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Ghising R, Dongol K, Suwal S. Internal auditory canal duplication with facial and cochlear nerve dysfunction: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231220812. [PMID: 38149116 PMCID: PMC10750504 DOI: 10.1177/2050313x231220812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
Internal auditory canal duplication is a rare anomaly of the temporal bone. The condition is diagnosed on performing High-Resolution Computed Tomography of the temporal bone and magnetic resonance imaging for sensorineural hearing loss. A bony septum divides the internal auditory canal into dual compartments. Duplication may be either unilateral or bilateral and vestibulocochlear nerve may be aplastic or hypoplastic. Rarely, patient may present with facial nerve palsy. A 26-year-old female presented with right grade IV lower motor neuron facial nerve palsy for 12 years and right-sided hearing loss for 9 years. Pure tone audiogram revealed 45 dB of moderate degree sensorineural hearing loss on the right ear. On High-Resolution Computed Tomography of the temporal bone, an incomplete bony septum was visualized in the right internal auditory canal, dividing it into two compartments. Internal auditory canal on the left side was normal. Other inner and middle ear structures were normal. On magnetic resonance imaging, both the vestibulocochlear and facial nerves were well visualized with normal calibers.
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Affiliation(s)
- Roshan Ghising
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Kripa Dongol
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sundar Suwal
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Karpeta N, Asp F, Edholm K, Bonnard Å, Wales J, Karltorp E, Duan M, Verrecchia L. Vestibular function in children with vestibulocochlear nerve aplasia/hypoplasia. Acta Otolaryngol 2023; 143:861-866. [PMID: 38063358 DOI: 10.1080/00016489.2023.2285453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Infants and young children with vestibulocochlear nerve (VCN) hypoplasia/aplasia present with severe hearing loss and are candidates for cochlear implantation (CI). It is unknown whether vestibular function is related to CI outcome and if vestibular tests can guide the operation decision. AIMS/OBJECTIVES Our aim was to describe the vestibular function in patients with VCN hypoplasia/aplasia before a possible CI. MATERIALS AND METHODS Forty-two ears in 23 patients were tested between 2019 and 2022 with bone-conducted cervical vestibular evoked myogenic potentials (BCcVEMP), video head impulse test (vHIT) and miniice-water caloric test (mIWC). RESULTS All ears could be tested with at least one vestibular test and 83% could be tested with more than one method. Twenty-nine ears (61%) showed normal function with at least one method. The presence of a normal response to any test doubled the likelihood of a measured hearing threshold after CI, the best predictors being the BCcVEMP and vHIT (p < 0.05). CONCLUSION Canal function may represent a predictor of auditive pathway integrity with a possible favourable audiological outcome after CI operation. SIGNIFICANCE Our results demonstrate high vestibular response rates suggesting a functioning pathway despite the radiological diagnosis.
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Affiliation(s)
- Niki Karpeta
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Filip Asp
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Kaijsa Edholm
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bonnard
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Jeremy Wales
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Karltorp
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Maoli Duan
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Luca Verrecchia
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
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Hiremath SB, Biswas A, Mndebele G, Schramm D, Ertl-Wagner BB, Blaser SI, Chakraborty S. Cochlear Implantation: Systematic Approach to Preoperative Radiologic Evaluation. Radiographics 2023; 43:e220102. [PMID: 36893052 DOI: 10.1148/rg.220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Sensorineural hearing loss results from abnormalities that affect the hair cells of the membranous labyrinth, inner ear malformations, and conditions affecting the auditory pathway from the cochlear nerve to the processing centers of the brain. Cochlear implantation is increasingly being performed for hearing rehabilitation owing to expanding indications and a growing number of children and adults with sensorineural hearing loss. An adequate understanding of the temporal bone anatomy and diseases that affect the inner ear is paramount for alerting the operating surgeon about variants and imaging findings that can influence the surgical technique, affect the choice of cochlear implant and electrode type, and help avoid inadvertent complications. In this article, imaging protocols for sensorineural hearing loss and the normal inner ear anatomy are reviewed, with a brief description of cochlear implant devices and surgical techniques. In addition, congenital inner ear malformations and acquired causes of sensorineural hearing loss are discussed, with a focus on imaging findings that may affect surgical planning and outcomes. The anatomic factors and variations that are associated with surgical challenges and may predispose patients to periprocedural complications also are highlighted. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Shivaprakash B Hiremath
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Asthik Biswas
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Gopolang Mndebele
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - David Schramm
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Birgit B Ertl-Wagner
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Susan I Blaser
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Santanu Chakraborty
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
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Corrêa DG, Hygino da Cruz LC, Freddi TDAL. The Vestibulocochlear Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2023; 44:81-94. [PMID: 37055143 DOI: 10.1053/j.sult.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The vestibulocochlear nerve is the eighth cranial nerve, entering the brainstem in the medullopontine sulcus after crossing the internal auditory canal and cerebellopontine angle cistern. It is a purely sensitive nerve, originating from the Scarpa's and spiral ganglions, responsible for balance and hearing. It has 6 nuclei located in the lower pons. Magnetic resonance imaging (MRI) is useful for evaluating the vestibulocochlear nerve, although computed tomography may have a complementary role in assessing bone lesions. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS), is crucial in imaging exams to depict the canalicular and cisternal segments of the vestibulocochlear nerve, as well as the fluid signal intensity in the membranous labyrinth. The vestibulocochlear nerve can be affected by several diseases, such as congenital malformations, trauma, inflammatory or infectious diseases, vascular disorders, and neoplasms. The purpose of this article is to review the vestibulocochlear nerve anatomy, discuss the best MRI techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil.; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil..
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Relationship between electrically evoked compound action potential thresholds and behavioral T-levels in implanted children with cochlear nerve deficiency. Sci Rep 2023; 13:4309. [PMID: 36922582 PMCID: PMC10017809 DOI: 10.1038/s41598-023-31411-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
It is challenging to program children with cochlear nerve deficiency (CND) due to limited auditory and speech abilities or concurrent neurological deficits. Electrically evoked compound action potential (ECAP) thresholds have been widely used by many audiologists to help cochlear implant programming for children who cannot cooperate with behavioral testing. However, the relationship between ECAP thresholds and behavioral levels of cochlear nerve in children with CND remains unclear. This study aimed to investigate how well ECAP thresholds are related to behavioral thresholds in the MAP for children with CND. This study included 29 children with CND who underwent cochlear implantation. For each participant, ECAP thresholds and behavioral T-levels were measured at three electrode locations across the electrode array post-activation. The relationship between ECAP thresholds and behavioral T-levels was analyzed using Pearson's correlation coefficient. The results showed that ECAP thresholds were significantly correlated with behavioral T-levels at the basal, middle, and apical electrodes. ECAP thresholds were equal to or higher than the behavioral T-levels for all tested electrodes, and fell within MAP's dynamic range for approximately 90% of the tested electrodes. Moreover, the contour of the ECAP thresholds was similar to the contour of T-levels across electrodes for most participants. ECAP thresholds can help audiologists select stimulation levels more efficiently for children with CND who cannot provide sufficient behavioral response.
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Dokoska M, Nikolova S, Kiteva-Trencevska G, Tilman K, Netkovski J. Bony Cochlear Nerve Canal as a Predictor for Cochlear Nerve Status in Prelingually Deaf Children. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:155-162. [PMID: 36987763 DOI: 10.2478/prilozi-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Objectives: The presence of a functional cochlear nerve is a key issue in the preoperative evaluation of pediatric candidates for cochlear implants. Correlations between cochlear nerve deficiency (CND) and bony abnormalities of the labyrinth or bony canal of the cochlear nerve are not yet well understood. The aim of this study was to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND. Materials and methods: A total of 11 children with a confirmed diagnosis of prelingual, severe sensorineural hearing loss were included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane and images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. Two factors were reviewed retrospectively: the presence of inner ear anomalies and the relationship between BCNC stenosis and the existence of CND. Results: From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). The BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR. Conclusion: Children with BCNC stenosis have a high incidence of CND. A narrowed BCNC on CT can be an indicator for the selection of children with sensorineural hearing loss who will need to be additionally referred for MRI in order to definitively assess the status of the cochlear nerve.
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Affiliation(s)
- Marija Dokoska
- 1University Clinic of Ear, Nose and Throat - Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Sonja Nikolova
- 2Institute of Radiology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Gordana Kiteva-Trencevska
- 3University Clinic of Neurology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Keck Tilman
- 4Department of ENT Medicine, Head and Neck Surgery, Hansa Private Hospital, Graz, Austria
| | - Jane Netkovski
- 1University Clinic of Ear, Nose and Throat - Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
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Kuzovkov VE, Sugarova SB, Koroleva IV, Korneva YS, Lilenko AS, Tanaschishina VA. [Prospects for cochlear implantation in patients with auditory nerve dysplasia]. Vestn Otorinolaringol 2023; 88:66-72. [PMID: 37767593 DOI: 10.17116/otorino20228804166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Auditory nerve dysplasia (AND) can encompass various conditions of the auditory nerve (AN), ranging from true aplasia to hypoplasia. The purpose of this review is to discuss the prospect of cochlear implantation (CI) and subsequent auditory speech rehabilitation for AN abnormality. Studies of different authors when working with this category of children, possible results and methods of diagnostics of the AN condition are presented.
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Affiliation(s)
- V E Kuzovkov
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
| | - S B Sugarova
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
| | - I V Koroleva
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
| | - Yu S Korneva
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
| | - A S Lilenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
| | - V A Tanaschishina
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health Russian Federation, St. Petersburg, Russia
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Long-Term Auditory and Speech Outcomes of Cochlear Implantation in Children With Cochlear Nerve Aplasia. Ear Hear 2022; 44:558-565. [PMID: 36476611 PMCID: PMC10097487 DOI: 10.1097/aud.0000000000001299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In this study, we aimed to (1) review the long-term outcomes of cochlear implantation in children with cochlear nerve aplasia and (2) compare the development of their auditory and speech abilities to children with normal-sized cochlear nerves. DESIGN This is a retrospective case-control study. Patients who underwent unilateral cochlear implant (CI) surgery in a tertiary referral center from September 2012 to December 2018 were reviewed. The study group included 55 children with cochlear nerve aplasia diagnosed using preoperative images. The control group included 35 children with normal-sized cochlear nerves. The control group did not differ from the study group in terms of age at implantation, pre-implantation auditory and speech abilities, or the electrode array type. Cochlear implantation outcomes were assessed using a test battery, including the Categories of Auditory Performance (CAP) score, the Speech Intelligibility Rating (SIR) score, behavioral audiometry, and closed- or open-set speech recognition tests. The development of auditory and speech abilities was compared between the two groups using Generalized Linear Mixed-effect Models. RESULTS The mean duration of CI usage was 4.5 years (SD = 1.5, range = 2.0 to 9.5) in the study group. The CAP scores, SIR scores, and aided hearing thresholds improved significantly post-implantation in the study group, but were significantly poorer than those in the control group. Generalized Linear Mixed-effect Models showed that the development of CAP and SIR scores was significantly slower in the study group than in the control group. Overall, 27 (49%) children with cochlear nerve aplasia had some degree of open-set speech perception skills, but the monosyllabic and bisyllabic word recognition rates were significantly lower than those in the control group. CONCLUSION For children with cochlear nerve aplasia, auditory perception and speech intelligibility continued to improve in the long-term follow-up, but this progress was significantly slower than in children with normal-sized cochlear nerves. Most children with cochlear nerve aplasia could obtain the ability of common phrase perception and understanding simple spoken language with consistent CI usage and auditory rehabilitation.
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Choe G, Kim YS, Oh SH, Lee SY, Lee JH. Functional Outcomes of Cochlear Implantation in Children with Bilateral Cochlear Nerve Aplasia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101474. [PMID: 36295634 PMCID: PMC9607978 DOI: 10.3390/medicina58101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023]
Abstract
Background and Objectives: Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. The goal of this study is to provide fresh evidence on cochlear implantation (CI) results in patients with CN aplasia. Materials and Methods: We scrutinized functional outcomes in 37 ears of 21 children with bilateral CN aplasia who underwent unilateral or bilateral CI based on cross-sectional and longitudinal assessments. Results: The Categories of Auditory Performance (CAP) scores gradually improved throughout the 3-year follow-up; however, variable outcomes existed between individuals. Specifically, 90% of recipients with a 1-year postoperative CAP score ≤1 could not achieve a CAP score over 1 even at 3-year postoperative evaluation, while the recipients with a 1-year postoperative CAP score >1 had improved auditory performance, and 72.7% of them were able to achieve a CAP score of 4 or higher. Meanwhile, intraoperative electrically evoked compound action potential was not correlated with postoperative CAP score. Conclusions: Our results further refine previous studies on the clinical feasibility of CI as the first treatment modality to elicit favorable auditory performance in children with CN aplasia. However, special attention should be paid to pediatric patients with an early postoperative CAP score ≤1 for identification of unsuccessful cochlear implants and switching to auditory brainstem implants.
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Affiliation(s)
- Goun Choe
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong 30099, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Young Seok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seung-Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul 03087, Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul 03087, Korea
- Correspondence: (S.-Y.L.); (J.H.L.)
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul 03087, Korea
- Correspondence: (S.-Y.L.); (J.H.L.)
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Bächinger D, Breitsprecher TM, Pscheidl A, Dhanasingh A, Mlynski R, Dazert S, Langner S, Weiss NM. Internal auditory canal volume in normal and malformed inner ears. Eur Arch Otorhinolaryngol 2022; 280:2149-2154. [PMID: 36210370 PMCID: PMC10066105 DOI: 10.1007/s00405-022-07676-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose
A narrow bony internal auditory canal (IAC) may be associated with a hypoplastic cochlear nerve and poorer hearing performances after cochlear implantation. However, definitions for a narrow IAC vary widely and commonly, qualitative grading or two-dimensional measures are used to characterize a narrow IAC. We aimed to refine the definition of a narrow IAC by determining IAC volume in both control patients and patients with inner ear malformations (IEMs).
Methods
In this multicentric study, we included high-resolution CT (HRCT) scans of 128 temporal bones (85 with IEMs: cochlear aplasia, n = 11; common cavity, n = 2; cochlear hypoplasia type, n = 19; incomplete partition type I/III, n = 8/8; Mondini malformation, n = 16; enlarged vestibular aqueduct syndrome, n = 19; 45 controls). The IAC diameter was measured in the axial plane and the IAC volume was measured by semi-automatic segmentation and three-dimensional reconstruction.
Results
In controls, the mean IAC diameter was 5.5 mm (SD 1.1 mm) and the mean IAC volume was 175.3 mm3 (SD 52.6 mm3). Statistically significant differences in IAC volumes were found in cochlear aplasia (68.3 mm3, p < 0.0001), IPI (107.4 mm3, p = 0.04), and IPIII (277.5 mm3, p = 0.0004 mm3). Inter-rater reliability was higher in IAC volume than in IAC diameter (intraclass correlation coefficient 0.92 vs. 0.77).
Conclusions
Volumetric measurement of IAC in cases of IEMs reduces measurement variability and may add to classifying IEMs. Since a hypoplastic IAC can be associated with a hypoplastic cochlear nerve and sensorineural hearing loss, radiologic assessment of the IAC is crucial in patients with severe sensorineural hearing loss undergoing cochlear implantation.
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Degirmenci Uzun E, Batuk MO, D'Alessandro HD, Sennaroglu G. Auditory perception in pediatric cochlear implant users with cochlear nerve hypoplasia. Int J Pediatr Otorhinolaryngol 2022; 160:111248. [PMID: 35870254 DOI: 10.1016/j.ijporl.2022.111248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to assess auditory perception and speech intelligibility outcomes in children with cochlear nerve (CN) hypoplasia who received cochlear implants (CIs) using Categories of Auditory Performance II (CAP II) and Speech Intelligibility Rating (SIR) scales. METHODS In total, 40 children who received CI and who were aged between 3 and 18 years were included in this study. The study group included 20 children with CN hypoplasia at least one ear, while the control group included 20 children with normal cochleas and cochlear nerve structures. All children in the study and control groups who participated were evaluated using the CAP II and the SIR scale. Demographic data were collected. RESULTS Significant differences were found between the study and control groups' CAP II and SIR scores (p < 0.001). It was found that CAP II scores were positively correlated with SIR scores in the study (r = 0.743, p < 0.001) and control (r = 0.601, p < 0.001) groups. In the study group, significant negative correlations were found between SIR scores and age at implantation (r = -0.674, p = 0.004) and between CAP II scores and age at implantation (r = 0.751, p = 0.003). In the control group, a significant negative correlation was found between age at implantation and CAP II scores (r = -0.805, p = 0.001). Similarly, a significant negative correlation was found between age at implantation and SIR scores (r = -0.702, p = 0.007). CONCLUSION Even for children with severe inner ear malformation and CN hypoplasia, CI is an effective treatment modality for auditory perception and speech production. However, it should be noted that CN hypoplasia affects auditory performance negatively in children with CI.
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Affiliation(s)
- Erva Degirmenci Uzun
- Department of Audiology, Faculty of Health Science, Izmir Bakircay University, Izmir, Turkey.
| | - Merve Ozbal Batuk
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | | | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
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吴 海, 李 同. [Cochlear nerve canal stenosis: a review of recent research]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:643-647. [PMID: 35959587 PMCID: PMC10128201 DOI: 10.13201/j.issn.2096-7993.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 06/15/2023]
Abstract
Some patients with severe-profound sensorineural hearing loss (SNHL) with normal cochlear anatomical structure received cochlear implantation (CI) and the hearing and speech rehabilitation effect was not ideal. Through retrospective analysis, it was found that some of these patients had cochlear never canal (CNC) stenosis, or atresia in severe cases.This article reviews the development of the CNC, the diagnostic criteria of CNC stenosis and the results of hearing and speech rehabilitation in these patients after CI.
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Affiliation(s)
- 海娟 吴
- 山西医科大学第五临床医学院(太原,030001)The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China
| | - 同丽 李
- 山西医科大学第五医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Fifth Hospital of Shanxi Medical University
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Chao X, Wang R, Luo J, Wang H, Fan Z, Xu L. Value of Preoperative Imaging Results in Predicting Cochlear Nerve Function in Children Diagnosed With Cochlear Nerve Aplasia Based on Imaging Results. Front Neurosci 2022; 16:905244. [PMID: 35774558 PMCID: PMC9237450 DOI: 10.3389/fnins.2022.905244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/29/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to assess the function of the cochlear nerve using electrically evoked compound action potentials (ECAPs) for children with cochlear implants who were diagnosed with cochlear nerve aplasia and to analyze the correlation between preimplantation imaging results and ECAP responses. Thirty-five children diagnosed with cochlear nerve aplasia based on magnetic resonance imaging (MRI) were included. Preimplantation MRI and high-resolution computed tomography (HRCT) images were reconstructed, and the width of the bone cochlear nerve canal (BCNC), the diameter of the vestibulocochlear nerve (VCN), and the diameter of the facial nerve (FN) were measured. ECAP input/output (I/O) functions were measured at three electrode locations along the electrode array for each participant. The relationship between ECAP responses (including ECAP threshold, ECAP maximum amplitude, and slope of ECAP I/O function) and sizes of the BCNC and VCN was analyzed using Pearson's correlation coefficients. Our analysis revealed that ECAP responses varied greatly among individual participants. Overall, ECAP thresholds gradually increased, while maximum amplitudes and ECAP I/O function slopes gradually decreased, as the electrode location moved from the basal to the apical direction in the cochlea. ECAP responses exhibited no significant correlations with BCNC width or VCN diameter. The ratio of the VCN to FN diameters was significantly correlated with the slope of the ECAP I/O function and the maximum amplitude. BCNC width could not predict the function of the cochlear nerve. Compared with the absolute size of the VCN, the size of the VCN relative to the FN may represent an indicator for predicting the functional status of the cochlear nerve in children diagnosed with cochlear nerve aplasia based on imaging results.
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Kari E, Gillard DM, Chuang N, Go JL. Can Imaging Predict Hearing Outcomes in Children With Cochleovestibular Nerve Abnormalities? Laryngoscope 2022; 132 Suppl 8:S1-S15. [PMID: 35015297 DOI: 10.1002/lary.30008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify the imaging characteristics associated with better hearing outcomes found in cochleovestibular nerve (CVN) abnormalities treated with hearing aids and/or cochlear implantation (CI). STUDY DESIGN Retrospective review. METHODS A retrospective review was undertaken of 69 ears with CVN abnormalities seen on magnetic resonance imaging (MRI) treated at a tertiary referral academic center analyzing the clinical features, imaging characteristics, and hearing data. We searched for associations among the hearing and imaging data, hypothesizing that the imaging data was not a good indicator of hearing function. RESULTS In univariable analysis of all those who underwent aided testing (hearing aid and CI), health status (P = .016), internal auditory canal (IAC) midpoint diameter (P < .001), and number of nerves in the IAC (P < .001) were predictors of positive hearing outcome. Modiolar abnormalities, cochlear aperture diameter, cochlear malformations, vestibular malformations, and nerves in the cerebellar cistern did not predict hearing outcome (P = .79, .18, .59, .09, .17, respectively). For patients who received CI, health status (P = .018), IAC midpoint (P = .024), and number of nerves in the IAC (P = .038) were significant. When controlling for health status, IAC midpoint diameter (P < .001) and number of nerves in the IAC (P < .001) remained significant. In our cohort, one out of the eight ears (13%) with Birman class 0 or 1 exhibited responses to sound compared to nine out of 13 ears (70%) with Birman class 2-4. CONCLUSIONS Current imaging modalities cannot accurately depict the status of the cochleovestibular nerve or predict a child's benefit with a CI. Cochlear implantation should be considered in children with abnormal cochleovestibular nerves. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Elina Kari
- Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Danielle M Gillard
- Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Nathaniel Chuang
- Radiology, Rady Children's Hospital, San Diego, California, U.S.A
| | - John L Go
- Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
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Matsuura K, Yoshimura H, Shinagawa J, Kurozumi M, Takumi Y. Audiological Features in 63 Patients With Cochlear Nerve Deficiency. Otol Neurotol 2022; 43:23-28. [PMID: 34538855 DOI: 10.1097/mao.0000000000003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to investigate the clinical features of cochlear nerve deficiency (CND), and in particular, the long-term course of hearing disability and audiogram shapes. STUDY DESIGN Retrospective observational nonrandomized group study. SETTING Academic medical center. PATIENTS/INTERVENTIONS The subjects were 63 children with congenital hearing loss who visited our hospital between 2009 and 2019 and underwent MRI, based on which they were diagnosed with CND. There were 61 cases of unilateral CND and two cases of bilateral CND. MAIN OUTCOME MEASURES Imaging tests by MRI and CT and audiometric assessments by pure-tone audiometry and distortion product otoacoustic emission were performed. RESULTS Among the cases of CND diagnosed by assessing the cochlear nerve on MRI, approximately 20% of the bony cochlear nerve canals that could be assessed on CT were normal. Of the 61 cases diagnosed with unilateral CND, 55 cases had cochlear nerve aplasia (90.2%), and six had cochlear nerve hypoplasia (9.8%), with a mean hearing ability of 92.2 and 94.6 dB HL, respectively. Thus, the majority of cases had severe-to-profound hearing loss. The overall audiometric patterns were 78.7% flat, 9.8% cookie-bite, and 9.8% high-frequency. Six of 61 cases (9.8%) had a distortion product otoacoustic emission (DPOAE) response based on the affected side, and none of the cases lost the response during follow-up. CONCLUSIONS Herein, we report the largest study on CND and performed CND image and audiometric assessments. Accurately in diagnosing CND requires not only CT but also MRI assessment. Hearing loss is often severe to profound; however, various audiometric patterns have been observed. CND includes a small number of cases that respond to DPOAE, indicating that some CND cases are clinically diagnosed with auditory neuropathy spectrum disorder (ANSD). A sustained DPOAE response might help in differentiating CND from other ANSDs. Children with congenital deafness who have passed the newborn hearing screening by DPOAE should be examined by MRI to rule out CND.
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Affiliation(s)
| | | | | | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Vaishnavi R, Selvarajan G, Prateep M, Jeevanandham B. Unilateral double-barreled internal auditory meatus with severe sensorineural hearing loss: A diagnostic challenge. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_154_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Casselman JW, Vanden Bossche S, De Foer B, Bernaerts A, Dekeyzer S. Temporal Bone. Clin Neuroradiol 2022. [DOI: 10.1007/978-3-319-61423-6_90-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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18
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Karamert R, Tutar H, Altinyay Ş, Düzlü M, Yildiz M, Akdulum İ, Uğur MB, Çolak M, Cebeci S, Şahin MM, Orçan E, Bayazit YA. Cochlear Implantation in Inner Ear Malformations: Considerations Related to Surgical Complications and Communication Skills. ORL J Otorhinolaryngol Relat Spec 2021; 84:211-218. [PMID: 34500448 DOI: 10.1159/000517562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 05/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. METHODS In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. RESULTS In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). CONCLUSION It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.
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Affiliation(s)
- Recep Karamert
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Şenay Altinyay
- Department of Audiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Düzlü
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Merve Yildiz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İsmail Akdulum
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Birol Uğur
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mustafa Çolak
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Süleyman Cebeci
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Muammer Melih Şahin
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Elçin Orçan
- Department of Audiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Tsukada K, Usami SI. Vestibular nerve deficiency and vestibular function in children with unilateral hearing loss caused by cochlear nerve deficiency. Acta Otolaryngol 2021; 141:835-840. [PMID: 34406114 DOI: 10.1080/00016489.2021.1959637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND High-resolution MR imaging enables the visualization of individual nerves in the internal auditory canal (IAC). Cochlear nerve deficiency (CND) is recognized as one of the major causes of sensory neural hearing loss (SNHL), especially in cases of unilateral hearing loss in childhood. Some patients with CND are thought to have accompanying vestibular nerve deficiency (VND). However, there have been few reports focusing on VND and vestibular function in these children. AIMS The aim of this study was to evaluate the frequency of VND and vestibular dysfunction in children with unilateral SNHL caused by CND. MATERIAL AND METHODS Thirty-eight children with unilateral SNHL, who were diagnosed with CND by 3 T-MRI, were evaluated for VND and underwent caloric testing and cervical vestibular evoked potential (cVEMP). RESULTS Fourteen of 38 patients (37%) had VND, and eleven (29%) of the patients [ten of the patients (71%) with VND] had at least one vestibular dysfunction. The patients with VND had significantly worse hearing and an IAC of smaller diameter than did patients without VND. CONCLUSIONS AND SIGNIFICANCE We should pay attention to VND as well as vestibular dysfunction in hearing loss patients with CND.
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Affiliation(s)
- Keita Tsukada
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto City, Japan
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Abstract
OBJECTIVE A small subset of children with congenital hearing loss have abnormal cochleovestibular nerves (i.e., absent, aplastic, or deficient cochlear nerves), with largely unknown etiology. Our objective was to investigate the underlying pathways and identify novel genetic variants responsible for cochleovestibular malformations and nerve abnormalities. It is our hypothesis that several cochleovestibular nerve abnormalities might share common causative pathways. DESIGN We used a family-based exome sequencing approach to study 12 children with known rare inner ear and/or cochleovestibular nerve malformations. RESULTS Our results highlight a diverse molecular etiology and suggest that genes important in the developing otic vesicle and cranial neural crest, e.g., MASP1, GREB1L, SIX1, TAF1, are likely to underlie inner ear and/or cochleovestibular nerve malformations. CONCLUSIONS We show that several cochleovestibular nerve malformations are neurocristopathies, which is consistent with the fact that cochleovestibular nerve development is based on otic placode-derived neurons in close association with neural crest-derived glia cells. In addition, we suggest potential genetic markers for more severely affected phenotypes, which may help prognosticate individual cochlear implantation outcomes. Developing better strategies for identifying which children with abnormal nerves will benefit from a cochlear implantation is crucial, as outcomes are usually far less robust and extremely variable in this population, and current neuroimaging and electrophysiologic parameters cannot accurately predict outcomes. Identification of a suitable treatment early will reduce the use of multiple interventions during the time-sensitive period for language development.
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Uchôa LRA, Luna LP, Farias LABG, Lima DLN, de Araujo Coimbra PP. Internal auditory canal hypoplasia associated with bilateral vestibulocochlear nerve aplasia and deviant facial nerve course: A case report and MRI findings. J Radiol Case Rep 2021; 15:17-23. [PMID: 34276875 DOI: 10.3941/jrcr.v15i5.3912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The evaluation of internal auditory canals and cochlea has gained significant importance due to the increasing number of cochlear implantations worldwide. This region's anatomical study is essential for cochlear implant surgery using magnetic resonance imaging as the method of choice. We report a case of a 6-year-old male patient diagnosed with a rare bilateral malformation of the internal auditory canals associated with an aberrant course of the facial nerve and vestibulocochlear nerve aplasia. This report raises the importance of identifying this rare malformation for appropriate management and reinforces awareness of possible complications.
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Affiliation(s)
| | - Licia Pacheco Luna
- Radiology Department, Fortaleza General Hospital (HGF), Fortaleza, Ceará, Brazil
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, USA
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梅 玲, 陈 向, 杨 军. [The analysis of the characteristics of hearing loss in patients with cochlear nerve aphasia identified by MRI]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:14-16. [PMID: 33540964 PMCID: PMC10128535 DOI: 10.13201/j.issn.2096-7993.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Objective:To explore the characteristics of hearing loss in patients with cochlear nerve aphasia(CNA) and to provide evidences for diagnosis and treatment of cochlear nerve aphasia. Methods:A retrospective study was performed. A total of 51 cases were included in the study. The data of hearing test, inner auditory canal MRI and temporal HRCT were analyzed. Results:77.19% of the affected ears had extremely severe hearing loss, and 7.02% of the affected ears had moderate hearing loss. The residual hearing was concentrated in low-medium frequency. A CNA ear with bone cochlear nerve canal atresia can exhibited moderate hearing loss. Conclusion:The patient with CNA may still present residual hearing function. CNA could not be excluded in patients with moderate hearing loss. The "three-dimensional integration" comprehensive evaluation system, which includesinternal auditory canal MRI, temporal thin-layer CT scan and audiology evaluation, could be helpful to the diagnosis of cochlear nerveaphasia.
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Affiliation(s)
- 玲 梅
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
| | - 向平 陈
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
| | - 军 杨
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
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Audiologic Outcome of Cochlear Implantation in Children With Cochlear Nerve Deficiency. Otol Neurotol 2020; 42:38-46. [DOI: 10.1097/mao.0000000000002849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Islamoglu Y, Kesici GG, Ercan K, Babademez MA. Single-sided deafness after sudden hearıng loss: late effect on cochlear nerve size. Eur Arch Otorhinolaryngol 2020; 277:2423-2426. [PMID: 32314048 DOI: 10.1007/s00405-020-05977-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Single-sided deafness (SSD) is a condition where an individual has non-functional hearing in one ear and receives no clinical benefit from amplification in that ear, with the contralateral ear possessing normal audiometric function. Cochlear implant presents a good choice in rehabilitation of SSD. The presence of a deficient cochlear nerve (CN) has been linked to poor performance with cochlear implants. CN can be measured by imaging techniques. The objective of this study was to compare CN diameter in patients who had a history of single-sided deafness because of sudden hearing loss. METHODS Retrospective study where radiologist was blind designed. 53 SSD patients who had a history of sudden hearing loss and MRI at least 5 years after the sudden hearing loss were included in this retrospective study. High-resolution 3-D constructive interference in steady state (CISS)-sequence magnetic resonance (MRI) images was review by the neurotology-experienced blind radiologist. Vertical, horizontal and area measurements of cochlear nerve between the deaf and the normal ear were made. RESULTS There was no statistically significant difference between the normal ear and deaf ear of the subjects in terms of cochlear nerve vertical diameter, horizontal diameter and area. (respectively, p = 0.250; p = 0.183; p = 0.874) CONCLUSION: The numbers of remaining cochlear neurons and spiral ganglion cells in the implanted deaf ears are critical and evidence was not found for spiral ganglion cell loss in the sudden hearing loss deaf ear with SSD in MRI. In the light of all these findings, implantation would be a good choice for rehabilitation in postlingual SSD regardless of auditory deprivation duration.
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Affiliation(s)
- Yuce Islamoglu
- Department of Otolaryngology-Head and Neck Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Gulin Gokcen Kesici
- Department of Otolaryngology-Head and Neck Surgery, Ankara City Hospital, Ankara, Turkey
| | - Karabekir Ercan
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Babademez
- Department of Otolaryngology-Head and Neck Surgery, Yıldırım Beyazıt Medical School, Ankara, Turkey
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Kari E, Llaci L, Go JL, Naymik M, Knowles JA, Leal SM, Rangasamy S, Huentelman MJ, Friedman RA, Schrauwen I. A de novo SIX1 variant in a patient with a rare nonsyndromic cochleovestibular nerve abnormality, cochlear hypoplasia, and bilateral sensorineural hearing loss. Mol Genet Genomic Med 2019; 7:e995. [PMID: 31595699 PMCID: PMC6900394 DOI: 10.1002/mgg3.995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023] Open
Abstract
Background Childhood hearing impairment affects language and cognitive development. Profound congenital sensorineural hearing impairment can be due to an abnormal cochleovestibular nerve (CVN) and cochleovestibular malformations, however, the etiology of these conditions remains unclear. Methods We used a trio‐based exome sequencing approach to unravel the underlying molecular etiology of a child with a rare nonsyndromic CVN abnormality and cochlear hypoplasia. Clinical and imaging data were also reviewed. Results We identified a de novo missense variant [p(Asn174Tyr)] in the DNA‐binding Homeodomain of SIX1, a gene which previously has been associated with autosomal dominant hearing loss (ADHL) and branchio‐oto‐renal or Branchio‐otic syndrome, a condition not seen in this patient. Conclusions SIX1 has an important function in otic vesicle patterning during embryogenesis, and mice show several abnormalities to their inner ear including loss of inner ear innervation. Previous reports on patients with SIX1 variants lack imaging data and nonsyndromic AD cases were reported to have no inner ear malformations. In conclusion, we show that a de novo variant in SIX1 in a patient with sensorineural hearing loss leads to cochleovestibular malformations and abnormalities of the CVN, without any other abnormalities. Without proper interventions, severe to profound hearing loss is devastating to both education and social integration. Choosing the correct intervention can be challenging and a molecular diagnosis may adjust intervention and improve outcomes, especially for rare cases.
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Affiliation(s)
- Elina Kari
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Lorida Llaci
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - John L Go
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marcus Naymik
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - James A Knowles
- Department of Cell Biology - MSC 5, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Suzanne M Leal
- Center for Statistical Genetics, Molecular and Human Genetics Department, Baylor College of Medicine, Houston, TX, USA
| | - Sampath Rangasamy
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Matthew J Huentelman
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Rick A Friedman
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Isabelle Schrauwen
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA.,Center for Statistical Genetics, Molecular and Human Genetics Department, Baylor College of Medicine, Houston, TX, USA
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Hearing Restoration in Cochlear Nerve Deficiency: the Choice Between Cochlear Implant or Auditory Brainstem Implant, a Meta-analysis. Otol Neurotol 2019; 39:428-437. [PMID: 29494474 DOI: 10.1097/mao.0000000000001727] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To answer the dilemma clinician's face when deciding between cochlear implant (CI) and auditory brainstem implant (ABI) treatment options in patients with cochlear nerve deficiency (CND). STUDY DESIGN Case study supplemented with literature review and meta-analysis. SETTING Tertiary referral center. PATIENT(S) Child with CHARGE syndrome and congenital deafness. INTERVENTION(S) ABI as there was no benefit after bilateral cochlear implantation. MAIN OUTCOME MEASURES Speech and language development, quality of life. RESULTS In one ear the cochleovestibular nerve was present on magnetic resonance imaging (MRI) without preoperative ABR responses. In the contra lateral ear the nerve could not be identified, despite present ABR responses. Nevertheless, there was no positive outcome with CI. The patient had improved speech and language and quality of life with ABI. Of the 108 patients with CND and CI identified in the literature review, 25% attained open-set speech perception, 34% attained closed-set speech perception, and 41% detected sounds or less. The appearance of the cochlear nerve on MRI was a useful predictor of success, with cochlear nerve aplasia on MRI associated with a smaller chance of a positive outcome post cochlear implantation compared with patients with cochlear nerve hypoplasia. CONCLUSION Although patients with (apparent) cochlear nerve aplasia are less likely to benefit from CI, CI before ABI is supported as some patients attain closed or open-set levels of speech perception after cochlear implantation.
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Chin O, Dharsono F, Kuthubutheen J, Thompson A. Is CT necessary for imaging paediatric congenital sensorineural hearing loss? Cochlear Implants Int 2019; 21:75-82. [PMID: 31547783 DOI: 10.1080/14670100.2019.1669291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: To determine if MRI alone is adequate for pre-operative assessment of paediatric congenital sensorineural hearing loss (SNHL). While aberrant intratemporal facial nerve anatomy is usually occult on MRI, we postulate that the majority of cases have no adverse bearing on surgical outcomes.Methods: MRI and CT of the temporal bones were analysed in 240 children who underwent both on the same day for SNHL. Only children under the age of 5 years with no reported clinical syndrome or dysmorphic external ear anatomy were included.Results and discussion: 169 patients satisfied the inclusion criteria. MRI detected 32/54 cases of cochleovestibular dysplasia, with the majority of the additional CT findings comprising subtle incomplete partition type 2 (IP2) anomalies. Of the 22 cases not evident on MRI, 13 patients also had large vestibular aqueduct syndromoe (LVAS), which would have prompted evaluation with CT due to the near universal co-existence of these entities. Only one patient exhibited aberrant intratemporal facial nerve anatomy that may have conferred surgical risk and was occult on MRI.Conclusion: In a defined paediatric SNHL cohort, the addition of routine temporal bone CT to MRI offers limited additional yield but confers a significant radiation burden on a young population.
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Affiliation(s)
- O Chin
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - F Dharsono
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - J Kuthubutheen
- Department of Otolaryngology Head and Neck Surgery, Perth Children's Hospital, Perth, Australia
| | - A Thompson
- Department of Radiology, Royal Perth Hospital, Perth, Australia.,Department of Radiology, Perth Children's Hospital, Perth, Australia
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Cinar BC, Tahir E, Batuk MO, Yarali M, Sennaroglu G, Sennaroglu L. Cochlear Nerve Hypoplasia: Audiological Characteristics in Children and Adults. Audiol Neurootol 2019; 24:147-153. [PMID: 31307043 DOI: 10.1159/000500938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/13/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cochlear nerve deficiency is a general term used to describe both cochlear nerve hypoplasia (CNH) and cochlear nerve aplasia. Although these two conditions can have similar results on audiological evaluation, CNH yields more variation in audiological tests. OBJECTIVES To describe the audiological characteristics of the CNH cases in our series in relation to radiological findings. METHODS We reviewed the medical charts, audiological findings, and radiological findings on cases with CNH. We included cases with CNH in one ear or both ears. Out of 90 subjects with CNH, we included a total of 40 individuals (21 women and 19 men; 49 ears) in the current study. We reviewed and analyzed the participants' audiological test results according to the radiological findings. RESULTS Cases with CNH showed variations according to the cochlear structure. There were 13 normal cochleae, 4 with incomplete partition type I, and 32 with cochlear hypoplasia. The accompanying cochlear apertures also showed variation: 17 were normal, 28 stenotic, and 4 aplastic cochlear apertures. The subjects displayed hearing loss ranging from moderate to profound; furthermore, 4 subjects had no response to sound whatsoever. The degree of hearing loss was not statistically significantly different with regard to the presence or absence of cochlear malformation with CNH (p > 0.005). We observed both sensorineural hearing loss and mixed-type hearing loss among the CNH cases. CONCLUSIONS CNH is the presence of a cochlear nerve that is smaller in diameter than the facial nerve. It can be accompanied with other associated inner ear malformations of different degrees of severity. We observed degrees of hearing loss ranging from moderate to profound.
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Affiliation(s)
| | - Emel Tahir
- Department of Ear, Nose and Throat, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Yarali
- Department of Audiology, Hacettepe University, Ankara, Turkey
| | | | - Levent Sennaroglu
- Department of Ear, Nose and Throat, Hacettepe University, Ankara, Turkey
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Wang L, Zhang L, Li X, Guo X. Duplicated Internal Auditory Canal: High-Resolution CT and MRI Findings. Korean J Radiol 2019; 20:823-829. [PMID: 30993933 PMCID: PMC6470090 DOI: 10.3348/kjr.2018.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 12/02/2018] [Indexed: 12/03/2022] Open
Abstract
Objective To summarize the high-resolution computed tomography (HRCT) and magnetic resonance imaging (HRMRI) features of duplicated internal auditory canals (DIACs). Materials and Methods Ear HRCT data of 64813 patients with sensorineural hearing loss (SNHL), obtained between August 2009 and November 2017, were reviewed. Among these patients, 12 (13 ears) were found to have DIACs, 9 of whom underwent HRMRI. Their images were evaluated by two otoradiologists. Results The rate of occurrence of DIAC among SNHL patients was 0.019% (12/64813). The internal auditory canals of 13 ears were divided into double canals by complete (n = 6) and incomplete (n = 7) bony septa, with varied orientations ranging from horizontal to approximately vertical. All of the anterosuperior canals extended into the facial nerve (FN) canal, except for 1, which also extended to the vestibule. The posteroinferior canals ended in the cochlea and vestibule, except for 2, which also connected to the FN canals. Magnetic resonance images revealed that 77.8% (7/9) and 22.2% (2/9) of vestibulocochlear nerves (VCNs) were aplastic and hypoplastic, respectively. Furthermore, 88.9% (8/9) of FNs were normal, except for 1, which was hypoplastic. All of the affected ears also had other ear anomalies: a narrow, bony cochlear nerve canal was the most common other anomaly, accounting for 92.3% (12/13). Malformations of other systems were not found. Conclusion Double-canal appearance is a characteristic finding of DIAC on HRCT, and it is usually accompanied by other ear anomalies. The VCN usually appears aplastic, with a normal FN, on HRMRI.
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Affiliation(s)
- Linsheng Wang
- Imaging Center, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Lihong Zhang
- Department of Radiology, the First People's Hospital of Jining City, Jining, China.
| | - Xian Li
- Imaging Center, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiang Guo
- Imaging Center, the Affiliated Hospital of Jining Medical University, Jining, China
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A Predictive Model for Cochlear Implant Outcome in Children with Cochlear Nerve Deficiency. Sci Rep 2019; 9:1154. [PMID: 30718613 PMCID: PMC6362156 DOI: 10.1038/s41598-018-37014-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/07/2018] [Indexed: 11/21/2022] Open
Abstract
The outcome of cochlear implantation (CI) in patients with cochlear nerve deficiency (CND) is variable, resulting in a wide range of speech perception performance, from degrees of environmental sound perception to conversation without lip-reading. Twenty-five cochlear implantees with CND were enrolled retrospectively to determine the factors correlated with CI outcome in patients with CND and to develop a predictive model for CI outcome. CI outcome was evaluated using the Categories of Auditory Performance (CAP) score at 2 years after CI. Patients with negative auditory brainstem response (ABR) showed a significantly lower CAP score than those with positive ABR (2.5 ± 1.7, 4.8 ± 0.7; p = 0.001). The area ratio of vestibulocochlear nerve (VCN) to facial nerve (FN) at the cerebellopontine angle on magnetic resonance images was positively correlated with CI outcome (p < 0.001). With multiple regression analysis, a predictive equation accounting for 66% of variance of CAP score at 2 years after CI was \documentclass[12pt]{minimal}
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\begin{document}$${\bf{deduced}}:{\bf{CAP}}\,{\bf{score}}{\boldsymbol{=}}{\bf{0.7}}{\boldsymbol{+}}{\bf{1.9}}{\boldsymbol{\ast }}{\boldsymbol{(}}{\bf{ABR}}{\boldsymbol{)}}{\boldsymbol{+}}{\bf{1.2}}{\boldsymbol{\ast }}(\frac{{\boldsymbol{V}}{\boldsymbol{C}}{\boldsymbol{N}}}{{\boldsymbol{F}}{\boldsymbol{N}}})$$\end{document}deduced:CAPscore=0.7+1.9∗(ABR)+1.2∗(VCNFN). We found that preoperative ABR and area ratio of VCN to FN at the cerebellopontine angle could predict CI outcome in patients with CND. Preoperative counselling based on our predictive model might be helpful to determine treatment modality for auditory rehabilitation and which ear to implant.
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Does the Width of the Bony Cochlear Nerve Canal Predict the Outcomes of Cochlear Implantation? BIOMED RESEARCH INTERNATIONAL 2018; 2018:5675848. [PMID: 29750161 PMCID: PMC5884285 DOI: 10.1155/2018/5675848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
A narrow bony cochlear nerve canal (BCNC) is associated with sensorineural hearing loss necessitating cochlear implantation (CI). This study evaluated the implications of BCNC width for post-CI outcomes. A total of 56 children who had received CIs were included. The patients were divided into three groups according to the width of the BCNC (Group 1: diameter < 1.4 mm, n = 17; Group 2: diameter 1.4-2.0 mm, n = 14; Group 3: diameter > 2.0 mm, n = 25). The post-CI speech performances were compared among the three groups according to BCNC width. The correlation between BCNC width and post-CI speech performance was evaluated. Logistic regression analysis was also performed to investigate factors that can impact post-CI speech performance. Cochlear nerve deficiency (CND) occurred more frequently in Group 1. Groups 1 and 2 had significantly worse post-CI outcomes. Patients with intact cochlear nerves had significantly better post-CI outcomes than those with CND. When the cochlear nerve was intact, patients with a narrower BCNC showed less favorable results. Therefore, patients with either a narrow BCNC or CND seemed to have poorer outcomes. A narrow BCNC is associated with higher CND rates and poor outcomes. Measurement of BCNC diameter may help predict CI outcomes.
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Moussa KM, Elmesidy DSE, Dabbous AO. Egyptian children with congenital sensorineural hearing loss candidates for cochlear implant: Is MRI evaluation necessary? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
OBJECTIVE To assess cochlear implant (CI) outcomes, and factors affecting outcomes, for children with aplasia/ hypoplasia of the cochlea nerve. We also developed a new grading system for the nerves of the internal auditory meatus (IAM) and cochlea nerve classification. STUDY DESIGN Retrospective patient review. SETTING Tertiary referral hospital and cochlear implant program. PATIENTS Children 0 to 16 years inclusive with a CI who had absent/hypoplastic cochlea nerve on magnetic resonance imaging (MRI). INTERVENTION Cochlear implant. MAIN OUTCOME MEASURES MRI, trans-tympanic electrical auditory brainstem response, intraoperative electrical auditory brainstem response, Neural Response Telemetry, Categories of Auditory Perception score, Main mode of communication. RESULTS Fifty CI recipients (26 males and 24 females) were identified, 21 had bilateral CIs, 27 had developmental delay. MRI showed cochlea nerve aplasia in 64 ears, hypoplasia in 25 ears, and a normal nerve in 11 ears. Main mode of communication was analyzed for 41 children: 21 (51%) used verbal language (15 speech alone, 5 speech plus some sign, 1 bilingual in speech and sign), and 20 (49%) used sign language (10 sign alone, 9 sign plus some speech, 1 tactile sign). Seventy-three percent of children used some verbal language. Cochlea nerve aplasia/ hypoplasia and developmental delay were both significant factors affecting main mode of communication. Categories of Auditory Performance scores were available for 59 CI ears; 47% with CN Aplasia (IAM nerve grades 0-III) and 89% with CN hypoplasia (IAM nerve grade IV) achieved Categories of Auditory Performance scores of 5 to 7 (some verbal understanding) (p = 0.003). CONCLUSION Our results are encouraging and useful when counselling families regarding the likelihood of language outcomes and auditory understanding.
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Abstract
Morphologically congenital sensorineural hearing loss can be investigated under two categories. The majority of congenital hearing loss causes (80%) are membranous malformations. Here, the pathology involves inner ear hair cells. There is no gross bony abnormality and, therefore, in these cases high-resolution computerized tomography and magnetic resonance imaging of the temporal bone reveal normal findings. The remaining 20% have various malformations involving the bony labyrinth and, therefore, can be radiologically demonstrated by computerized tomography and magnetic resonance imaging. The latter group involves surgical challenges as well as problems in decision-making. Some cases may be managed by a hearing aid, others need cochlear implantation, and some cases are candidates for an auditory brainstem implantation (ABI). During cochlear implantation, there may be facial nerve abnormalities, cerebrospinal fluid leakage, electrode misplacement or difficulty in finding the cochlea itself. During surgery for inner ear malformations, the surgeon must be ready to modify the surgical approach or choose special electrodes for surgery. In the present review article, inner ear malformations are classified according to the differences observed in the cochlea. Hearing and language outcomes after various implantation methods are closely related to the status of the cochlear nerve, and a practical classification of the cochlear nerve deficiency is also provided.
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Affiliation(s)
- Levent Sennaroğlu
- Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Münir Demir Bajin
- Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
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Peng KA, Kuan EC, Hagan S, Wilkinson EP, Miller ME. Cochlear Nerve Aplasia and Hypoplasia: Predictors of Cochlear Implant Success. Otolaryngol Head Neck Surg 2017; 157:392-400. [DOI: 10.1177/0194599817718798] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To identify factors predicting performance outcomes following cochlear implantation in patients with cochlear nerve aplasia or hypoplasia. Data Sources Individual patient data extracted from published case series and reports. Review Methods The MEDLINE database, Cochrane Library, Embase, Web of Science, and Google Scholar were queried for “cochlear implant” in conjunction with “aplasia” or “hypoplasia” between 1985 and 2015. Eighteen studies were included describing 97 subjects with individual postimplant auditory data. Postimplant performance was categorized as follows: level 1, nonstimulation/minimal detection; level 2, improved detection; level 3, closed-set speech perception; or level 4, open-set speech perception. The subjects achieving speech perception (levels 3 and 4) were descriptively compared with those who did not. Results Subjects with a hypoplastic cochlear nerve on magnetic resonance imaging had higher reported rates of achieving speech perception than those with an aplastic nerve. Subjects with syndromic medical comorbidities had higher reported rates of nonstimulation than nonsyndromic subjects. The data showed that some children with an aplastic cochlear nerve or those with partial electrode insertion could obtain levels of speech discrimination. Reporting of patient characteristics and auditory outcomes was extremely variable across studies. Conclusion As previously shown, cochlear implant in patients with cochlear nerve aplasia or hypoplasia can provide meaningful hearing for select patients. The current study suggests that presence of a cochlear nerve on magnetic resonance imaging and lack of comorbid medical syndrome are associated with better auditory outcomes in such patients. Future efforts to report individual data in a consistent manner may allow better determination of predictive factors.
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Affiliation(s)
| | - Edward C. Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
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Predicting Auditory Outcomes From Radiological Imaging in Cochlear Implant Patients With Cochlear Nerve Deficiency. Otol Neurotol 2017; 38:685-693. [DOI: 10.1097/mao.0000000000001382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Takanashi Y, Kawase T, Tatewaki Y, Suzuki J, Yahata I, Nomura Y, Oda K, Miyazaki H, Katori Y. Duplicated internal auditory canal with inner ear malformation: Case report and literature review. Auris Nasus Larynx 2017; 45:351-357. [PMID: 28446373 DOI: 10.1016/j.anl.2017.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
Internal auditory canal anomalies are rare. Narrow internal auditory canal is believed to occur as a result of aplasia or hypoplasia of the vestibulocochlear nerve. Narrow duplication of the internal auditory canal is considered to be very rare. Narrow duplication of the internal auditory canal with inner ear malformation has been reported in only 3 cases. We present 2 cases of narrow duplication of the internal auditory canal with inner ear malformation. The first case had inner ear malformation on only one side and the second case had inner ear malformation on both sides. The embryogenesis may be different between internal auditory canal and inner ear.
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Affiliation(s)
- Yoshitaka Takanashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; Laboratory of Rehabilitative Auditory Science, Tohoku University Graduate School of Biomedical Engineering, 6-6 Aoba, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan
| | - Yasuko Tatewaki
- Department of Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Jun Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Izumi Yahata
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yuuri Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kazuha Oda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hiromitsu Miyazaki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Connor SEJ. Contemporary imaging of auditory implants. Clin Radiol 2017; 73:19-34. [PMID: 28388970 DOI: 10.1016/j.crad.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
There have been significant advances in the diversity and effectiveness of hearing technologies in recent years. Implanted auditory devices may be divided into those that stimulate the cochlear hair cells (bone conduction devices and middle ear implants), and those that stimulate the neural structures (cochlear implants and central auditory implants). Contemporary preoperative and postoperative imaging may be used to help individualise implant selection, optimise surgical technique and predict auditory outcome. This review will introduce the concepts behind auditory implants, and explains how imaging is increasingly used to aid insertion and evaluation of these devices.
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Affiliation(s)
- S E J Connor
- Neuroradiology Department, King's College Hospital, London, UK; Radiology Department, Guy's and St Thomas' Hospital, London, UK.
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Naguib NNN, Hey C, Shaaban MS, Elabd AM, Hassan HHM, Gruber-Rouh T, Kaltenbach B, Harth M, Ackermann H, Stöver T, Vogl TJ, Nour-Eldin NEA. Assessment of the cochlear nerve to facial nerve size ratio using MR multiplanar reconstruction of the internal auditory canal in patients presenting with acquired long-standing hearing loss. Br J Radiol 2017; 90:20160870. [PMID: 28368665 DOI: 10.1259/bjr.20160870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To test using the facial nerve as a reference for assessment of the cochlear nerve size in patients with acquired long-standing sensorineural hearing loss (SNHL) using MRI multiplanar reconstruction. METHODS The study was retrospectively performed on 86 patients. Group 1 (study group, n = 53) with bilateral long-standing SNHL. Group 2 (control group, n = 33) without hearing loss. The nerve size was measured by drawing a region of interest around the cross-sectional circumference of the nerve in multiplanar reconstruction images. RESULTS No significant correlation was noted between the cochlear nerve and facial nerve size, and the patient's age, gender and weight (p > 0.05). In Group 1, the mean ratio of the cochlear to facial nerve size was 0.99 ± 0.30 (range: 0.52-1.86) and 1.12 ± 0.35 (range: 0.34-2.3) for the right and left sides, respectively. In Group 2, it was 1.18 ± 0.23 (range: 0.78-1.71) and 1.25 ± 0.25 (range: 0.85-1.94) for the right and left sides, respectively. The cochlear nerve size was statistically (p = 0.0004) smaller in Group 1 than in Group 2. CONCLUSION The cochlear nerve size and the cochlear to facial nerve size ratio are significantly smaller in patients with acquired long-standing SNHL. Advances in knowledge: The facial nerve can be used as a reference for assessment of the cochlear nerve in patients with acquired long-standing SNHL.
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Affiliation(s)
- Nagy N N Naguib
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany.,3 Department of Radiology, Faculty of Medicine, Alexandria university, Alexandria, Egypt
| | - Constanze Hey
- 2 Department of Otolaryngology, Frankfurt University Hospital, Frankfurt, Germany
| | - Mohamed S Shaaban
- 3 Department of Radiology, Faculty of Medicine, Alexandria university, Alexandria, Egypt
| | - Amr M Elabd
- 3 Department of Radiology, Faculty of Medicine, Alexandria university, Alexandria, Egypt
| | - Hebatallah H M Hassan
- 3 Department of Radiology, Faculty of Medicine, Alexandria university, Alexandria, Egypt
| | - Tatjana Gruber-Rouh
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Benjamin Kaltenbach
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Marc Harth
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Hanns Ackermann
- 4 Department of Biomedical Statistics, Frankfurt University Hospital, Frankfurt, Germany
| | - Timo Stöver
- 2 Department of Otolaryngology, Frankfurt University Hospital, Frankfurt, Germany
| | - Thomas J Vogl
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- 1 Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany.,3 Department of Radiology, Faculty of Medicine, Alexandria university, Alexandria, Egypt
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Ai Y, Xu L, Li L, Li J, Luo J, Wang M, Fan Z, Wang H. The auditory characteristics of children with inner auditory canal stenosis. Acta Otolaryngol 2016; 136:687-91. [PMID: 26981851 DOI: 10.3109/00016489.2016.1152505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusions This study shows that the prevalence of auditory neuropathy spectrum disorder (ANSD) in the children with inner auditory canal (IAC) stenosis is much higher than those without IAC stenosis, regardless of whether they have other inner ear anomalies. In addition, the auditory characteristics of ANSD with IAC stenosis are significantly different from those of ANSD without any middle and inner ear malformations. Objectives To describe the auditory characteristics in children with IAC stenosis as well as to examine whether the narrow inner auditory canal is associated with ANSD. Method A total of 21 children, with inner auditory canal stenosis, participated in this study. A series of auditory tests were measured. Meanwhile, a comparative study was conducted on the auditory characteristics of ANSD, based on whether the children were associated with isolated IAC stenosis. Results Wave V in the ABR was not observed in all the patients, while cochlear microphonic (CM) response was detected in 81.1% ears with stenotic IAC. Sixteen of 19 (84.2%) ears with isolated IAC stenosis had CM response present on auditory brainstem responses (ABR) waveforms. There was no significant difference in ANSD characteristics between the children with and without isolated IAC stenosis.
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MESH Headings
- Audiometry
- Child
- Child, Preschool
- Ear, Inner/abnormalities
- Ear, Inner/diagnostic imaging
- Ear, Inner/physiopathology
- Evoked Potentials, Auditory, Brain Stem
- Female
- Hearing
- Hearing Loss, Sensorineural/congenital
- Hearing Loss, Sensorineural/diagnostic imaging
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Humans
- Infant
- Magnetic Resonance Imaging
- Male
- Otoacoustic Emissions, Spontaneous
- Retrospective Studies
- Temporal Bone/diagnostic imaging
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Affiliation(s)
- Yu Ai
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- b Clinical Auditory Center, Eye & Ear Infirmary of Shandong Provincial Hospital Group , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
- d Artificial Auditory Engineering Centre of Shandon Province , Jinan , PR China
| | - Lei Xu
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- b Clinical Auditory Center, Eye & Ear Infirmary of Shandong Provincial Hospital Group , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
- d Artificial Auditory Engineering Centre of Shandon Province , Jinan , PR China
| | - Li Li
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
| | - Jianfeng Li
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
| | - Jianfen Luo
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- b Clinical Auditory Center, Eye & Ear Infirmary of Shandong Provincial Hospital Group , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
- d Artificial Auditory Engineering Centre of Shandon Province , Jinan , PR China
| | - Mingming Wang
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
| | - Zhaomin Fan
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
- d Artificial Auditory Engineering Centre of Shandon Province , Jinan , PR China
| | - Haibo Wang
- a Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University , Jinan , PR China
- c Shandong Provincial Key Laboratory of Otology , Jinan , PR China
- d Artificial Auditory Engineering Centre of Shandon Province , Jinan , PR China
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Kim LS, Jeong SW, Huh MJ, Park YD. Cochlear Implantation in Children with Inner Ear Malformations. Ann Otol Rhinol Laryngol 2016; 115:205-14. [PMID: 16572611 DOI: 10.1177/000348940611500309] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to assess the outcomes of cochlear implantation in children with inner ear malformations (IEMs). Methods: A retrospective review of 212 children who received implants from September 1994 to May 2004 was performed. Forty-six of them had radiologic evidence of IEMs. The preoperative evaluations, intraoperative findings, postoperative complications, and performance outcomes were analyzed. For the comparative analysis of performance outcomes, the children with IEMs were matched and compared with children with a normal inner ear who had received implants. Statistical analysis was performed with a repeated-measures analysis of variance. Results: All of the children were studied with computed tomography and magnetic resonance imaging. Three-dimensional volume rendering of magnetic resonance images was performed in cases that were difficult to interpret because of structural complexity. The operative findings included aberrant facial nerves in 2 children and cerebrospinal fluid gushers in 22 children. Intraoperative fluoroscopic examination was performed to evaluate electrode placement. There were no serious postoperative complications. All children with IEMs achieved open-set speech perception abilities, except for the children with a narrow internal auditory canal (IAC), and showed progressive improvement of their speech perception abilities over time. There were no statistically significant differences in performance measured by the Common Phrases test between the 2 groups. Although the repeated-measures analysis of variance indicated that children with IEMs performed more poorly than those with a normal inner ear on the Phonetically Balanced Kindergarten test for phonemes, statistical significance was not found at 2 years after implantation. The children with a narrow IAC benefited from the implantation and used the device every day, although their speech perception abilities were limited. Conclusions: The results of the present study show that cochlear implantation can be performed relatively safely in deaf children with IEMs and that they receive considerable benefit from their implants. Substantial benefit can be expected from implantation in children with most kinds of IEMs, except for a narrow IAC, which is often associated with limited results.
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Affiliation(s)
- Lee-Suk Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
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Ito K, Endo A, Monobe H, Ochiai A, Iwasaki S. Nonsyndromic Isolated Unilateral Cochlear Nerve Aplasia without Narrow Internal Auditory Meatus: A Previously Overlooked Cause of Unilateral Profound Deafness in Childhood. Ann Otol Rhinol Laryngol 2016; 114:859-62. [PMID: 16358605 DOI: 10.1177/000348940511401109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Juvenile or adolescent unilateral profound sensorineural deafness (worldwide prevalence, 0.1% to 0.2%) has been attributed to postnatal viral infection, sudden deafness, prenatal and perinatal problems including maternal rubella and viral infections, congenital inner ear anomalies, and other factors. Herein, 2 cases are reported and another potentially important cause of unilateral profound hearing loss is proposed. Methods: Two nonsyndromic cases of a presently “very rare” cause of pediatric unilateral deafness are presented as a retrospective case study. Results: The 2 patients showed isolated aplasia of the cochlear nerve; other branches of the eighth cranial nerve, the seventh nerve, and the inner ear were spared, and there was no anomaly of the internal auditory meatus. Both functional and imaging studies confirmed the isolated lesion (absence) of the cochlear nerve. Conclusions: Because of the absence of bony abnormalities, such cases may have been overlooked. The authors would like to advocate this isolated anomaly of the cochlear nerve as an important cause of juvenile or adolescent unilateral profound deafness.
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Affiliation(s)
- Ken Ito
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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A Prospective Longitudinal Study of U.S. Children Unable to Achieve Open-Set Speech Recognition 5 Years After Cochlear Implantation. Otol Neurotol 2016; 36:985-92. [PMID: 25700015 DOI: 10.1097/mao.0000000000000723] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify characteristics associated with the inability to progress to open-set speech recognition in children 5 years after cochlear implantation. STUDY DESIGN Prospective, longitudinal, and multidimensional assessment of auditory development for 5 years. SETTING Six tertiary cochlear implant (CI) referral centers in the United States. PATIENTS Children with severe-to-profound hearing loss who underwent implantation before age 5 years enrolled in the Childhood Development after Cochlear Implantation study, categorized by level of speech recognition ability. INTERVENTION(S) Cochlear implantation before 5 years of age and annual assessment of emergent speech recognition skills. MAIN OUTCOME MEASURE(S) Progression to open-set speech recognition by 5 years after implantation. RESULTS Less functional hearing before implantation, older age at onset of amplification, lower maternal sensitivity to communication needs, minority status, and complicated perinatal history were associated with the inability to obtain open-set speech recognition by 5 years. CONCLUSION Characteristics of a subpopulation of children with CIs associated with an inability to achieve open-set speech recognition after 5 years of CI experience were investigated. These data distinguish pediatric CI recipients at risk for poor auditory development and highlight areas for future interventions to enhance support of early implantation.
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Jallu AS, Jehangir M, Ul Hamid W, Pampori RA. Imaging Evaluation of Pediatric Sensorineural Hearing Loss in Potential Candidates for Cochlear Implantation. Indian J Otolaryngol Head Neck Surg 2015; 67:341-6. [PMID: 26693449 PMCID: PMC4678264 DOI: 10.1007/s12070-015-0819-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022] Open
Abstract
Computerized tomography (CT) and magnetic resonance (MR) are complementary in the imaging of the labyrinth, the internal auditory canal and the brain in children with sensorineural hearing loss who are being evaluated for cochlear implantation. An accurate anatomical description of the inner ear is essential in the preoperative work up. Computerized tomography visualizes the bony structures, whereas MR can discern soft-tissue components including intra labyrinthine fluid, cerebrospinal fluid (CSF), nerves, and vessels within the IAC. This prospective study was conducted in the Department of Otorhinolaryngology, Head & Neck Surgery, Government Medical College, Srinagar. 40 children in the age group of 1-16 years with unidentified causes of bilateral SNHL were analysed radiologically over the period of 2 years from Dec 2011 to Jan 2014. Each patient underwent MRI and high resolution CT scanning of temporal bone in axial and coronal planes. Out of the 40 patients 22 were males (55 %) and 18 were females (45 %). 30 patients (72.5 %)in our study had normal radiological scans. Five patients (12.5 %) had B/L large vestibular aqueduct and two patients (5 %) had internal auditory canal stenosis with cochlear nerve hypoplasia on CT and MR imaging. Cochlear dysplasia was present in two patients (5 %) and semicircular canal dysplasia was present in one patient (2.5 %) as an isolated finding on HRCT. In addition isolated cochlear nerve hypoplasia was present in one patient (2.5 %). Hyperintense basal ganglia lesion suggestive of kernicterus was present in one patient (2.5 %) and hyperintense posterior parietal and occipital white matter lesions suggestive of congenital CMV infection was present in one patient (2.5 %) on MR imaging. Arachnoid cysts of middle cranial fossa was an incidental finding present in one patient. Radiological abnormalities of the inner ear are not uncommon. Computerized tomography and MRI are important modalities to analyze the inner ear in children with unexplained SNHL. MRI with an extremely small field of view should be used to study possible abnormalities of the vestibulocochlear nerves.
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Affiliation(s)
- Aleena Shafi Jallu
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Majid Jehangir
- />Department of Radiology, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Waqar Ul Hamid
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Rafiq Ahmad Pampori
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
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Colletti G, Mandalà M, Colletti L, Colletti V. Nervus Intermedius Guides Auditory Brainstem Implant Surgery in Children with Cochlear Nerve Deficiency. Otolaryngol Head Neck Surg 2015; 154:335-42. [PMID: 26567046 DOI: 10.1177/0194599815615858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 10/15/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the anatomic features of the nervus intermedius and cranial nerve VII in children with cochlear nerve deficiency and to verify whether the nervus intermedius can provide an additional landmark to help guide placement of the auditory brainstem implant electrode. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS High-definition video was captured during retrosigmoid surgery in 64 children (mean age, 3.91 ± 2.83 years) undergoing auditory brainstem implant placement. These videos were examined with particular reference to the number and variety of nervus intermedius bundles and any associated facial nerve anomalies. RESULTS Absence of cranial nerves VI, VII, and VIII was observed in 3, 6, and all 64 children, respectively. Fifteen children had several abnormalities of the facial nerve in the cerebellopontine angle. Anatomic identification of the facial nerve and the bundles composing the nervus intermedius was possible in 46 children. In 12 children, identification was possible with the assistance of intraoperative monitoring. The number of bundles composing the nervus intermedius varied from 1 to 6. The nervus intermedius and cranial nerve IX were useful landmarks for identifying the foramen of Luschka of the lateral recess. CONCLUSION The nervus intermedius provides an additional landmark during auditory brainstem microsurgery since it was identified in all subjects. The nervus intermedius anatomy and its topographic relationship with the neurovascular structures around the foramen of Luschka have been described for the first time in children with cochlear nerve deficiency.
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Affiliation(s)
- Giacomo Colletti
- Department of Maxillo-facial Surgery, University of Milan, Milan, Italy
| | - Marco Mandalà
- Otological and Skull Base Surgery Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Vittorio Colletti
- International Center for Performing and Teaching Auditory Brainstem Surgery in Children, Milan, Italy
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Partitioned versus duplicated internal auditory canal: when appropriate terminology matters. Otol Neurotol 2015; 35:1140-4. [PMID: 24836591 DOI: 10.1097/mao.0000000000000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A double internal auditory canal (IAC) is an uncommon malformation among temporal bone anomalies related to sensorineural hearing loss. This anomaly has been described as an isolated finding in otherwise normal patients, as well as a frequent feature in pontine tegmental cap dysplasia (PTCD). In both circumstances, the term duplication is currently used to describe this malformation. We conducted a retrospective study on 3 cases of IAC duplication (2 isolated and 1 PTCD-associated form) and reviewed the literature to evaluate both imaging features and differences between the 2 forms. INTERVENTION(S) All 3 patients underwent high-resolution computed tomography and magnetic resonance imaging. RESULTS Neuroimaging documented different radiologic features between isolated and PTCD-associated IAC duplication. In the isolated form, the IAC seemed to have normal position and size, but it was partitioned in 2 portions by a complete or incomplete bony septum. Conversely, in the PTCD-associated form, neuroimaging revealed the presence of 2 separated and anomalously coursing canals for the facial and vestibulocochlear nerve. CONCLUSION The aforementioned different radiologic findings probably reflect a more complex spectrum of etiopathogenetic mechanisms affecting the facioacoustic primordium and leading to overlapping anomalies of the IAC. We speculate on the appropriate terminology in describing this entity and propose that "partition" should be used to describe a double IAC otherwise normal in size and location; conversely, "duplication" should be reserved for IAC anomalies encountered in patients with PTCD or other hindbrain malformations.
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Some Remarks on Imaging of the Inner Ear: Options and Limitations. Clin Neuroradiol 2015; 25 Suppl 2:197-203. [DOI: 10.1007/s00062-015-0422-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
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Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:696281. [PMID: 26236732 PMCID: PMC4506828 DOI: 10.1155/2015/696281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Abstract
Background. Specific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders. Methods. The present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests. Results. Between January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0). Conclusions. Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent.
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Han S, Wang L, Zhang D, Peng K. Neural Response Telemetry Thresholds in Patients with Cochlear Nerve Canal Stenosis. Otolaryngol Head Neck Surg 2015; 153:447-51. [PMID: 26138606 DOI: 10.1177/0194599815592365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
Objective To explore neural response telemetry (NRT) thresholds in patients with stenotic versus normal cochlear nerve canals. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Thirty pediatric patients with profound sensorineural hearing loss in at least 1 ear and no benefit from amplification underwent computed tomography imaging of the temporal bones. They were divided into 3 groups according to the diameter of the cochlear nerve canal: group A, <1.5 mm; group B, 1.5 to 1.7 mm; group C, 1.8 to 2.1 mm. All patients underwent cochlear implantation with full insertion of all electrodes. NRT was performed both intraoperatively and 6 months postoperatively in all patients; thresholds of electrodes 1, 11, and 22 were compared. Results Per analysis of variance, intraoperative and 6-month postoperative NRT thresholds were both significantly different among groups A, B, and C at electrodes 1 and 22 but not at electrode 11. On intergroup analysis, group A showed statistically higher thresholds than those of groups B and C; however, no difference was found between groups B and C. Conclusion Cochlear nerve canal stenosis, defined as a canal diameter <1.5 mm, is associated with significantly increased NRT thresholds, which may play a role in postimplant performance.
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Affiliation(s)
- Shuguang Han
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Line Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Daoxing Zhang
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kevin Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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