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Case Report
 
Collision injury-induced superior semicircular canal fracture and therapeutic effect of round and oval window reinforcements
Jing Zou1,2, Guiliang Zheng1, Rishunzi Peng1, Yingna Gao1, Shiyue Chen3, Hongliang Zheng1
1Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China.
2Hearing and Balance Research Unit, Field of Oto-laryngology, School of Medicine, University of Tampere, Tampere, Finland.
3Department of Radiology, National Key Discipline, Changhai Hospital, Second Military Medical University, Shanghai, China.

Article ID: 100002JZO042014
doi: 10.5348/O04-2014-3-CR-3

Address correspondence to:
Jing Zou
MD, Ph.D, Professor, Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital,
Second Military Medical University, Changhai Road #168
Shanghai 200433
China
Phone: +86 21 81873220
Fax: +86 21 81873220

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How to cite this article
Zou J, Zheng G, Peng R, Gao Y, Chen S, Zheng H. Collision injury-induced superior semicircular canal fracture and therapeutic effect of round and oval window reinforcements. Edorium J Otolaryngol 2014;1:11–17.


Abstract
Introduction: A patient demonstrated sound induced vertigo and hearing loss among others as a result of superior semicircular canal (SSC) fracture was successfully treated using a minimally invasive method of round and oval window reinforcements.
Case Report: We report a case demonstrating SSC dehiscence syndrome among other symptoms that developed after a car accident. Vertigo was induced by pure tone at 1.5 kHz. An audiogram demonstrated a 10–15 dB air-bone gap at low frequencies and sensorineural hearing loss at frequencies higher than 4 kHz. Cervical vestibular evoked myogenic potential was absent on the left side and was successfully induced on the right side. An magnetic resonance imaging (MRI) using a 3D FIESTA sequence demonstrated an abnormal gap between brain and membranous SSC, and a high-resolution computed tomography (CT) scan with reconstruction of the panel of SSC confirmed the fractures on the SSC wall. The symptoms were well controlled by round and oval window reinforcements. A fibrous connection between the caput stapedis and the upper structures was identified, and the ossicular chain was reconstructed using a partial ossicular replacement prosthesis. More than 20 dB improvement was obtained in bone conduction at 4 kHz.
Conclusion: Collision injury-induced SSC wall fracture might display symptoms that are similar to SSC dehiscence syndrome. A combination of magnetic resonance imaging and high resolution CT with reconstruction of the panel of the potentially injured semicircular canal is recommended to identify the lesion site. Round and oval window reinforcements proved to be an efficient management technique for collision injury-induced SSC dehiscence syndrome.

Keywords: Imaging, Semicircular canal dehiscence, Surgery, Trauma, Vertigo


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Author Contributions
Jing Zou – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guiliang Zheng – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Rishunzi Peng – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yingna Gao – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shiyue Chen – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Hongliang Zheng – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Jing Zou et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Jing Zou is Professor in Department of Otolaryngology-Head & Neck Surgery at Changhai Hospital, Second Military Medical University, Changhai, China, and Head of Hearing and Balance Research Unit at School of Medicine, University of Tampere, Tampere, Finland. He earned the Bachelor's Degree from Third Military Medical University, Chongqing, China and Master's Degree from Department of Otolaryngology-Head & Neck Surgery, Daping Hospital, Third Military Medical University, Chongqing, China and Doctor's Degree from, Department of Otolaryngology-Head & Neck Surgery, National Key Discipline, Chinese PLA General Hospital, Beijing, China. His research topic for both the Master's Degree and Doctor's Degree was autoimmune inner ear disease. He did the Post-doc research in Department of Otolaryngology, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden, on the topic of inner ear MRI and vibration induced inner ear responses, and found that gadolinium-enhanced MRI is capable of demonstrating endolymphatic hydrops in animal model for the first time in the world. He has published 82 research papers in national and international academic journals and authored four books. His research interests include inner ear disease, inner ear imaging, and nanomedicine. We first visualization of endolymphatic hydrops in vivo in animal model and perilymphatic and endolymphatic spaces separately in human using MRI have significantly changed the clinical practice of Otology globally. Afterwards, we have been developing advanced diagnosis and smart drug delivery for the inner ear therapy using nanotechnology using superparamagnetic iron oxide nanoparticles, liposome nanocarriers, gadolinium-fullerenes (C60) derivatives, lipid nanocapsules, polymersomes, hyperbranched polylysine nanoparticles, chitosan nanoparticles, and silica nanogel. Developing neuroprosthesis with a gapless interface to auditory nerve fibers is one of my research aims. Cone beam CT was used to identify scala location of the electrodes of cochlear implant.



Guiliang Zheng is Attending Physician in Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China. He earned Doctor's Degree from, Department of Otolaryngology-Head & Neck Surgery, National Key Discipline, Chinese PLA General Hospital, Beijing, China. His research focuses on noise-induced hearing loss.



Rishunzi Peng is a candidate of Master's Degree in is Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China.



Yingna Gao is Resident in Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China.



Shiyue Chen is Resident in Department of Radiology, National Key Discipline, Changhai Hospital, Second Military Medical University, Shanghai, China.



Hongliang Zheng is Professor in Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China. He earned Bachelor's Degree, Master's Degree, and Doctor's Degree from, Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, Second Military Medical University Shanghai, China. His research focuses on vocal cord disorders and head & neck cancers.