New marsupialization technique in endolymphatic sac surgery

Daneshi, Ahmad; Hosseinzadeh, Farideh; Mohebbi, Saleh; Mohseni, Mohammad; Mohammadi, Saeed; Asghari, Alimohamad

doi:10.1002/lio2.403

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…The resulting AI system serves to automate summarization of critical radiologic findings and enables efficient evaluation of COM with minimum manual input. It provides tangible benefit in assisting otologists during preoperative assessment and results in favorable clinical outcomes that are comparable to historical results [34][35][36][37]. These findings further support the clinical viability and advantages of AI technology, which is expected to improve efficiency, reduce errors, and facilitate precision medicine in healthcare in the new era of big data.…”

Section: Principal Resultssupporting

confidence: 60%

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

Chen,

Li,

Sun

et al. 2024

J Med Internet Res

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Background: Computed tomography (CT) of the temporal bone has become a critical diagnostic approach to chronic otitis media (COM), but it requires training and experience for interpretation. Artificial intelligence may assist clinicians in evaluating COM using CT with efficiency and reliability, but the logic for decision-making can be incomprehensible and there is currently no model that makes full use of the multidimensional diagnostic information.Objective: This study was to develop an explainable and three-dimensional (3D) deep learning framework for detection and differential diagnosis of COM based on CT.Methods: Temporal bone CT scans were retrospectively obtained from patients receiving surgeries for COM between December 2015 and July 2021 at two independent institutes. The region of interest containing the middle ear was automatically segmented, followed by 3D convolutional neural networks trained to identify pathological ears and cholesteatoma. Gradient-weighted class activation mapping was used to generate heatmaps highlighting the critical regions for decision-making. Model performance was evaluated over five rounds of cross-validation and external validation and benchmarked against clinical experts. Results:The internal and the external datasets contained 1,661 patients (number of eligible ears[n]= 3,153) and 108 patients (n=211), respectively. The deep learning model achieved decent and comparable area under the receiver operating characteristic curve (AUROC) scores ([mean ± SD]: 0.96±0.01 and 0.93±0.01) and accuracies (87.8±1.7% and 84.3±1.5%) in detection of pathological ears on two datasets. Similar outcomes were also observed in identifying cholesteatoma, with AUROC of 0.85±0.03 and 0.83±0.05, and accuracies of 78.3±4.0% and 81.3±3.3%, respectively. The model exhibited equivalent or superior performance and a much higher consistency compared to experts' averages in both tasks. The heatmaps properly highlighted the middle ear and mastoid regions, consistent with human knowledge in interpreting temporal bone CT. Conclusions:This study suggests the feasibility of a 3D deep learning framework in automatic evaluation of COM using CT. This model demonstrates decent performance, generalizability, and transparency, making it a useful tool to assist clinicians in assessment of COM.

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Section: Principal Resultssupporting

confidence: 60%

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

Chen,

Li,

Sun

et al. 2024

J Med Internet Res

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“…The vertigo control rate was evaluated by the vestibular score and deceased in 97.7% of the patients, which is consistent with our point on the vertigo control efficiency. However, there was no control group, only a pre- and post-operative control, and the inadequate evaluation of vertigo control, limiting the evidence effect in the study ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Resection of Lateral Wall of Endolymphatic Sac for Treatment of Meniere's Disease

Zhang

et al. 2022

Front. Neurol.

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BackgroundTo explore the long-term efficacy and safety of resection of the lateral wall of the endolymphatic sac for the treatment of intractable Meniere's disease (MD) as an alternative surgical procedure for treating this disorder.MethodsData from 73 patients who were referred to our hospital and diagnosed with unilateral MD between January 2015 and June 2019 were retrospectively analyzed in this study. Seventy-three patients who had frequent vertigo even after receiving standardized conservative treatment for at least half a year underwent resection of the lateral wall of the endolymphatic sac. Vertigo control and auditory function were assessed. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential were performed to evaluate audiological and vestibular functions. The post-operative follow-up duration was more than 2 years.ResultsAmong the 73 patients (male 34 cases, female 39 cases; age 20–69 years, average 51.4), vertigo was controlled effectively for 66 cases (90.4%) after 2 years of follow-up; 45 cases (61.6%) were completely controlled, and 21 cases (28.8%) were substantially controlled in this study. The patients of 16.4% had hearing loss with more than 10 dB change based on the four-tone average (0.5, 1, 2 and 3 kHz). No patient had a facial nerve weakness, cerebrospinal fluid leakage, or other complications.ConclusionResection of the lateral wall of the endolymphatic sac, which can effectively control vertiginous symptoms in intractable MD patients, represents an effective and safe therapy for this disease. Resection of the lateral wall of the endolymphatic sac is expected to be used as an alternative treatment for MD.

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“…Pure-tone audiometry was performed in a soundproof room with the use of an audiometer (Type Madsen, Astera, Denmark). The Pure-tone average (PTA) was calculated as the mean of 0.5, 1 k, 2 k, and 4 k Hz air conduction thresholds ( 37 , 38 ). Stage criteria were not mentioned in the 2015 consensus, so the clinical MD stage was classified according to the 1995 AAO-HNS guidelines by dividing PTA into four stages: I 0–25 dBnHL, II 26–40 dBnHL, III 41–70 dBnHL, IV > 70 dBnHL.…”

Section: Methodsmentioning

confidence: 99%

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

Zhang

Zheng

et al. 2021

Front. Neurol.

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Background: Although magnetic resonance imaging (MRI) of the membranous labyrinth and electrocochleography (ECochG) have been used to diagnose endolymphatic hydrops (ELH) in patients with Ménière's disease (MD), the relationship between imaging and ECochG is not well-documented.Objectives: This study evaluates the ELH using 3D-FLAIR MRI and extra-tympanic ECochG (ET-ECochG) and correlates the results from 3D-FLAIR MRI to those from ET-ECochG.Materials and Methods: 3D-FLAIR MRI images of 50 patients were assessed using a 2D volume-referencing grading system (VR scores, relative scores according to the known volumes of the cochlea, vestibule, and semicircular canals). Forty healthy subjects were included and compared to 51 definite MD ears of 50 patients while analyzing the ET-ECochG, which used a self-made bronze foil electrode. The amplitude ratio of the summating potential (SP) to the action potential (AP) (SP/AP) and the area ratio of SP to AP (Asp/Aap) were collected. Relative ELH grade scores were then correlated to ET-ECochG (SP/AP, Asp/Aap).Results: The VR scores showed a better correlation (r = 0.88) with the pure tone average (PTA), disease duration, and vertigo frequency of MD than the Bernaerts scores (grading the cochlea and vestibule separately) (r = 0.22). The SP/AP and Asp/Aap of the unilateral MD patients were statistically comparable to those measured in contralateral ears and the results between the definite MD ears with healthy ears were statistically comparable (p < 0.05). In a ROC analysis Asp/Aap (area under curve, AUC 0.98) significantly (p = 0.01) outperformed SP/AP (AUC 0.91). The total score of ELH, vestibular ELH, and cochlear ELH were also correlated with SP/AP and Asp/Aap. The strongest correlation was found between the Asp/Aap and cochlear ELH (r = 0.60).Conclusion: The 2D volume-referencing grading system was more meaningful than the Bernaerts scores. A correlation was found between ELH revealed by 3D-FLAIR MRI and the SP/AP of ET-ECochG in evaluating definite MD patients. The Asp/Aap appeared a more sensitive and reliable parameter than SP/AP for diagnosing the ELH of the membranous labyrinth.

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New marsupialization technique in endolymphatic sac surgery

Cited by 4 publications

References 22 publications

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

Efficacy of Resection of Lateral Wall of Endolymphatic Sac for Treatment of Meniere's Disease

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

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