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Annales Françaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale
Vol 124, N° 6  - décembre 2007
pp. 322-325
Doi : 10.1016/j.aorl.2007.03.007
Received : 27 février 2007 ;  accepted : 12 mars 2007
Labyrinthite ou pseudotumeur inflammatoire après stapédectomie
Labyrinthitis, or inflammatory pseudotumor after stapedectomy
 

C. Pavillon-Maisonnier [1], F. Faure [1], I. Plouin-Gaudon [1], E. Truy [1 et 2]
[1] Service d'ORL, de chirurgie cervicomaxillofaciale et d'audiophonologie, hôpital Édouard-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France
[2] UMR CNRS 5020, université Claude-Bernard–Lyon-I, France

Tirés à part : C. Pavillon-Maisonnier

Auteur correspondant.

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Résumé
Objectifs

Décrire une entité pseudotumorale expansive compliquant une chirurgie d'otospongiose.

Méthode

Réalisation d'un bilan radiologique et exploration chirurgicale d'une surdité rapidement progressive post-stapédectomie.

Résultats

Le scanner initial normal est répété à sept mois postopératoires. Il met en évidence un élargissement du conduit auditif interne ainsi qu'une destruction du vestibule. L'imagerie par résonance magnétique (IRM) en séquence CISS confirme la présence d'un comblement de tout le conduit auditif interne, de la cochlée et du labyrinthe postérieur, de l'oreille moyenne rehaussée de façon homogène après injection de gadolinium. L'exploration chirurgicale confirme l'aspect invasif du processus et l'examen anatomopathologique conclut à un remaniement inflammatoire associé à la présence de calcifications. Il n'y a pas de lésion autre qu'inflammatoire.

Discussion

Les imageries tomodensitométrique et par résonance magnétique confirment le diagnostic rare de processus expansif pseudotumoral au niveau de l'oreille interne après stapédectomie.

Conclusion

Le bilan radiologique pour une surdité de perception post-stapédectomie doit comporter un scanner complété par une IRM si un processus inflammatoire est suspecté. Les atteintes inflammatoires de l'oreille interne peuvent prendre l'aspect de pseudotumeur expansive.

Abstract
Abstract
Objectives

To describe an extensive pseudotumor as a complication of stapes surgery.

Methods

Radiological workup and surgical exploration in a 38-year-old man suffering from postoperative hearing loss. The patient presented with tinnitus, inferior facial palsy, vertigo, and rapidly progressive hearing loss after his operation.

Results

The initial postoperative CT scan was normal. However, seven months after surgery, the CT scan showed an enlargement of the inner ear canal and complete vestibular destruction. The CISS sequence of the magnetic resonance imaging (MRI) enhanced after gadolinium injection revealed the presence of a mass filling the entire inner ear canal, the cochlear, the posterior labyrinth, and the middle ear. The aspect suggested an inflammatory pseudotumor. Surgical exploration confirmed the invasive aspect of the mass and pathological analysis revealed inflammatory tissue associated with microcalcifications.

Discussion

Hearing loss, vertigo, and tinnitus after stapes surgery require a radiologic workup. The CT scan is done first. It could be normal or eliminate other diagnoses. MRI may lead to a more precise diagnosis. It can reveal an inflammatory process of the inner ear after gadolinium injection. Surgical exploration is indicated in case of aggressive and extensive lesions.

Conclusion

In the context of hearing loss complicating otosclerosis surgery, an imaging workup should include a CT scan. In case of a suspected expansive and inflammatory mass, it should be completed by an MRI (CISS sequence and gadolinium injection). An inflammatory lesion of the inner ear could indicate extensive pseudotumor.


Mots clés : Otospongiose , Pseudotumeur , Oreille interne , Complication , Imagerie

Keywords: Otosclerosis , Inflammatory pseudotumor , Failure , Imaging , Inner ear complication






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