Otic Capsule Research Articles

Imaging Patterns of Temporal Bone Fracture among Patients with Head Injury at Tikur Anbessa Specialized Hospital, Ethiopia.

Temporal bone fracture is usually a sequel of significant blunt head injury. Fracture of the temporal bone is mainly classified according to the orientation of the fracture plane and whether there is involvement of the otic capsule. Despite its frequent occurrence, there is limited research on the frequency and pattern of temporal bone fractures in our setup. Retrospective cross-sectional hospital - based study of 60 patients who underwent computed tomography of the head for head trauma at Tikur Anbessa Specialized Hospital during the study period from October 2020 - October 2022. Among the 60 patients enrolled in the study, the mean age of presentation was 31.1 years with a male-to-female ratio of 4:1. There were 69 temporal bone fractures, 9(15%) were bilateral and 51(85%) unilateral The longitudinal fracture pattern was the most common fracture pattern, occurring in 40(78.4%) of unilateral cases, 15(83.3%) of bilateral cases. Otic capsule sparing fractures accounted for 49(96.07%) of unilateral fracture cases, and all patients with bilateral involvement had an otic capsule sparing fracture. Among the 42 patients for whom data regarding post-traumatic hearing outcome was available, 4 patients had post-traumatic hearing impairment. Anatomically, the squamous portion of the temporal bone was involved in 30(43.5%) of cases. Fractures affecting the squamous portion of the temporal bone, longitudinal fracture patterns, and otic capsule sparing were the most frequent forms. The majority of temporal bone fractures were associated with other bone fractures and intracranial injuries.

SURG-45. THE EFFECT OF STAPEDECTOMY IN POSTOPERATIVE OUTCOME OF SUPERIOR SEMICIRCULAR CANAL DEHISCENCE: A CASE SERIES OF 349 REPAIRS

Abstract INTRODUCTION Superior Semicircular Canal Dehiscence (SSCD) is a pathology of the otic capsule, in which, a “third mobile window” is formed on the osseous labyrinth surrounding the superior semicircular canal. Otosclerosis, another otic capsule pathology, can occur concurrently, therefore obscuring the symptoms seen in patients with SSCD. It is currently unknown whether the surgical procedures to treat otosclerosis such as stapedectomy can affect symptom resolution in patients following SSCD repair. Objective: To examine the association between post-SSCD repair symptom resolution and history of stapedectomy. METHODS A single institution retrospective review was conducted to evaluate post-operative symptom resolution in patients undergoing SSCD repair from 2011-2021. 349 SSCD repairs performed in a cohort of 279 patients were included, and among those were 10 patients with a history of stapedectomy. A p-value < 0.05 was considered statistically significant. RESULTS A total of 349 surgical repairs were analyzed. The patient population was composed of 63% female and 37% male with patient ages’ ranging from 13-84 years. Patients were divided into two different cohorts based on their history of stapedectomy. We compared these cohorts looking at their post-SSCD repair symptom changes and found no statistically significant differences between patients with and without history of stapedectomy. We also compared pre- and post-operative symptoms amongst the 10 patients with a history of stapedectomy and found no statistically significant differences in symptom resolution post-SSCD repair. Post-operative symptoms analyzed included amplification (p = 0.2), aural fullness (p = 0.2), autophony (p = 0.8), disequilibrium/imbalance (p = 0.8), dizziness (p = 0.3), headache (p = 0.7), hearing loss (p = 1), hyperacusis (p = 1), tinnitus (p = 0.4), and vertigo (p = 0.3). CONCLUSIONS With respect to symptom resolution post-SSCD repair, there were no significant differences between patients with and without a history of stapedectomy. Hence, previous stapedectomy surgery should not be considered an adverse condition to SSCD repair, with similar rates of improvement after SSCD surgery.

Is the promontory a promising site to diagnose otitis media in paleopathology? A search for evidence

ObjectiveThe promontory of the middle ear was recently suggested to be an appropriate site for diagnosing otitis media (OM) in archaeological bones by endoscopic inspection. The present study scrutinized the underlying assumption that a bulgy, irregular promontorial surface represents a pathological condition. MaterialsWe compared an allegedly healthy individual and an allegedly diseased individual in skeletal remains of two human individuals from the early Medieval period in Germany. MethodsThe specimens were studied using microscopic analyses of thin ground sections. ResultsThe osseous architecture of the three-layered promontorial wall was the same in both specimens. Both the contour of the resorption front of the middle layer and the thickness of the overlying outer periosteal layer showed some variation, resulting in an either smooth or a bulgy promontorial surface, while signs of resorptive or proliferative changes at the periosteal surface were missing in both cases. ConclusionsOur results suggest that an irregular promontorial surface represents normal variation in the development of the otic capsule rather than a pathological condition. We therefore conclude that the promontory is not an appropriate site for diagnosing OM in archaeological bone. SignificanceThe study contributes to evidence-based diagnoses in paleo-otological studies. Our assumption is in line with clinical and experimental findings indicating that the otic capsule is protected against bone remodeling. LimitationsOnly two specimens were studied. Suggestions for further researchSEM-studies to detect more subtle changes to the promontorial surface.

Cavitating Lesions around the Cochlea Can Affect Audiometric Threshold and Clinical Practice.

There are several pathologies that can change the anatomy of the otic capsule and that can distort the bone density of the bony structures of the inner ear, but otosclerosis is one of the most frequent. Similar behavior has been shown in patients affected by osteogenesis imperfecta (OI), a genetic disorder due to a mutation in the genes coding for type I (pro) collagen. In particular, we note that otosclerosis and OI can lead to bone resorption creating pericochlear cavitations in contact with the internal auditory canal (IAC). In this regard, we have collected five cases presenting this characteristic; their audiological data and clinical history were analyzed. This feature can be defined as a potential cause of a third-window effect, because it causes an energy loss during the transmission of sound waves from the oval window (OW) away from the basilar membrane.

Superior semicircular canal dehiscence and subsequent closure induces reversible impaired decision-making.

Vestibular loss and dysfunction has been associated with cognitive deficits, decreased spatial navigation, spatial memory, visuospatial ability, attention, executive function, and processing speed among others. Superior semicircular canal dehiscence (SSCD) is a vestibular-cochlear disorder in humans in which a pathological third mobile window of the otic capsule creates changes to the flow of sound pressure energy through the perilymph/endolymph. The primary symptoms include sound-induced dizziness/vertigo, inner ear conductive hearing loss, autophony, headaches, and visual problems; however, individuals also experience measurable deficits in basic decision-making, short-term memory, concentration, spatial cognition, and depression. These suggest central mechanisms of impairment are associated with vestibular disorders; therefore, we directly tested this hypothesis using both an auditory and visual decision-making task of varying difficulty levels in our model of SSCD. Adult Mongolian gerbils (n = 33) were trained on one of four versions of a Go-NoGo stimulus presentation rate discrimination task that included standard ("easy") or more difficult ("hard") auditory and visual stimuli. After 10 days of training, preoperative ABR and c+VEMP testing was followed by a surgical fenestration of the left superior semicircular canal. Animals with persistent circling or head tilt were excluded to minimize effects from acute vestibular injury. Testing recommenced at postoperative day 5 and continued through postoperative day 15 at which point final ABR and c+VEMP testing was carried out. Behavioral data (d-primes) were compared between preoperative performance (training day 8-10) and postoperative days 6-8 and 13-15. Behavioral performance was measured during the peak of SSCD induced ABR and c + VEMP impairment and the return towards baseline as the dehiscence began to resurface by osteoneogenesis. There were significant differences in behavioral performance (d-prime) and its behavioral components (Hits, Misses, False Alarms, and Correct Rejections). These changes were highly correlated with persistent deficits in c + VEMPs at the end of training (postoperative day 15). The controls demonstrated additional learning post procedure that was absent in the SSCD group. These results suggest that aberrant asymmetric vestibular output results in decision-making impairments in these discrimination tasks and could be associated with the other cognitive impairments resulting from vestibular dysfunction.

Mortui vivos docent: a modern revival of temporal bone plug harvests.

Human temporal bones (HTBs) are invaluable resources for the study of otologic disorders and for evaluating novel treatment approaches. Given the high costs and technical expertise required to collect and process HTBs, there has been a decline in the number of otopathology laboratories. Our objective is to encourage ongoing study of HTBs by outlining the necessary steps to establish a pipeline for collection and processing of HTBs. In this methods manuscript, we: (1) provide the design of a temporal bone plug sawblade that can be used to collect specimens from autopsy donors; (2) establish that decalcification time can be dramatically reduced from 9 to 3 months if ethylenediaminetetraacetic acid is combined with microwave tissue processing and periodic bone trimming; (3) show that serial sections of relatively-rapidly decalcified HTBs can be successfully immunostained for key inner ear proteins; (4) demonstrate how to drill down a HTB to the otic capsule within a few hours so that subsequent decalcification time can be further reduced to only weeks. We include photographs and videos to facilitate rapid dissemination of the developed methods. Collected HTBs can be used for many purposes, including, but not limited to device testing, imaging studies, education, histopathology, and molecular studies. As new technology develops, it is imperative to continue studying HTBs to further our understanding of the cellular and molecular underpinnings of otologic disorders.

Braincase and neuroanatomy of the lagerpetid Dromomeron gregorii (Archosauria, Pterosauromorpha) with comments on the early evolution of the braincase and associated soft tissues in Avemetatarsalia.

The anatomy of the braincase and associated soft tissues of the lagerpetid Dromomeron gregorii (Archosauria: Avemetatarsalia) from the Late Triassic of the United States is here described. This corresponds to the first detailed description of cranial materials of Lagerpetidae, an enigmatic group of Late Triassic (c. 236-200 Million years ago) animals that are the closest known relatives of pterosaurs, the flying reptiles. The braincase of D. gregorii is characterized by the presence of an anteriorly elongated laterosphenoid and a postparietal, features observed in stem-archosaurs but that were still unknown in early members of the avian lineage of archosaurs. Using micro-computed tomography (CT-scan data), we present digital reconstructions of the brain and endosseous labyrinth of D. gregorii. The brain of D. gregorii exhibits a floccular lobe of the cerebellum that projects within the space of the semicircular canals. The semicircular canals are relatively large when compared to other archosauromorphs, with the anterior canal exhibiting a circular shape. These features of the sensory structures of D. gregorii are more similar to those of pterosaurs than to those of other early avemetatarsalians. In sum, the braincase anatomy of D. gregorii shows a combination of plesiomorphic and apomorphic features in the phylogenetic context of Archosauria and suggests that the still poorly understood early evolution of the braincase in avemetatarsalians is complex, with a scenario of independent acquisitions and losses of character states.

Association of the superior semicircular canal and tegmen tympani dehiscences and its relationship with the pneumatisation of the temporal bone

PurposeTo analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani.Materials and methodsWe analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus.ResultsOf the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017).ConclusionWe have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone.

Isolation and Culture of Primary Cochlear Hair Cells from Neonatal Mice.

Cochlear hair cells are the sensory receptors of the auditory system. These cells are located in the organ of Corti, the sensory organ responsible for hearing, within the osseous labyrinth of the inner ear. Cochlear hair cells consist of two anatomically and functionally distinct types: outer and inner hair cells. Damage to either of them results in hearing loss. Notably, as inner hair cells cannot regenerate, and damage to them is permanent. Hence, in vitro cultivation of primary hair cells is indispensable for investigating the protective or regenerative effects of cochlear hair cells. This study aimed to discover a method for isolating and cultivating mouse hair cells. After manual removal of the cochlear lateral wall, the auditory epithelium was meticulously dissected from the cochlear modiolus under a microscope, incubated in a mixture consisting of 0.25% trypsin-EDTA for 10 min at 37 °C, and gently suspended in culture medium using a 200 µL pipette tip. The cell suspension was passed through a cell filter, the filtrate was centrifuged, and cells were cultured in 24-well plates. Hair cells were identified based on their capacity to express a mechanotransduction complex, myosin-VIIa, which is involved in motor tensions, and via selective labeling of F-actin using phalloidin. Cells reached >90% confluence after 4 d in culture. This method can enhance our understanding of the biological characteristics of in vitro cultured hair cells and demonstrate the efficiency of cochlear hair cell cultures, establishing a solid methodological foundation for further auditory research.

Delayed Hearing Recovery After Transverse Temporal Bone Fracture with Otic Capsule violation - Case Report and Literature Review

We present a patient who suffered a temporal bone fracture (TBF) encompassing the bony labyrinth. Sensorineural hearing loss was confirmed with an unfavorable prognosis for recovery. Thirteen years later, there is regression of the hearing loss.

The comparative anatomy of the petrosal bone and bony labyrinth of four small-sized deer.

Here we provide complete 3D reconstructions of the petrosal bone and bony labyrinth of four kinds of small-sized deer (Elaphodus cephalophus, Muntiacus reevesi, Muntiacus muntjak, Hydropotes inermis) based on high-resolution CT scanning, and select one musk deer (Moschus moschiferus) as a comparative object. The petrosal bone and bony labyrinth of E. cephalophus are illustrated for the first time, as well as the petrosal bones of M. reevesi and H. inermis. Some morphological characters of petrosal bone and bony labyrinth can be used to distinguish the above-mentioned species. For example, M. moschiferus shows a prominent transpromontorial sulcus and a ventral basicapsular groove on the petrosal bone; there is a bifurcate cochlear aqueduct on the bony labyrinth of E. cephalophus; there is a distinct fusion between the lateral and posterior semicircular canals on the bony labyrinth of H. inermis. Meanwhile, there are some intraspecific variations on the subarcuate fossa, the tegmen tympani, the cochlear aqueduct, as well as the endolymphatic sac. Our results further confirm that the petrosal bone and bony labyrinth have enormous potential for taxonomy. This work will provide new anatomical data for the phylogenetic study of ruminants in the future, and it will be very practical to identify the isolated ruminants' petrosal bones that are frequently unearthed from paleontological or archeological sites.

Extracting the Cochlea from a Human Temporal Bone: A Cadaveric Protocol.

The extraction of the cochlea from a cadaver human temporal bone may be required for different studies of the inner ear. For histological evaluations, the inner ear must be extracted from the temporal bone to facilitate histologic processing; likewise, some micro-computed tomography devices are too small to accommodate the complete temporal bones; additionally, the image quality can be enhanced when the cochlea is isolated. The inner ear is located within the petrous part of the temporal bone. The inner ear can be divided into the osseous labyrinth or otic capsule and the membranous labyrinth inside the otic capsule. Furthermore, the inner ear can be divided into the vestibular system (the semicircular canals and the vestibule) and the cochlea. The appreciation of the location and orientation of the cochlea within the temporal bone is difficult, as it is embedded within bony structures and thus cannot be directly visualized. Nevertheless, there are distinct anatomical structures that can help guide the process to allow a reliable drill-out of the cochlea. The landmarks in the posterior parts of the cochlea are the facial nerve, semicircular canals, and the vestibule. In the middle, the inferior borders of the cochlea are identified by the round window and the basal turn of the cochlea. In the anterior border, one encounters the carotid artery; the landmark for the superior border is the genicular ganglion (GG) of the facial nerve. The medial structures are determined by the locations of the internal auditory canal, the superior semicircular canal, and the canal of the internal carotid artery. In this article, we present a method for extracting the cochlea reliably out of the temporal bone by drill-out while following several anatomical landmarks.

Why should multiple dehiscences of the otic capsule be considered before surgically treating patients with superior semicircular canal dehiscence? A radiological monocentric review and a case series.

This review aims to draw attention to the multiple ipsilateral otic capsule dehiscences (OCDs), which may cause therapeutic failure in operated patients. A series of six severely disabled patients with symptoms and signs consistent with a superior semicircular canal dehiscence (SSCD) diagnosis, confirmed by a high-resolution CT scan, is presented here. Five of the patients underwent surgery, and in four of the cases, the postoperative results were poor and/or disappointing. The ethical principles underlying modern medicine encourage medical staff to learn from past experience even when the results are modest despite the accuracy of the treatment applied to a patient. Consequently, we reviewed the radiological records of symptomatic and asymptomatic patients diagnosed or referred to our center for confirmation over the past 5 years to determine the incidence of multiple OCD in this population. Multiple localizations of suspected OCD in the ipsilateral ear did not appear to be rare and were found in 29 of 157 patients (18.47%) in our retrospective review using high-resolution thin-sliced CT scans. The decision to perform surgery for a documented symptomatic superior SSCD should be made with caution only after ruling out concomitant lesser-known variants of OCD in the ipsilateral ear.

The exceptionally well-preserved Sauropleura scalaris (Nectridea: Urocordylidae) from the late Carboniferous of the Czech Republic: new information on ontogeny, lateral line and tail

Abstract Urocordylids represent a group of the late Carboniferous–early Permian basal tetrapods, with short limbs, extremely elongated bodies and a deep and distinctive tail and vertebral architecture, which is indicative of an aquatic habitat. However, the important morphological structures that would indicate their ecological preferences unambiguously (e.g. hyobranchial apparatus, lateral line sulci) remain unknown. Moreover, the high degree of skeletal ossification present in urocordylids contrasts with the common pattern seen in most other basal tetrapods known to inhabit aquatic environments. Here, we describe an exceptionally well-preserved skull, with an associated mandible and a partial postcranial skeleton, of Sauropleura scalaris from the locality of Nýřany, Czech Republic, based on high-resolution micro-computed tomography. The labial surface of the mandible shows the first evidence of the lateral line system in Urocordylidae, which consists of both small pits and elongated grooves, and unambiguously supports the aquatic ecology of the group. The juvenile stage of the specimen provides new information on ontogeny of sauropleurines. The partly ossified opisthotic bone indicates that, unlike development in most other early tetrapods, the otic capsules were among the first neurocranial elements to ossify in nectrideans. Finally, an almost complete caudal region suggests that tails were much longer in sauropleurines than previously assumed.

Morphological variability in the inner ear of mice with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is known to cause hearing loss in ~60% of the affected human population. While OI-related pathologies have been studied in the middle ear, the development of cochlear pathologies is less well understood. In this study, we examine OI-related pathologies of the cochlea in a mouse model of OI to (1) document variation between OI and unaffected mice, and (2) assess the intrusion of the otic capsule onto the cochlea by analyzing differences in duct volumes. Juvenile and adult OIM C57BL/6mice were compared to unaffected wildtype (WT) mice using three-dimensional models of the cochlea generated from high resolution micro-CT scans. Two-tailed Mann-Whitney U tests were then used to investigate duct volume differences both within and between the OI and WT samples. Areas of higher ossification were observed at the cochlear base in the OI sample. OI mice also had significant intraindividual differences in duct volume between right and left ears (4%-15%), an effect not observed in WT mice. WT and OI duct volumes showed a large degree of overlap, although the OIM volumes were more variable. Our findings indicate that OIM mice are likely to exhibit more asymmetry and variation in cochlear volume despite minor differences in sample cochlear volumes, possibly due to bony capsule intrusion. This suggests a potential mechanism of hearing loss, and a high potential for cochlear and otic capsule alteration in OIM mice.

Otosclerosis under the magnifying glass.

Otosclerosis is a bone condition affecting the stapes bone within the otic capsule, and its exact cause is still unknown. It is characterized by a lack of proper remodeling of newly formed vascular and woven bone, leading to the development of abnormal osteons and the formation of sclerotic bone. Bilateral otosclerosis is seen in 80% of patients and 60% of otosclerosis patients have a family history of the condition. The etiology of this disease is still unknown, there are lots of theories to explain it. The histopathological (HP) studies of otosclerosis showed that osteoblasts, osteoclasts, vascular proliferation, fibroblasts, and histiocytes were observed in the stapes footplate. The onset of the symptoms occurs by the early third decade of life, usually it doesn't start later. In otosclerosis, the energy exerted by sound at the level of the tympanic membrane is reduced in the inner ear due to the fixation and rigidity of the ossicular chain, leading to hearing loss, especially for low frequencies. The primary clinical symptom of otosclerosis is conductive hearing loss but it is important to note that sensorineural hearing loss and mixed hearing loss can also occur as secondary symptoms of the condition. Another symptom present in patients with otosclerosis is tinnitus. The paper carried out a retrospective study of 70 patients diagnosed with otosclerosis in the Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between January 2021 to December 2022. Tissue fragments were processed at Service of Pathology by standard Hematoxylin-Eosin staining. The HP diagnosis was completed using Masson's trichrome staining, Giemsa histochemical staining, and immunohistochemical (IHC) reactions with anti-cluster of differentiation (CD)20, anti-CD3, anti-CD4, anti-CD8, anti-CD34, and anti-CD31 antibodies. The microscopic examination showed a chronic diffuse inflammatory infiltrate that consisted predominantly of mature T-lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare CD20-positive B-lymphocytes. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by the Giemsa staining. They had numerous purple-violet intracytoplasmic granules. In the connective tissue support, a relatively rich vascular network was identified, consisting of hyperemic capillaries, highlighted immunohistochemically with anti-CD31 and anti-CD34 antibodies. Bone tissues trabeculae showed extensive areas of fibrosis. The collagen fibers were highlighted by Masson's trichrome staining, being stained in green, blue, or bluish green.

Sex determination by linear measurements of the bony labyrinth in cone-beam and computed tomography: a practical method.

The determinism of the sex is of most importance for reconstruction of the biological profile of deceased individuals. In this study, we aim to implement a technique to improve the accessibility of sex determination by the study of the bony labyrinth on cone-beam computed tomography (CBCT) and computed tomography (CT) scans. CBCT and CT scans of temporal bones performed between 2014 and 2022 were collected with demographic information. The width of the lateral (LSCw), posterior (PSCw), and anterior semicircular canal (ASCw) was measured. The primary outcome was the diagnostic performance of the individual linear measures and the product of these measures. This analysis is supplemented by establishing thresholds using ROC curves. Inter-judge and intra-judge reliability evaluation was performed blinded in randomly selected exams. One hundred forty-one petrous bones were included for analysis of their imaging. The analysis of the PSCw, ASCw, and ASCw*PSCw for sex determination was associated with area under curves of 0.88 ± 0.11, 0.82 ± 0.14, and 0.84 ± 0.10 respectively and accuracies of 0.74 ± 0.13, 0.78 ± 0.11, and 0.79 ± 0.13 respectively. In ROC-curve analysis, a PSCw*ASCw product > 48.5 allows to determine a male sex with > 95% specificity and a sensitivity of 50.1%. A PSCw*ASCw product ≤ 43 allows to determine a female sex with 88% specificity and 64% sensitivity. Reproducibility analyses showed good to excellent intra-judge and inter-judge reproducibility for ASCw and PSCw. Linear measurement of the semicircular canals of the vestibule on CBCT or CT could provide easy-to-use sex determination of the majority of females and males with a good predictive value.

Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis

ObjectivesTo evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. Materials and methodsThis is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. ResultsEleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4–47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5–4 khZ and BC 0,5–3 kHz thresholds was observed between both techniques. ConclusionEven middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

Endoscope-Assisted Visualization of the Internal Auditory Canal Using the Middle Fossa Approach.

Angled endoscopes have been postulated to increase visualization of the internal auditory canal (IAC); however, few studies have quantified the extent of IAC visualization using endoscopes of varying angles. Preservation of the bony labyrinth in middle fossa (MF) vestibular schwannoma surgery may limit visualization of the lateral IAC. We sought to determine the extent to which IAC visualization is increased with endoscopes in these situations. Computed tomography (CT) scans were acquired before and after two cadaveric MF bony drill-outs. An atlas-based method was used to localize the IAC in the preprocedure CT and then registered with the postprocedure CT using standard image registration methods. Virtual microscope and endoscope positions and angles of approach were determined in a 3D rendering environment. Using ray casting techniques, the percentage of IAC surface area visible (unobscured by bony structures) with the microscope and 0°, 30°, and 45° endoscopes was calculated. For cadaver 1, the microscope led to visible IAC surface areas of 72%, whereas 0°, 30°, and 45° endoscopes visualized 58%, 79%, and 84%, respectively. For cadaver 2, the microscope led to visible surface areas of 67%, whereas the same endoscopes visualized 66%, 84%, and 84%, respectively. Using a microscope yields similar proportions of visible IAC surface area to a 0° endoscope in MF bony drill-outs. Increased visualization of the IAC is possible with more angled endoscopes. Using angled endoscopes may facilitate improved tumor dissection in the lateral IAC with neural and vascular preservation in vestibular schwannoma surgery aimed at hearing preservation.

SMARCA4 mutation causes human otosclerosis and a similar phenotype in mice

BackgroundOtosclerosis is a common cause of adult-onset progressive hearing loss, affecting 0.3%–0.4% of the population. It results from dysregulation of bone homeostasis in the otic capsule, most commonly leading to...