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Miriam S. Welgampola
Institute of Clinical Neurosciences, Royal Prince Alfred Hospital
Central Clinical School, University of Sydney
Sydney, NSW 2050 (Australia)
E-Mail [email protected]
Clinical Evaluation of the Dizzy Patient
Lea J, Pothier D (eds): Vestibular Disorders. Adv Otorhinolaryngol. Basel, Karger, 2019, vol 82, pp 12–31
DOI: 10.1159/000490268
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I. Pyykköa · J. Zoua, b · R. Gürkovc · S. Naganawad · T. Nakashimae–g
aHearing and Balance Research Unit, University of Tampere, Tampere, Finland; bDepartment of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China; cDepartment of Otorhinolaryngology, Campus Grosshadern, University of Munich, Munich, Germany; dDepartment of Radiology, Nagoya University Graduate School of Medicine, Nagoya, eIchinomiya Medical Treatment and Habilitation Center, Ichinomiya, fDepartment of Otorhinolaryngology, National Center for Geriatrics and Gerontology, Obu, and gDepartment of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Multidetector computed tomography has been the benchmark for visualizing bony changes of the ear, but has recently been challenged by cone-beam computed tomography. In both methods, all inner ear bony structures can be visualized satisfactorily with 2D or 3D imaging. Both methods produce ionizing radiation and induce adverse health effects, especially among children. In 3T magnetic resonance imaging, the soft tissue can be imaged accurately. Use of gadolinium chelate (GdC) as a contrast agent allows the partition of fluid spaces to be visualized, such as the bulging of basilar and Reissner’s membranes. Both intravenous and intratympanic administration of GdC has been used. The development of positive endolymph imaging method, which visualizes endolymph as a bright signal, and the use of image subtraction seems to allow more easily interpretable images. This long-awaited possibility of diagnosing endolymphatic hydrops in living human subjects has enabled the definition of Hydropic Ear Disease, encompassing typical Meniere’s disease as well as its monosymptomatic variants and secondary conditions of endolymphatic hydrops. The next challenge in imaging of the temporal bone is to perform imaging at the cellular and molecular levels. This chapter provides an overview of current temporal bone imaging methods and a review of emerging concepts in temporal bone imaging technology.
© 2019 S. Karger AG, Basel
Introduction
Rapid development of radiological equipment over the last several decades has significantly promoted the role of imaging in otology. Computed tomography (CT) and magnetic resonance imaging (MRI) have become an integral part of the evaluation of children and adults with hearing loss and diseases associated with temporal bone. The currently used multidetector CT (MDCT) techniques allow bony tissue determination with an accuracy of 0.1 mm. Recently, cone-beam CT (CBCT) technology has become particularly attractive for temporal bone imaging as CBCT imaging reduces the exposure to ionizing radiation when compared with traditional MDCT. However, changes in inner ear fluid spaces became possible only with 3T or higher MRI equipment in combination with contrast agents and special imaging techniques.
Abnormalities on CT or MRI are found in 20–50% of children with sensorineural hearing loss and correlate with the degree of hearing loss [1]. Imaging of the temporal bone by using both MRI and MDCT is likely the future gold standard for temporal bone imaging [2]. Some recent and novel imaging methods have been currently used experimentally in temporal bone studies but have not yet been applied clinically and these may provide additional imaging benefits