Hypothesis
An objective cochlear framework, for evaluation of the cochlear anatomy and description of the position of an implanted cochlear implant electrode, would allow the direct comparison of measures performed within the various sub-disciplines involved in cochlear implant research.
Background
Research on the human cochlear anatomy in relation to tonotopy and cochlear implantation is conducted by specialists from numerous disciplines such as histologists, surgeons, physicists, engineers, audiologists and radiologists. To allow accurate comparisons between and combinations of previous and forthcoming scientific and clinical studies, cochlear structures and electrode positions must be specified in a consistent manner.
Methods
Researchers with backgrounds in the various fields of inner ear research as well as representatives of the different manufacturers of cochlear implants (Advanced Bionics Corp, Med-El, Cochlear Corp) were involved in consensus meetings held in Dallas, March 2005 and Asilomar, August 2005. Existing coordinate systems were evaluated and requisites for an objective cochlear framework were discussed.
Results
The consensus panel agreed upon a 3-dimensional, cylindrical coordinate system of the cochlea using the “Cochlear View” as a basis and choosing a z-axis through the modiolus. The zero reference angle was chosen at the centre of the round window, which has a close relationship to the basal end of the Organ of Corti.
Conclusions
Consensus was reached on an objective cochlear framework, allowing the outcomes of studies from different fields of research to be compared directly.
Dysphagia is an important yet inconsistently recognized symptom of inclusion body myositis (IBM). It can be disabling and potentially life-threatening. We studied the prevalence and symptom-sign correlation of dysphagia. Fifty-seven IBM patients were interviewed using a standard questionnaire for dysphagia and 43 of these underwent swallowing videofluoroscopy (VFS). Symptoms of dysphagia were present in 37 of 57 patients (65%). Nevertheless, only 17 of these patients (46%) had previously and spontaneously complained about swallowing to their physicians. Both symptoms of impaired propulsion (IP) (59%) and aspiration-related symptoms (52%) were frequently mentioned. Swallowing abnormalities on VFS were present in 34 of 43 patients (79%) with IP of the bolus in 77% of this group. The reported feeling of IP was confirmed by VFS in 92% of these patients. Dysphagia in IBM is common but underreported by the vast majority of patients if not specifically asked for. In practice, two questions reliably predict the presence of IP on VFS: ‘Does food get stuck in your throat’ and ‘Do you have to swallow repeatedly in order to get rid of food’. These questions are an appropriate means in selecting IBM patients for further investigation through VFS and eventual treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-009-5229-9) contains supplementary material, which is available to authorized users.
A 57-year-old man presented with a progressively growing tumor mass on the left side of his neck. An examination revealed an androgen receptor-positive salivary duct carcinoma (AR-positive SDC; Fig 1, histology) located in his left parotid gland with multiple cervical lymph node metastases (Fig 2A, contrast-enhanced T1-
Using geometrically tailored dielectric pads enables high spatial resolution magnetic resonance imaging of the human inner ear at 7 T. The high spatial resolution improves the depiction of the fine inner ear structures, showing the benefit of magnetic resonance imaging at ultrahigh fields.
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