高分辨率计算机断层扫描可显示圆窗龛膜，且其是内耳局部药物疗效的预测指标。

Round Window Niche Veil is Visible on High-Resolution Computed Tomography and a Predictor of Local Drug Efficacy to Inner Ear.

作者信息

Zhuo Shipei, Li Yong, Cui Bozhen, Liu Yuxiang, Deng Jingman, Lou Jintao, Yuan Jianpeng, Si Yu, Zhang Zhigang

机构信息

Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

Institute of Hearing and Speech, Sun Yat-sen University, Guangzhou, China.

出版信息

Laryngoscope. 2024 Mar;134(3):1396-1402. doi: 10.1002/lary.31006. Epub 2023 Aug 28.

DOI:10.1002/lary.31006

PMID:37638702

Abstract

OBJECTIVES

To determine the morphologies and effect of the round window niche veil (RWNV) on local drug delivery efficacy and develop diagnostic criteria on high-resolution computed tomography (HRCT).

METHODS

Patients diagnosed with otosclerosis, bilateral profound sensorineural hearing loss or vestibular schwannoma were enrolled from 2019 to 2022, receiving temporal bone HRCT scanning, and anatomic variations of RWMV were summarized intraoperative. For patients with vestibular schwannoma, 1 mL of dexamethasone solution (4 mg/mL) was administered via facial recess during operation, and samples of perilymph were collected to analyze. The diagnostic criteria of RWNV on HRCT were developed and verified.

RESULTS

A total of 85 patients were enrolled. RWNV was observed in 54 cases intraoperatively with an incidence of 63.5% (95% CI, 52.9%-73.0%). The median perilymph concentrations were 4.86-fold higher in the group without RWNV than with RWNV (p < 0.0001). RWNV could be visualized on HRCT with a window width of 3500-4500 HU and a window level of 300-500 HU. The characteristic features were as follows: (1) a thin soft tissue shadow could be seen at the entrance of the round window niche (RWN); (2) it was visible in at least 2 consecutive layers along the upper margin of RWN from top to bottom; (3) it was discontinuous with the adjacent bone margin. The sensitivity and specificity of the diagnostic criteria were 77.8% and 93.6%, respectively.

CONCLUSION

RWNV could reduce local dexamethasone diffusion efficacy to the inner ear, which could be diagnosed on HRCT and used as a predictor of local drug delivery efficacy to the inner ear.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1396-1402, 2024.

摘要

目的

确定圆窗龛膜（RWNV）的形态及其对局部药物递送疗效的影响，并制定高分辨率计算机断层扫描（HRCT）的诊断标准。

方法

选取2019年至2022年诊断为耳硬化症、双侧重度感音神经性听力损失或前庭神经鞘瘤的患者，进行颞骨HRCT扫描，并在术中总结RWMV的解剖变异。对于前庭神经鞘瘤患者，术中经面神经隐窝给予1 mL地塞米松溶液（4 mg/mL），并收集外淋巴样本进行分析。制定并验证了HRCT上RWNV的诊断标准。

结果

共纳入85例患者。术中观察到54例存在RWNV，发生率为63.5%（95%CI，52.9%-73.0%）。无RWNV组的外淋巴中位浓度比有RWNV组高4.86倍（p < 0.0001）。RWNV在HRCT上可通过窗宽3500 - 4500 HU和窗位300 - 500 HU显示。其特征如下：（1）在圆窗龛（RWN）入口处可见一薄软组织影；（2）沿RWN上缘从顶部到底部至少连续2层可见；（3）与相邻骨缘不连续。诊断标准的敏感性和特异性分别为77.8%和93.6%。