Radiology quiz case 1. Fibromyxoid tumor of the petrous apex.
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Female↗
Biomedical subjects
Patrick J Antonelli
Publications and source records attributed to Patrick J Antonelli.
Hearing loss with stapedotomy in otitis media.
OBJECTIVE: Stapes fixation is often found in patients with either active or inactive otitis media (OM). Stapedotomy is generally not performed in ears with OM because of the potential risk of sensorineural hearing loss (SNHL). Recent studies have demonstrated that the inner ear may be fenestrated in the presence of OM without significantly increased risk of SNHL. The goal of this study was to determine if stapedotomy in the presence of OM significantly increases the incidence of postoperative SNHL. METHODS: Streptococcus pneumoniae or Pseudomonas aeruginosa was injected bilaterally into the middle ears of guinea pigs (n = 18 and 16, respectively). A control group (n = 14) was injected with saline solution. Two days postinjection, a unilateral stapedotomy was performed. Auditory thresholds were evaluated by electrocochleography before and after stapedotomy. RESULTS: Bacterial OM was induced in all ears injected with pneumococci and pseudomonas. Auditory thresholds increased in all ears treated with stapedotomy. Stapedotomy performed in the presence of pseudomonas OM resulted in significantly greater SNHL than in control or pneumococcal ears (P = 0.0055). Hearing thresholds were not significantly different between pneumococcal OM and control ears treated with stapedotomy. CONCLUSION: Stapedotomy in the presence of pseudomonas OM, but not pneumococcal OM, significantly increases the risk of SNHL in the guinea pig model. SIGNIFICANCE: Stapedotomy should be avoided in patients with active OM, particularly in the presence of pseudomonas.
Animals↗
Hyperbaric compression in the guinea pig with perilymph fistula.
OBJECTIVE: The study goal was to evaluate the effects of hyperbaric therapy on the auditory and vestibular function of guinea pigs compromised by perilymph fistula (PLF). METHODS: Twenty-four pigmented guinea pigs underwent induction of bilateral eustachian tube dysfunction before the creation of a unilateral PLF. Half of the animals were randomly assigned to receive immediate hyperbaric compression treatment of 4 "dives" each. Hearing was tested electrocochleographically, and signs of vestibulopathy were recorded before and after compression. RESULTS: After accounting for the effects of PLF, compression was not associated with significant hearing loss (P = 0.5411). Vestibulopathy was seen only in ears with PLF, and its incidence was similar for compression and noncompression groups. CONCLUSION: Hyperbaric compression does not compromise auditory or vestibular function in guinea pig ears with experimental PLF. SIGNIFICANCE: Our observations support the relative safety of recompression in patients with PLF.
Animals↗
Opening plugged tympanostomy tubes: effect of tube composition.
OBJECTIVE: We sought to determine if tympanostomy tube (TT) composition impacts the rate of clearing mucoid plugs. DESIGN: The study used an ex vivo model. METHODS: TTs with a standard shaft length and inner diameter, varying only by composition materials, were studied. Thirty TTs of each biomaterial (stainless steel, titanium, silicone, fluoroplastic, ion-bombarded silicone, and phosphorylcholine-coated fluoroplastic) were plugged with middle-ear mucus and placed in a model ear chamber. Ofloxacin otic solution was instilled into the chamber to cover the plugged TT. Time to clear each plug was recorded. RESULTS: Ion-bombarded silicone TTs cleared more rapidly than plain silicone TTs (P = 0.0042), but no other statistically significant difference among TT materials was observed. CONCLUSIONS: TT composition does not significantly affect the rate or "ease" with which TTs may be opened after they become plugged with mucus ex vivo. The higher rate of plug clearance observed with ion-bombarded silicone relative to untreated silicone suggests that improvements may be possible with alterations in either TT composition or surface preparations.
Biocompatible Materials↗
Matrix metalloproteinases in a gerbil cholesteatoma model.
OBJECTIVE: The goal of this study was to determine whether expression of matrix metalloproteinases (MMP) and tumor necrosis factor-alpha (TNF-alpha) occurs in a gerbil cholesteatoma model, which may be involved early in the pathogenesis of cholesteatoma. Study design Atelectasis was induced by transpalatal, bilateral Eustachian tube obstruction on gerbil ears (n = 60). Tympanic membranes were removed at days 0, 3, 7, 14, 28, 56, and 84, and quantitative analysis of TNF-alpha and MMPs was performed. RESULTS: Atelectasis and middle ear inflammation increased with time. TNF-alpha and MMP levels increased (P < 0.0083) with time, inflammation, and atelectatic stage with some variability seen between different MMPs. CONCLUSION: Elevation of TNF-alpha and MMPs associated with progressive tympanic membrane atelectasis suggests a possible role for these inflammatory mediators in the pathogenesis of cholesteatoma.
Animals↗
Tympanic membrane metalloproteinase inflammatory response.
OBJECTIVE: The goal of this study was to determine whether expression of matrix metalloproteinases (MMP) in tympanic membranes (TM) is stimulated by host tumor necrosis factor-alpha (TNF-alpha) and bacterial toxin (lipopolysaccharide, LPS), which may play a role in the pathogenesis of cholesteatoma. STUDY DESIGN: Gerbil TMs (n = 48) were cultured in the presence of either TNF-alpha or LPS. Quantitative analysis of TNF-alpha and MMPs was performed on both the homogenized TMs and the culture media supernatant. RESULTS: Levels of TNF-alpha and MMPs did not increase significantly in TMs with exposure to inflammatory mediators. TNF-alpha levels in supernatant were elevated (P < 0.007) with more concentrated LPS exposure. Supernatant levels of MMP2 were increased (P < 0.007) at most concentrations of LPS and TNF-alpha. CONCLUSION: Cultured TMs expressed MMPs in response to bacterial and host inflammatory mediators. These findings support a link between inflammation and the secretion of potentially destructive MMPs in the TM, which may contribute to the pathogenesis of cholesteatoma.
Animals↗
Cellular telephone use and risk of intratemporal facial nerve tumor.
OBJECTIVES/HYPOTHESIS: Microwave radiation exposure from cellular telephone use has been implicated in the development of intracranial tumors. The intratemporal facial nerve (IFN) is exposed to higher levels of cellular telephone radiation than intracranial tissues. The purpose of the study was to determine whether cellular telephone use is associated with an increased risk of IFN tumors. STUDY DESIGN: Case-control using a structured telephone survey at an academic, tertiary-care referral center. METHODS: Patients with IFN tumors (n = 18) were case-matched with patients treated for acoustic neuroma (n = 51), rhinosinusitis (n = 72), and dysphonia or gastroesophageal reflux disease (n = 69). Risk of facial nerve tumorigenesis was compared by extent of cellular telephone use and other risk factors. RESULTS: The odds ratio of developing an IFN tumor was 0.6 (95% CI, 0.2-1.9) with any handheld cellular telephone use and 0.4 (95% CI, 0.1-2.1) with regular cellular telephone use. No factors were associated with an increased risk for IFN tumor development. CONCLUSIONS: Regular cellular telephone use does not appear to be associated with a higher risk of IFN tumor development. The short duration of widespread cellular telephone use precludes definite exclusion as a risk for IFN tumor development.
Cell Phone↗
Alpha 1-antitrypsin and ilomastat inhibit inflammatory proteases present in human middle ear effusions.
OBJECTIVES: Proteases of both the serine and metalloproteinase families have been shown to play a role in the pathogenesis of otitis media (OM). Inhibitors of proteases from each of these families have been shown to beneficially impact disease progression in a number of related chronic inflammatory conditions, but their use has not been studied in OM. The purpose of this study was to assess the activity of the protease inhibitors recombinant alpha 1-antitrypsin (rAAT) and ilomastat on inflammatory proteases present in human middle ear effusions (MEEs), with a view to their potential utility in the treatment of OM. STUDY DESIGN: Prospective and ex vivo. METHODS: MEEs were collected from 100 patients presenting for middle ear surgery, most commonly tympanostomy tube placement or treatment of acute posttympanostomy otorrhea (APTO). MEEs were analyzed for the presence of matrix metalloproteinases (MMPs) and human neutrophil elastase (HNE) and the inhibitory activity of rAAT and ilomastat on these proteases, respectively. RESULTS: MMP levels were highest in APTO, and HNE was highest in chronic suppurative OM and APTO. High levels of MMP and HNE (>3 mAU/min) were found in 52% and 37% of MEEs, respectively. Ilomastat and rAAT demonstrated significant inhibition of MMP and HNE activity (>30% reduction), respectively, in 80% and 82% of MEEs with high levels of activity. CONCLUSIONS: Proteases are commonly found in OM. Ilomastat and rAAT are potent inhibitors of proteases in MEEs across a wide range of OM in humans. Investigation into the potential therapeutic benefits of these protease inhibitors is warranted.
Adolescent↗
Protease inhibitors alpha1-antitrypsin and ilomastat are not ototoxic in the chinchilla.
OBJECTIVES: Proteases of both the serine and the metalloprotease families have been shown to play a role in the pathogenesis of otitis media. Inhibitors of proteases from each of these families have been shown to beneficially impact disease progression in a number of related chronic inflammatory conditions. The purpose of this study was to assess the safety of protease inhibitors when instilled into the middle ear, with a view to their potential use in the treatment of human otitis media. STUDY DESIGN: Prospective, randomized, controlled trial in the chinchilla model. METHODS: After completing baseline auditory testing and bilateral transpalatal obstruction of the Eustachian tube, chinchillas received weekly transbullar injections of protease inhibitor (alpha1-antitrypsin, ilomastat, or both), vehicle, or saline. After 1 month, hearing was tested and the animals were sacrificed. Temporal bone histopathologic examination was performed. RESULTS: All treatment groups demonstrated a statistically insignificant average loss in long-term hearing (0 dB) for all measures using clicks and tones (P >.15 for all conditions). All treatment groups were statistically insignificantly different from one another (P =.5625). Histopathologic examination revealed no significant inner ear changes. CONCLUSIONS: Protease inhibitors that are currently under study in animal models and humans for the treatment of inflammatory diseases that are related to imbalances between protease and protease inhibitor have no significant toxic effect on the inner ear of chinchillas. These findings support the safety of further clinical trials using these inhibitors to treat middle ear inflammation.
Animals↗
Epineurial pseudocysts of the intratemporal facial nerve.
OBJECTIVE: Facial nerve pseudocysts are infrequently encountered during temporal bone surgery or neurotologic evaluation. This report describes the senior author's experience with epineurial pseudocysts of the intratemporal facial nerve. STUDY DESIGN: Retrospective case review. SETTING: Academic, tertiary referral center. RESULTS: Epineurial pseudocysts were identified on computed tomography in the mastoid segment in seven patients during evaluation for profound sensorineural hearing loss or facial nerve symptoms. Histopathologic examination revealed fibroadipose tissue without nerve tissue in five cases that underwent excision. CONCLUSIONS: Facial nerve epineurial pseudocysts are uncommon, benign lesions of the mastoid segment. Surgical excision may be safely performed for facial motor symptoms or for cochlear implant placement.
Adolescent↗
Extramedullary hematopoiesis presenting as a middle ear mass.
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Anemia, Sickle Cell↗
Radiosurgery for paraganglioma of the temporal bone.
PURPOSE: To report the outcome of patients with paraganglioma of the temporal bone treated with stereotactic radiosurgery at the University of Florida. METHODS AND MATERIALS: Between January 1997 and June 1999, five patients with paraganglioma of the temporal bone were treated with Linac-based stereotactic radiosurgery at the University of Florida. The ages of the three female and two male patients were between 40 and 88 years (median, 49 years). Four patients were treated at initial presentation, and one had recurrent disease. Treatment volumes ranged from 4.9 cm3 to 18.4 cm3, with a mean of 10.84 cm3. The dose applied to the margin of the tumor varied from 12.5 to 15 Gy (median, 15 Gy). The treatment dose was specified to the 80% isodose shell in two cases and to the 70% isodose shell in three cases. The median follow-up time was 27 months, ranging from 14 to 50 months. RESULTS: One of four previously untreated patients had a relapse at the primary tumor site. Treatment failure occurred at the field margin 6 months after radiosurgery; the patient was subsequently treated with fractionated stereotactic radiotherapy and at the time of analysis had no evidence of disease, 21 months after initiation of salvage therapy. The patient treated at the time of recurrence after conventional radiotherapy had a local recurrence 40 months after radiosurgery. At the time of this recurrence, the patient had biopsy-proven metastatic disease in two cervical lymph nodes, and no salvage therapy was performed. All patients were alive at the time of the analysis, one with disease present. Presenting symptoms improved in two patients and stabilized in one. The two patients who had local recurrence develop had worsening of their symptoms. One patient had a cranial nerve V palsy develop 6 months after treatment, which resolved after a few months. CONCLUSIONS: In this series, the results with stereotactic radiosurgery are discouraging compared with our results with conventional fractionated radiotherapy in patients with paraganglioma of the temporal bone.
Adult↗
Privacy and security of medical information.
Increasingly, medical information is being stored, accessed, and communicated electronically, which makes this information vulnerable to breaches in security and privacy. Clinicians must be familiar with the best practices for keeping medical information private, as well as the local, state, and federal regulations that govern the security, privacy and patient-identifiable information. Noncompliance carries the potential for civil and criminal penalties.
Computer Security↗
Computerized physician-order entry: are we there yet?
Computerized physician-order entry (CPOE) is a system of hardware and software through which a physician enters orders directly into a computer rather than writing them on paper. The advantages of CPOE include order legibility, improved response time, reduction in adverse drug reactions, reduced cost of care, and improved patient outcomes. The maturation of mobile computing platforms, graphical user interfaces, and wireless technologies are making CPOE more practical for both outpatient and inpatient care. Significant barriers to the implementation of CPOE include the reluctance of physicians to change existing practices, doubt about the possible benefits, increased front-end time to enter orders, and system cost.
Computer Systems↗
Skull base fungal osteomyelitis in an immunocompetent host.
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Aspergillosis↗
Sympathetic cochleolabyrinthitis in revision stapedectomy surgery.
OBJECTIVE: The purpose of this study was to determine whether revision stapedectomy could precipitate sensorineural hearing loss in the contralateral ear. METHODS: We conducted a retrospective review of 148 patients undergoing primary or revision stapedectomy at an academic, tertiary care facility. RESULTS: Stapedectomy resulted in significant improvements in mean air conduction thresholds in the ipsilateral ear. Overall, there were no significant changes in either the air or bone conduction values of the contralateral ear. Two patients demonstrated a >20-dB decline in speech reception threshold and/or >20% decrease word recognition in the contralateral ear. Both of these patients demonstrated the decline only after revision surgery. CONCLUSION: Revision stapedectomy is on rare occasions associated with hearing loss in the contralateral ear. Contralateral hearing loss after revision stapedectomy may be due to sympathetic cochleolabyrinthitis.
Adolescent↗
Inhibition of matrix metalloproteinases in gerbil cholesteatoma: preliminary findings.
OBJECTIVES: This study was conducted to examine the role of matrix metalloproteinases (MMPs) and the impact of a topical MMP inhibitor, ilomostat, on the development of tympanic membrane (TM) atelectasis in the gerbil model. METHODS: Eustachian tubes were cauterized bilaterally in 19 gerbils. Thereafter, both TMs received once-daily topical treatment for 8 weeks with ilomostat or vehicle or no treatment (n = 6 or 7 per group). TM atelectasis was serially graded, and TMs were harvested at 8 weeks. Gelatin zymograms were performed to determine MMP activity. RESULTS: The mean activity levels of proenzyme and active MMP-9 and MMP-2 and degree of atelectasis did not differ between groups. TM atelectasis did not correlate to levels of enzymes across individual samples. CONCLUSIONS: Topical application of an MMP inhibitor did not significantly prevent the development of TM atelectasis. It remains to be determined whether the use of MMP inhibitors may prevent the progression of atelectasis in humans.
Animals↗
Fetal central auditory system metabolic response to cochlear implant stimulation.
OBJECTIVES: The purpose of this study was to examine the effects of profound auditory deprivation and its treatment by cochlear implantation and stimulation on the metabolic activity of the central auditory system in fetal sheep. METHODS: Six ovine fetuses at 85% to 90% gestation were bilaterally deafened by kanamycin perfusion and unilaterally implanted with cochlear electrode arrays. Half of the implanted animals were stimulated with an extrauterine sound processor, and half were not. Four animals served as hearing controls. One week postoperatively, central nervous system metabolic activity was evaluated in ambient laboratory noise by quantitative autoradiography using (14)C-deoxyglucose. RESULTS: Kanamycin perfusion deafened all treated animals as verified by auditory brainstem response and scanning electron microscopy. Glucose utilization in the inferior colliculus was markedly lower in deafened and unstimulated animals relative to hearing controls. Glucose utilization in implanted-stimulated animals was similar to normal controls. CONCLUSIONS: Changes in central auditory system metabolic activity associated with congenital deafness may be minimized by prompt auditory habilitation.
Animals↗