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Type:
Educational Exhibit
Keywords:
Fistula, Education and training, Developmental disease, Education, MR, CT-High Resolution, CT, Neuroradiology brain, Ear / Nose / Throat, Bones
Authors:
E. Grive1, A. M. Garcia Correa1, A. A. MARIN SUAREZ2, I. Ciampa1, E. Serrano Alcalá3, S. Grossi1, V. C. Mercedes1; 1Barcelona/ES, 208029, BARCELONA/ES, 3Reus/ES
DOI:
10.1594/ecr2017/C-1397
Findings and procedure details
We present findings on CT performed for conductive hearing loss in two patients showing associated SSCD with tegmen tympani defect.
In our patients we observed absence of the bony coverage of the superior semicircular canal,
tegmen tympani defect and meningoencephalocele in the middle ear in contact with the inner-ear bones.
Both,
encephalocele with bone fixation and SSCD can be a cause of conductive hearing loss.
We have used a 64 multidetector scanner in bone window with axial,
coronal and oblique reconstructions of the petrous bone. In one patient we have added an MR imaging study to confirm the encephalocele using a 1.5 Tesla magnetic field.
Our first patient is a 59 year old female with conductive hearing loss since 2 years ago.
Physical examination revealed unsteadiness with the Valsalva maneuver (Hennebert sign).
Acumetry test: Rinne right ear negative ,
left ear positive (normal).
Weber lateralized to the right. Impedance-audiometry was normal in both sides and Pure-tone audiometry of the right ear showed 15% conversational loss for transmissive bass sounds (conductive hearing loss).
In consequence of this findings a CT was performed.
Fig. 1 Fig. 2 Fig. 3 Fig. 4
We observed absence of the bony coverage of the superior semicircular canal,
tegmen tympani defect and a small image of soft tissue density located at the tegmen tympani in direct contact with the inner-ear bones suggesting encephalocele in the middle ear.
The brain MRI showed a soft tissue signal in the area of the right epitympanum on T1 and T2 sequences compatible with a small encephalocele.
Even though MR imaging is not the best option when evaluating temporal bone,
it is useful when there is CSF leak and/or encephalocele suspicion.
Our second patient is another 59 year old woman with chronic hearing loss.
Physical examination revealed normal otoscopy; Acumetry test: Rinne negative on both sides (abnormal) Weber test not lateralized.
Pure-tone audiometry results showed conductive hearing loss on both sides more severe on the left ear.
CT was performed Fig. 5 Fig. 6 showing bilateral tegmen tympani defect,
superior semicircular canal dehiscence and middle ear encephalocele on both sides.
The ossicular compromise was greater on the left side.
No surgical treatment was performed by willing of the patients as there was no severe symptomatology.