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Radiologic anatomy of the middle ear and internal ear in computed tomography images

100%
Wojciechowski T.
Polski Przegląd Otorynolaryngologiczny
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2022
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vol. 11
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issue 4
30-41
EN
The development of imaging methods that has taken place in the last twenty years and the increase in the availability of highresolution CT of temporal bones makes it possible to analyze the complex anatomy of the interior of temporal bone in detail with even greater accuracy. Simultaneous advances in middle ear surgery require from the surgeon to be proficient in interpreting imaging studies. This approach creates the possibility of selecting the treatment method individually for each patient and may also contribute to reducing the risk of complications. The article presents a description of CT examination technique with a historical outline, as well as the interpretation of the CT scan of temporal bones along with a description of the anatomical structures, with particular emphasis on the structures of the middle ear. In addition, anatomical variants that may be encountered by a person viewing images obtained with this method are presented.
2
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Anatomia radiologiczna ucha środkowego i wewnętrznego w obrazach tomografii komputerowej

100%
Wojciechowski T.
Polski Przegląd Otorynolaryngologiczny
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2022
|
vol. 11
|
issue 4
30-41
PL
Rozwój metod obrazowania jaki nastąpił w ostatnich 20 latach i zwiększenie dostępności badania tomografii komputerowej (TK) kości skroniowych wysokiej rozdzielczości stwarza możliwość szczegółowej analizy skomplikowanej anatomii wnętrza kości skroniowej z większą niż dotychczas dokładnością. Równoczesny postęp w chirurgii ucha środkowego wymaga od chirurga znakomitej znajomości interpretacji badań obrazowych. Takie podejście stwarza możliwości dobierania metody leczenia indywidualnie dla każdego chorego, a także może przyczynić się do zmniejszenia ryzyka powikłań. W artykule został przedstawiony opis techniki badania TK wraz z rysem historycznym, a także sposób interpretacji badania TK kości skroniowych wraz z opisem struktur anatomicznych, ze szczególnym uwzględnieniem struktur ucha środkowego i tych widocznych w badaniu TK. Ponadto przedstawione zostały warianty anatomiczne, na które może natrafić osoba przeglądająca obrazy uzyskane tą metodą.
3
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Computed tomography multi-planar and 3D image assessment protocol for detailed analysis of inner ear malformations in patients undergoing cochlear implantation counseling

51%
Szleper A., Lachowska M., Wojciechowski T., Niemczyk K.
Polish Journal of Otolaryngology
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2024
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vol. 78
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issue 2
35-43
EN
Introduction: Congenital inner ear malformations resulting from embryogenesis may be visualized in radiological scans. Many attempts have been made to describe and classify the defects of the inner ear based on anatomical and radiological findings. Aim: The aim was to propose and discuss computed tomography multi-planar and 3D image assessment protocols for detailed analysis of inner ear malformations in patients undergoing cochlear implantation counseling. Material and methods: A retrospective analysis of 22 malformed inner ears. CT scans were analyzed using the Multi-Planar Reconstruction (MPR) option and 3D reconstruction. Results: The protocol of image interpretation was developed to allow reproducibility for evaluating each set of images. The following malformations were identified: common cavity, cochlear hypoplasia type II, III, and IV, incomplete partition type II and III, and various combinations of vestibule labyrinth malformations. All anomalies have been presented and highlighted in figures with appropriate descriptions for easier identification. Figures of normal inner ears were also included for comparison. 3D reconstructions for each malformation were presented, adding clinical value to the detailed analysis. Conclusions: Properly analyzing CT scans in cochlear implantation counseling is a necessary and beneficial tool for appropriate candidate selection and preparation for surgery. As proposed in this study, the unified scans evaluation scheme simplifies the identification of malformations and reduces the risk of omitting particular anomalies. Multi-planar assessment of scans provides most of the necessary details. The 3D reconstruction technique is valuable in addition to diagnostics influencing the decision-making process. It can minimize the risk of misdiagnosis. Disclosure of the inner ear defect and its precise imaging provides detailed anatomical knowledge of each ear, enabling the selection of the appropriate cochlear implant electrode and the optimal surgical technique.
4
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Anatomical and clinical aspects and outcomes of bilateral cochlear implantation in cochlear hypoplasia type IV – a case report

39%
Szleper A., Lachowska M., Pastuszka A., Łukaszewicz-Moszyńska Z., Wojciechowski T., Niemczyk K.
Polski Przegląd Otorynolaryngologiczny
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2022
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vol. 11
|
issue 4
57-63
EN
Cochlear hypoplasia is a congenital inner ear malformation (IEM) characterized by a reduced external cochlear dimension, usually accompanied by an abnormal internal architecture. Type IV cochlear hypoplasia is a cochlea with hypoplastic middle and apical turns. It may occur along with dislocation of the facial nerve, associated with semicircular abnormalities, less clearly marked promontory, or stapedial fixation. Such patients can present a broad spectrum of audiological test results, from sensorineural or mixed mild to profound hearing loss. The above anatomical changes may be responsible for intraoperative difficulties during cochlear implantation. In the studied case, a 6-month-old patient was diagnosed with an inner ear malformation – cochlear hypoplasia type IV on both sides. Computed tomography with multiplanar and 3D reconstruction was performed to analyze the middle and inner ear anatomy in detail. Both types of imaging reconstruction helped decide which cochlear implant electrode to choose. Perimodiolar-positioned cochlear implant electrode was found to be the most suitable choice. The patient underwent sequential bilateral cochlear implantation with expected incomplete electrode array insertion on both sides. First repeatable auditory responses were observed 2 months after the second implant activation. Good parental cooperation with therapists and adequately defined developmental goals in the presented patient allowed the multidisciplinary team to take advantage of the child’s intellectual abilities and choose a suitable communication method; however, the patient’s auditory responses were obtained slowly. The final auditory results cannot be predicted in inner ear malformations due to abnormal anatomical structure and, thus, heterogeneous innervation within the deformed cochlea. The programming of the sound processor must be individual in each case, based on the child’s behavior observation and, if possible, objective test results. Patients with cochlear malformations usually require higher stimulation intensities to obtain sound sensations than patients with a typical cochlear structure.
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