fundus but in only 33% when the fundus was obliterated by tumor. A "normal" intralabyrinthine signal on CISS images (being an isointense signal when compared with the contralateral unaffected ear) was followed by hearing preservation in 82% of ears, whereas in cases where the intralabyrinthine signal was low, hearing was preserved in only 20%. This correlation was statistically significant (p < 0.05). The intralabyrinthine signal intensity on 3DFT-CISS gradient-echo images is a valuable additional tool for determining candidacy for hearing preservation surgery. In two cases with preoperative decrease in signal intensity of the intralabyrinthine fluids, control MRI after surgery showed spontaneous recovery of normal intralabyrinthine signal intensity. The authors hypothesize that vascular compression in the internal auditory canal by the tumor is responsible for the observed intralabyrinthine signal decrease.
Otology & Neurotology, 2006
... Imaging Case of the Month Congenital Bilateral Oval and Round Window Aplasia with a Hypoplast... more ... Imaging Case of the Month Congenital Bilateral Oval and Round Window Aplasia with a Hypoplastic Stapes *Jean-Philippe Vercruysse, Jan Casselman, Bert De Foer, *Thomas Somers, and *Erwin Offeciers *University ENT Department and Radiology Department, St. ...
Otology & Neurotology, 2008
Objective: The primary goal of cholesteatoma surgery is complete eradication of the disease. To l... more Objective: The primary goal of cholesteatoma surgery is complete eradication of the disease. To lower the recurrence rate in the pediatric population in canal wall up techniques and to avoid the disadvantages of canal wall down techniques, the bony obliteration technique with epitympanic and mastoid obliteration has been developed. The objective of this study was to evaluate the long-term surgical outcome and recurrence rate of this technique in children. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifty-two children (G16 yr) were operated on in 90.4% (n = 47) for a primary or recurrent cholesteatoma and in 9.6% (n = 5) for an unstable cavity. Intervention: In all cases, we closed the tympanoattical barrier and the posterior tympanotomy with sculpted cortical bone and then completed obliteration of the epitympanum and mastoid with bone pâté. A reconstruction of the middle ear was performed by means of an allograft tympanic membrane including the malleus handle and a sculpted allograft malleus or incus for columellar reconstruction. Main Outcome Measures: Recurrent rate; residual rate; functional outcome; hygienic status of the ear; long-term safety issues. Results: The mean follow-up time was 49.5 months (range, 12Y101.3 mo). Recurrent cholesteatoma occurred in 1.9% (n = 1). Residual cholesteatoma was detected in 15.4% (n = 8) of the cases. Postoperative hearing results revealed a median gain on pure-tone averages of 14.3 dB and a median postoperative air-bone gap of 25.6 dB. Conclusion: The mastoid and epitympanic BOT is an effective technique to lower the recurrence rate of cholesteatoma in the pediatric population. Follow-up by magnetic resonance imaging provides a safe, noninvasive method for postoperative detection of residual cholesteatoma. Key Words: Bone pâtéVCholesteatomaVMastoid obliterationVMastoidectomy. Otol Neurotol 00:00Y00, 2008.
Otology & Neurotology, 2008
To use a study on dysgeusia to assess the usefulness of an otology database. Data were extracted ... more To use a study on dysgeusia to assess the usefulness of an otology database. Data were extracted from the international Common Otology Database. Primary stapes operations. From a cohort of 14 otologists, only 8 (57%) were able to satisfy external validation and maintain data input for a period of at least 6 months. The rates of dysgeusia varied from 0 to 39% at 3 months and 0 to 27% at 6 months. The percentages of patients with taste disturbance at 6 months in the "nerve-cut" and "nerve-preserved" groups were 22.7 and 10.9%, respectively, although this was not statistically significant (chi2; p = 0.325). Many surgeons found it difficult to maintain a prospective otology database. The rates of certain subjective symptoms such as dysgeusia are influenced by how vigorously the reviewers prompt the response from the patients. Dysgeusia after stapes surgery is common even if the chorda tympani nerve is preserved. Many patients whose chorda tympani nerve is divided may not complain of dysgeusia.
Otology & Neurotology, 2009
- To quantify the audiometric differences between the preoperative tests with the Bone-Anchored ... more 1) To quantify the audiometric differences between the preoperative tests with the Bone-Anchored Hearing Aid (BAHA) attached to the headband or the testband and the final postoperative result with the BAHA positioned at the implanted abutment. 2) To compare the results obtained with the headband and the testband. 3) To quantify the magnitude of the damping through the skin for the BAHA placed at the testband (important for comparison with the implantable hearing aids). Prospective. Tertiary otological referral centre. Ten adult (> or = 14 yr old) BAHA patients (6 male and 4 female subjects) with bilateral air-bone gaps of minimum 40-dB hearing loss and with more than 6 months of BAHA experience with the BAHA "Compact." Audiometric free-field thresholds and speech audiometry scores (Consonant-Vowel-Consonant lists, phonemic score) have been evaluated for 3 conditions: BAHA attached to the implanted "Snap" abutment, to the headband, or to the testband. For frequencies 1 to 4 kHz, significant differences in the range of 5 to 20 dB were found between the BAHA coupled with the Snap abutment and the preoperative testing conditions with the BAHA positioned at the headband or the testband. These differences were also reflected in the speech audiometry with a difference in speech reception threshold of approximately 4 to 7 dB. 1) Significant differences in the audiometric thresholds and the speech understanding scores were found between the preoperative test conditions and the final postoperative result. 2) Audiometric results obtained with the headband and the testband are comparable; therefore, the more comfortable headband is also suitable for the preoperative audiologic evaluation. 3) The magnitude of the skin damping must be accounted for when referring to the audiometric results obtained with the BAHA attached to the testband or headband.
Otology & Neurotology, 2008
Objective: The aim of this study is to determine the role of PROPELLER diffusionweighted MR imagi... more Objective: The aim of this study is to determine the role of PROPELLER diffusionweighted MR imaging combined with conventional MR imaging for the detection of residual cholesteatoma in patients who have undergone middle ear surgery. Subjects and methods: Twenty patients who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging (1.5 T) was performed using a PROPELLER DWI, T2WI, FLAIR and T1WI before and after IV injection of gadopentetate dimeglumine. An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity and calculated corresponding ADC values. Imaging findings were correlated with findings from surgery in 14 patients and with findings from clinical follow-up examination in six patients. Results: Diffusion-weighted MR imaging combined with conventional MR imaging depicted eight cholesteatomas. Two lesions were missed that were <3 mm. One patient was misdiagnosed as cholesteatoma, biopsy revealed acute inflammation. Sensitivity was 80%, specificity was 90%, positive predictive value was 89% and negative predictive value was 82%. Conclusion: Diffusion-weighted MR imaging combined with conventional MRI and calculation of ADC values is useful in the detection of secondary cholesteatoma and would decrease the need for un-necessary second canal wall-up operation.
Neuroradiology, 2007
Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance im... more Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear cholesteatoma and evaluated the size of middle ear cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear cholesteatomas, with a size limit as small as 2 mm.
Advances in oto-rhino-laryngology, 2011
The headbands, the testbands and the softbands are applied for coupling of the sound processors o... more The headbands, the testbands and the softbands are applied for coupling of the sound processors of the bone-anchored devices to the patient's head before the titanium fixture/abutment can be implanted. The bands are used for acute and/or prolonged testing of the bone-anchored devices, and are able to approximate the results of postoperative amplification. Yet, whatever the type of the band coupling, the transducers interface with the bone through a layer of skin and subcutaneous tissue that damp the transmission and decrease effective amplification. Therefore, the final hearing result with the bone-anchored device after implantation is usually better than with the sound processor attached to the headband, testband or softband, especially in the high-frequency zone. The results of our studies performed in experienced Baha Compact users quantified the magnitude of the skin damping and showed significant threshold differences for frequencies 1-4 kHz (in the range of 5-20 dB) when t...
The Annals of otology, rhinology, and laryngology, 2006
A prospective randomized audiological analysis of 336 otosclerosis operations was conducted to co... more A prospective randomized audiological analysis of 336 otosclerosis operations was conducted to compare the evolution of bone conduction thresholds after primary stapedotomy with two different techniques to open the footplate: microdrill and carbon dioxide laser stapedotomy. To monitor the inner ear function, we compared the preoperative bone conduction thresholds with the postoperative levels at day 2, week 2, week 6, and month 6. Evolution of the bone conduction was compared for the two studied groups (laser versus microdrill). An average bone conduction loss of 1.8 dB was measured at day 2 for the middle frequencies (0.5, 1, and 2 kHz). At 4 kHz, a bone conduction loss of 7 dB was found. The bone conduction thresholds measured in the first and second months after surgery showed a gradual recovery with overclosure as the end result. Our results confirm the transient depression of inner ear function in the immediate postoperative period, with recovery within the first weeks after su...
AJNR. American journal of neuroradiology, 2006
Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadoliniu... more Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadolinium T1-weighted MR images and/or echo-planar (EPI) diffusion-weighted (DWI) MR images. We describe the appearance of a case of a complicated attical middle ear cholesteatoma on single-shot (SS) turbo spin-echo (TSE) DWI compared with EPI-DWI. This case suggests a higher reliability of SS TSE-DWI in the diagnosis of acquired middle ear cholesteatoma.
American Journal of Otolaryngology, 2007
PurposeThe objective of this study was to assess the value of high-resolution computed tomography... more PurposeThe objective of this study was to assess the value of high-resolution computed tomography (HRCT) and that of magnetic resonance imaging (MRI), including postcontrast T1-weighted images and echo-planar diffusion-weighted (EP-DW) images, in the detection of residual cholesteatomas after primary bony obliteration of the mastoid.
European Radiology, 2006
Our goal was to determine the value of echo-planar diffusion-weighted MR imaging in detecting the... more Our goal was to determine the value of echo-planar diffusion-weighted MR imaging in detecting the presence of primary acquired and residual cholesteatoma. One hundred patients were evaluated by preoperative magnetic resonance (MR) imaging with diffusion-weighted MR imaging. The patient population consisted of a first group of 55 patients evaluated in order to detect the presence of a primary acquired cholesteatoma.
Neuroimaging Clinics of North America, 2009
Otology & Neurotology, 2002
*University Department of Otorhinolaryngology and Department of Pathology, St. Augustinus Hospit... more *University Department of Otorhinolaryngology and Department of Pathology, St. Augustinus Hospital, Antwerp, Belgium Squamous cell carcinomas (SCC) of the external au-ditory canal are rare tumors (1). An isolated localization on the tympanic membrane has never been ...
Otology & Neurotology, 2014
Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetratin... more Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetrating trauma to the external ear canal. In this type of ossicular dislocation, disruption of the annular ligament or footplate fracture may lead to a perilymphatic fistula (PLF) presenting with cochleovestibular symptoms including (progressive) sensorineural hearing loss, tinnitus, and vestibular symptoms. The objective of this article is to define the optimal treatment of stapediovestibular luxations and review the literature on this topic. We present a case of internal stapediovestibular dislocation and pneumolabyrinth after penetrating trauma with predominantly conductive hearing loss and incapacitating vertigo. Middle ear inspection with removal of the luxated incus, repositioning of the stapes with a &amp;amp;amp;amp;amp;amp;amp;quot;stapedial strut&amp;amp;amp;amp;amp;amp;amp;quot; and closure of the tympanic membrane. Hearing outcome and vestibular symptoms of this patient are presented, and all comparable cases in the literature are reviewed. Complete resolution of the vestibular symptoms and stabilization of the bone conduction thresholds. In patients with pneumolabyrinth after middle ear trauma with mild symptoms, we recommend initial conservative treatment with close monitoring of hearing. In patients with severe, persisting, or progressive vestibulocochlear symptoms, exploratory tympanotomy should be performed to check for and treat PLF. Oval window fistula repair is reported to have variable hearing outcomes but offers complete resolution of vestibular symptoms in most cases. The stapedial strut is one of the possible surgical techniques in case of an internally luxated stapes.
Annals of Otology, Rhinology & Laryngology, 2014
An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosi... more An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosis depends on careful history taking and otoscopic examination. Different treatment options are available. Reconstruction with hydroxyapatite bone cement is a relatively new technique. The aim of this article is to review the current diagnostic work-up and treatment options and to demonstrate our method of treatment with hydroxyapatite bone cement. Three cases, repaired with hydroxyapatite bone cement in a tertiary referral otologic center, were retrospectively analyzed. A review of the literature on diagnosis and treatment procedures was performed. One fracture occurred by withdrawing a finger from the external auditory canal and 2 occurred without clear prior trauma. Our 3 cases were successfully repaired with hydroxyapatite bone cement. Diagnosis of an isolated malleus handle fracture still depends on careful clinical examination. In addition to pure tone audiometry, both low and higher frequency tympanometry may be useful. High resolution computed tomography with reformatting through the malleus handle is the most accurate imaging modality. Reconstruction with hydroxyapatite bone cement is reliable by restoring the original situation with only minimal manipulation and without additional ossicular interruption.
Skull Base, 2010
The major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality t... more The major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality to functional preservation of the facial nerve and hearing. Absence of fluid between the lateral end of the VS and the internal auditory canal fundus on magnetic resonance imaging (MRI) appeared to have a negative influence on hearing outcome. Our goal was to study the prognostic significance of fundus obliteration on facial nerve function after VS surgery in patients with clinically normal facial function. We performed a retrospective review in a tertiary referral neurotology unit or 110 consecutive patients with a surgically removed VS and normal preoperative facial nerve function. Facial nerve function was evaluated at 1 month and 1 year by using the House-Brackmann (HB) scale and correlated to fundus obliteration on MRI. Facial nerve function was intact preoperatively in 114 of 123 patients (92.7%). We noticed a statistically significant difference and worse short-term outcome when the fundus was obliterated: 29.7% had HB 3 or more versus 13.0% if no fundus obliteration was seen. This statistically significant difference disappeared at 1 year. Fundus obliteration has a negative prognostic influence on short-term facial nerve function after VS surgery in patients with clinically normal facial function preoperatively.
Radiology, 2010
To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gado... more To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gadoliniumenhanced T1-weighted magnetic resonance (MR) imaging, and the combination of both techniques in the evaluation of patients with cholesteatoma.
Otology & Neurotology, 2001
The purpose of this study was to determine whether three magnetic resonance imaging (MRI) finding... more The purpose of this study was to determine whether three magnetic resonance imaging (MRI) findings (tumor size, extension to the fundus, intralabyrinthine signal intensity) have a predictive value to hearing preservation in vestibular schwannoma surgery. A retrospective study was conducted of preoperative high-resolution MR images in a series of consecutive hearing preservation attempts for vestibular schwannomas. Twenty-six consecutive records of patients with an acoustic tumor removed via a retrosigmoid transcanal approach were analyzed, and the MR images were reviewed blindly and compared with postoperative hearing. The study took place in a tertiary referral center. Imaging Techniques: The MR sequences used in this study were unenhanced and gadolinium-enhanced T1-weighted spin-echo images and gradient echo images (3DFT-CISS). The predictive value of three MRI signs was analyzed: tumor size, lateral extension of the tumor (with and without obliteration of the fundus), and the maintenance of, or decrease in, the intralabyrinthine signal intensity on the affected side in comparison with the signal intensity on the opposite normal side as seen on 3DFT-CISS images. The tumor size in ears in which hearing was preserved averaged 15 mm and was 17 mm in those cases where hearing was not preserved. Hearing was preserved in 50% of ears when the tumor did not extend to the fundus but in only 33% when the fundus was obliterated by tumor. A &amp;quot;normal&amp;quot; intralabyrinthine signal on CISS images (being an isointense signal when compared with the contralateral unaffected ear) was followed by hearing preservation in 82% of ears, whereas in cases where the intralabyrinthine signal was low, hearing was preserved in only 20%. This correlation was statistically significant (p &amp;lt; 0.05). The intralabyrinthine signal intensity on 3DFT-CISS gradient-echo images is a valuable additional tool for determining candidacy for hearing preservation surgery. In two cases with preoperative decrease in signal intensity of the intralabyrinthine fluids, control MRI after surgery showed spontaneous recovery of normal intralabyrinthine signal intensity. The authors hypothesize that vascular compression in the internal auditory canal by the tumor is responsible for the observed intralabyrinthine signal decrease.
Otology & Neurotology, 2006
... Imaging Case of the Month Congenital Bilateral Oval and Round Window Aplasia with a Hypoplast... more ... Imaging Case of the Month Congenital Bilateral Oval and Round Window Aplasia with a Hypoplastic Stapes *Jean-Philippe Vercruysse, Jan Casselman, Bert De Foer, *Thomas Somers, and *Erwin Offeciers *University ENT Department and Radiology Department, St. ...
Otology & Neurotology, 2008
Objective: The primary goal of cholesteatoma surgery is complete eradication of the disease. To l... more Objective: The primary goal of cholesteatoma surgery is complete eradication of the disease. To lower the recurrence rate in the pediatric population in canal wall up techniques and to avoid the disadvantages of canal wall down techniques, the bony obliteration technique with epitympanic and mastoid obliteration has been developed. The objective of this study was to evaluate the long-term surgical outcome and recurrence rate of this technique in children. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifty-two children (G16 yr) were operated on in 90.4% (n = 47) for a primary or recurrent cholesteatoma and in 9.6% (n = 5) for an unstable cavity. Intervention: In all cases, we closed the tympanoattical barrier and the posterior tympanotomy with sculpted cortical bone and then completed obliteration of the epitympanum and mastoid with bone pâté. A reconstruction of the middle ear was performed by means of an allograft tympanic membrane including the malleus handle and a sculpted allograft malleus or incus for columellar reconstruction. Main Outcome Measures: Recurrent rate; residual rate; functional outcome; hygienic status of the ear; long-term safety issues. Results: The mean follow-up time was 49.5 months (range, 12Y101.3 mo). Recurrent cholesteatoma occurred in 1.9% (n = 1). Residual cholesteatoma was detected in 15.4% (n = 8) of the cases. Postoperative hearing results revealed a median gain on pure-tone averages of 14.3 dB and a median postoperative air-bone gap of 25.6 dB. Conclusion: The mastoid and epitympanic BOT is an effective technique to lower the recurrence rate of cholesteatoma in the pediatric population. Follow-up by magnetic resonance imaging provides a safe, noninvasive method for postoperative detection of residual cholesteatoma. Key Words: Bone pâtéVCholesteatomaVMastoid obliterationVMastoidectomy. Otol Neurotol 00:00Y00, 2008.
Otology & Neurotology, 2008
To use a study on dysgeusia to assess the usefulness of an otology database. Data were extracted ... more To use a study on dysgeusia to assess the usefulness of an otology database. Data were extracted from the international Common Otology Database. Primary stapes operations. From a cohort of 14 otologists, only 8 (57%) were able to satisfy external validation and maintain data input for a period of at least 6 months. The rates of dysgeusia varied from 0 to 39% at 3 months and 0 to 27% at 6 months. The percentages of patients with taste disturbance at 6 months in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;nerve-cut&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;nerve-preserved&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; groups were 22.7 and 10.9%, respectively, although this was not statistically significant (chi2; p = 0.325). Many surgeons found it difficult to maintain a prospective otology database. The rates of certain subjective symptoms such as dysgeusia are influenced by how vigorously the reviewers prompt the response from the patients. Dysgeusia after stapes surgery is common even if the chorda tympani nerve is preserved. Many patients whose chorda tympani nerve is divided may not complain of dysgeusia.
Otology & Neurotology, 2009
- To quantify the audiometric differences between the preoperative tests with the Bone-Anchored ... more 1) To quantify the audiometric differences between the preoperative tests with the Bone-Anchored Hearing Aid (BAHA) attached to the headband or the testband and the final postoperative result with the BAHA positioned at the implanted abutment. 2) To compare the results obtained with the headband and the testband. 3) To quantify the magnitude of the damping through the skin for the BAHA placed at the testband (important for comparison with the implantable hearing aids). Prospective. Tertiary otological referral centre. Ten adult (&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 14 yr old) BAHA patients (6 male and 4 female subjects) with bilateral air-bone gaps of minimum 40-dB hearing loss and with more than 6 months of BAHA experience with the BAHA &amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Compact.&amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Audiometric free-field thresholds and speech audiometry scores (Consonant-Vowel-Consonant lists, phonemic score) have been evaluated for 3 conditions: BAHA attached to the implanted &amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Snap&amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; abutment, to the headband, or to the testband. For frequencies 1 to 4 kHz, significant differences in the range of 5 to 20 dB were found between the BAHA coupled with the Snap abutment and the preoperative testing conditions with the BAHA positioned at the headband or the testband. These differences were also reflected in the speech audiometry with a difference in speech reception threshold of approximately 4 to 7 dB. 1) Significant differences in the audiometric thresholds and the speech understanding scores were found between the preoperative test conditions and the final postoperative result. 2) Audiometric results obtained with the headband and the testband are comparable; therefore, the more comfortable headband is also suitable for the preoperative audiologic evaluation. 3) The magnitude of the skin damping must be accounted for when referring to the audiometric results obtained with the BAHA attached to the testband or headband.
Otology & Neurotology, 2008
Objective: The aim of this study is to determine the role of PROPELLER diffusionweighted MR imagi... more Objective: The aim of this study is to determine the role of PROPELLER diffusionweighted MR imaging combined with conventional MR imaging for the detection of residual cholesteatoma in patients who have undergone middle ear surgery. Subjects and methods: Twenty patients who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging (1.5 T) was performed using a PROPELLER DWI, T2WI, FLAIR and T1WI before and after IV injection of gadopentetate dimeglumine. An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity and calculated corresponding ADC values. Imaging findings were correlated with findings from surgery in 14 patients and with findings from clinical follow-up examination in six patients. Results: Diffusion-weighted MR imaging combined with conventional MR imaging depicted eight cholesteatomas. Two lesions were missed that were <3 mm. One patient was misdiagnosed as cholesteatoma, biopsy revealed acute inflammation. Sensitivity was 80%, specificity was 90%, positive predictive value was 89% and negative predictive value was 82%. Conclusion: Diffusion-weighted MR imaging combined with conventional MRI and calculation of ADC values is useful in the detection of secondary cholesteatoma and would decrease the need for un-necessary second canal wall-up operation.
Neuroradiology, 2007
Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance im... more Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear cholesteatoma and evaluated the size of middle ear cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear cholesteatomas, with a size limit as small as 2 mm.