If something beyond the physical is becoming a living reality in your life, contentment is a very bad idea. If you were truly greedy, you would aspire for the highest. A powerful desire without a goal, if your energy becomes full force, not towards anything, this is meditation. More ideology, that contentment is the greatest virtue. If you are content with who you are right now, you are not even aware that if you are willing to strive who you could be. The possibility, a human being causing his own evolution, the possibility of a human being blossoming into a beautiful state of fragrance and beauty has been completely discounted. That is why contentment, once it happened, a newly married woman or a girl went back to her mother's place and said, my husband is such a wonderful man that he gives me whatever I ask. The worldly wise mother looked at her and said, obviously you're not asking enough. That's a mother's advice. This is the mother-in-law. So obviously you're not asking enough from life, that is why you're content. If I'm greedy, would it be better? Yes, you must be greedy. The problem right now is you're stingy about your greediness. The problem in this world is not of greed. The problem in this world is people are stingy. They are stingy. That's why they don't aspire for the biggest possibility. They want to save themselves for the next world. If you were greedy, you would want everything from life, isn't it? Would you be just satisfied with little more money or little more property or little more power or little more pleasure? If you were truly greedy, you would aspire for the highest, isn't it? Now greed is not the problem. People are stingy, that's a problem. Enough. The word enough must be removed from our vocabulary because enough is relevant only to the physicality of life. If you're being served food, at some point you have to say it's enough. It doesn't matter what. Anything that is physical, at some point you will have to say enough. And enough or contentment has become a valuable thing in people's minds only because they have not looked at or they have not explored dimensions beyond the physical because physicality is a limited entity. Physicality is a limited quantity by itself. Anything that's physical is within certain limitations. So if you get greedy with the physical, there will not be enough for somebody else. Suppose there is this much food, if you say I want all of it, then somebody else will not have it. There's only this much land. If somebody says I want all of it, somebody else will have it. Like Mahatma said, there is enough for everybody's need, not enough for even one man's greed. That is true with the physicality. If your life and the realm of your experience is limited to the physical nature of the existence, enough contentment is a good idea. But if your life is beginning to explore dimensions beyond the physical, if something beyond the physical is becoming a living reality in your life, contentment is a very bad idea. That means you will stunt yourself. The very possibility of becoming a limitless being, the very possibility of becoming a boundless nature, you will destroy the moment you say I will be content. Contentment is a boundary. This much is enough means you're drawing that bigger boundary. Enough is not a good idea. Contentment is not a good idea. Your limited ideas of success is not a good idea. Till this being allows itself to blossom to a boundless state, you should not be content. You must burn with this content. Now contentment is need not be brought into our life as an ideology. It is just that if your aspiration becomes limitless, if your aspiration and desire is not selective, it desires for just everything, then naturally you would not limit yourself to the physicality of the existence. When it is no more selective, desire just becomes a powerful energy to expand, to burst open this being who is containing himself with contentment. People are trying to achieve contentment at different levels at different stages of life. Please see this. What you call as contentment is just containment.  But that boundary satisfies you and gives you sanity only for a short period of time. Then it has to be expanded, otherwise it will not… it's not going to work. At the age of twenty, whatever you thought is going to be your contentment, does it remain your contentment when you're thirty? Whatever your ideas of contentment at thirty, does it remain contentment at forty unless you're going down the tube?  But if you are on a upswing, your ideas of contentment keep expanding, isn't it?  Contentment is just a cautious way of attending to boundlessness. You're being cautious. You want to go towards boundlessness in installments. In installments, if you seek the infinite, you're a lost case. Because nobody has ever reached what we refer to as infinite by counting one, two, three, four, five. Through installments, you are not going to go to the infinite. That cannot happen in the very nature of things. If you choose installments as a way towards boundlessness or infinite nature, you will just become endless counting. That's all that can happen. Endless counting will tire you one day. Just count and see. Today you start counting now. Don't stop. Just keep counting simply at your own pace. Not at my pace. At your own pace. One, two, three, four, five. Start counting. Don't stop. You say till where you can go without tiring yourself. Not physical exhaustion. I'm saying you'll just be tired of counting because you know it's not getting you anywhere. So, desiring process is a limitless process. But you're limiting it by being selective about your desires. I desire this. I desire that. I desire that. I desire that. But not this, this and this. If you take away the discriminatory nature of your desire, if you sit here right now and do not desire for anything particular, just desire for everything. Just everything. Just see if your mind can do it. Don't desire for anything in particular. Just simply desire for everything. First of all, you don't know what is everything. Nobody knows what is everything, isn't it? Everything that you know and everything that you do not know. Just desire for all the things that you know and do not know. You will see desire, the energy that you call as desire becomes a powerful force to become meditative. Meditation, devotion is just this. A desire without a goal, a powerful desire without a goal. If your desire, if your energy becomes full force, not towards anything, this is meditation. If you're on the spiritual process, there is no such thing as contentment. There is no such thing as enough. Greed is the rule. Greed is a bad word though, but greed is the rule. Because limitless desire is generally considered greed. But it's not true. Greed is going by installments. If someone is taking larger installments than you, you consider that as greed, isn't it? Yes or no? Yes or no? If somebody is going for larger installments than yourself, you consider that person greedy. If they're going at the same level of installments as you, you consider that competition. If somebody is going at a smaller installments than you, you call that incompetent, isn't it so?  Somebody is going at the same level of installments as you, that's competition. Somebody is going for leaps and bounds, greedy. So, greed is a very relative term. Everybody is attaching a certain level of desire as greed, according to their understanding, according to their limitations. In my vocabulary, there is no such thing as greed, because I feel a human being should seek nothing less than everything. And when he's seeking everything, small things will not keep his attention. He will not be thinking of food, he will not be thinking of currency, he will not be thinking of pieces of property, he will be thinking of the largest possibility, nothing less.


Welcome to the Bookmap Platform Details webinar. This is Bruce at Bookmap, risk disclaimer, trading equities and futures involves substantial risk of loss and is not suitable for all investors. Past performance is not necessarily indicative of future results. For more information, you go to bookmap.com and there's a 14-day free trial of the product, fully featured, and it comes with education. Okay, there is a Bookmap Educational Course. That would be the first thing to start to watch and start to digest. And then go to the advanced order flow webinars that I was just mentioning, okay? They start at 11 Eastern, okay? There are other resources as well. It's a pretty robust, you know, offering here that comes along with the platform, okay? All right, so let's take a look at Bookmap here. Okay, and just want to go through the basics in the website, okay? So start at the home page here and just drops down into the intro page and about Bookmap, there's a quick video here, just gives you an overview and then just information here about Bookmap, okay? There's also Bookmap for equities, okay? It's with this data feed here and NASDAQ TotalView, and if we continue on down, you will need connectivity, okay? We're a platform, we're not a data provider, okay? So you will need to connect Bookmap to one of these data providers, okay? Now, that said, you can see that there's some other platforms here like TTX Trader Pro, Ninja Trader, and Interactive Brokers Traders Workstation, okay? These platforms here, we connect to the API. So there's a kind of a number of different ways of connecting Bookmap, okay, if you use these platforms, right? A bit further down, this is where you can find the trial information, okay? 14 days free trial, there's Bookmap, Basic, Advanced, and then Quant, okay? If you want to know the differences here, there's a link down here that does a comparison of each feature. So there's really only one version of Bookmap, it's Bookmap Basic, it's 49 per month, billed quarterly, and you get that 14 day free trial, okay? Bookmap Advanced is the same as Basic, except for mainly these add-ons that you see here, okay? The one-click trading from the chart, nice advantage there because you see the liquidity heat map, we've been covering that in detail in the second webinar, how to use that heat map to your advantage for your trade management, okay? Especially with your targets and your stops. And then you can see there's proprietary indicators that we've put together that go through the order flow, all right? Quants, you'll have special needs for your own data or your own proprietary indicators, so click here to learn more about that. Social media, you can follow us on atbookmap underscore pro, okay? To get latest information and just understanding some of the other users that we will retweet. And then the Bookmap YouTube page, okay? There's some intro videos here for those of you who are new. And then there's the features and components here. This playlist, I would recommend if you're new to watch some of these just to get a feel for what it is, Bookmap, how it works, et cetera. And then these order flow video snippets. Now, these go through the concepts, conceptual content that we cover in detail in the live markets during the live webinar, okay? This is the phenomena, many of the different phenomena that we cover, okay? So just when we see something interesting, we'll make a video of it. They're very short here, but this is something that you wanna understand what the markets are doing, how Bookmap offers you transparency into what the markets are doing. Then these are the videos to watch, okay? All right, let's go back and let's take a look at Bookmap, okay? So let's wanna take a quick look at, you know, we could look at the ES today. ES has been moving. You know, it's up to you guys, put your comments in what you'd like to look at. We've been covering the NASDAQ for quite a while now. It's been bullish just because tech has been bullish and you can see that again here. Let's see, that's a five minute chart. So let's go to 30 minute. All right, so yeah, still very bullish and more bullish than the S&P, okay? But yeah, up to you guys, kind of like sticking with this NASDAQ, but if you guys wanna look at the S&P, I know there's many S&P traders, then let me know, all right? Okay, let's see. Okay, I got a question here from Brian immediately. Let's take a look at Bookmap, okay? Okay, Brian, all right. So let's go through some of these column settings. Okay, this is great. This is what this webinar here is for. For those of you who are new here, just want to quickly show you what Bookmap is displaying and I usually go through this in detail, okay? But I'm just gonna quickly go through it here, okay? So there's three elements. I mean, it looks like there's a lot going on this chart, okay? It's actually pretty simple. It's one of the most objective views you're gonna get of the marketplace, okay? And what you're looking at here is historical best bid and offer, okay? Volume dots and the heat map, okay? So if I just turn off all of these things and all we're looking at here, and that can turn on candles, okay? Just quickly look at some candlesticks here, but the candlesticks really don't give you much transparency because just looking at historical best bid and offer, that's all we're looking at here with the candle, okay? We're seeing all sorts of microstructural detail here that give significant input or understanding to what's going on with price. And that is lost in the candlesticks. It's because the candlestick aggregates that information on a bar, okay? Whereas you're seeing everything here in Bookmap, all right? So that's the historical best bid and offer, okay? Let's turn off the candles. Let's turn on the volume, okay? The volume dots, what we're looking at here, and let me turn down these dots, dot size, okay? What we're looking at here is the volume that transacts on the historical best bid and offer, okay? So very much like a footprint chart, we're showing you exactly where the volume is trading, what type of volume it is, and how much, all right? Very important information to understand. Now, the one benefit that you're gonna get looking at Bookmap compared to a footprint chart is the microstructure, okay? So little details like this, you may not see, you probably won't see in the footprint chart, see how we, you see the breakout here above this high, some consolidation here in the breakout again, okay? Now, that actually kind of failed. It came back down to the bottom of this range, but then the buyer stepped in here again. But starting to understand these little areas are key, all right? So that information is lost in other charting platforms because they aggregate it, all right? Whereas like if I zoom in here, we're gonna see every single detail, okay? Historical best bid and offer and every single transaction. All right, now combine that with the dome, okay? The depth of market. What we do is we take the dome here, let me zoom in, okay? Brian, I'm almost there, I'll get to your question. We take the dome data here. This is it here, let me get rid of this column, okay? The COB is a current order book, all right? We take this dome data and you can see all of the liquidity here. So a lot of liquidity up here at 33, right? Looks like we're just about to test it as well. And, you know, this is very important information. We're understanding the auction here. It is an auction and we're understanding the players in the auction, okay? We can see them here in the dome. The problem with the dome is once these numbers change and you can see they're changing all the time, once they change, that data is lost. Where bookmap solves that issue is we record it, okay? We record it in this window here with the heat map, okay? Here's your best bid and offer current, last traded volume here with the number. And here you can see these areas here. They're painted bright white, okay? That's that high liquidity, okay? You'll see subtleties in the heat map here. The grayscale will change, right?  So we can see the subtlety a little bit better here. Now you can change the heat map however you like. But what we're looking at now is these subtle, more subtle shifts in the liquidity and it's recorded in the heat map, okay? We're testing through 33, there we go. And we were looking at that and we just got it. Anyway, so you can see the change here take place and it's recorded and transposed on the chart historically, all right? So now we can start to gauge all sorts of information here by zooming out and understanding the players at these levels, if they're longer term, larger players that wanna get filled at these levels or if they have no intent to trade and they're starting to pull that liquidity. We see the auction here, we see it historically. That's the benefit that you're getting, all right? So let's get to Brian's question. He's talking about or asking about setting up some of the columns data here, okay? There's all sorts of ways of doing this and there's tremendous flexibility in these columns. So let's go through it, okay? So first thing is I'm just gonna right click in a column here, okay? And you can see I have the ability to format the column. This is a current order book column, okay? So I can also set the depth here if I want as well. Now I'm using Rhythmic, I have unlimited depth. So I like that view, I don't want to limit it and set the depth, okay? Anyway, let's click again. So these up here are some formats for the current order book and you can see that's what I have selected here with the radio dot, all right? You can see there's different types of data here. Everything that has a radio dot here, including two different notes, columns, they have a radio dot, these are different types of data. So I can choose volume if I want, all right? And then I can, I have other settings here for volume. Okay, I can reset it. I have all sorts of abilities here to reset the volume, or I can change it to a chart range or a session range, okay? Chart range just means give me the profile or the volume information for what's in my current window. So if I zoom in, you'll note how this column now reflects the volume there, okay? And session is for the entire session since when I opened up Bookmap, okay? All right, Brian, I think right off the bat that should answer your question on where you find all the settings. If I can go into further detail here. Yeah, let's just do it and play around with it, play around with the settings so you guys get a feel for what you're looking at here because there's unlimited settings almost and there's all sorts of things you can do here. Just great, great stuff. All right, so I'm gonna change this back to current order book, all right? And I have two different current order books set up here side by side, all right? Now you can also move these around, all right? So if I left click and hold, okay? I can drag this, I can even drag it to the other side of the chart, all right?  And very quickly you can configure a pretty extensive dome here with all sorts of data and information. You can have multiple columns, right? I can click and insert or hide a column down here, right? So let's click and insert another one. You can see that it duplicates the one that I just came from and it duplicates it here on the right hand side, okay? So now let's right click here and let's format this column, okay? So I'm gonna format it and you can see I can show either the bid, okay? Or the ask and I can show an aggregate view of it. So that means that the first level is added to the second level, which is added to the third level, et cetera, okay? So this could be an important view for your current order book. If you are looking for, you know, if you're a larger player or if you're looking to see larger players coming with 100 lot, where they might get filled, right? Because 100 lots and we need to see the numbers here, okay? So where would that 100 lot trader get filled, okay? Well, right around here, right? He would only go like two levels basically, right? If he swept the book, okay? That's important to know, all right? It can be important to know. Anyway, that's an aggregate view. There's an extended view that shows the extended book or the historical book. Now, since I have unlimited depth here, this is irrelevant. You can show as bars, you can show as bars and numbers or numbers only, okay? You can split this data out as well, all right? So we can split it and then I can inverse that split, okay? All right, so, and then if you don't want that, you can justify it left, right, et cetera, et cetera, okay? That's the formatting. Let's turn it to a volume column, okay? And let's format that, all right? So now you can see it's CVP. If I hover over here, it says chart range volume profile, okay? All right, let's see. So I can change it to session range or there's all sorts of ways of resetting this information. Let me right click again on, and then left click on format and I wanna show this as bars and numbers, okay? It's almost a duplicate here of the other chart that you see or column that you see here. And, but I wanna split this data out, okay? So now you can see the difference here. This is a view a lot of traders like, all right? They wanna see who's winning the battle in the aggressor classification here, all right? So, you know, they'll split out the data like this and let's move this to the front of the line here. And you can see that, well, for example, sellers are starting to take control 287 versus 100, or I'm sorry, 288 versus 91, 170 of or versus 22 down here. So, you know, they're starting to hit the bid, okay? And these guys actually now we're starting to come back up into this little micro range. This might be trap volume, okay? Or, you know, if you have reasons to be bearish, then you're looking for, you know, maybe a test up here to the top of the range and for exhaustion on the sell side, okay? And then you're looking for continuation to the downside. And we can do that by resetting this column. Let's just reset it now, okay? And I'm looking to see who might be winning the battle now. Okay, here come the sellers, all right? Okay, and let's see if they continue to hit the bid. Let's see if they have control here. Anyway, this is really a lot of traders like this, a lot of dome traders like this, okay? Because they're looking for insight for, you know, just a few ticks or so. And it's a great view. I like it too. But, you know, what I like so much about book map is the historical view. I can just zoom out. And I don't need to look for a few ticks. I can look for several points. In book map, so, you know, I think a lot of the dome trading is looking at a lot of scalping. Whereas book map, because it shows the historical, you know, liquidity map here, you can use this on much higher time frames. Or you can also use it for much smaller time frames. It's really up to you, okay? So anyway, that's one way to configure your volume chart here, all right? We can show the VWAP as well. Where is that? If I just click on Format, then there's the VWAP here. And that's this white line that you see here, okay? All right. Okay, now let's go back and reset it here to our chart range. Okay. Okay, let's see, what else? All right, let's just go through quickly the different data types, okay? This is volume, okay? Most people are looking at volume. But we also wanna cover, there's trade counters, there's a quotes counter. All these three, volume, trades counter, and quotes counter are very similar, okay? And they have the same formatting. A trades counter, if I click on that, okay? Instead of showing the volume that traded, and you can see it says CTC here, instead of CVP, so chart range, trades counter, it's showing me the number of trade events. And why is that important, all right? Well, because in the algorithmically dominated marketplace here, a lot of these larger block orders are broken into several small trades, okay? So we wanna understand maybe the events, the flurry of activity more so than the actual volume that traded, because if there's a lot of activity, it means that it can trade there. The algorithms read that information. In fact, a lot of them have more weight on the trades counter than they do on the volume count, okay? Now, and you can look at this again, you can format it as a profile or as split out, okay? Now let's go over the next one, which is the quotes counter, okay? What I'm showing here is not volume, not events, but quotes refreshed, okay? So again, it's like, this is very similar to pit noise, okay, in the old, back in the days with the pits, the trading pits, you might all of a sudden hear all sorts of noise in the pit. Doesn't even have to, one trade does not even have to occur. Just means that they are very interested in trading at that area because they're shouting at each other, trying to facilitate a trade, okay? But they may hold steady and maybe they don't want to trade, still it shows that there's interest at that level and that's what the quotes counter is doing, okay? So it's not just for historical best bid and offer, it's for the depth, okay? That's why you get the bigger profile here. Okay, you get these really nice profiles as well because it's giving you data for this information up here or these price levels up here as well as the current or just previously historical view, right? Quotes Delta, that's showing here, a lot of traders like this view quite a bit, okay? And let me cover this one and I'm gonna move this around and format this just a little bit, okay? And what it's showing you, okay? I'm not gonna split this data out, okay? All right, so what the quotes counter here is, I'm sorry, the quotes Delta is showing you, it's not the, here's the current order book that's showing you liquidity, okay? But the quotes counter instead is showing you the numbers of contracts that were either added or pulled, okay? So that may be more important to you if you really know your market well, you're looking at instead of the liquidity, it's like what's more important is how much was pulled or added, okay? To understand which direction the market might go, right? So anyway, there's a quotes Delta there, there's some notes, custom notes, don't have time to go over those, but you can really build these out in many different ways, and then time and sales, okay? So a lot of traders wanna see their time and sales, here you go, you can filter it, look for a number of contracts, size by minimum or maximum, whatever you want, you can export this data in a CSV file, you can also pop this window out, okay? And put this into another area on your chart, okay? A lot of traders like time and sales, they wanna see where the transactions are taking place, right? If I close that window, it pops back in and let's turn that back into, well, let's hide the column, okay, and let's just go back to what we had earlier and I'll just format this and I just like looking at it split out and reversed. All right, it's quick, but that's the columns, all sorts of different ways, and I've seen so many different configurations, I've seen columns built out that are like 10 different columns, all sorts of different colors, all sorts of different studies, it's really up to you. You know, a lot of traders like the dome and rely on that information, others traders may just have one or two columns and that's it, okay? Anyway, you can really configure this out and you can match any dome that's out there, all of the data, not only can you match it, you can do much better because we're offering data types that they don't offer and that's shown here as you can see going through all of these different data types, all right? Anyway, let's wrap it up, for those of you who are in the advanced webinar, I'll see you next, for those of you who are not and you're new here, show up tomorrow and I'll give you access to the advanced, we do this on Friday to give you a peek to what that might be like before you do your trial, okay? Because we really go into depth, but you know, I'm not gonna answer questions regarding the platform in there, that is reserved for this webinar, okay? All right guys, yeah, thanks for coming and we'll catch up with you tomorrow, bye.


Okay, we're finished with trauma now. Let's talk a bit about mixed hearing loss because there are only a few diagnoses that cause true mixed hearing loss. Certainly you can have two different diagnoses, one causing sensor neural and one causing conductive hearing loss, but in true mixed hearing loss, it is a very limited differential diagnosis. The first thing we want to talk about here is otosclerosis. Otosclerosis is the most famous thing that causes a mixed hearing loss. It has a cochlear and a finestral form and I'll show you examples of both of those, but there are several mimics of otosclerosis that we need to keep in mind when we are in the setting of mixed hearing loss. One is otosophilus, which has become so rare that it is almost never seen, but the other two are Padgett's disease and fibrous dysplasia and if we are careful, we will be able to distinguish these radiologically. Here's our first example of otosclerosis. You must look very carefully for otosclerosis because it's often very, very subtle. When you hear the history mixed hearing loss, that's your cue. That is going to remind you to look very carefully in this one particular location, this triangle of bone between the vestibule and the cochlea. That triangle of bone is the region where the normal structure, the fistula antifinestrum, lives. Now we can't see the fistula antifinestrum, but we know it lives there, so we call this the region of the fistula antifinestrum and that is where the finestral form of otosclerosis is.  That is otosclerosis. Some radiologists like to use the term otospungiosis here, but I've found that the surgeons don't care for that term. Here's another example of finestral otosclerosis and again, to show how subtle this is, it's this triangle of bone right here should be just as dense. There's another example, finestral form. Now there's another, later form of otosclerosis. This is cochlear otosclerosis and in this case, it's a more severe disease. You see a halo of lucency all the way around the cochlea. You can see it in the coronal plane here. If you see it on MRI, there is abnormal enhancement all the way around the periphery of the otocapsal. This is the more severe, the more advanced cochlear form of otosclerosis. Now, there's a couple things that can look a lot like otosclerosis and can cause lucency in the inner ear, but we don't want a mistake for otosclerosis because we see them in the setting of mixed hearing loss. If you look carefully, that triangle of bone, the region of the fissula antifinestrum is too lucent in this case, but so is everything else. And that is our clue that we're dealing here with Padgett's disease and not just otosclerosis. Fibrous dysplasia is another lesion that can cause a lucency surrounding the otocapsal in something this extensive. I don't think anyone would be fooled. You've got all these areas of ground glass, classic fibrous dysplasia. Fibrous dysplasia usually spares the otocapsal and so this is a good clue, but this can also cause mixed hearing loss and we'll be on our differential diagnosis. Okay, let me speak specifically about one particular diagnosis, superior semi-circular canal dehiscence. Superior semi-circular canal dehiscence presents with a symptom called Tulio's Phenomenon. Tulio's Phenomenon is dizziness in response to a loud noise. So for example, someone will walk into a party and suddenly get dizzy or a truck driver might say, when I walk down this side of my truck, I get dizzy but this side I'm fine and it's which ear is closest to the engine. It's causing the noise, causing the dizziness. Tulio's Phenomenon used to be associated with otociphalus but as otociphalus has diminished in frequency, we've started to associate it more with superior semi-circular canal dehiscence. So what's superior semi-circular canal dehiscence? That's when there is a hole in the bony covering that's normally covers the superior semi-circular canal. So pressure can go from the semi-circular canals into the cranial vault. And there can be transmission of pulsation between the inner ear and the intracranial vault. This is called a third window phenomenon. We should only have two windows. We should have a round window and an oval window into the inner ear. And the reason you have a round window is that when you press on the oval window with the stapes, the round window allows that fluid to shift. It's a carefully orchestrated scheme that allows this fluid to shift in one window and come out the other. If you add a third window on that superior semi-circular canal, it's all messed up. And those vibrations, instead of a nice neat shifting of fluid instead, the fluid comes out here, it doesn't shift right, and the whole system is messed up. So it's that third window phenomenon that allows this to happen. Now many people have advocated for the planes of Stenver and Pauschel as a way of carefully looking for superior semi-circular canal dehiscence and I'll show you what it looks like in those planes. The reason we need separate planes of imaging is it can be very near, a very near thing whether the superior semi-circular canal is intact or not on an axial image. So we need some help from reformatted images. So we are gonna take reformatted images along the superior semi-circular canal and perpendicular to the superior semi-circular canal. The ones that are perpendicular are the plane of Stenver and the ones that are along the superior semi-circular canal is the plane of Pauschel. So here's what it looks like in the plane of Stenver. This is a normal superior semi-circular canal, a nice bony covering on top of it. This one, dehiscence semi-circular canal, you can see there's no bony covering on the top of the canal. Plane of Pauschel, same idea. Here is a nice bony covering over the superior semi-circular canal and here there is a gap over the top of the superior semi-circular canal. But now I'm gonna let you in on a secret, you don't need the planes of Stenver and Pauschel.  It performs just as well as the planes of Stenver and Pauschel. They are fun to play with, but they don't improve your diagnostic accuracy. So if you don't like looking at that many images, this will do just fine. You can see the intact bone over the semi-circular canal on this coronal and the dehiscent bone over the semi-circular canal on that side. There are no classic imaging findings for Meniere's disease, also called idiopathic endolymphatic hydrops. What's happening here in this disease is that the endolymphatic cavity in the center of the membranous labyrinth is expanding at the expense of the surrounding perilymphatic cavity. And so this disrupts the normal fluid dynamics in the membranous labyrinth. So how can you tell the difference between the endolymphatic cavity and the perilymphatic cavity? You have to distinguish between them to note that one is enlarged at the expense of the other. Well, one way you can do this is you can put a needle through the tympanic membrane and inject some dilute gadolinium and then wait for 24 hours. And it turns out that the perilymph preferentially takes up the gadolinium and you can see this on 3D flare sequences. These produce beautiful images. They are very high specificity. You can definitely identify patients with Meniere's disease. But to wait 24 hours and then re-image is very inconvenient for patients and it's an invasive test. You have to put a needle through the tympanic membrane. If you don't like that, you can do something that's not quite as nice but still very useful and that's delayed post-contrast imaging. If you give intravenous contrast and wait four hours, again, the perilymph preferentially takes up that gadolinium and you can do high-resolution flare imaging and you can get good images. They're not as nice as the tympanic injection and they have moderate specificity. This is only moderately inconvenient because you're waiting for four hours. Still not very convenient. There's one other option. The other option is your usual SSFP or KISS or Fiesta sequences. This is part of every single examination of the interviewer that you already do.  Now, if you use this, it has the lowest specificity. They aren't as pretty pictures. You're not as certain of your diagnosis but it's very convenient because you're already doing it on all of your patients and you can go back to patients that you've already looked at and look again. Let me show you an example of what we are looking for in endolymphatic hydrops here. Notice, if you look very carefully, that in this high, even though there's high T2 signal throughout the entire inner ear here, there's a small stripe of slightly darker T2 signal down the center. That is the endolymphatic cavity and the perilymphatic cavity is around it and normally it is just a very thin stripe like we see here. Very small amounts of endolymphatic fluid. If that endolymphatic cavity expands and more than about one-third of the vestibule has endolymph in it and now you can see how much larger the endolymph is here compared to here at the expense of the perilymph, that is suggestive of many users. Not diagnostic. It's not as good quality as these contrast images. It's not diagnostic but you can suggest the diagnosis and the patient may go on to more confirmatory clinical testing.


Today on another pop review. We're taking a look at the pop Disney 298 darkwing duck Goslin Mallard, so stay tuned Hey guys, welcome back to come again TV. We're all geek culture collides if you're new to the channel Don't forget to hit that subscribe button, so you don't miss out on future videos All right guys as I said today, we're taking a look at the pop Disney darkwing duck number 298 Goslin Mallard vinyl figure Now this completes the hero line of the darkwing duck line of pups as You know, we've already taken a look at darkwing duck And we've taken a look at launch Padma quack and now the final one Goslin Mallard As you can see here a nice little display image here Goslin I however Like to display him this way I like the background there really nice Goslin is of course the adopted daughter of Drake Mallard aka darkwing duck You have 296 here darkwing 297 is launch pad 298 is Goslin collect them all real quick Let's get the other two Show you how they display There's a nice little display there. It would have been nice though if Funko did like a Entire cityscape to where when you collect them all it's like a puzzle That would really be really nice. I can understand why they wouldn't do that though Because you never know how people like to display their pops some Some display them like this some display them out of the box Some display them like I do like this You just never know Others may even display them stacked on top of each other So let's go ahead and move these guys out of the way and We'll go ahead and open Goslin up Very nice looking pop as you can see as usual her head turns all the way around Nice little pig tails there or duck tails. Oh I Know dad joke Got her number one jersey there She's got no pants Purple converse tennis shoes and socks Very nice looking pop. I really like it Now I'm gonna have to get webby next for my duck tails collection Can't have just one female in the group got to have multiples Otherwise the one feels left out and here we have all three heroes From the Darkwing duck line as you can see Goslin stands quite a bit taller than Darkwing Which I don't really care for She should be smaller than Darkwing. So they should have probably made launch pad Maybe a deluxe an oversized pop And then made Darkwing maybe About launch pad size now and then kept Goslin that size or even made her smaller about the size of Darkwing As you can see her beak does stand a lot lower than Darkwing's However, her head is a lot bigger which makes her stand a lot taller Yeah, I don't really care for that Luckily, I'm not an out of the out of the box collector So it's not gonna be too bad since I'm not now the box collector Displaying them on the sides on the display sides like I like It I doubt it would really even be noticeable. So there you have it guys The pop Disney Darkwing duck number 298 Goslin Mallard as I said this completes the heroes line of the Disney Darkwing duck line of Pops I'm not sure if I'm gonna get the villains or not I've on the duck tails line. I've still got to get Huey Dewey Louis and webby So maybe I'll get those guys first and then I'll consider getting the villains I'm Shannon for come again TV the only place on YouTube where all geek culture collides Don't forget to hit that subscribe button. So you don't miss out on another episode. We do pop reviews every Tuesday Right here on come again TV. Take care everyone