Objective:To investigate the audiological characteristics of unilateral vestibular schwannoma（VS） and their correlations with disease duration and tumor size, and to evaluate the clinical value of pure-tone audiometry（PTA）, speech discrimination score（SDS）, and auditory brainstem response（ABR） in screening and prognostic assessment. Methods:A retrospective analysis was performed on 93 patients with unilateral VS confirmed by surgery and pathology in our hospital from May 2008 to March 2025. PTA, SDS, ABR, and tumor size were analyzed. Correlation analysis and group comparisons were conducted to explore the relationships between audiological parameters, disease duration, and tumor size. Results:The mean age was（47.1±11.3） years. Hearing loss occurred in 97.8% of patients, tinnitus in 63.4%, and vertigo in 37.6%. PTA showed normal hearing in 2 cases and varying degrees of loss in 91 cases, with descending（33.3%） and flat（29.0%） curves being most common. Hearing loss duration was positively correlated with PTA average（r=0.52, P<0.001）, and flat curves were more frequent in longer disease courses. SDS was significantly negatively correlated with PTA average（P=-0.81） and tumor size（P=-0.61）, with a faster decline than PTA. ABR abnormalities were detected in 82.0%-89.5% of cases, with prolonged wave Ⅲ latency, wave Ⅴ latency, Ⅰ-Ⅴ interpeak interval, and interaural Ⅴ wave interval difference being most frequent. The mean tumor size was （20.5±10.6） mm, with stage Ⅲ being most common（46.2%）. Tumor diameter was positively correlated with hearing loss severity（r=0.37, P=0.001）, and Ⅲ-Ⅴ interpeak interval abnormalities were significantly more frequent in tumors>15 mm（P=0.042）. Conclusion:Hearing curve patterns in VS patients are closely related to hearing loss severity, disease duration, and tumor size. ABR demonstrates high diagnostic sensitivity for VS, particularly when tumor diameter exceeds 15 mm, as indicated by increased Ⅲ-Ⅴ interpeak interval abnormalities. Multidimensional audiological assessment can assist in early detection and prognostic evaluation. ABR screening combined with MRI is recommended for patients with unilateral hearing loss.

Objective:To investigate the clinical and imaging characteristics of intralabyrinthine and internal auditory canal（IAC） lipomas so as to improve diagnostic accuracy. Methods:A retrospective analysis was conducted on the clinical follow-up data of 8 patients diagnosed with intralabyrinthine or IAC lipomas at our hospital from January 2017 to September 2024. The diagnostic key points and diagnosis and treatment strategies were discussed with reference to the literature. Results:The cohort comprised 4 males and 4 females, all with unilateral involvement（left: 3; right: 5）, aged 7-61 years. The predominant symptoms were unilateral sensorineural hearing loss（SNHL） with tinnitus（progressive in 5 cases, sudden in 3）. Two patients experienced vertigo. Imaging features: Temporal bone HRCT revealed fat-density lesions（HU: -30 to -100）; MRI demonstrated T1WI hyperintensity, T2WI heterogeneous signals, no contrast enhancement, and signal attenuation on fat-suppressed sequences. Lesion size ranged from 2 to 8 mm. All cases were confirmed by imaging and without surgical intervention. Follow-up duration spanned 6 months to 9 years（mean: 59.3 months）. No tumor growth was observed during follow-up; one patient exhibited worsened hearing loss and tinnitus, while the other 7 had stable symptoms. Conclusion:Imaging is definitive for diagnosing intralabyrinthine and IAC lipomas. These lipomas exhibit indolent growth, making follow-up observation the optimal clinical strategy.

BackgroundTinnitus, a common and troublesome symptom of idiopathic sudden sensorineural hearing loss (ISSNHL), is the perception of sound without any external or internal sound source. The etiology of ISSNHL accompanied by tinnitus remains unclear. Tinnitus often occurs alongside or before hearing loss and can severely impact patients’ quality of life, leading to psychological stress and emotional distress. Current treatments primarily focus on improving hearing loss while neglecting tinnitus treatment. Electroacupuncture (EA), a technique widely applied in China for tinnitus management, may become a promising intervention by addressing both auditory and psychological symptoms. ObjectiveThis study aims to conduct a double-center, assessor-blinded, prospective randomized pilot clinical trial to explore the potential effects and feasibility of EA combined with medication for patients with ISSNHL accompanied by tinnitus, and to generate preliminary data to inform future large-scale trials of EA as an adjunctive therapy for this condition. MethodsIn this double-center, assessor-blinded, randomized controlled trial, 60 patients with ISSNHL accompanied by tinnitus will be randomly allocated to either the EA group, receiving EA combined with medication, or the control group, receiving standard medication treatment, for a total treatment duration of 4 weeks. Follow-up assessments will be conducted at weeks 2 and 4, and at 1, 2, and 3 months after treatment. The feasibility primary outcomes are recruitment rate, adherence rate, data completeness, and safety outcomes. The primary outcome measures will include pure tone audiometry, tinnitus matching, and the Tinnitus Handicap Inventory, while the secondary outcome measures will comprise speech-recognition thresholds in noise, the Self-Rating Anxiety Scale, and the 36-item Short Form Health Survey Questionnaire. ResultsThis study began recruitment on July 15, 2024, and is scheduled to conclude on August 31, 2025. To date, 42 participants have been enrolled, with 35 having completed the intervention and posttreatment assessments (control group: n=21; EA group: n=14). Following protocol publication, data compilation and analysis will be conducted, with results anticipated to be published in a relevant journal in 2026. ConclusionsThis pilot trial is expected to provide critical insights into the feasibility of integrating EA with standard medication for managing ISSNHL with tinnitus. By generating preliminary evidence on its practicality and potential benefits, this study aims to inform the design and sample size estimation of future multicenter trials, potentially advancing nonpharmacological treatment options for this challenging condition. Trial RegistrationChinese Clinical Trial Registry ChiCTR2400086802; https://tinyurl.com/mtxthpzj International Registered Report Identifier (IRRID)DERR1-10.2196/69163

Objective:To observe the position and morphology of tubular cell in lateral facial recess by CT scanning and surgical finding, and its clinical significance. Methods:Thirty patients（32 ears） with cholesteatoma and/or adhesive otitis media requiring radical mastoidectomy and tympanoplasty were included in this study. To observe the morphology of the tubular cell in the lateral facial recess cavity through temporal bone HRCT and surgery, and to analyze its relationship with the facial nerve. Results:Tubular cell were found in 59.4%（19/32） ears by temporal bone HRCT and through surgeon. The length ranged from 1.5-6.5 mm, with median length of 2.5 mm. All of them opened in the facial recess, ran on the posterior wall of the facial recess, and even reached the bottom of the inferior tympanic cavity or the level of the inferior wall of the external auditory canal（sagittal view and surgical findings）. Probing from the inside out, the tubular cell located between the second genu of the facial nerve and the chorda tympani, which was a part of the lateral wall of the facial nerve（facial crest）. When the tubular cell is occupied by granulation tissue, it is easy to be regarded as the facial nerve. Fully drilling out the tubular cell is helpful to cut down the facial nerve crest. In the study, the follow-up and/or postoperative no facial paralysis happens during the operation and in the follow up. Conclusion:Preoperative temporal bone HRCT can clearly show the tubular cell in the lateral facial recess cavity. Comprehensive and accurate identification of these structures is helpful to fully cut down the facial nerve crest and remove the hidden lesions in the posterior tympanic cavity.

To the Editor: Acoustic neuroma is the most common tumor in the cerebellopontine angle (CPA) area. The surgical approaches used for acoustic neuroma include the labyrinth, middle cranial fossa, posterior sigmoid sinus, and posterior labyrinth routes. However, regardless of the approach used to expose the tumor in the internal auditory canal (IAC), the bone around the IAC must be abraded, which inevitably exposes the surrounding air cells to damage and increases the risk of cerebrospinal fluid (CSF) leak after surgery. CSF leak is the most common postoperative complication after the removal of a tumor from the CPA area and has a reported incidence of 2% to 10% after acoustic neuroma surgery.[1-3] Clinical treatment of CSF leak is challenging; and continuous lumbar puncture and drainage or reoperation are sometimes required to avoid meningitis. Therefore, prevention of postoperative CSF leak is a key issue to consider when surgery is performed to remove a tumor in the CPA area. Risk factors for CSF leak after tumor removal in the CPA area include a high body mass index, cranial hypertension, hyper pneumatization of the air chambers in the temporal bone, and a long operating time.[4-6] Although several studies have shown that CSF leak is related to the air chamber in the temporal bone, their conclusions are mostly based on the air chamber in the mastoid portion.[7-9] Moreover, some researchers have proposed that hyper pneumatization of the petrous apex is an independent risk factor for CSF leak,[4] but have not provided quantitative assessment data. Therefore, a comprehensive assessment of pneumatization of the air cells in the petrous apex is needed before surgery to prevent postoperative CSF leak. Air cells in the petrous apex around the IAC reach from the superior margin to the inferior margin of the petrous bone and from the labyrinth to the IAC. There is a positive relationship between the volume of the air chamber around the IAC and the actual surgical cavity that needs to be treated, that is, the larger the volume of the air chamber around the IAC, the larger the cavity that needs to be treated during surgery. However, there have been no reports on the three-dimensional distribution or volume of air cells around the IAC. Therefore, the aims of this study were to (1) perform a multi-planar reconstruction and analysis of the air chambers around the IAC using standardized temporal high-resolution computed tomography (HRCT) data and (2) observe the distribution of air chambers in the different quadrants centered on the IAC and calculate their volumes to provide an anatomic foundation for predicting potential sites of postoperative CSF leak before surgery. This study was approved by the Institutional Review Board in Beijing Tongren Hospital, Capital Medical University (No. HXP201611ST). All the patients signed an informed written consent form. A total of 110 temporal HRCT scans obtained for 73 patients with acquired sensorineural hearing loss (35 males, 38 females) of mean age 41 ± 16 (range, 18–76) years at Beijing Tongren Hospital between January 2019 and December 2019 were retrospectively analyzed. The inclusion criteria were that the structures of temporal bones were normal on HRCT. The exclusion criteria were as follows: (1) patients with external, middle, and inner ear malformation or inflammation; (2) patients with a history of ear trauma; (3) patients with a history of ear surgery; and (4) patients with a high jugular bulb or an anterior sigmoid sinus. The HRCT images were obtained using a SOMATOM Definition Flash scanner (Siemens, Erlangen, Germany) in a spiral mode. All scans were obtained with the patient in the supine position, and the scanning range was from the superior margin of the petrous bone to the inferior margin of the external auditory meatus. The scanning parameters were as follows: voltage, 140 kV; effective tube current, 150 mAs/slice; collimator width, 64 mm × 0.6 mm; pitch, 0.5; tube rotation time, 1 s per revolution; field of view, 180.00 mm; matrix, 512 × 512; slice thickness 0.5 mm; and inter-slice gap, 0.25 mm. All source images were reconstructed using the bone algorithm. The window width was kept at 4000 HU and the window level at 700 HU. The source HRCT images were sent to an image post-processing workstation (Extended Brilliance Workspace 2, Phillips Medical Systems, Best, The Netherlands) and then standardized for multi-planar reconstruction. The reformatted baseline of the oblique plane was parallel to the long axis of the superior semicircular canal. To standardize the volume, the following temporal bone structures were marked: the middle cranial fossa meninges (superior margin of the petrous bone), inferior margin of the petrous bone, lateral semicircular canal, posterior semicircular canal, common crus, the bottom of the IAC, and porus of the IAC. Axial images were used to completely expose the horizontal semicircular canal and show the posterior semicircular canal simultaneously. A straight line was drawn along the middle line of the longitudinal axis of the IAC, after which a vertical line was drawn through the common crus and used as the starting point to cut the IAC into several 1-mm thick slices. The boundaries of the air chamber around the IAC were defined as follows: superior boundary, the middle cranial fossa meninges (superior margin of the petrous bone); inferior boundary, the inferior margin of the petrous bone; anterior boundary, the bottom of the IAC, and posterior boundary, the porus of the IAC. On an axial view, the air chamber around the IAC was divided into four quadrants, labeled counterclockwise as I (anterior–superior), II (posterior–superior), III (posterior–inferior), and IV (anterior–inferior). We calculated the area of the air chambers in the petrous bone in four quadrants for each layer. Next, the volume of each layer was obtained by multiplying the area of the air chamber in each layer by 1 mm. Finally, the total volume of the air chamber around the IAC was calculated. In this study, we found that the volume of each quadrant around the IAC and the total volume of the four quadrants varied widely from patient to patient. The average volumes of quadrants I, II, III, and IV were 66.87 ± 132.16 mm3, 67.99 ± 111.47 mm3, 236.45 ± 372.47 mm3, and 302.37 ± 560.17 mm3, respectively. And the average total air chamber volume was 673.68 ± 737.47 mm3, which is consistent with the range of 0.93–3.56 cm3 previously reported for the anterior portion of the petrous apex.[10] This wide range of values means that the relevant anatomic variables in the air chambers around the IAC should be assessed in each individual patient before surgery. In quadrant I, the air chamber was not developed (air volume, 0) in 37 temporal bones, accounting for 33.6% of the entire study cohort; for quadrants II, III, and IV, 56, 2, and 9 temporal bones were not developed, accounting for 50.9%, 1.8%, and 8.2%, respectively. Furthermore, the air chambers were not developed in quadrants I and II in 30 cases, which represented 27.3% of the total study cohort. Analysis of variance and Tamhane's T2 multiple comparisons test revealed a statistically significant difference in air chamber volume between quadrants I, II, III, and IV (P < 0.05) but no significant difference between quadrants I and II or between quadrants III and IV (both P > 0.05) [Figure 1]. The air volumes were significantly greater in quadrants III and IV than in quadrants I and II (P < 0.05). This finding indicates that the volumes of the air chambers in the posterior–inferior and anterior–inferior quadrants should be investigated carefully while planning CPA surgery.Figure 1: (A–C) The axial view of the IAC and the four quadrants. (D) Comparison of mean volume of four quadrants. Green line: middle line of a longitudinal axis of the IAC on HRCT; blue line: the vertical line perpendicular to the middle line through the common crus; red line: middle line of the IAC perpendicular to the green line in the axial view of the IAC on HRCT. ∗ P > 0.05. HRCT: High-resolution computed tomography; IAC: Internal auditory canal.This cohort contained HRCT data for 52 male ears and 58 female ears. There was no significant sex-related difference in air volume for quadrants I, II, and III (P > 0.05, Wilcoxon rank-sum test). However, there was a significant difference between the air volume in quadrant IV and total air volume (P < 0.05). The air volume was significantly greater in men than in women [Supplementary Table 1, https://links.lww.com/CM9/B331]. In this study, we found no significant correlation between patient age and the volume of the air chambers around the IAC (P > 0.05). The patients in this cohort were all at least 18 years of age, indicating that the air chambers around the IAC do not change with age. Our findings in this regard are consistent with a previous suggestion that the development of the mastoid air chambers is independent of age in persons over the age of 20 years.[11] The Wilcoxon rank-sum test revealed a significant difference in air volume in quadrants III and IV (P < 0.05) but not in quadrants I and II (P > 0.05) between the left and right ears. There was no significant difference in total air volume between the two sides (P > 0.05) [Supplementary Table 2, https://links.lww.com/CM9/B331]. This study investigated the three-dimensional distribution and volume of the air chambers around the IAC. Its findings provide a new perspective on these chambers. Unlike in previous studies of the air chambers at the petrous apex, the present study shows that the distribution and volume of these air chambers is an important consideration while predicting the risk of postoperative CSF leak before surgery and during surgical planning. Moreover, its findings show that standardized post-processing of HRCT images is useful for determining the distribution and volume of the air chambers around the IAC. Acoustic neuroma is one of the most common tumors found in the posterior cranial fossa. Complete removal of a tumor in the IAC requires the removal of an extensive amount of bone around the IAC. During surgery, the air chambers around the IAC may be opened, leading to exposure of the subarachnoid space and a risk of CSF leak in the temporal bone area or directly into the nasopharynx via the Eustachian tube. CSF leak occurs nearly twice as often in patients with a well-pneumatized petrous apex compared with those in whom the petrous apex is poorly pneumatized. Furthermore, larger acoustic neuromas have less risk of CSF leak, possibly because they extend into and obstruct the air chambers in the petrous apex surrounding the IAC, which decreases the communication channels for CSF.[12] Therefore, accurate evaluation of the distribution and volume of air chambers around the IAC is one of the key issues while planning surgery to remove a CPA tumor. Our finding indicates that the volumes of the air chambers in the posterior–inferior and anterior–inferior quadrants may play an important role. Taken together, we found that the distribution and volume of the air chambers in the different quadrants around the IAC may help to prevent CSF leak after surgery in the CPA area. Acknowledgments The authors thank the patients, as well as the global network of investigators, nurses, study coordinators, and operations staff. Funding None. Conflicts of interest None.

目的 探讨颅底内淋巴囊肿瘤(ELST)的临床特点及手术疗效.方法 回顾性分析2014年8月至2022年2月首都医科大学附属北京同仁医院神经外科联合耳鼻咽喉头颈外科手术治疗的7例ELST患者的临床资料.术前均经多学科讨论制定治疗方案.其中4例患者术前行供血动脉血管内栓塞;肿瘤最大径＜3 cm的4例患者,采用经乳突入路;≥3 cm的3例患者,1例采用经颞下窝入路,2例采用经颞下窝入路联合中颅底入路或乙状窦后入路.结果 4例患者首发症状表现为听力下降和耳鸣,1例合并von Hippel-Lindau病.术前面神经功能House-Brackmann分级Ⅰ级4例,Ⅱ级1例,Ⅳ级2例.CT主要表现为溶骨性骨质破坏;MRI表现为肿物呈囊实性,血供丰富.肿瘤最大径＜3 cm的4例患者,全切除2例,次全切除1例,大部分切除1例;≥3 cm的3例患者,全切除1例,大部分切除2例.7例患者术后中位随访时间为48个月(2个月至6年).3例全切除及1例次全切除者均无肿瘤复发.2例肿瘤大部分切除者术后接受放疗,1例肿瘤消失,随访6年无复发;1例随访3年,肿瘤有缩小趋势.1例患者术后4年死于肿瘤进展,其余6例正常生活.结论 ELST具有特征性影像学表现;多学科合作制定个体化手术治疗方案、术后残余肿瘤辅助放疗,均有助于提高患者的疗效.

老年性聋大多表现为双侧、进行性、对称的感音神经性听力下降，该病以高频听力减退、言语识别率下降为主要特征。老年性聋的病变部位包括外周听觉系统特别是耳蜗以及听觉中枢的退行性改变。老年性聋表现出中枢处理听觉信息速度的减慢、噪声环境下言语识别困难，而且中枢听觉处理障碍是老年性聋的重要组成部分。功能性磁共振成像（functional magnetic resonance imaging，fMRI）是研究大脑中枢病变的新型手段。本文从老年性聋的诊疗现状以及fMRI应用在老年性聋中的研究进展做一综述，旨在探讨fMRI对于明确老年性聋中枢听觉处理机制以及为未来听觉康复干预提供指导等方面的应用前景。

Background The presigmoid retrolabyrinthine approach (PRA) for small vestibular schwannoma (VS) has unique advantages. Combination with partial labyrinthectomy further makes up its defect of high demand for anatomy. Objective Aimed to describe our use of the PRA with partial labyrinthectomy in VS surgery. Methods We retrospectively analyzed 10 patients diagnosed with VS who underwent PRA between September 2017 and November 2020. Their perioperative data were analyzed. Results Six tumors were on the left and three were on the right. One case was due to neurofibromatosis type 2 with bilateral involvement and underwent internal auditory canal decompression by PRA without tumor removal; all other patients underwent total tumor resection. Four patients underwent cochlear implantation simultaneously because of hearing loss that was detected during surgery. Three patients underwent partial labyrinthectomy. Five patients achieved hearing preservation, and one experienced hearing improvement. One of the three patients who underwent partial labyrinthectomy maintained hearing. All patients' pre- and postoperative facial nerve functions were House-Brackmann grade I. After a median follow-up time of 13 months, no tumors recurred. Conclusions PRA for small VS is a safe and effective surgery that can achieve facial nerve and hearing preservation. Combination with partial labyrinthectomy can also preserve hearing.

Objective:To explore the clinical application value of each sequence by analyzing the characteristics of labyrinthine signal on MRI in patients with unilateral sudden deafness.Methods:Totally 52 patients of unilateral sudden deafness with inner ear MRI were analyzed retrospectively at Beijing Tongren Hospital, Capital Medical University from January 2016 to July 2019, all of which could find abnormalities in the labyrinth, including 17 cases of plain scan and 35 cases of enhanced scan, with sequences including plain T 1WI, enhanced T 1WI, plain and enhanced delayed 3D fluid attenuation inversion recovery (3D-FLAIR). The affected labyrinthine signal characteristics of each sequence were analyzed and the involvement sites were judged. The ability of each sequence to show labyrinthine abnormal signal was evaluated and scored. The Friedman test and Wilcoxon signed rank sum test were used to compare the subjective scores of the ability to show labyrinthine high signal in different sequences in plain and enhanced patients, respectively. Fisher′s exact probability method was used to analyze the relationship between the affected sites and the recovery of hearing, tinnitus and vertigo symptoms. Results:Fifty-two patients (100%, 52/52) showed labyrinthine high signal on T 1WI, 8 (15.4%, 8/52) showed higher signal and 3 (5.8%, 3/52) showed low signal on T 2WI. Thirty-five (100%, 35/35) showed high signal on enhanced T 1WI, among which 27 had enhancement (77.1%, 27/35). Fifty-two (100%, 52/52) showed significant high signal of the affected labyrinth on 3D-FLAIR (17 plain scan, 35 enhanced scan). The scores were 2 (2, 2), 3 (2, 3), 3 (3, 4) and 4 (4, 4) of T 1WI, enhanced T 1WI, plain and enhanced 3D-FLAIR respectively. The overall difference in subjective scores of plain T 1WI, enhanced T 1WI and enhanced 3D-FLAIR in enhanced patients was statistically significant (χ2=64.528, P<0.001), and the comparison between the two was statistically different (all corrected P<0.05). The plain 3D-FLAIR score was higher than the plain T 1WI in patients with a statistically significant difference ( Z=-3.729, P<0.001). Twenty-seven cases (51.9%, 27/52) exhibited high signal at the ampulla of semicircular canals, with a statistically significant difference in the distribution of hearing recovery or not ( P=0.001). Conclusions:Both T 1WI and 3D-FLAIR sequences can effectively identify the labyrinthine high signal, but the latter was better than the former of its ability to display, especially delayed enhanced 3D-FLAIR. The high signal at the ampulla of semicircular canals was a characteristic predictor of non-recovery of hearing.

Objective: To explore the value of speculating etiology of the magnetic resonance imaging (MRI) T1 weighted imaging (T1WI) labyrinthine high signal ratio in patients with unilateral sudden deafness accompanied by vertigo and tinnitus and its relationship with hearing prognosis. Methods: Fifty-two patients with unilateral sudden deafness accompanied by vertigo and tinnitus who were admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2016 to July 2019 were collected, including 27 males and 25 females, aged (47.7±15.1) years. The inner ear MRI data of 52 patients (17 plain scan, 35 enhanced scan) with unilateral sudden deafness were retrospectively analyzed. Two radiologists independently measured the labyrinthine high signal intensity of the affected side and the contralateral normal side on T1WI and enhanced T1WI and calculated the signal ratio (the normal labyrinth signal was subtracted from the affected signal and then divided by the normal signal). The etiology of the enhanced group was judged based on two methods, including whether the abnormal high signal was enhanced or not (unenhancement indicated hemorrhage and enhancement indicated inflammation), and the locations of labyrinthine involvement on enhanced three-dimensional fluid attenuated inversion recovery (3D-FLAIR) (inflammation usually involved the perilymph spaces, while hemorrhage involved the perilymph and endolymph spaces). In the plain group, the locations of labyrinthine involvement on 3D-FLAIR was applied to infer the potential etiology. Results: The two methods presumed that 8 cases might be hemorrhage (22.9%, 8/35) and 27 be inflammation (77.1%, 27/35) in the enhanced group, which had a high consistency, while it was speculated that 7 patients might be hemorrhage (7/17) and 10 patients be inflammation (10/17) in the plain group. The measurement results of the two radiologists were highly consistent within and between the groups [the intraclass correlation coefficient (ICC) values were greater than 0.800]. The area under the receiver operating characteristic (ROC) curve (AUC) of the T1WI high signal ratio in the enhanced group for speculating etiology was 0.949 (P<0.01), when the predictive threshold value was 0.467, with a sensitivity of 96.3% and a specificity of 87.5%. It might be hemorrhage when the ratio was higher than the threshold value, otherwise it was inflammation. The T1WI labyrinthine high signal ratio was higher in the hemorrhage group than that of the inflammation group, and the hearing prognosis was worse (all P<0.05). The T1WI labyrinthine high signal ratio of the unrecovered group was higher than that of the recovered group (P=0.034). Conclusions: The etiology of labyrinthine high signal formation can be inferred by quantitative values combined with the involved sites. The high signal in the labyrinth indicates poor hearing prognosis, the higher the signal intensity, the greater the possibility of hemorrhage and the worse the hearing prognosis.

目的 1.利用影像重建技术建立标准耳蜗坐标系统,通过测量骨蜗管结构,量化分析语前聋耳蜗不全分隔畸形患儿耳蜗形态;2.评估语前聋耳蜗不全分隔畸形患儿人工耳蜗术后2年听力言语康复效果,分析不全分隔畸形耳蜗形态与术后听觉言语效果的关系.方法 收集2013年至2015年使用奥地利MED-EL公司FLEX系列人工耳蜗产品的27例语前聋伴耳蜗不全分隔畸形患儿的临床资料.将27例患儿依据耳蜗畸形种类分为不全分隔畸形I型组(IP-I组,17例)和不全分隔畸形II型组(IP-II组,10例).选取耳蜗形态正常且使用FLEX系列人工耳蜗的患儿作为对照组(对照组,17例).影像学评估实验组与对照组患儿术侧耳颞骨CT:通过影像重建骨蜗管,测量骨蜗管长度、耳蜗底转长径和宽径、耳蜗底转蜗管高度与宽度.术后两年使用听觉行为分级标准(CAP)、言语可懂度分级标准(SIR)、有意义听觉整合量表(MAIS)、有意义使用言语量表(MUSS)评估患者听觉及言语康复情况.结果 IP-I组:植入年龄为21.76±10.92月龄,骨蜗管长度20.29±4.39mm,耳蜗底转长径8.11±0.91mm,耳蜗底转宽径5.39±0.73mm,耳蜗底转蜗管高度3.10±0.94mm,耳蜗底转蜗管宽度2.55±0.91mm;术后两年CAP=5.76±1.53,SIR=3.21±1.03,MAIS=26.84±7.63,MUSS=20.84±8.23.IP-II组:植入年龄为18.2±8.94月龄,骨蜗管长度为24.35±2.92mm,耳蜗底转长径为8.58±0.55mm,耳蜗底转宽径为5.72±0.66 mm、耳蜗底转蜗管高度为2.37±0.80mm,耳蜗底转蜗管宽度为1.94±0.26mm;术后两年CAP=6.30±0.95,SIR=3.50±0.85,MAIS=28.40±5.92,MUSS=25.40±5.58;对照组:植入年龄为22.85±10.30月龄,骨蜗管长度31.19±1.88mm,耳蜗底转长径9.05±0.31mm,耳蜗底转宽径6.82±0.43mm,耳蜗底转蜗管高度1.83±0.19mm,耳蜗底转蜗管宽度为1.77±0.20mm;术后两年CAP=6.71±1.14,SIR=4.14±0.86,MAIS=30.93±6.84,MUSS=27.5±7.69.相关性分析发现各组耳蜗底转长径和宽径之间存在明显正相关(P<0.05),耳蜗底转蜗管宽度和高度之间存在明显正相关(P<0.05);IP-I组骨蜗管长度与术后CAP、SIR、MAIS、MUSS得分存在明显正相关(P<0.05);IP-II组骨蜗管长度与术后CAP、SIR、MAIS得分存在明显正相关(P<0.05),与MUSS得分无明显相关关系(P>0.05);对照组骨蜗管长度与术后CAP、SIR、MAIS、MUSS得分无相关关系(P>0.05).结论 不全分隔畸形患儿骨蜗管长度、耳蜗底转长径、耳蜗底转宽径、耳蜗底转蜗管高度、耳蜗底转蜗管宽度明显异于正常对照组;不全分隔畸形患儿耳蜗形态、耳蜗底转蜗管形态存在较大个体差异.通过术后两年CAP、SIR、MAIS、MUSS分析得知,不全分隔畸形患者听觉言语功能显著提高,且与骨蜗管长度存在明显正相关.因此术前对于不全分隔畸形患儿进行耳蜗结构测量具有重要意义.

Objective:To evaluate the therapeutic outcome and complication of grommet insertion for cancer patients in head and neck suffering from otitis media with effusion following radiotherapy. Method:Retrospectively analyze the clinical data of grommet insertion in patients with head and neck cancer suffering from otitis media with effusion following radiotherapy. Result:Fifty-five ears in 33 cases of cancer patients in head and neck with otitis media with effusion following radiotherapy had been performed grommet insertion. All patients were revisited seven days after operation, the phonetic frequency hearing in 55 ears had been improved in various degrees, and on average, it was increased 20.79 dB compared to that prior to the procedure. Sensation of the ear fullness had been disappeared in all the ears; the symptoms of tinnitus and headache were relieved in 80% of the patients. However, postoperative complications occurred in 67.3%（37/55） of the ears, including: ventilation tube falling out in 11（20%） ears, all of which had been re-catheterized; otorrhea in 10（18.2%） ears, which were healed after antibiotic treatment; Ventilation tube occlusion in 9（16.4%） ears, and they were recanalized after 5% sodium bicarbonate ear drops treatment; tympanic membrane retraction in 4（7.3%） ears, which were restored after eustachian tube blowing; eardrum perforation in 2（3.6%） ears without further treatment; the ventilation tube sliding into the tympanic cavity in 1（1.8%） ear, which was removed by surgery. The grommet was inserted more than twice in 31（56.4%） ears because of complications or recurrence of symptoms after grommet was removed. Conclusion:The grommet insertion is used for the treatment of radiotherapy-induced otitis media with effusion, which can improve the hearing and relieve the discomfort symptoms in ear in such patients. However, the incidence of postoperative complications is high and should be actively prevented to improve the therapeutic effect.

Objective: To investigate the visualization of endolymph in patients with otogenic vertigo by intravenous administration of single dose of gadolinium contrast agents and magnetic resonance three-dimensional fluid-attenuated inversion recovery sequence (3D-FLAIR MRI), and further assess the extent of endolymphatic hydrops. Methods: From Beijing Tongren Hospital of Capital Medical University between October 2017 and June 2018, 30 patients (16 males, 14 females) with unilateral otogenic vertigo were involved in this study, with the age of 30 to 68 years, mean age of (53±10) years. Eight hours after intravenous administration of single dose (0.1 mmol/kg, body weight) of gadopentetate (Gd-DTPA), 3D-FLAIR sequence was performed in 30 patients. The location of endolymphatic hydrops was observed and then the degree of hydrops was quantitatively elevated by two radiologists. The consistency test was used to analyze the location and degree of endolymphatic hydrops in the two radiologists and the paired t-test was used to compare the difference between the affected and healthy side of endolymphatic spaces of the patients with otogenic vertigo. Results: In 30 patients, the gadolinium distributed in all parts of the perilymph inside the inner ear, and can accurately outline the boundaries of the peri-and endolymph. Twenty-six patients (26/30, 86.7%) were found to have unilateral endolymphatic hydrops, including 18 mild hydrops, 8 significant hydrops. The two radiologists had a very good agreement on the assessment of endolymphatic hydrops(kappa=0.864, ICC=0.959). In the 3D-FLAIR MR images of 26 patients with endolymphatic hydrops, the saccule (26/26, 100%) had a higher rate of hydrops than the cochlea and utricle(16/26, 61.5%; 14/26, 53.8%), and two radiologists had a very good agreement on the location of endolymphatic hydrops(kappa=0.820). Moreover, there was a significantly statistical difference between the affected and healthy area of the endolymphatic space in this study (P<0.01). Conclusion: The technique of 3D-FLAIR MR imaging through single dose intravenous gadolinium injection is feasible, which can estimate endolymphatic hydrops in patients with otogenic vertigo, and accurately classify the degree of hydrops.

BACKGROUND:The surgical approach of acoustic neuroma includes translabyrinthine, transcranial fossa, suboccipital retrosigmoid sinus, and presigmoid retrolabyrinthine approach. Aims/Objective: To provide the anatomical basis for the surgical selection of presigmoid retrolabyrinthine approach by measuring the anatomical parameters of retrolabyrinthine space of the petrous bone by high-resolution CT.MATERIAL AND METHODS:A retrospective study of 208 high-resolution CT (HRCT) images of 104 patients examined in our hospital were analyzed retrospectively. Forty-nine males and 55 females were included in this study. Lines were drawn on the HRCT to measure the morphological data for pre-operational assessment.RESULT:Morphological data were retracted from HRCT, for preoperational assessment.CONCLUSION AND SIGNIFICANCE:Using the standard postprocessing images of temporal bone HRCT can predict the size of the retrolabyrinthine space and the degree of exposure to the inner auditory canal, providing an important anatomical index for the choice of presigmoid retrolabyrinthine approach.

Objective:To investigate the long-term efficacy of endolymphatic sac mastoid drainage for Ménière disease.Method:Data from 26 patients diagnosed with MD strictly meeting the criteria issued by " Guideline of diagnosis and treatment of Meniere disease(2017)" from 2006 to 2015 were analyzed in this study.Endolymphatic sac mastoid shunt surgery was performed for each patient.The therapeutic effect was evaluated against the " Guideline of diagnosis and treatment of Meniere disease(2017)".Vertigo control and auditory function were measured after at least two years follow up.Result:In 26 cases,16 cases were male and 10 cases were femaleThe age ranged from 24 to 71 years old,with an average of 52.04 years.The disease duration ranged from 1 to 32 years.22 cases were diagnosed as unilateral Ménière disease,and bilateral involvement was identified in 4 cases,thus a total of 30 ears were included.According to the preoperative staging of hearing,there were 0 cases in stage one,5 cases in stage two,16 in stage three and 9 cases in stage four.15 cases(57.7%)achieved class A vertigo conrol(complete control),9 cases(34.6%)class B(substantial control)and 2 cases(7.7%)class D(no control).The severity of vertigo and its impact on daily life were improved in 24 cases(92.3%)with a score of 0 point,and 2 cases(7.7%)scored 2 points.Post-operative hearing was improved in 3 cases(11.5%),unchanged in 16 cases(61.6%)and worsened in 7 cases(26.9%).After operation,tinnitus disappeared in 5 cases(19.2%),reduced in 13 case(50%)and unchanged in 8 cases(30.8%).Conclusion:Endolymphatic sac mastoid drainage was an effective and safe management for intractable Ménière disease patients with pre-operative residual hearing.The occurrence of complication was unsual.The patients who are in stage four could gain benifits from the surgery.

Mouret abscess is a rare extracranial complication of suppurative otitis media. It is generally believed to be a deep neck abscess caused by inflammation leading to the rupture of the bony tip of the mastoid tip. The location of Mouret abscess is deep. The symptoms are insidious at the onset, but may eventually spread to the surrounding tissue, and even lead to mediastinal abscess, cavernous sinus thrombosis, meningitis, dyspnea and other serious complications. At present, with the popularization of antibiotics, the occurrence rate of Mouret abscess is very low, and only sporadic cases have been reported.In this paper, a case of Mouret abscess caused by cholesteatoma was analyzed to explore Mouret abscess in terms of the route of infection, clinical manifestations, imaging features, diagnosis and treatment.

OBJECTIVE To explore the CT and MRI appearances of otogenic sigmoid sinus thrombophlebitis(SST) and abscess. METHODS The HRCT, plain MRI, magnetic resonance venography(MRV), enhanced MRI findings in 11 patients with otogenic SST were retrospectively analyzed. RESULTS On CT, the bony wall of sigmoid sinus was eroded in 10 cases (10/11), and air bubbles were found in or around sigmoid sinus in 4 cases. On plain MRI, sigmoid sinus flow void effect disappeared in all 11 cases. SST manifested as high signal on T2W1 in all 11 cases, and as low signal on T1WI in 2 cases, isointense signal on T1WI in 6 cases, high signal on T1WI in 3 cases. Contrast enhancement MRI showed enhancement in wall of venous sinus, but venous sinus thrombosis did not enhanced, but showed as irregular filling defect or empty triangle. MRV showed that involved venous sinus was not visualized. CONCLUSION CT can show the erosion of the bony wall of sigmoid sinus which may indicate the SST; and if air bubbles are found around or in the sigmoid sinus, the abscess around or in the sigmoid sinus should be doubted. Conventional MRI combined with MRV are effective and noninvasive methods in the diagnosis of SST.

听神经瘤是起源于第八对颅神经的良性肿瘤,大多数来源于前庭神经的鞘膜,来源于蜗神经者极少.前庭上神经来源的肿瘤比前庭下神经来源者术后听力的保留效果好,蜗神经来源者术后保留听力的效果最差.术前准确判断听神经瘤的起源对于手术进路的选择以及预估术后听力的保存均具有指导意义.本文通过介绍1例蜗神经起源的听神经瘤,并通过文献复习,分析听力学检查、内耳MRI以及冷热实验、前庭诱发肌源性电位(VEMP)对于听神经瘤的起源所具有的术前评估作用.

Objective:To identify the audiological improvement postoperatively and improve the understand of otosclerosis for a better performance of personalized surgical treatment.Method:We retrospectively reviewed a series of 200 cases after surgery for ototsclerosis.The clinical characteristics,pre-and postoperative audiometric results,signs of Carhart notch, Gelle test and the characteristics of high-resolution computed tomography of temporal bone were analyzed retrospectively.Result:73% of patients had tinnitus, while 4% had sense of ear fullness,80.79% had Carhart notch,92.09% had negative result in Gelle test and 45.66% had positive signs on computed tomography. 68% of the patients revealed a type A tympanogram with only 22% type As.Fifty-six cases with laser stapedotomy achieved a the air bone gap at 250 Hz,500 Hz,1 kHz,2 kHz and 4 kHz of 25.54,16.25,13.75,6.34,15.96 dB,respectively. The bone conduction thresholds at 250 Hz,500 Hz,1 kHz,2 kHz improved 2.05,1.51,3.75 and 3.93 dB,respectively. At 4 kHz, bone conduction threshold increased by 1.34 dB.The improvement of bone conduction threshold at 250 Hz,1 kHz,2 kHz was significantly but for the revisions at 500 Hz and 4 kHz.Conclusion:The diagnosis of otosclerosis should be based on the combination of medical history, pure tone audiometry, tympanometry, Carhart notch, Gelle test and high resolution computed tomography of temporal bone.Surgical technique of stapedotomy with Piston artificial auditory ossicle implantation could improve not only the air conduction threshold, but also the bone conduction threshold at 250 Hz,1 kHz,2 kHz.