Anterior Canal Research Articles

Endoscopic Cartilage Slice Reinforcement Technique for Anterior Perforation Repair with Anterior Canal Wall Protrusion.

Objective: To evaluate the outcomes and complications of the endoscopic cartilage slice reinforcement technique used on anterior margins for anterior perforation repair with anterior canal wall protrusion. Material and Methods: We conducted a prospective study on 38 cases of anterior perforation with anterior canal wall protrusion, treated using the endoscopic cartilage slice reinforcement technique from February 1, 2017 to August 29, 2023. The follow-up period was 6 months. Results: Of the 38 patients, medium perforations were present in 28.9%, large in 65.8%, and subtotal in 5.3%. The cause was mucosal chronic otitis media in 92.1%, traumatic perforation in 5.3%, and ventilation tube removal in 2.6%. The average operation time was 27.2 ± 4.6 minutes. The graft success rate was 94.7% (36/38) at 6 months postoperative. The average preoperative air-bone gap (ABG) was 19.8 ± 4.2 dB, and postoperative ABG was 8.6 ± 2.9 dB; this improvement was statistically significant (P < .001; paired-sample t-test). The ABG gain was 11.8 ± 5.1 dB, and the rate of successful surgery (postoperative ABG ≤ 20 dB) was 97.4% (37/38). No complications such as altered taste, vertigo, or tinnitus were reported, and no cases involved graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion. However, myringitis was observed in 4 (10.5%) patients. Conclusion: The endoscopic cartilage slice reinforcement technique for anterior margins is a simple and effective method for repairing anterior perforations with anterior canal wall protrusion, achieving a high graft success rate, improved hearing, and minimal complications.

Classification, angioarchitecture and treatment outcomes of medullary bridging vein-draining dural arteriovenous fistulas in the foramen magnum region: a multicenter study.

This study aimed to classify medullary bridging vein-draining dural arteriovenous fistulas (MBV-DAVFs) located around the foramen magnum (FM) according to their location and characterize their angioarchitecture and treatment outcomes. Patients with MBV-DAVFs diagnosed between January 2013 and October 2022 were included. MBV-DAVFs were classified into four groups. Jugular vein-bridging vein (JV-BV) DAVF: located in proximity to jugular fossa, Anterior condylar vein (ACV)-BV DAVF: proximity to anterior condylar canal, Marginal sinus (MS)-BV DAVF: lateral surface of FM and Suboccipital cavernous sinus (SCS)-BV DAVF: proximity to dural penetration of vertebral artery. Twenty patients were included, three JV-BV, four ACV-BV, three MS-BV and ten SCS-BV DAVFs, respectively. All groups showed male predominance. There were significant differences in main feeders between JV (jugular branch of ascending pharyngeal artery) and SCS group (C1 dural branch). Pial feeders from anterior spinal artery (ASA) or lateral spinal artery (LSA) were visualized in four SCS and one MS group. Drainage pattern did not differ between groups. Transarterial embolization (TAE) was performed in three, two, one and two cases and complete obliteration was obtained in 100%, 50%, 100% and 0% in JV, ACS, MS and SCS group, respectively. Successful interventions without major complications were finally obtained in 100%, 75%, 100%, and 40% in JV, ACS, MS and SCS group, respectively. JV-BV DAVFs were successfully treated using TAE alone. SCS-BV DAVFs were mainly fed by small C1 dural branches of vertebral artery often with pial feeders from ASA or LSA, and difficultly treated by TAE alone.

Relationship between Location of Focal Traumatic Brain Injury and Canal Involved in Benign Paroxysmal Positional Vertigo.

Benign paroxysmal positional vertigo (BPPV) has a prevalence of 58% in a traumatic brain injury (TBI) population. Research on idiopathic BPPV has demonstrated a higher prevalence of right-sided canal involvement. While many studies have investigated the epidemiology of canal involvement in BPPV in both idiopathic and traumatic BPPV (BPPV associated with a fall), there has been no assessment of trauma location as a predictor of the location of BPPV. The aim of this study was to assess the relationship between the location of a focal TBI and canal involvement in BPPV. Patients who were admitted to an inpatient rehabilitation unit with a diagnosis of TBI were screened for BPPV. The primary outcome of this study was the side of the TBI, the BPPV type (posterior, horizontal, or anterior canal), and the side of the BPPV (right, left, or bilateral). There were 42 people who had BPPV. Twenty-one had right-sided canal involvement, 14 had left-sided involvement, and 7 had bilateral involvement. Sixteen had right-side tissue involvement, 13 had left-side involvement, and 13 had bilateral involvement. There was no significant correlation between variables (χ2 = 1.70, p = 0.80). All patients with a TBI should have all canals assessed for BPPV as there is no relationship between the side of focal damage and canal involvement.

Assessment of hearing and balance functions in patients with acromegaly by the use of an audiovestibular test battery: a cross-sectional study.

Patients with acromegaly may have abnormalities in their hearing and balance as a result of modifications in body composition and involvement of the temporal bone. The objective of this study is to examine if there are any changes in the auditory and vestibular systems in individuals with acromegaly by using audiogram and vestibular function tests. This prospective study included 33 healthy controls and 33 acromegaly patients who were matched for age and gender distribution. A pure-tone audiometry test was conducted, including frequencies ranging from 250Hz to 8000Hz. Videonystagmography (VNG) was employed to assess nystagmus, an essential parameter used for assessing vestibular functions. The Video Head Impulse Test (v-HIT) was used to assess the vestibulo-ocular reflex (VOR). The Dizziness Handicap Inventory (DHI) was applied to evaluate the subjective complaints of the participants. The acromegaly patients had significantly elevated hearing thresholds at all frequencies (250, 500, 1000, 2000, 4000, and 6000Hz) compared to the control group (p < 0.005). The VNG tests, including gaze horizontal, gaze vertical, saccade, spontaneous nystagmus, optokinetic, smooth pursuit, and positioning tests, did not show any statistically significant difference between the two groups (p values > 0.05). The patient group demonstrated reduced VOR gains compared to the control group in the anterior and posterior channels (p < 0.005). There was no statistically significant difference between the two groups for the occurrence of aberrant eye movements (p values > 0.05). The patient group had a total DHI score of 6.6 ± 3.2, while the control group had a score of 3.2 ± 2.6 (independent samples t-test; p < 0.001). Therefore, The patient group exhibited significantly greater subjective vestibular symptoms. Patients with acromegaly experience impaired auditory function. The central vestibular system remains unaffected, while the gains of the vestibulo-ocular reflex (VOR) in the posterior and anterior semicircular canals are decreased. Additionally, these patients report experiencing subjective dizziness. Screening for hearing and balance in patients with acromegaly may improve the quality of life of patients and prevent problems related to balance disorders at an early stage.

Intelligent analysis and measurement of semicircular canal spatial attitude.

The primary aim of this investigation was to devise an intelligent approach for interpreting and measuring the spatial orientation of semicircular canals based on cranial MRI. The ultimate objective is to employ this intelligent method to construct a precise mathematical model that accurately represents the spatial orientation of the semicircular canals. Using a dataset of 115 cranial MRI scans, this study employed the nnDetection deep learning algorithm to perform automated segmentation of the semicircular canals and the eyeballs (left and right). The center points of each semicircular canal were organized into an ordered structure using point characteristic analysis. Subsequently, a point-by-point plane fit was performed along these centerlines, and the normal vector of the semicircular canals was computed using the singular value decomposition method and calibrated to a standard spatial coordinate system whose transverse planes were the top of the common crus and the bottom of the eyeballs. The nnDetection target recognition segmentation algorithm achieved Dice values of 0.9585 and 0.9663. The direction angles of the unit normal vectors for the left anterior, lateral, and posterior semicircular canal planes were [80.19°, 124.32°, 36.08°], [169.88°, 100.04°, 91.32°], and [79.33°, 130.63°, 137.4°], respectively. For the right side, the angles were [79.03°, 125.41°, 142.42°], [171.45°, 98.53°, 89.43°], and [80.12°, 132.42°, 44.11°], respectively. This study successfully achieved real-time automated understanding and measurement of the spatial orientation of semicircular canals, providing a solid foundation for personalized diagnosis and treatment optimization of vestibular diseases. It also establishes essential tools and a theoretical basis for future research into vestibular function and related diseases.

Radiologic evaluation of the internal carotid artery and jugular bulb in lateral temporal bone resection using 3D computed tomography.

This study investigated the internal carotid artery (ICA) and jugular bulb (JB) structures in terms of lateral temporal bone resection using 3D computed tomography (CT). We retrospectively investigated 80 ears of 40 patients using 3D reconstruction data from normal temporal bone CT. Ten critical points (P) in the temporal bone were marked in the 3D object with reference to the axial, coronal, and sagittal images of the CT scans. An imaginary plane of the facial nerve (PLf) course was also reconstructed in relation to the three points of the chorda-facial junction, P5 (second genu), and P3 (cochleariform) process. The distances (mean ± SD; mm) from points P3 to P1 (the highest level of the JB) and P2 (the posterior wall of the ascending petrous IAC at the level of the Eustachian tube) were 12.03 ± 2.56 and 9.79 ± 1.78, respectively. The distances from point P4 (chorda-facial junction) to P1 and P2 were 10.98 ± 2.70 and 17.66 ± 2.26, respectively. The angles (mean ± SD; degree) between the PLf to the line from Pa (point of the anterior bony canal) to P3 and P4 were 17.80 ± 10.05º and 8.93 ± 5.37º, respectively. The angles between the PLf to the line from P3 to P1 and P2 were - 36.35 ± 13.28º and - 24.78 ± 13.91º, respectively. The angles between the PLf to the line from P4 to P1 and P2 respectively were - 40.35 ± 15.37º and - 13.34 ± 7.63º. Understanding the anatomical relationships of P1 and P2 at P3 and P4 can be helpful in preventing iatrogenic trauma of the ICA and JB.

Beam Dynamic Equations for Predictive Modeling of Semicircular Canal Pathologies

This short paper presents a general strategy devoted to an original analytical approach of looped 1.5D equations. It considers particular properties of rod/beam equations for wave and structural modal representation. Specific boundary conditions introduce local singularities representing discontinuities and inversions. The process presented in the paper links this kind of original analysis with possible models of the physiological and pathological dynamic behavior of solid-fluid interaction in inner-ear elements such as the anterior and superior semicircular canals. Thus, these models propose a robust representation of these elements, offering observation/control perspectives for diagnostics and cure.

The Impact of Serums Calcium 25-Hydroxy Vitamin D, Ferritin, Uric Acid, and Sleeping Disorders on Benign Paroxysmal Positional Vertigo Patients.

This study's objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. This is a case and control design study. The consecutive patients' visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix-Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette-water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients.

Adoption of the international classification of vestibular disorders criteria in cases of Benign positional paroxysmal vertigo: a single-center experience.

Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility.

The Role of Asymmetry Values, Gain, and Pathological Saccades of the Video Head Impulse Test (vHIT) in Sudden Sensorineural Hearing Loss.

The purpose of this study was to evaluate the value of asymmetry values, gain, and pathological saccades of the video head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL). Retrospective study. Tertiary referral center. A total of 226 individuals diagnosed with unilateral definite SSNHL were hospitalized. The assessment included a comprehensive evaluation of medical history, pure-tone test, acoustic impedance, positional test, video nystagmography (VNG), vHIT, vestibular evoked myogenic potentials (VEMPs) and magnetic resonance. vHIT, VNG, cVEMP, oVEMP. Statistical analysis was performed with SPSS version 22.0 for Windows. The asymmetry values, gain, and pathological saccades of the vHIT. The abnormal gain of vHIT in anterior, horizontal, and posterior canal in SSNHL patients with vertigo were revealed in 20 of 112 (17.9%), 24 of 112 (21.4%), and 60 of 112 (53.6%), respectively. The vHIT pathological saccades (overt + covert) of anterior, horizontal, and posterior canal in SSNHL patients with vertigo were observed in 5 of 112 (4.6%), 52 of 112 (46.4%), and 58 of 112 (51.8%), respectively. Multivariate analysis indicated that the prognosis of patients with vertigo was correlated with vHIT gain of posterior canal, pathological saccade in horizontal canal, asymmetric ratio of horizontal canal gain, asymmetric ratio of posterior canal gain, Canal paresis (%) on caloric test and spontaneous nystagmus. In the vHIT of patients with SSNHL with vertigo, the posterior canal is most easily affected. Reduced gain of posterior canal, pathological saccade of horizontal canal, and larger asymmetric gain of posterior canal and horizontal canal may be negative prognostic factors.

Can antimicrobial photodynamic therapy serve as an effective adjunct protocol for disinfecting the necrotic root canal system? A randomized controlled study

BackgroundBacterial infection plays an important role in persistent periapical lesions and inadequate disinfection of root canals is considered the biggest factor responsible for endodontic treatment failure. Antimicrobial Photodynamic Therapy (aPDT) has become the latest choice to eradicate microorganisms in root canals.ObjectiveThis study aims to evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT) in bacterial count reduction compared to Passive Ultrasonic Activation (PUI) and Ca(OH)2 dressings.Materials and methodsForty-five anterior single canal teeth with medium-sized periapical lesions (2–5 mm) were divided into three groups according to the disinfecting technique (each group consists of 15 canals with 1:1:1 allocation ratio): Group A: Ca(OH)2 dressing. Group B: Passive Ultrasonic Activation (PUI). Group C: Antimicrobial Photodynamic Therapy (aPDT). Direct bacterial viable count method was used to count the colonies forming units (CFU) before and after the disinfecting and the bacterial count reduction was estimated, the statistical analysis was performed at a 95% confidence level using the Chi-square and Mann–Whitney U test.ResultsaPDT showed no statistically significant difference when compared to passive ultrasonic irrigation (P > 0.05) but showed higher and more promising results when compared to Ca(OH)2 dressings (P < 0.05).ConclusionsaPDT has the ability and effectiveness as a disinfecting technique in necrotic and infected root canals.Clinical significance of the studyThe results of this clinical trial provide that aPDT can be considered an adjunct method for root canal disinfection with the same effectiveness as passive ultrasonic irrigation.

Neck rigidity: a pitfall for video head-impulse tests in Parkinson's disease.

Video head impulse tests (video-HITs) are commonly used for vestibular evaluation; however, the results can be contaminated by various artifacts, including technical errors, recording problems, and participant factors. Although video-HITs can be used in patients with Parkinson's disease (PD), the effect of neck rigidity has not been systematically investigated. This study aimed to investigate the effect of neck rigidity on video-HIT results in patients with PD. We prospectively recruited 140 consecutive patients with PD (mean age ± standard deviation = 68 ± 10 years, 69 men) between September 2021 and April 2024 at Korea University Medical Center. The video-HIT results were compared with those of 19 age- and sex-matched healthy participants. Neck rigidity was stratified as a subdomain of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III). In 59 patients, the vestibulo-ocular reflex (VOR) gain was overestimated in at least one canal plane (58/140, 41%), mostly in the anterior canal (AC, n = 44), followed by the horizontal (HC, n = 15) and posterior canals (PC, n = 7). VOR gain overestimation was also observed in patients with no (18/58, 35%), subtle (20/58, 34%), or mild (17/58, 29%) neck rigidity. Multivariable logistic regression analysis showed that VOR overestimation was positively associated with neck rigidity (odds ratio [OR] [95% confidence interval] = 1.51 [1.01-2.25], p = 0.043). The head velocities of patients decreased during head impulses for the AC (p = 0.033 for the right AC; p = 0.014 for the left AC), whereas eye velocities were similar to those of healthy participants. Our findings suggest that neck rigidity may be a confounder that can contaminate video-HIT results. Thus, the results of video-HITs, especially for the AC, should be interpreted with the context of head velocity during head impulses in patients with neck rigidity.

Use of transrectal high-frequency ultrasound in assessment of middle compartment prolapse.

To investigate the superiority of transrectal high-frequency ultrasound (TRUS) in precise assessment of middle compartment prolapse in comparison with routine transperineal ultrasound (TPUS). Prospectively analyzed and compared detection rates of entire cervical length and uterine descent on TPUS and TRUS in 101 patients with pelvic organ prolapse (POP). Detection rates of entire cervix on TRUS were significantly higher than those on TPUS both at rest and during Valsalva maneuver (90.10% VS 49.50%, 92.08% VS 9.90% respectively, both p < 0.05). Uterine descent was able to be evaluated in 92.08% of patients by TRUS and in 5.94% of patients by TPUS, which was statistically significant (p < 0.05). The interobserver repeatability for the measurements of anterior lip, cervical canal and posterior lip on TRUS was excellent. The mean lengths of anterior lip, cervical canal and posterior lip were significantly increased during Valsalva maneuver than those measured at rest (p < 0.05). And mean length of anterior lip was longer than posterior lip both at rest and during Valsalva (p < 0.05). TRUS can significantly raise detection rates of entire cervix, and make the direct evaluation of uterine descent feasible. TRUS can be used as a complementary method to TPUS to attain more comprehensive and accurate presurgical imaging information in middle compartment prolapse patients.

Establishment of a new subfamily for the parasitic isopod genus Pleurocryptella (Isopoda: Bopyridae), including recognition of epicaridium larval yolk sacs and description of a new genus and species of hyperparasite

Abstract External yolk sacs in free-living larvae of marine invertebrates are extremely rare, with all reported cases exhibiting yolk that is taken up through connection with the anterior alimentary canal. Herein, we confirm a novel yolk sac connected to the posterior end of the alimentary canal in the first larval stage of species in the bopyrid isopod genus PleurocryptellaBonnier, 1900, all known as ectoparasites in the branchial chambers of squat lobsters. Pleurocryptella poseidon Williams &amp; Boyko sp. nov. infesting the munidopsid Galacantha bellis Henderson, 1885 in the Arabian Sea, is described on the basis of adults and larvae. In common with conspecifics, the new species exhibits a suite of putative “primitive” characters including the presence of oostegites on the sixth and seventh pereomeres of females and maxillipeds and articulated uropods in males. Pleurocryptella poseidon Williams &amp; Boyko sp. nov. differs from other species of Pleurocryptella by characters of body shape, antennae, oostegite 1, pleon, and uropods of females and midventral tubercles, pleomeres, and pleopods of males. The epicaridium larvae have a large posterior, external yolk sac and segmented maxillipeds, a unique set of characters within Epicaridea. In addition to larval and adult characters, molecular data (COI) indicate that the genus is distinct from other members of Bopyridae, so we erect the new subfamily Pleurocryptellinae for it. Pleurocryptella poseidon Williams &amp; Boyko sp. nov. bears a new genus and species of hyperparasitic isopod that is herein described based on its cryptoniscus stage. A review of epicaridium larval morphology and a key to the species of Pleurocryptella are provided.

Changes of video head impulse test before and after translabyrinthectomy in patients with acoustic neuroma.

Acoustic neuroma (AN) is a benign tumor that usually affects a patient's hearing and balance function. For the screening and diagnosis of AN, the traditional approach mainly relies on audiological examination and magnetic resonance imaging (MRI), often ignoring the importance of vestibular function assessment in the affected area. As an emerging method of vestibular function detection, video head impulse test (vHIT) has been widely used in clinic, but research on its use in AN diagnosis is relatively limited. This study aims to explore the value of vHIT in the diagnosis of AN, vestibular dysfunction assessment, and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach. This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University. vHIT was performed 1 week before surgery to assess vestibular function, pure tone audiometry (PTA) was used to assess hearing level, and ear MRI was used to assess tumor size. Follow-up vHIT was conducted at 1 week, 1 month, 6 months, and 1 year post-surgery. The correlation of vHIT with hearing and tumor size was analyzed. Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex (VOR) gain. There was a correlation between the VOR gain of vHIT on the affected side and the hearing level (r=-0.47, P<0.05) or tumor size (r=-0.54, P<0.01). The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time, and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased, while the latency time decreased, with the most obvious changes occurring 1 week post-surgery. vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.

Morphological Variations of the Nasopalatine Canal in the North Cyprus Population: A Cone Beam Computed Tomography Study.

BACKGROUND This study aimed to evaluate the morphological characteristics of the anterior maxillary nasopalatine canal and the width of the buccal bone using cone-beam computed tomography (CBCT) in 150 adults in Northern Cyprus. MATERIAL AND METHODS The study included 150 participants, and their anterior maxillary morphometric measurements (eg, length of the nasopalatine canal and anteroposterior diameter of the nasal foramen) were taken using CBCT with the scanning parameters of 90 kvP, 24 s, 4 mA, voxel size 0.3 mm, and field of view 10×6 cm. The shapes of the nasopalatine canal (NPC) were categorized into 4 types: cylindrical, hourglass, funnel-shaped, and banana (54%, 20.6%, 18.6%, and 4%, respectively). RESULTS The findings showed a clear link between the shape of the NPC and the horizontal dimensions of the anterior maxilla's morphometric properties. In general, decreased horizontal bone dimensions were found in the premaxilla at the banana- and funnel-shaped type for the nasopalatine canal. Also, the anteroposterior diameter of a nasal foramen in the hourglass shape was significantly larger in diameter than all other shapes. Additionally, the morphology of the nasopalatine canal is influenced by its shape. The sagittal cross-section has shown significant correlations with the sizes of the incisive foramen, nasal foramen, and the length of the nasopalatine canal. CONCLUSIONS The study found a correlation between the shape of the NPC and the horizontal dimensions of the anterior maxilla's anatomy. The measurements of NPC in a North Cyprus population slightly differ from the established standards found in the existing literature. Conducting more extensive studies with a larger number of CBCT images will offer additional insights.

Assessing the Vestibulo-ocular Reflex of Contralesional Sides According to Head Impulse Velocity Utilizing the Video Head Impulse Test in Patients with Vestibular Neuritis.

There is a lack of comparative studies examining changes in vestibulo-ocular reflex (VOR) gain with head velocity in the video head impulse test (vHIT) of patients with vestibular neuritis (VN). Thus, the purpose of present study was to identify the effect of head impulse velocity on the gain of the VOR during the vHIT in patients with VN. Head impulse velocities ranging from 100%-200°/s [158.08 ± 23.00°/s in the horizontal canal (HC), 124.88 ± 14.80°/s in the anterior canal (AC), and 122.92 ± 14.26°/s in the posterior canal (PC) were used during vHIT trials of 32 patients with VN. Differences in VOR gain on the ipsilesional and contralesional sides according to head velocity were analyzed. The mean VOR gains in ipsilesional side were decreased to 0.47 in the HC and 0.56 in the AC, leading to marked asymmetry compared to the contralesional side; PC gain was relatively preserved at 0.82 in the ipsilesional side. The mean head impulse velocity applied during vHIT trials in each semicircular canal plane did not differ bilaterally. On the contralesional side, VOR gain was negatively correlated with head impulse velocity (R2=0.25, P=.004 in HC; R2=0.17, P=.021 in AC; R2=0.24, P=.005 in PC), while VOR gain on the ipsilesional sides of the HC and AC was not. Head impulse velocity may have a differential impact on VOR gain, depending on the degree of deficit. Increasing head velocity in vHIT may be considered to identify subtle deficits on the contralesional side of patients with VN.

Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation.

The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for differential diagnosis and quantification of the vestibulo-oculomotor reflex (VOR) in various disorders. However, the results of its application after lesions of the CNS are discordant and have never been studied in rehabilitation. This study aims to assess the VOR performance in a sample of stroke survivors. This is a cross-sectional study on 36 subacute and chronic stroke survivors; only persons with first-ever stroke and able to walk independently, even with supervision, were included. We performed VOR assessments for each semicircular canal by vHIT and balance assessments by the Berg Balance Scale and the MiniBESTest scale. Two hundred and sixteen semicircular canals were assessed using the Head Impulse paradigm (in both the vertical and horizontal planes), while 72 semicircular canals were assessed using the Suppressed Head Impulse paradigm (horizontal plane). There was a high prevalence of participants with dysfunctional canals, particularly for the left anterior and right posterior canals, which were each prevalent in more than one-third of our sample. Furthermore, 16 persons showed an isolated canal dysfunction. The mean VOR gain for the vertical canals had confidence intervals out of the normal values (0.74-0.91 right anterior; 0.74-0.82 right posterior; 0.73-0.87 left anterior). Our findings suggest that peripheral vestibular function may be impaired in people with stroke; asystematic assessment in a rehabilitation setting could allow a more personalized and patient-centred approach.

Detailed Radiomorphometric Analysis of the Surgical Corridor for the Suprageniculate Approach.

The suprageniculate fossa (SGF) is located between the geniculate ganglion, the middle cranial fossa (MCF) and the anterior semicircular canal (ASCC). An endoscopic transcanal approach has been recently proposed to treat the different lesions in this area. The aim of the study is to describe the anatomical pathway of this approach by measuring the dimensions of its boundaries while checking their correlation with the pneumatization of the SGF area. This is a retrospective anatomical analysis of Cone Beam CT scans of 80 patients, for a total of 160 temporal bones analyzed. Two checkpoints were measured for the SGF route, as an internal and an external window. These are triangles between the MCF dura, the geniculate ganglion and the ASCC on parasagittal and axial planes. The pneumatization of the SGF was also assessed, classified and correlated with the measured dimensions. The depth of the SGF was 7.5 ± 1.8 mm. The width of the external window was 7.5 ± 1.9, 5.6 ± 2.4 and 1.6 ± 1.6 mm for the posterior, middle and anterior points of measurement, respectively. The height of the internal window was 7.6 ± 1.2, 4.5 ± 1.5 and 1.7 ± 1.7 mm for the posterior, middle and anterior points of measurement, respectively. Type A pneumatization was found in 87 cases, type B in 34 and type C in 39. The degree of pneumatization directly correlated to the depth and height of the fossa. The suprageniculate approach route is defined by the internal and external windows which should be evaluated during a pre-surgery imaging assessment. The detailed anatomy of the approach and the novel classification of the pneumatization of the SGF are here described which may be useful to plan a safer procedure with minimal complications.

Posterior Semicircular Canal Plugging Relieves Tumarkin's Crisis in Ménière's Disease Patients.

(1) Background: Patients affected by Ménière's disease can experience Tumarkin's syndrome, which is characterized by postural instability, gait abnormalities, and, occasionally, an abrupt loss of balance known as vestibular drop attack or Tumarkin's crisis. In this study, semicircular canal plugging is proposed as the definitive treatment for this condition. The outcomes of this type of surgery are discussed. (2) Methods: A total of 9 patients with a confirmed diagnosis of Ménière disease suffering from Tumarkin crisis underwent posterior semicircular canal plugging. These patients were assessed with Video Head Impulse Tests, vestibular evoked myogenic potentials, and Pure Tone Audiometry preoperatively and postoperatively. (3) Results: VHIT showed a postoperative decrease in PSC gain median (Preop. 0.86 and postop. 0.52; p < 0.009). No statistically significant differences were described for the anterior semicircular canal and the lateral semicircular canal. No patient experienced new Tumarkin crisis after the surgical treatment. (4) Conclusions: Our ten years of experience with posterior semicircular canal plugging in Ménière disease patients with Tumarkin's syndrome has shown that this type of surgical procedure is successful in controlling Tumarkin's crisis, with high patient satisfaction and little worsening in hearing level.