karen nicolas - Academia.edu (original) (raw)
Papers by karen nicolas
Comprehensive and Clinical Anatomy of the Middle Ear, 2019
An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There i... more An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There is no light at the end of the tunnel concerning treatment and worries from a possible second wave start to arise even before the end of the first one. We conducted a multicenter study to reassess the different aspects of radiology departments’ preparedness in Lebanon stating the points of strength and more importantly depicting the points of weakness. Lessons were then extracted to be more prepared for possible future similar circumstances.
Middle Ear Diseases, 2018
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Comprehensive and Clinical Anatomy of the Middle Ear, 2019
The human middle ear system is the result of a distinct event of the species evolution. This chap... more The human middle ear system is the result of a distinct event of the species evolution. This chapter emphasizes on the developmental courses to better understand the comparative and actual anatomical results concerning the human middle ear structures. Also it is admitted that the middle ear is a fragile organ with weak defense mechanisms against invaders! Why?
Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear cl... more Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear cleft, which presents with recurrent ear discharges or otorrhea through a tympanic membrane perforation. The prevalence of CSOM remains considerable with a huge impact on the health systems.
Middle Ear Diseases, 2018
International Journal of Case Reports, 2019
Case Report IJCR (2019) 4:90 Crowned dens syndrome : a case report followed by an update on diffe... more Case Report IJCR (2019) 4:90 Crowned dens syndrome : a case report followed by an update on differential diagnosis and treatment Crowned dens syndrome (CDS) is a rare clinical presentation of chondrocalcinosis or calcium pyrophosphate crystal deposition (CPPD) disease, characterized by fever, neck pain and stiffness, associated with increased biological markers of inflammation. Diagnosis is made mainly via imaging, and the best modality remains the magnetic resonance imaging (MRI) of the neck showing calcification and calcium pyrophosphate crystals deposition around the odontoid process (1). The aim of this report is to increase awareness of this rare and ill-known clinical tableau and to review its complications and the latest modalities of its diagnosis and treatment.
Middle Ear Diseases, 2018
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT The following synopsis of the ME anatomy reviews the basic anatomical knowledge necessar... more ABSTRACT The following synopsis of the ME anatomy reviews the basic anatomical knowledge necessary to better understand our future approach of the RP, focusing on the tympanic membrane, the different middle ear compartments and their ventilation pathways, the mastoid air cell system, and the Eustachian tube. This chapter relies on the detailed description of the middle ear cleft anatomy presented in “The Comprehensive and Clinical Anatomy of the Middle Ear” (Springer).
Tympanic Membrane Retraction Pocket, 2014
Recent literature lacks appreciable and specific studies relative to the clinico-radiologic corre... more Recent literature lacks appreciable and specific studies relative to the clinico-radiologic correlations in cases of RP. However, the analysis of the middle ear structures has greatly improved over the last years by the multislice techniques and the continuously raising spatial resolution. Nowadays, CT imaging of ears with RP may enrich the clinical exam in a very precious way. In addition to the description of the RP and its extensions, often incomplete by the clinical examination, CT imaging offers an assessment of the pneumatization status of the temporal bone and the aeration or condensation status of the middle ear cleft spaces which we consider as new objective criteria for a better diagnostic evaluation of the RP. As demonstrated below, these objective criteria offer key information not only for the prognosis but also for the management of the RP.
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT Atelectasis, adhesive otitis media, and fibroadhesive otitis media are different forms o... more ABSTRACT Atelectasis, adhesive otitis media, and fibroadhesive otitis media are different forms of a retraction of an intact tympanic membrane, transformed into a very thin epidermal membrane, retracted towards the medial wall of the tympanic cavity, as shown in Fig. 7.1.
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT Epidemiologic studies already done on the frequency of tympanic membrane retractions hav... more ABSTRACT Epidemiologic studies already done on the frequency of tympanic membrane retractions have been rare and almost exclusively exploring pediatric populations. Numerous studies agreed on the fact that in the presence of otitis media, the frequency of tympanic membrane pathologies is significantly higher.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
The Journal of Otolaryngology, 2007
The Journal of Otolaryngology, 2005
To demonstrate the important role of the anterior epitympanic recess (AER) in the surgery of nonc... more To demonstrate the important role of the anterior epitympanic recess (AER) in the surgery of noncholesteatomateous chronic inflammatory middle ear disorders. To establish selective criteria as to the indication of surgical intervention on the AER, aiming to create a permanent anterior aeration pathway for the attic. In addition, to point out the mandatory role of preoperative temporal bone computed tomography (CT) demonstrating whether the AER is involved and thus contributing, within the clinical context, to the indication for this surgery and its appropriate approach. Prospective study on patients with persistent or recurring chronic inflammatory middle ear disease for at least 3 years, after failure of conventional medical or surgical treatments. Tertiary referral university centre. Between November 2002 and July 2003, every patient presenting with clinical findings suggestive of an AER pathology was included in this study. Surgical approach of the AER during a mastoatticotomy and tympanoplasty with excision of the Cog and the tensor tympani fold, preserving the ossicular chain in almost all cases. Absence of postoperative otorrhea, satisfactory otoscopic examination, and improvement in the air-bone gap postoperatively in case the presurgery hearing level was abnormal and not due to an ossicular chain abnormality. Eight patients were included in the study. The preoperative CT scan showed AER opacities in all patients that were either isolated or associated with a diseased meso- or hypotympanum or the mastoid cavity. The measurement of the relevant transverse diameter of the AER is proposed to evaluate preoperatively the distance between the Cog laterally and the facial nerve canal medially to minimize the risk of a perioperative injury. During the operation, we found granulation tissue and adhesions in the AER in all cases A clinical follow-up 3 months after the intervention showed good local control in all patients, absence of otorrhea, and almost complete closure of the air-bone gap at audiometric evaluation. The last clinical follow-up in August 2004, a mean of 18 months after our intervention, did not reveal any relapse of symptoms in any case. CT control could be obtained in five of eight cases, within 13 to 21 months after the intervention, showing a reaerated tympanic cavity and AER. The AER plays a major role in sustaining some noncholesteatomateous chronic or recurrent inflammatory middle ear disorders that do not respond to conventional medical treatment. Definitive control of this pathology will be obtained by approaching the AER through an excision of the Cog and the tensor tympani fold, exenterating the inflammatory tissues, and creating a sufficient and permanent anterior atticomesotympanic communication. The indication for such a surgical approach is highly dependent on clinical findings correlated to temporal bone CT. Familiarity with the AER and its critical role should become part of every resident's training program in otology.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Otology & Neurotology, 2011
To develop a radiologic classification of severity of round window involvement in otosclerosis an... more To develop a radiologic classification of severity of round window involvement in otosclerosis and describe the impact of each class on hearing and outcome of stapes surgery. Retrospective chart review with radiologic review of computed tomographic scans. Hospital and private otolaryngology clinics. We reviewed computed tomographic scans of 930 ears with clinical otosclerosis; 121 (13%) had round window involvement, with no pericochlear involvement in 41 of these-the primary subjects of the study. A control group consisted of 15 ears with stapedial otosclerosis. Round window involvement was classified into 5 groups from isolated round window edge hypodensity (RW-I) to overgrowing obliteration with possible extension to the cochlea (RW-V). Hearing measures included 4-frequency pure-tone average air conduction, bone conduction, and air-bone gap (ABG). Of the 41 ears, 17.1%, 31.7%, 34.1%, and 17.1% were classified as RW-I to RW-IV, respectively. Patients with RW-I and RW-II otosclerosis, compared with the controls, showed no statistically significant differences in preoperative hearing or in ABG after stapes surgery. Patients with RW-III otosclerosis had significantly poorer hearing and a larger postoperative ABG (mean, 15 dB) than controls and groups RW-I and RW-II, whereas the RW-IV group showed the most severe hearing loss and poorest surgical outcome (all p's ≤ 0.001). The proposed classification for round window otosclerosis is a valuable clinical tool that can help in decisions regarding, and counseling about, stapes surgery. Classes RW-I and RW-II have no clinical impact. Patients with RW-III otosclerosis may have a mild residual gap after surgery; those with RW-IV have dramatically poorer results.
Comprehensive and Clinical Anatomy of the Middle Ear, 2019
An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There i... more An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There is no light at the end of the tunnel concerning treatment and worries from a possible second wave start to arise even before the end of the first one. We conducted a multicenter study to reassess the different aspects of radiology departments’ preparedness in Lebanon stating the points of strength and more importantly depicting the points of weakness. Lessons were then extracted to be more prepared for possible future similar circumstances.
Middle Ear Diseases, 2018
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Comprehensive and Clinical Anatomy of the Middle Ear, 2019
The human middle ear system is the result of a distinct event of the species evolution. This chap... more The human middle ear system is the result of a distinct event of the species evolution. This chapter emphasizes on the developmental courses to better understand the comparative and actual anatomical results concerning the human middle ear structures. Also it is admitted that the middle ear is a fragile organ with weak defense mechanisms against invaders! Why?
Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear cl... more Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear cleft, which presents with recurrent ear discharges or otorrhea through a tympanic membrane perforation. The prevalence of CSOM remains considerable with a huge impact on the health systems.
Middle Ear Diseases, 2018
International Journal of Case Reports, 2019
Case Report IJCR (2019) 4:90 Crowned dens syndrome : a case report followed by an update on diffe... more Case Report IJCR (2019) 4:90 Crowned dens syndrome : a case report followed by an update on differential diagnosis and treatment Crowned dens syndrome (CDS) is a rare clinical presentation of chondrocalcinosis or calcium pyrophosphate crystal deposition (CPPD) disease, characterized by fever, neck pain and stiffness, associated with increased biological markers of inflammation. Diagnosis is made mainly via imaging, and the best modality remains the magnetic resonance imaging (MRI) of the neck showing calcification and calcium pyrophosphate crystals deposition around the odontoid process (1). The aim of this report is to increase awareness of this rare and ill-known clinical tableau and to review its complications and the latest modalities of its diagnosis and treatment.
Middle Ear Diseases, 2018
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT The following synopsis of the ME anatomy reviews the basic anatomical knowledge necessar... more ABSTRACT The following synopsis of the ME anatomy reviews the basic anatomical knowledge necessary to better understand our future approach of the RP, focusing on the tympanic membrane, the different middle ear compartments and their ventilation pathways, the mastoid air cell system, and the Eustachian tube. This chapter relies on the detailed description of the middle ear cleft anatomy presented in “The Comprehensive and Clinical Anatomy of the Middle Ear” (Springer).
Tympanic Membrane Retraction Pocket, 2014
Recent literature lacks appreciable and specific studies relative to the clinico-radiologic corre... more Recent literature lacks appreciable and specific studies relative to the clinico-radiologic correlations in cases of RP. However, the analysis of the middle ear structures has greatly improved over the last years by the multislice techniques and the continuously raising spatial resolution. Nowadays, CT imaging of ears with RP may enrich the clinical exam in a very precious way. In addition to the description of the RP and its extensions, often incomplete by the clinical examination, CT imaging offers an assessment of the pneumatization status of the temporal bone and the aeration or condensation status of the middle ear cleft spaces which we consider as new objective criteria for a better diagnostic evaluation of the RP. As demonstrated below, these objective criteria offer key information not only for the prognosis but also for the management of the RP.
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT Atelectasis, adhesive otitis media, and fibroadhesive otitis media are different forms o... more ABSTRACT Atelectasis, adhesive otitis media, and fibroadhesive otitis media are different forms of a retraction of an intact tympanic membrane, transformed into a very thin epidermal membrane, retracted towards the medial wall of the tympanic cavity, as shown in Fig. 7.1.
Tympanic Membrane Retraction Pocket, 2014
ABSTRACT Epidemiologic studies already done on the frequency of tympanic membrane retractions hav... more ABSTRACT Epidemiologic studies already done on the frequency of tympanic membrane retractions have been rare and almost exclusively exploring pediatric populations. Numerous studies agreed on the fact that in the presence of otitis media, the frequency of tympanic membrane pathologies is significantly higher.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
The Journal of Otolaryngology, 2007
The Journal of Otolaryngology, 2005
To demonstrate the important role of the anterior epitympanic recess (AER) in the surgery of nonc... more To demonstrate the important role of the anterior epitympanic recess (AER) in the surgery of noncholesteatomateous chronic inflammatory middle ear disorders. To establish selective criteria as to the indication of surgical intervention on the AER, aiming to create a permanent anterior aeration pathway for the attic. In addition, to point out the mandatory role of preoperative temporal bone computed tomography (CT) demonstrating whether the AER is involved and thus contributing, within the clinical context, to the indication for this surgery and its appropriate approach. Prospective study on patients with persistent or recurring chronic inflammatory middle ear disease for at least 3 years, after failure of conventional medical or surgical treatments. Tertiary referral university centre. Between November 2002 and July 2003, every patient presenting with clinical findings suggestive of an AER pathology was included in this study. Surgical approach of the AER during a mastoatticotomy and tympanoplasty with excision of the Cog and the tensor tympani fold, preserving the ossicular chain in almost all cases. Absence of postoperative otorrhea, satisfactory otoscopic examination, and improvement in the air-bone gap postoperatively in case the presurgery hearing level was abnormal and not due to an ossicular chain abnormality. Eight patients were included in the study. The preoperative CT scan showed AER opacities in all patients that were either isolated or associated with a diseased meso- or hypotympanum or the mastoid cavity. The measurement of the relevant transverse diameter of the AER is proposed to evaluate preoperatively the distance between the Cog laterally and the facial nerve canal medially to minimize the risk of a perioperative injury. During the operation, we found granulation tissue and adhesions in the AER in all cases A clinical follow-up 3 months after the intervention showed good local control in all patients, absence of otorrhea, and almost complete closure of the air-bone gap at audiometric evaluation. The last clinical follow-up in August 2004, a mean of 18 months after our intervention, did not reveal any relapse of symptoms in any case. CT control could be obtained in five of eight cases, within 13 to 21 months after the intervention, showing a reaerated tympanic cavity and AER. The AER plays a major role in sustaining some noncholesteatomateous chronic or recurrent inflammatory middle ear disorders that do not respond to conventional medical treatment. Definitive control of this pathology will be obtained by approaching the AER through an excision of the Cog and the tensor tympani fold, exenterating the inflammatory tissues, and creating a sufficient and permanent anterior atticomesotympanic communication. The indication for such a surgical approach is highly dependent on clinical findings correlated to temporal bone CT. Familiarity with the AER and its critical role should become part of every resident's training program in otology.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Otology & Neurotology, 2011
To develop a radiologic classification of severity of round window involvement in otosclerosis an... more To develop a radiologic classification of severity of round window involvement in otosclerosis and describe the impact of each class on hearing and outcome of stapes surgery. Retrospective chart review with radiologic review of computed tomographic scans. Hospital and private otolaryngology clinics. We reviewed computed tomographic scans of 930 ears with clinical otosclerosis; 121 (13%) had round window involvement, with no pericochlear involvement in 41 of these-the primary subjects of the study. A control group consisted of 15 ears with stapedial otosclerosis. Round window involvement was classified into 5 groups from isolated round window edge hypodensity (RW-I) to overgrowing obliteration with possible extension to the cochlea (RW-V). Hearing measures included 4-frequency pure-tone average air conduction, bone conduction, and air-bone gap (ABG). Of the 41 ears, 17.1%, 31.7%, 34.1%, and 17.1% were classified as RW-I to RW-IV, respectively. Patients with RW-I and RW-II otosclerosis, compared with the controls, showed no statistically significant differences in preoperative hearing or in ABG after stapes surgery. Patients with RW-III otosclerosis had significantly poorer hearing and a larger postoperative ABG (mean, 15 dB) than controls and groups RW-I and RW-II, whereas the RW-IV group showed the most severe hearing loss and poorest surgical outcome (all p's ≤ 0.001). The proposed classification for round window otosclerosis is a valuable clinical tool that can help in decisions regarding, and counseling about, stapes surgery. Classes RW-I and RW-II have no clinical impact. Patients with RW-III otosclerosis may have a mild residual gap after surgery; those with RW-IV have dramatically poorer results.