title: Anatomic Variations in Temporal Bones Affect the Intensity of Nystagmus During Warm Caloric Irrigation.
abstract: Anatomic variables within the mastoid will correlate with intensity of caloric responses.
  
  
  
  During caloric irrigation, heat is transferred from the external auditory canal to the lateral semicircular canal (LSCC) through aerated mastoid bone. Temporal bone airspace volume and bone volume vary widely but the effect of this variation on caloric irrigation testing is not well characterized. Understanding this effect is necessary to understand how mastoid surgery may alter caloric irrigation results.
  
  
  
  Twenty-two mastoid airspace and bones, as well as LSCC, were reconstructed from computed tomography scans of 11 subjects with normal anatomy who underwent vestibular function evaluation. Respective surface area (SA) and volume (V) of the mastoid airspace, bones, LSCC, and distance from LSCC to tympanic membrane (LSCC-TM) were calculated. In addition, computed values from these anatomic structures were correlated with the maximum velocity of slow phase nystagmus during warm caloric irrigation (MVwarm).
  
  
  
  Our results showed that the combined effect of airspace SA:V, bone SA:V, LSCC SA:V, and LSCC-TM distance accounted for 69.5% of the variation in MVwarm. Airspace SA:V (R = 0.22) and LSCC SA:V (R2 = 0.02) positively correlated with MVwarm, while bone SA:V (R = 0.17) demonstrated an inverse correlation with MVwarm.
  
  
  
  Preliminary results from this pilot study suggest that a substantial amount of the variability in MVwarm can be explained by temporal bone anatomy. Results also indicate that the denser the bone, the more heat is transferred to the LSSC, whereas increased airspace serves as an insulator. A larger study is necessary to confirm our findings.
authors.affiliation: *Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A.†Department of Otorhinolaryngology/Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Aniruddha Uday
authors.initials: AU
authors.lastname: Patki
authors.forename: Ofri
authors.initials: O
authors.lastname: Ronen
authors.forename: David Marcus
authors.initials: DM
authors.lastname: Kaylie
authors.forename: Dennis Onyeka
authors.initials: DO
authors.lastname: Frank-Ito
authors.forename: Erin Gillikin
authors.initials: EG
authors.lastname: Piker
mesh_terms: D000328:Adult; D063405:Anatomic Variation; D002150:Caloric Tests / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000503:physiopathology; D010865:Pilot Projects; D012665:Semicircular Canals / Q000502:physiology; D013701:Temporal Bone / Q000033:anatomy & histology*; D014057:Tomography, X-Ray Computed