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Non-echo planar diffusion-weighted MRI increases follow-up accuracy after one-step step canal wall-down obliteration surgery for cholesteatoma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
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2013 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 133, no 6, 574-583 p.Article in journal (Refereed) Published
Abstract [en]

Conclusion:

Non-echo planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) increases the number of detected cholesteatoma after one-step canal-wall down (CWD) obliteration surgery for cholesteatoma compared with clinical evaluation alone.

Objective:

To evaluate the use of DW-MRI for detection of cholesteatoma after surgical treatment using CWD obliteration technique.

Methods:

Thirty-eight adult patients (41 ears) treated with identical one-step canal-wall down obliteration surgical technique were included in a prospective and blinded study. All patients were investigated with non-EPI and EPI DW-MRI 1-9 months after the clinical examination. Follow-up time after primary surgery varied between 10 and 234 months. DW-MRI were assessed by two neuroradiologists and compared with clinical results. Inter-rater agreement was calculated. Positive non-EPI DW-MRI cases underwent revision surgery within 18-159 days after imaging.

Results:

Out of 41 cases seven were evaluated as positive for cholesteatoma on non-EPI DW-MRI. Since one patient refused surgery six of these seven cases underwent surgical revision and all were verified. There was agreement between clinical and non-EPI findings in five of eight cases. EPI findings correlated poorly with non-EPI and clinical findings. Inter-rater agreement (Cohen´s kappa) was 0.91 for non-EPIDW-MRI (p<0.001) and -0.062 for EPI DW-MRI (p=0.43)

 

Place, publisher, year, edition, pages
2013. Vol. 133, no 6, 574-583 p.
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-198119DOI: 10.3109/00016489.2012.762118ISI: 000319011800003PubMedID: 23675808OAI: oai:DiVA.org:uu-198119DiVA: diva2:615258
Available from: 2013-04-09 Created: 2013-04-09 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Middle Ear Cholesteatoma: Surgical Treatment, Follow-up and Hearing Restoration
Open this publication in new window or tab >>Middle Ear Cholesteatoma: Surgical Treatment, Follow-up and Hearing Restoration
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although middle-ear cholesteatoma is a major topic in otological research, its etiology and pathogenesis remain unclear. Pediatric cholesteatoma is considered more aggressive than adult cholesteatoma, as it has a higher rate of growth, is more often infected and exhibits wider extension. Higher incidence of residual and recurrent disease after surgical treatment of pediatric cholesteatoma has been observed in most studies. In this study, the results are presented from a canal wall down (CWD) obliteration technique used in 330 adult patients (Paper I) with cholesteatoma, evaluated at 1, 3 and 6 years following surgery. Additionally, results are offered from 57 pediatric patients (Paper II) using identical surgical technique and compared with adults. The surgical and hearing outcomes in both groups showed a low incidence of residual and recurrent disease and a high rate of ear water resistance without infection. The results were unrelated to the severity and extension of disease, as well as to age and previous surgery. No differences were found in outcomes between adult and pediatric cholesteatoma patients.

The thesis also describes the use of diffusion-weighted magnetic resonance imaging (DW-MRI) (Paper III) in follow-up examinations of adult cholesteatoma patients undergoing surgical treatment. Non-echo planar diffusion-weighted imaging (Non-EPI DW-MRI)increased the accuracy of clinical examinations. It is concluded that the use of non-EPI DW-MRI should be mandatory in clinical follow-ups after cholesteatoma surgery. In Paper IV a relatively new mode of hearing rehabilitation was investigated, with an active middle ear implant (AMEI), in patients with chronically disabled ears. Functional hearing results were compared with the previous use of conventional hearing aids before and after AMEI implantation. Moreover, the consequences of positioning of the implant in the middle ear were evaluated using cone beam computed tomography (CBCT), a modification of conventional computed tomography. The hearing results, assessed with AMEI, were found to be less dependent on the precise positioning of the floating mass transducer(FMT) against the round window membrane (RWM) than was anticipated. Further, the hearing results were noted to be comparable with those with conventional hearing aids and even superior at high frequencies.

 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 905
National Category
Medical and Health Sciences
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-198121 (URN)978-91-554-8672-3 (ISBN)
Public defence
2013-06-12, Enghoffsalen, ingång 50, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2013-05-22 Created: 2013-04-09 Last updated: 2013-08-30Bibliographically approved

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Edfeldt, LennartStrömbäck, KarinDanckwardt-Lillieström, NiklasRask-Andersen, HelgeWikström, Johan

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Otolaryngology and Head and Neck SurgeryDepartment of Radiology, Oncology and Radiation ScienceRadiology
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