1
|
Sokolov M, Raveh E, Yaniv D, Reuven Y, Ulanovski D, Barkan N, Greenstein T, Lipshitz N, Attias J. Long-term outcomes and electrophysiological measures of children with inner ear malformations and cochlear implants. Int J Pediatr Otorhinolaryngol 2024; 178:111875. [PMID: 38364548 DOI: 10.1016/j.ijporl.2024.111875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To compared auditory and speech performance outcomes of children with cochlear implants (CI), between those with inner ear malformations (IEMs) and with normal ear anatomy; and to describe differences in electrophysiological measurements. STUDY DESIGN A retrospective study. SETTING A tertiary care pediatric medical center. PATIENTS Forty-one children with IEMs who underwent CI during 2003-2017, and 41 age-matched CI recipients with normal ear anatomy (control group). MAIN OUTCOME MEASURES Post-CI auditory performance outcomes including educational setting, Categories of Auditory Performance (CAP), and Speech Intelligibility Rating (SIR); and electrophysiological measurements, Including maximal comfortable electrical levels (CLs) and impedances along CI electrodes. RESULTS The ANOVA on ranks revealed lower CAP scores in the study than control group: H3 = 18.8, P < 0.001. Among children with IEMs, CAP scores were better in children with enlarged vestibular aqueduct (EVA) (P < 0.04). SIR scores of the control group did not differ from those with isolated EVA; however, SIR scores of the IEMs without EVA subgroup were lower than all the other study subgroups (P < 0.01). The proportion of the control group that was integrated with full inclusion educational settings into the regular mainstream schools was higher than for those with IEMs without EVA (47 % vs. 15 %, P < 0.05), but similar to those with isolated EVA. For the study group versus control group, maximal comfortable electrical levels (CLs) were higher)P > 0.03) while impedance measurements were similar. CONCLUSIONS Outcomes of pediatric recipients with normal anatomy were better than those with IEMs. Among pediatric recipients of CI with IEMs, auditory performance was better and CLs were lower among children with isolated EVA than all other IEM subgroups.
Collapse
Affiliation(s)
- Meirav Sokolov
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Eyal Raveh
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dan Yaniv
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - David Ulanovski
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Neta Barkan
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel
| | - Tally Greenstein
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel
| | - Noga Lipshitz
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Joseph Attias
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel; Department of Communication Sciences & Disorders, University of Haifa, Haifa, Israel
| |
Collapse
|
2
|
Fehrmann MLA, Huinck WJ, Thijssen MEG, Haer-Wigman L, Yntema HG, Rotteveel LJC, Widdershoven JCC, Goderie T, van Dooren MF, Hoefsloot EH, van der Schroeff MP, Mylanus EAM, Lanting CP, Pennings RJE. Stable long-term outcomes after cochlear implantation in subjects with TMPRSS3 associated hearing loss: a retrospective multicentre study. J Otolaryngol Head Neck Surg 2023; 52:82. [PMID: 38102706 PMCID: PMC10724910 DOI: 10.1186/s40463-023-00680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The spiral ganglion hypothesis suggests that pathogenic variants in genes preferentially expressed in the spiral ganglion nerves (SGN), may lead to poor cochlear implant (CI) performance. It was long thought that TMPRSS3 was particularly expressed in the SGNs. However, this is not in line with recent reviews evaluating CI performance in subjects with TMPRSS3-associated sensorineural hearing loss (SNHL) reporting overall beneficial outcomes. These outcomes are, however, based on variable follow-up times of, in general, 1 year or less. Therefore, we aimed to 1. evaluate long-term outcomes after CI implantation of speech recognition in quiet in subjects with TMPRSS3-associated SNHL, and 2. test the spiral ganglion hypothesis using the TMPRSS3-group. METHODS This retrospective, multicentre study evaluated long-term CI performance in a Dutch population with TMPRSS3-associated SNHL. The phoneme scores at 70 dB with CI in the TMPRSS3-group were compared to a control group of fully genotyped cochlear implant users with post-lingual SNHL without genes affecting the SGN, or severe anatomical inner ear malformations. CI-recipients with a phoneme score ≤ 70% at least 1-year post-implantation were considered poor performers and were evaluated in more detail. RESULTS The TMPRSS3 group consisted of 29 subjects (N = 33 ears), and the control group of 62 subjects (N = 67 ears). For the TMPRSS3-group, we found an average phoneme score of 89% after 5 years, which remained stable up to 10 years post-implantation. At both 5 and 10-year follow-up, no difference was found in speech recognition in quiet between both groups (p = 0.830 and p = 0.987, respectively). Despite these overall adequate CI outcomes, six CI recipients had a phoneme score of ≤ 70% and were considered poor performers. The latter was observed in subjects with residual hearing post-implantation or older age at implantation. CONCLUSION Subjects with TMPRSS3-associated SNHL have adequate and stable long-term outcomes after cochlear implantation, equal to the performance of genotyped patient with affected genes not expressed in the SGN. These findings are not in line with the spiral ganglion hypothesis. However, more recent studies showed that TMPRSS3 is mainly expressed in the hair cells with only limited SGN expression. Therefore, we cannot confirm nor refute the spiral ganglion hypothesis.
Collapse
Affiliation(s)
- M L A Fehrmann
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - W J Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - M E G Thijssen
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - L Haer-Wigman
- Department of Clinical Genetics, Radboudumc, Nijmegen, The Netherlands
| | - H G Yntema
- Department of Clinical Genetics, Radboudumc, Nijmegen, The Netherlands
| | - L J C Rotteveel
- Department of Otorhinolaryngology, Leiden UMC, Leiden, The Netherlands
| | - J C C Widdershoven
- Department of Otorhinolaryngology, Maastricht UMC, Maastricht, The Netherlands
| | - T Goderie
- Department of Otorhinolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam UMC, Amsterdam, The Netherlands
| | - M F van Dooren
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - E H Hoefsloot
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - E A M Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - C P Lanting
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - R J E Pennings
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands.
| |
Collapse
|
3
|
Deep NL, Carlson ML, Hoxworth JM, Driscoll CLW, Lohse CM, Lane JI, Ho ML. Classifying the Large Vestibular Aqueduct: Morphometry to Audiometry. Otol Neurotol 2023; 44:47-53. [PMID: 36509439 DOI: 10.1097/mao.0000000000003748] [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: 12/15/2022]
Abstract
OBJECTIVE Large vestibular aqueduct (LVA) is the most common inner ear dysplasia identified in patients with hearing loss. Our objective was to systematically quantify LVA morphologies and correlate imaging findings with established audiometric outcomes. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Patients with large vestibular aqueduct identified radiographically, with or without hearing loss. INTERVENTIONS Diagnostic only. MAIN OUTCOME MEASURES Vestibular aqueduct (VA) width at midpoint, width at external aperture, and length were measured on cross-sectional imaging. Morphology was classified as type I (borderline), type II (tubular), or type III (funneled). Audiometric endpoints included air/bone conduction, pure tone averages, and air-bone gaps at 250 and 500 Hz. Statistical associations were evaluated using linear regression models, adjusted for age at first audiogram and sex. RESULTS One hundred seventeen patients (197 ears) were included, with mean age at first audiogram of 22.2 years (standard deviation, 21.7 yr). Imaging features associated with poor audiometric outcomes were increasing VA width at midpoint and external aperture, decreasing VA length, dilated extraosseous endolymphatic sac, cochleovestibular malformations, and increasing VA type (III > II > I). CONCLUSIONS Quantitative LVA measurements and a standardized morphologic classification system aid in prediction of early audiometric endpoints.
Collapse
Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Matthew L Carlson
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph M Hoxworth
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Colin L W Driscoll
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - John I Lane
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
4
|
Geneci F, Uzuner MB, Bilecenoğlu B, Torun Bİ, Orhan K, Ocak M. Examination of inner ear structures: a micro-CT study. Acta Otolaryngol 2022; 142:1-5. [PMID: 34985378 DOI: 10.1080/00016489.2021.2015078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND We investigated the inner ear anatomy accurately in detail by microcomputed tomography (micro-CT) to contribute to the data related to the inner ear anatomy and the potential clinical contribution of these data in the treatment of the inner ear's pathologies. AIMS/OBJECTIVES This study aimed to define a range for normal measurements of the VA, vestibule, lateral semicircular canal, and cochlea. We scanned temporal dry bone samples at high resolution using micro-CT. MATERIAL AND METHODS Forty dry temporal bones used in anatomy student education were included in this study with a micro-CT device. All measurements were made on sections in the axial plane with micro-CT programs. RESULTS The operculum and the vestibular aqueduct middle diameters median values were 0.487 mm and 0.294 mm, respectively. The median value of middle diameters for the nonampullated section of lateral semicircular canal was 1.103 mm. The mean height of the cochlea was 3.417 mm and the width of the cochlea was 5.615 mm. The mean length of the vestibule was 6.085 mm and the width of the vestibule was 3.002 mm. CONCLUSIONS AND SIGNIFICANCE We present a database that clinicians can consider in their studies by creating normal anatomical values measured with high precision for the bone labyrinth.
Collapse
Affiliation(s)
- Ferhat Geneci
- Department of Anatomy, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Burak Bilecenoğlu
- Deparment of Anatomy, Faculty of Medicine, Medipol University, Ankara, Turkey
| | - Bilge İpek Torun
- Department of Anatomy, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Kaan Orhan
- Deparment of Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Mert Ocak
- Deparment of Anatomy, Faculty of Dentistry, Ankara University, Ankara, Turkey
| |
Collapse
|
5
|
Parlak S, Akgoz Karaosmanoglu A, Ozbal Batuk M, Sennaroglu L, Ozgen B. 3 Tesla MR imaging of the large endolymphatic duct and sac anomaly with audiological correlation. Eur J Radiol 2021; 145:110064. [PMID: 34839211 DOI: 10.1016/j.ejrad.2021.110064] [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: 07/29/2021] [Revised: 11/06/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Large endolymphatic duct and sac (LEDS) is one of the most common imaging abnormalities in congenital sensorineural hearing loss and is frequently seen with coexistent cochlear anomalies, especially incomplete partition type II. However, MRI findings of accompanying cochlear and especially modiolar dysplasias may be subtle. The purpose of this study is to evaluate the imaging findings of LEDS with high-resolution imaging at 3 T and correlate with the audiological data. METHODS 3 T temporal bone MRIs of 54 ears in 30 LEDS patients were retrospectively evaluated. The cochlear dysmorphism and modiolar deficiency were assessed qualitatively and quantitatively. The severity of LEDS anomaly, the signal changes within the LEDS and cochlea were also noted. The imaging findings were correlated to the audiological data. RESULTS The cochlea was abnormal in 77.8% of the ears with an isolated modiolar deficiency in 11.1%. Cochlea and modiolus were completely normal in 11.1% of the ears. In 63% of the ears X-distance was increased. T2 hypointensity within LEDS and cochlea were detected in 42.6%, and 7.4% of the ears, respectively. The median diameters of LEDS were higher in ears with severe to profound HL than ears with normal to moderate HL (p < 0.05). The X-distance, presence of T2 hypointensity within LEDS, and diameters of modiolus did not show statistical correlation with the audiographic data. CONCLUSION High-resolution 3 T imaging of patients with LEDS anomaly revealed a spectrum of cochlear anomalies, but up to 11.1% of the ears had no underlying anomaly despite severe (endolymphatic duct/sac) dilatation and/or profound HL.
Collapse
Affiliation(s)
- Safak Parlak
- Hacettepe University, Faculty of Medicine, Department of Radiology, Turkey.
| | | | - Merve Ozbal Batuk
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Turkey
| | - Levent Sennaroglu
- Hacettepe University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Burce Ozgen
- University of Illinois at Chicago, Department of Radiology, United States
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
Honda K, Griffith AJ. Genetic architecture and phenotypic landscape of SLC26A4-related hearing loss. Hum Genet 2021; 141:455-464. [PMID: 34345941 DOI: 10.1007/s00439-021-02311-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022]
Abstract
Mutations of coding regions and splice sites of SLC26A4 cause Pendred syndrome and nonsyndromic recessive hearing loss DFNB4. SLC26A4 encodes pendrin, a transmembrane exchanger of anions and bases. The mutant SLC26A4 phenotype is characterized by inner ear malformations, including an enlarged vestibular aqueduct (EVA), incomplete cochlear partition type II and modiolar hypoplasia, progressive and fluctuating hearing loss, and vestibular dysfunction. A thyroid iodine organification defect can lead to multinodular goiter and distinguishes Pendred syndrome from DFNB4. Pendred syndrome and DFNB4 are each inherited as an autosomal recessive trait caused by biallelic mutations of SLC26A4 (M2). However, there are some EVA patients with only one detectable mutant allele (M1) of SLC26A4. In most European-Caucasian M1 patients, there is a haplotype that consists of 12 variants upstream of SLC26A4, called CEVA (Caucasian EVA), which acts as a pathogenic recessive allele in trans to mutations affecting the coding regions or splice sites of SLC26A4. This combination of an M1 genotype with the CEVA haplotype is associated with a less severe phenotype than the M2 genotype. The phenotype in EVA patients with no mutant alleles of SLC26A4 (M0) has a very low recurrence probability and is likely to be caused by other factors.
Collapse
Affiliation(s)
- Keiji Honda
- Department of Otorhinolaryngology, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Andrew J Griffith
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
8
|
Sousa R, Guerreiro C, Eça T, Campos J, Luis L. MR Imaging of Cochlear Modiolus and Endolymphatic Hydrops in Patients With Menière's Disease. Front Surg 2021; 8:667248. [PMID: 34355012 PMCID: PMC8329086 DOI: 10.3389/fsurg.2021.667248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD. Purpose: Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD? Methods: We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops. Results: No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area. Conclusion: No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.
Collapse
Affiliation(s)
- Rita Sousa
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carla Guerreiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago Eça
- Otorhinolaryngology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Jorge Campos
- Imaging Department, Red Cross Hospital, Lisbon, Portugal
| | - Leonel Luis
- Otorhinolaryngology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clinical Physiology Translational Unit, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
9
|
Re M, Giannoni M, Scarpa A, Cassandro C, Ralli M, De Luca P, Aragona T, Viola P, Cassandro E, Gioacchini FM, Franceschini SS. Cerebrospinal Fluid Leak During Stapes Surgery: The Importance of Temporal Bone CT Reconstructions in Oblique Anatomically Oriented Planes. EAR, NOSE & THROAT JOURNAL 2021; 102:227-230. [PMID: 33624550 DOI: 10.1177/0145561320984569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stapes gusher is a massive flow of perilymph and cerebrospinal fluid leak that fills the middle ear immediately after surgical opening of the labyrinth, such as during stapedectomy. Stapes gusher usually occurs as the result of a congenital malformation that causes an abnormal communication between the perilymphatic space and the subarachnoid space involving the internal auditory canal or the cochlear duct. To date, the potential risk of stapes gusher cannot be assessed preoperatively, as there are not pathognomonic signs suggestive of this complication. However, high-resolution computed tomography scan (HRCT) of the temporal bone can provide information that may help recognizing patients at risk. Recently, an anatomic evaluation of the inner ear with oblique reformation at HRCT has been described. This reformation offers a new and more detailed topographic vision of temporal bone structures compared to the classic axial and coronal planes and may help identifying anatomical alterations otherwise not visible. In this article, we present a case of stapes gusher and the role of preoperative HRCT with oblique reformation in its prevention.
Collapse
Affiliation(s)
- Massimo Re
- Department of Clinical and Molecular Sciences, Section of Otorhinolaryngology, Polytechnic University of Marche, Ancona, Italy
| | - Mirko Giannoni
- Neuroradiology Unit, University Hospital of Ancona, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Pietro De Luca
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | | |
Collapse
|
10
|
Kumari A, Arumugam SV, Malik V, Goyal S, Kameswaran M. Audiological and Surgical Outcomes of Pediatric Cochlear Implantation in Mondini's Dysplasia: Our Experience. J Int Adv Otol 2021; 17:19-22. [PMID: 33605216 DOI: 10.5152/iao.2020.8983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Aim of present study is to compare audiological and surgical outcomes in prelingual deaf children with Mondini's dysplasia (MD) and those with normal inner ear anatomy. MATERIALS AND METHODS Retrospective data was collected from Jan 2008 to Dec 2016. Children with bony IEM other than MD, syndromic association, multiple disabilities, those lost to follow up, and perilingual or postlingual deafness were excluded from study. Audiological outcomes for auditory perception (CAP score) and speech intelligibility (SIR score) was noted for a follow up period of 1 year. RESULTS Mean age at implantation was 2.8 years (Range of 2 to 6 years). 2 patients had intraoperative CSF ooze which was controlled intraoperatively by conservative measures. Post operative facial nerve function was normal in all patients. None of the patient in either group had any complications at one year of follow up period. There was statistically significant improvement in CAP - SIR score in Group A at 6 - 12 months compared to pretreatment. There was no statistically significant difference between the 2 groups in terms of CAP - SIR score at 6 - 12 months. CONCLUSION The study stresses the fact that cochlear implantation can be safely performed in children with MD although there is a risk of intraoperative CSF leak which can be controlled intraoperatively. Cochlear implantation in children with MD has good surgical, auditory and speech outcomes at par with children with normal bony inner ear anatomy.
Collapse
Affiliation(s)
- Abha Kumari
- Department of ENT HNS, Command Hospital (Southern Command), Pune, India
| | | | - Virender Malik
- Department of Imaging - Interventional Radiology, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Sunil Goyal
- Department of ENT-HNS, Army Hospital (R-R), Delhi Cantt, India
| | | |
Collapse
|
11
|
Chen BS, Newman NJ, Biousse V. Atypical presentations of idiopathic intracranial hypertension. Taiwan J Ophthalmol 2021; 11:25-38. [PMID: 33767953 PMCID: PMC7971435 DOI: 10.4103/tjo.tjo_69_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/11/2020] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in isolated raised intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia from sixth nerve palsy and divergence insufficiency, and pulsatile tinnitus. Atypical presentations include: (1) highly asymmetric or even unilateral papilledema, and IIH without papilledema; (2) ocular motor disturbances from third nerve palsy, fourth nerve palsy, internuclear ophthalmoplegia, diffuse ophthalmoplegia, and skew deviation; (3) olfactory dysfunction; (4) trigeminal nerve dysfunction; (5) facial nerve dysfunction; (6) hearing loss and vestibular dysfunction; (7) lower cranial nerve dysfunction including deviated uvula, torticollis, and tongue weakness; (8) spontaneous skull base cerebrospinal fluid leak; and (9) seizures. Although atypical findings should raise a red flag and prompt further investigation for an alternative etiology, clinicians should be familiar with these unusual presentations.
Collapse
Affiliation(s)
- Benson S. Chen
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
12
|
Varadarajan VV, Dayton OL, De Jesus RO, Antonelli PJ. Prevalence of occult cochlear basal turn patency. Acta Otolaryngol 2020; 140:889-892. [PMID: 32804558 DOI: 10.1080/00016489.2020.1800815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perilymph gusher (PLG) is a rare complication of otologic surgery attributed to a communication between the cochlea and the internal auditory canal (IAC). Subtle patency between the cochlear basal turn and IAC has recently been identified on computed tomography (CT) as a risk factor, specifically when the defect is > 0.75 mm. OBJECTIVES Investigate the prevalence of radiographic cochlear basal turn patency. MATERIALS AND METHODS Patients with CT of the temporal bones and inner ears interpreted as "normal" were included. An otologist and a radiologist independently reviewed CTs to measure radiographic dehiscence in an oblique plane along the interface of the cochlea and IAC. Known PLGs were excluded. RESULTS Two hundred and ten ears were included (88 conductive or mixed hearing loss, 62 sensorineural hearing loss, 41 audiometrically normal ears). 71 ears (33.8%) were radiographically patent. Mean defect width was 0.41 mm (0.15-0.7 mm). Defect width was not associated with type of hearing loss, age, or gender. No defects were wider than 0.75 mm. CONCLUSIONS Radiographic patency of the cochlear basal turn may be present in patients with hearing loss and normal hearing, but patency > 0.75 mm (i.e. risk for PLG) is rare.
Collapse
Affiliation(s)
| | - Orrin L. Dayton
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | | | | |
Collapse
|
13
|
Jahn KN, Bergan MD, Arenberg JG. Auditory Detection Thresholds and Cochlear Resistivity Differ Between Pediatric Cochlear Implant Listeners With Enlarged Vestibular Aqueduct and Those With Connexin-26 Mutations. Am J Audiol 2020; 29:23-34. [PMID: 31934787 DOI: 10.1044/2019_aja-19-00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The goal of this study was to evaluate differences in the electrode-neuron interface as a function of hearing loss etiology in pediatric cochlear implant (CI) listeners with enlarged vestibular aqueduct (EVA) syndrome and in those with autosomal recessive connexin-26 mutations (DFNB1). Method Fifteen implanted ears (9 participants, 5 ears with EVA, 10 ears with DFNB1) were assessed. Single-channel auditory detection thresholds were measured using broad and spatially focused electrode configurations (steered quadrupolar; focusing coefficients = 0 and 0.9). Cochlear resistivity estimates were obtained via electrode impedances and electrical field imaging. Between-group differences were evaluated using linear mixed-effects models. Results Children with EVA had significantly higher auditory detection thresholds than children with DFNB1, irrespective of electrode configuration. Between-group differences in thresholds were more pronounced on apical electrodes than on basal electrodes. In the apex, electrode impedances and electrical field imaging values were higher for children with EVA than for those with DFNB1. Conclusions The electrode-neuron interface differs between pediatric CI listeners with DFNB1 and those with EVA. It is possible that optimal clinical interventions may depend, in part, on hearing loss etiology. Future investigations with large samples should investigate individualized CI programming strategies for listeners with EVA and DFNB1.
Collapse
Affiliation(s)
- Kelly N. Jahn
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston
| | - Molly D. Bergan
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Julie G. Arenberg
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston
| |
Collapse
|
14
|
Varadarajan VV, Dayton OL, De Jesus RO, Sarntinoranont M, Antonelli PJ. Cochlear basal turn patency in unrecognized perilymph gushers. Int J Pediatr Otorhinolaryngol 2019; 126:109601. [PMID: 31369970 DOI: 10.1016/j.ijporl.2019.109601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Perilymph gusher (PLG), an uncommon complication of otologic surgery, has been attributed to communication between the cochlea and the internal auditory canal (IAC). Subtle osseous defects may be missed on routine review of computed tomography (CT). This study aimed to quantify cochlear basal turn patency not seen on axial CT in patients with PLG and compare those against patients without intraoperative PLG. METHODS Ears that underwent cochlear implantation or stapedotomy with preoperative helical CT that was interpreted as "normal" at a tertiary referral center. An otologist and a radiologist independently and in a blinded fashion measured the dimensions of cochlear basal turn patency on CT images in oblique plane and parasagittal planes along the interface of the cochlea and IAC fundus. RESULTS Sixty-one ears were reviewed, including 3 with surgically confirmed PLGs and 12 with apparent dehiscence without a PLG. Mean defect width with PLG was 0.83 mm (range 0.75-0.9 mm) and without PLG was 0.43 mm (range 0.3-0.65 mm, p = 0.011). A greater proportion of PLGs occurred in ears with defects (3 of 15) than in ears without (0 of 46, p = 0.013). Using a cutoff of 0.75 mm, a greater proportion of PLGs occurred with defect width >0.75 mm (3 of 3) than in defects <0.75 mm (0 of 12, p = 0.022). CONCLUSIONS CT dehiscence between the IAC and cochlear basal turn, particularly with a width > 0.75 mm, should be considered a risk for PLG with stapedotomy or cochlear implantation.
Collapse
Affiliation(s)
| | - Orrin L Dayton
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | | | - Malisa Sarntinoranont
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | | |
Collapse
|
15
|
Sensorineural Hearing Loss in the Nonimplanted Ear Following Cochlear Implantation in a Patient With Bilateral Enlarged Vestibular Aqueducts. Otol Neurotol 2019; 40:e782-e786. [PMID: 31348130 DOI: 10.1097/mao.0000000000002319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations. PATIENTS One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center. INTERVENTION(S) Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion. MAIN OUTCOME MEASURE(S) Bone conduction hearing thresholds, word recognition scores. RESULTS The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation. CONCLUSION As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
Collapse
|
16
|
Tobia A, Khayr R, Shpak T, Peleg C, Genizi J, Khnifes R, Borissovsky N, Luntz M. Idiopathic Intracranial Hypertension Presenting as Auditory Neuropathy Hearing Disorder in a Child. Laryngoscope 2019; 129:E407-E411. [PMID: 31268557 DOI: 10.1002/lary.28150] [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: 01/15/2019] [Revised: 03/19/2019] [Accepted: 06/03/2019] [Indexed: 11/11/2022]
Abstract
Otologic manifestations are known to occur in patients with idiopathic intracranial hypertension (IIH), but the occurrence of sensorineural hearing loss, especially in pediatric populations, has been addressed in only a few reports. Here, we describe a pediatric patient who presented with IIH and severe bilateral hearing loss. The patient's hearing loss was diagnosed as a form of auditory neuropathy (AN) and resolved after prompt treatment of the increased intracranial pressure. This case points to a possible association between IIH and AN and suggests that IIH may potentially be a reversible cause of AN spectrum disorder. Laryngoscope, 129:E407-E411, 2019.
Collapse
Affiliation(s)
- Amjad Tobia
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ranin Khayr
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Talma Shpak
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Caroline Peleg
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Jacob Genizi
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Riyad Khnifes
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Borissovsky
- Department of Radiology, Bnai-Zion Medical Center, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Luntz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Ear and Hearing Unit, ARAM Medical Center for Otolaryngology, Head and Neck, and Maxillofacial Surgery, Assuta Medical Center, Tel Aviv, Israel
| |
Collapse
|
17
|
Quesada JL, Cammaroto G, Bonanno L, Galletti F, Quesada P. Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena. EAR, NOSE & THROAT JOURNAL 2018; 96:302-310. [PMID: 28846785 DOI: 10.1177/014556131709600817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients-23 men and 15 women, aged 23 to 71 years (mean: 47)-who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.
Collapse
Affiliation(s)
- Juan Luis Quesada
- Department of Otorhinolaryngology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | |
Collapse
|
18
|
Aimoni C, Ciorba A, Cerritelli L, Ceruti S, Skarżyński PH, Hatzopoulos S. Enlarged vestibular aqueduct: Audiological and genetical features in children and adolescents. Int J Pediatr Otorhinolaryngol 2017; 101:254-258. [PMID: 28780189 DOI: 10.1016/j.ijporl.2017.07.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Enlarged Vestibular Aqueduct (EVA) is one of the most common congenital malformations associated with sensorineural or mixed hearing loss. The association between hearing loss and EVA is described in syndromic (i.e. Pendred Syndrome, BOR, Waardenburg) and non-syndromic disorders, as isolate or familiar mutations of the SLC26A4 gene. The audiological phenotype of the EVA syndrome is heterogeneous, the type and entity of hearing loss may vary and vertigo episodes might also be present. OBJECTIVE The aim of this retrospective study was to describe the clinical and genetic features of a group of adolescent subjects presenting an EVA clinical profile, considering the presence of SLC26A4 gene mutations. METHODS 14 Caucasian patients were assessed (24 ears in total; 4 patients presented a monolateral EVA), 10 females and 4 males. Their age at the time of diagnosis was between 1 and 6 years (mean age 2.5 years). Subjects were assessed by an ENT microscopy evaluation with a complete audiometric assessment, CT & MRI scans and genetic tests for the evaluation of the pendrin gene mutations (SLC26A4). RESULTS Considering the presence of SLC26A4 mutations and thyroid function, we could identify three sub-groups of patients: group 1, non syndromic EVA (ns EVA, no SLC26A4 mutation and no thyroid dysfunction); group 2, EVA with DFNB4 (single SLC26A4 gene mutation and no thyroid dysfunction); group 3, EVA with Pendred Syndrome (two pathological mutation of SLC26A4 and thyromegaly with thyroid dysfunction). Patients of group 1 (ns-EVA) showed various degrees of hearing loss from mild (55%) to severe-profound (45%). In groups 2 (DFNB4) and 3 (PDS), the degree of hearing loss is severe to profound in 70-75% of the cases; middle and high frequencies are mainly involved. CONCLUSIONS The phenotypic expressions associated with the EVA clinical profile are heterogeneous. From the available data, it was not possible to identify a representative audiological profile, in any of the three sub-groups. The data suggest that: (i) a later onset of hearing loss is usually related to EVA, in absence of SLC26A4 gene mutations; and (ii) hearing loss is more severe in patients with SLC26A4 gene mutations (groups 2 and 3 of this study).
Collapse
Affiliation(s)
- C Aimoni
- Clinic of Audiology & ENT, University of Ferrara, Italy
| | - A Ciorba
- Clinic of Audiology & ENT, University of Ferrara, Italy.
| | - L Cerritelli
- Clinic of Audiology & ENT, University of Ferrara, Italy
| | - S Ceruti
- Neuroradiology Department, University Hospital of Ferrara, Italy
| | - P H Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland; World Hearing Center, Warsaw, Poland; Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland; Institute of Sensory Organs, Kajetany, Poland
| | - S Hatzopoulos
- Clinic of Audiology & ENT, University of Ferrara, Italy
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
CT and MR Imaging of the Pediatric Temporal Bone: Normal Variants and Pitfalls. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
21
|
DeMarcantonio M, Choo DI. Radiographic Evaluation of Children with Hearing Loss. Otolaryngol Clin North Am 2015; 48:913-32. [DOI: 10.1016/j.otc.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
22
|
Muskett JA, Chattaraj P, Heneghan JF, Reimold FR, Shmukler BE, Brewer CC, King KA, Zalewski CK, Shawker TH, Butman JA, Kenna MA, Chien WW, Alper SL, Griffith AJ. Atypical patterns of segregation of familial enlargement of the vestibular aqueduct. Laryngoscope 2015; 126:E240-7. [PMID: 26485571 DOI: 10.1002/lary.25737] [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: 06/15/2015] [Revised: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Hearing loss and enlarged vestibular aqueduct (EVA) can be inherited as an autosomal recessive trait caused by mutant alleles of the SLC26A4 gene. In some other families, EVA does not segregate in a typical autosomal recessive pattern. The goal of this study was to characterize the SLC26A4 genotypes and phenotypes of extended families with atypical segregation of EVA. STUDY DESIGN Prospective study of cohort of families ascertained between 1998 and 2014 at the National Institutes of Health Clinical Center. METHODS Study subjects were members of eight families segregating EVA in at least two members who were not related as siblings. Evaluations included pure-tone audiometry, temporal bone imaging, SLC26A4 nucleotide sequence analysis, SLC26A4-linked marker genotype and haplotype analysis, and pedigree analysis. RESULTS One family had members with EVA caused by different etiologies, and two families had pseudodominant inheritance of recessive mutations of SLC26A4. In five families, the etiology remained unknown and could include inheritance of mutant alleles at another genetic locus, nongenetic influences, or a combination of these factors. CONCLUSIONS Familial EVA can demonstrate a variety of atypical segregation patterns. Pseudodominant inheritance of SLC26A4 mutations or recessive alleles of other hearing loss genes may be more likely to occur in families in which deaf individuals have intermarried. The etiologic basis of atypical segregation of EVA without detectable SLC26A4 mutations remains unknown. Future studies of these families may reveal novel genes for EVA. LEVEL OF EVIDENCE NA Laryngoscope, 126:E240-E247, 2016.
Collapse
Affiliation(s)
- Julie A Muskett
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Parna Chattaraj
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - John F Heneghan
- Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Fabian R Reimold
- Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Boris E Shmukler
- Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Carmen C Brewer
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Kelly A King
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Christopher K Zalewski
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Thomas H Shawker
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Margaret A Kenna
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Wade W Chien
- Office of the Clinical Director, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A
| | - Seth L Alper
- Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Griffith
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
23
|
Vaid S, Vaid N. Imaging for cochlear implantation: Structuring a clinically relevant report. Clin Radiol 2014; 69:e9-e24. [DOI: 10.1016/j.crad.2014.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/19/2014] [Accepted: 03/13/2014] [Indexed: 11/25/2022]
|
24
|
Quan Y, Liu J, Liu Z, Wu L, Gong R. Detection of hypoplasia of bony cochlear nerve canal by the opening threshold of virtual endoscopy: a pilot study. Acta Radiol 2014; 55:318-24. [PMID: 23926232 DOI: 10.1177/0284185113495832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dimensions of the bony cochlear nerve canal (BCNC) have been proposed as a potential diagnostic standard for BCNC hypoplasia, but the standard remains inconsistent. Some studies have revealed that computed tomography virtual endoscopy (CTVE) with variation of reconstruction threshold is good at identifying labyrinthine fistulas or semi-circular canal dehiscence. PURPOSE To examine diagnostic accuracy of VE in the evaluation of BCNC hypoplasia on basis of opening threshold. MATERIAL AND METHODS Twenty ears diagnosed with BCNC hypoplasia were included in this study. One hundred ears served as controls. The opening thresholds were measured by two reviewers. Intraclass correlation coefficients (ICC) were reported. The width of BCNC was obtained on transverse CT images. Association between the width of BCNC and opening threshold was assessed by using Spearman correlation coefficients. ROC curves were applied to assess the best cut-off value of opening threshold. RESULTS The opening threshold of BCNC was significantly higher in diseased ears (926 ± 308 Hounsfield units [HU]) than that in control ears (287 ± 72 HU). Inter-observer agreement was very good. The mean width of BCNC for diseased ears and control ears were 0.83 ± 0.36 mm and 2.21 ± 0.35 mm, respectively. Significant negative linear correlation was found between opening thresholds and width of BCNC (Spearman coefficient, -0.768; P < 0.001). The area under the ROC curve was 0.981. The cut-off opening thresholds of 408 for differentiation between the two groups provided the best combination of sensitivity (85%) and specificity (94%). CONCLUSION The VE with opening threshold may be an effective optional tool for prediction of hypoplasia of BCNC.
Collapse
Affiliation(s)
- Yong Quan
- CT Room, Shanxian Central Hospital, affiliated with Jining Medical College, Heze, PR China
| | - Jie Liu
- Department of Radiology, Wendeng Central Hospital, Weifang Medical College, Weihai, PR China
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Lebin Wu
- Shandong Medical Imaging Research Institute, Shandong University, Shandong, PR China
| | - Ruozhen Gong
- Shandong Medical Imaging Research Institute, Shandong University, Shandong, PR China
| |
Collapse
|
25
|
Size of the semicircular canals measured by multidetector computed tomography in different age groups. J Comput Assist Tomogr 2014; 38:196-9. [PMID: 24625604 DOI: 10.1097/rct.0b013e3182aaf21c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to obtain reference values for the sizes of the semicircular canals (SCCs) on multidetector computed tomographic (CT) images in different age groups. METHODS Computed tomographic images of the temporal bone of 210 patients, a total of 420 ears without inner ear pathology, have been evaluated. These patients were divided into 4 groups by age: young children (<7 years), older children and adolescents (8-17 years), adults (18-59 years), and the elderly patients (>60 years). The inner diameter, maximum height, and width of the SCCs were measured. RESULTS There was no significant difference in the size of SCC among the 4 age groups. The inner diameter measurements of the anterior SCC, lateral SCC, and posterior SCC were 0.101 ± 0.016, 0.135 ± 0.033, and 0.124 ± 0.021 cm, respectively. The height measurements of the anterior SCC, lateral SCC, and posterior SCC were 0.535 ± 0.086, 0.349 ± 0.090, and 0.490 ± 0.109 cm, respectively. The width measurements of the anterior SCC, lateral SCC, and posterior SCC were 0.567 ± 0.080, 0.302 ± 0.082, and 0.472 ± 0.099 cm, respectively. CONCLUSIONS The size of SCCs remains constant from children to the elderly people, unlike the other human organs. The reference values provided by multidetector CT can serve as an aid for the interpretation of CT images.
Collapse
|
26
|
Maiolo V, Savastio G, Modugno GC, Barozzi L. Relationship between multidetector CT imaging of the vestibular aqueduct and inner ear pathologies. Neuroradiol J 2013; 26:683-92. [PMID: 24355188 DOI: 10.1177/197140091302600612] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/02/2013] [Indexed: 11/16/2022] Open
Abstract
This study investigated the relationships between morphological changes in the vestibular aqueduct (VA) in different inner ear pathologies. Eighty-eight patients (34 males and 54 females, ranging from seven to 88 years of age; average age 49.2 years) with cochleovestibular disorders underwent temporal bone CT (with a 64-channel helical CT system according to temporal bone protocol parameters; 0.6 mm slice thickness, 0.6 mm collimation, bone reconstruction algorithm). All patients with cochleovestibular disorders who underwent temporal bone CT had been previously divided into six different suspected clinical classes: A) suspected pathology of the third window; B) suspected retrocochlear hearing loss; C) defined Ménière's disease; D) labyrinth lithiasis; E) recurrent vertigo. On CT images we analyzed the length, width and morphology of the VA, contact between the VA and the jugular bulb (JB), the thickness of the osseous capsule covering the semicircular canals, the pneumatization rate of the temporal bone and the diameter of the internal auditory canal. At the end of the diagnostic work-up all patients were grouped into six pathological classes, represented as follow: 1) benign paroxysmal positional vertigo (BPPV), 2) recurrent vertigo (RV), 3) enlarged vestibular aqueduct syndrome (EVAS), 4) sudden or progressive unilateral sensorineural hearing loss (SNHL), 5) superior semicircular canal dehiscence syndrome (SSCD), 6) recurrent vestibulocochlear symptoms in Ménière's disease. We evaluated 176 temporal bones in 88 patients. The VA was clearly visualized in 166/176 temporal bones; in ten ears the VA was not visualized. In 14 ears (11 patients, in three of whom bilaterally) we found an enlarged VA while in 31 ears the VA was significantly narrower. In 16 ears a dehiscence of the JB with the vestibular or cochlear aqueduct was noted. In all six patients with suspected EVAS we found a AV wider than 1.5 mm on CT scans; moreover CT identified four patients with large VA and ill-defined clinical symptoms. Most patients with BPPV (11 patients, Class 1) we did not find any VA abnormalities on CT scans, confirming the clinical diagnosis in ten patients; in the remaining patients we found an enlarged VA, not clinically suspected. In the RV class (eight patients, Class 2) we found three patients with negative CT scans, two patients with narrow aqueduct and subsequently reclassified as Ménière's disease patients, and three patients with ectasic JB dehiscence with the VA. In patients suffering from SNHL we found no statistically significant correlation with the morphological abnormalities. The clinical suspicion of SSCD was confirmed by CT in 11/13 patients (84.6 %); in addition another seven patients showed a thinning or dehiscence of the superior semicircular canals as the prevailing alteration on CT scans, and were reclassified in this group. Ménière's disease symptoms were correlated with a VA alteration in more than half of the cases; the most striking finding in this class was that the VA was significantly narrower (21 patients). Our study demonstrates that alterations of the VA morphology are not only related to EVAS but are also found in other inner ear pathologies such as Ménière's disease. Furthermore, MDCT may confirm the presence of correlations between the morphology of inner ear structures such as VA, semicircular canals or JB dehiscence, and alterations of vestibulocochlear function.
Collapse
Affiliation(s)
- Vincenzo Maiolo
- Radiology Department, S.Orsola-Malpighi University Hospital; Bologna, Italy -
| | | | | | | |
Collapse
|
27
|
Sennaroglu L. Cochlear Implantation in Inner Ear Malformations — A Review Article. Cochlear Implants Int 2013; 11:4-41. [DOI: 10.1002/cii.416] [Citation(s) in RCA: 237] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
28
|
Krouchi L, Callonnec F, Bouchetemblé P, Tollard E, Dehesdin D, Marie JP. Preoperative computed tomography scan may fail to predict perilymphatic gusher. Ann Otol Rhinol Laryngol 2013; 122:374-7. [PMID: 23837389 DOI: 10.1177/000348941312200605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A stapes gusher is a very rare event in ear surgery, but the consequences for hearing can be dramatic. It can usually be predicted by characteristic radiologic abnormalities. We report 2 cases of gusher without any abnormalities seen on the preoperative computed tomography scans. METHODS The first case was in a 30-year-old man with a bilateral mixed hearing loss. The gusher occurred after a stapedotomy performed with a microdrill. The oval window was plugged with a vein graft, and a fluoroplastic piston was inserted. The second case was in a 39-year-old woman with a family history of hearing loss who presented with a bilateral mixed hearing loss. The footplate was fractured during the stapedotomy drilling and was covered with a temporalis fascia graft that was fixed with a fluoroplastic piston. RESULTS The first patient had no cerebrospinal fluid leakage and no vertigo or tinnitus. He did have a sensorineural hearing loss. The second patient had dizziness and tinnitus. Postoperative magnetic resonance imaging scans were performed, but again no features were identified that might have predicted these cases. CONCLUSIONS Surgeons should be reminded that a preoperative computed tomography scan may fail to detect the risk of a perilymphatic gusher.
Collapse
Affiliation(s)
- Lydia Krouchi
- Department of Otolaryngology-Head and Neck Surgery, Rouen University Hospital-Charles Nicolle, France
| | | | | | | | | | | |
Collapse
|
29
|
Marcus S, Whitlow CT, Koonce J, Zapadka ME, Chen MY, Williams DW, Lewis M, Evans AK. Computed tomography supports histopathologic evidence of vestibulocochlear sexual dimorphism. Int J Pediatr Otorhinolaryngol 2013; 77:1118-22. [PMID: 23688380 DOI: 10.1016/j.ijporl.2013.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether the effects of sex (male/female) that have been demonstrated in the pathology literature using 0.1 mm histopathologic slices are measurable and statistically significant using high-resolution (0.625 mm slice) computed tomography (CT). METHODS IRB-approved retrospective analysis of high-resolution "normal" CT temporal bone images in pediatric subjects (0-18 years) using comparative anatomic measurements between males and females obtained from the semicircular canals, cochlea and vestibule as follows: (1) lateral semicircular canal (LSCC) bony island width, (2) superior semicircular canal (SSCC) bony island width, (3) central lucency of the LSCC bony island, (4) coronal cochlear height, (5) axial cochlear height, (6) cochlear length, (7) cochlea basal turn lumen width, (8) cochlear aperture width, (9) cochlear aperture height, (10) vestibular length, (11) vestibular width, and (12) coronal vestibule oblique diameter. RESULTS Eighteen females (36 ears) and twenty males (36 ears) were included in the study. Independent-samples t-tests revealed statistically significant differences in measurements for females and males as follows (differences reported as a percentage and as an absolute difference (AD) in mm): (1) vestibular width was 4.2% (0.13 mm AD) smaller in females (mean ± SD; 3.0 ± 0.27) compared to males (mean ± SD; 3.2 ± 0.25) [t(70) = 2.083, p = 0.041]; (2) cochlear length was 3.9% (.23 mm AD) smaller in females (mean ± SD; 5.8 ± 0.32) compared to males (mean ± SD; 6.0 ± 0.40) [t(70)=2.660, p = 0.010]; (3) cochlear aperture height was 11.6% (0.13 mm AD) smaller in females (mean ± SD; 1.0 ± 0.18) compared to males (mean ± SD; 1.2 ± 0.22) [t(70)=2.549, p = 0.013]; and (4) coronal cochlear height was 11.4% (0.55 mm AD) smaller in females (mean ± SD; 4.8 ± 0.58) compared to males (mean ± SD; 5.4 ± 0.48) [t(68) = 4.270, p < 0.005]. CONCLUSION Sexual dimorphism of inner ear structures may contribute to variability in reported normative and pathologic measurements of inner ear structures. This variability must be taken into consideration when designing future research studies to investigate inner ear structures and for drawing accurate conclusions about possible inner ear morphologic abnormalities associated with SNHL compared to controls.
Collapse
Affiliation(s)
- Sonya Marcus
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Yi JS, Lim HW, Kang BC, Park SY, Park HJ, Lee KS. Proportion of bony cochlear nerve canal anomalies in unilateral sensorineural hearing loss in children. Int J Pediatr Otorhinolaryngol 2013; 77:530-3. [PMID: 23352796 DOI: 10.1016/j.ijporl.2012.12.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/22/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the various bony anomalies of the inner ear in patients with unilateral sensorineural hearing loss using high-resolution temporal bone computed tomography and establish the relationship between hearing and the diameter of the bony cochlear nerve canal. METHODS We performed a retrospective review of 51 patients (mean age 11 years, range 0-20 years, 27 boys, 24 girls) who were diagnosed with unilateral sensorineural hearing loss with an audiogram. Coronal and axial diameter of the inner ear structures, including the internal auditory canal, bony cochlear nerve canal, and each turn of the cochlea and semicircular canals, were measured with high-resolution temporal bone computed tomography. The mean values (± 2 standard deviations) were calculated and compared between sensorineural hearing loss and normal ears, and between narrow bony cochlear nerve canal and normal bony cochlear nerve canal ears. Bony cochlear nerve canal atresia/stenosis was defined as a value less than 1.4mm in axial images. RESULTS The diameter of the bony cochlear nerve canal was significantly smaller in sensorineural hearing loss ears than in normal ears (p<.05). Associated inner ear anomalies, such as IAC stenosis (24%), cochlear hypoplasia (7-17%), and narrow semicircular canal bony island (8%) were only observed in the narrow bony cochlear nerve canal group. This group also showed statistically significant, severe to profound hearing loss compared to the normal bony cochlear nerve canal group (p<.05, R(2)=12.8%). CONCLUSIONS Most (57%) of the unilateral sensorineural hearing loss ears had bony cochlear nerve canal stenosis/atresia and this group showed associated inner ear anomalies. When the diameter of the bony cochlear nerve canal was less than 1.4mm, pure tone audio averages were more than 70 dB HL in most ears.
Collapse
Affiliation(s)
- Jong Sook Yi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Republic of Korea
| | | | | | | | | | | |
Collapse
|
31
|
A case of bilateral incomplete partition type I with enlarged vestibular aqueducts: An unreported entity. Clin Radiol 2013; 68:98-9. [DOI: 10.1016/j.crad.2012.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 06/09/2012] [Accepted: 06/15/2012] [Indexed: 11/21/2022]
|
32
|
ANGELI SIMON, LIN XI, LIU XUEZHONG. Genetics of hearing and deafness. Anat Rec (Hoboken) 2012; 295:1812-29. [PMID: 23044516 PMCID: PMC4523052 DOI: 10.1002/ar.22579] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 01/20/2023]
Abstract
This article is a review of the genes and genetic disorders that affect hearing in humans and a few selected mouse models of deafness. Genetics is playing an increasingly critical role in the practice of medicine. This is not only in part to the importance that genetic knowledge has on traditional genetic diseases but also in part to the fact that genetic knowledge provides an understanding of the fundamental biological process of most diseases. The proteins coded by the genes related to hearing loss (HL) are involved in many functions in the ear, such as cochlear fluid homeostasis, ionic channels, stereocilia morphology and function, synaptic transmission, gene regulation, and others. Mouse models play a crucial role in understanding of the pathogenesis associated with these genes. Different types of familial HL have been recognized for years; however, in the last two decades, there has been tremendous progress in the discovery of gene mutations that cause deafness. Most of the cases of genetic deafness recognized today are monogenic disorders that can be broadly classified by the mode of inheritance (i.e., autosomal dominant, autosomal recessive, X-linked, and mitochondrial inheritance) and by the presence of associated phenotypic features (i.e., syndromic; and nonsyndromic). In terms of nonsyndromic HL, the chromosomal locations are currently known for ∼ 125 loci (54 for dominant and 71 for recessive deafness), 64 genes have been identified (24 for dominant and 40 for recessive deafness), and there are many more loci for syndromic deafness and X-linked and mitochondrial DNA disorders (http://hereditaryhearingloss.org). Thus, today's clinician must understand the science of medical genetics as this knowledge can lead to more effective disease diagnosis, counseling, treatment, and prevention.
Collapse
Affiliation(s)
- SIMON ANGELI
- Department of Otolaryngology, University of Miami, Miami, Florida
| | - XI LIN
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - XUE ZHONG LIU
- Department of Otolaryngology, University of Miami, Miami, Florida
| |
Collapse
|
33
|
Magnetic resonance imaging features of large endolymphatic sac compartments: audiological and clinical correlates. The Journal of Laryngology & Otology 2012; 126:586-93. [PMID: 22643203 DOI: 10.1017/s0022215112000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES (1) To study the prevalence and characteristics of large endolymphatic sac internal compartments on thin-section T2- and T2*-weighted magnetic resonance imaging, and to relate these to other large endolymphatic sac magnetic resonance imaging features, and (2) to correlate the compartment imaging features, endolymphatic sac size and labyrinthine anomalies with the patients' clinical and audiological data. METHOD Magnetic resonance imaging studies for 38 patients with large endolymphatic sac anomalies were retrospectively reviewed in a tertiary referral centre. Endolymphatic sac compartment presence, morphology and imaging signal were assessed. Endolymphatic sac size and labyrinthine anomalies were also recorded. Endolymphatic sac compartments and other imaging features were correlated with clinical and audiological data. RESULTS Compartments were present in 57 per cent of the imaged endolymphatic sacs, but their presence alone did not correlate with other imaging features or clinical data. The endolymphatic sac : internal auditory meatus signal ratio was associated with a history of sudden or fluctuating hearing loss. Hearing loss correlated with opercular and extraosseous endolymphatic sac size measurements. A larger midpoint intraosseous endolymphatic sac size was associated with clear fluid loss at cochlear implantation. CONCLUSION The magnetic resonance imaging characteristics of large endolymphatic sac compartments have been defined. The endolymphatic sac size and distal compartment signal should be recorded, as these provide prognostic information and assist the planning of appropriate interventions.
Collapse
|
34
|
|
35
|
Kim M, Kim J, Kim SH, Kim SC, Jeon JH, Lee WS, Kim UK, Kim HN, Choi JY. Hemorrhage in the endolymphatic sac: a cause of hearing fluctuation in enlarged vestibular aqueduct. Int J Pediatr Otorhinolaryngol 2011; 75:1538-44. [PMID: 21963424 DOI: 10.1016/j.ijporl.2011.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Most of the patients with enlarged vestibular aqueduct (EVA) experience sudden hearing deterioration, but the exact mechanism is unclear. We analyzed magnetic resonance (MR) images and the cellular components of endolymph obtained from the endolymphatic sac in patients with EVA, in order to demonstrate the cause of sudden hearing loss. METHODS A total of 25 patients (50 ears) with EVA, who had severe to profound hearing loss, were included in this retrospective clinical study. MR examinations were performed by a 3.0-T MR system using an 8-channel sensitivity-encoding head coil. We analyzed endolymphatic fluid harvested from the endolymphatic sac during cochlear implantations in four patients. RESULTS The area of low signal intensity in the endolymphatic sac was observed on T2-weighted MR images for 15 of 50 ears. This area was observed more frequently in patients who experienced recent sudden hearing loss (10/12, 83%) than those with stable hearing (5/38, 13%)(Fisher's exact test, p<0.001). In addition, this area showed high signal intensity on fluid attenuated inversion recovery images. Cytologic analysis of the aspirated endolymph from the endolymphatic sac in the patients with this area revealed many erythrocytes. CONCLUSION Our data suggests that hemorrhage in the endolymphatic sac could be a cause of sudden hearing deterioration in patients with EVA.
Collapse
Affiliation(s)
- Minbum Kim
- Department of Otology, Hana ENT Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Prades JM, Elmaleh-Berges M, Chatard S, Veyret C, Martin C, Richard C. [Computed tomography of the normal and pathologic temporal bone]. Morphologie 2011; 95:159-169. [PMID: 22079599 DOI: 10.1016/j.morpho.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
High-resolution computed tomography scanning (CT) allows depiction of microanatomic structures of the temporal bone. CT is useful for detecting several pathologic conditions of the temporal bone such as congenital malformations, particularly in young children with sensorineural hearing loss. Some external, middle and inner ear structures are difficult to evaluate. The objective of this study has been to provide the key planes in coronal and axial planes (five coronal planes and three axial planes) but also with oblique planes reconstruction (two planes) for normal temporal bones evaluation. These standardized planes help to improve visualization of the main congenital malformations. Identification of obvious morphogenetic malformations (Michel aplasia, Mondini deformity….) is not difficult. However, less severe dysplasia may be missed or normal micro anatomic structures in newborn misreaded.
Collapse
Affiliation(s)
- J-M Prades
- Laboratoire d'anatomie, service d'ORL et de chirurgie cervico-faciale, faculté de médecine J.-Lisfranc, hôpital Nord, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.
| | | | | | | | | | | |
Collapse
|
37
|
Dilated dysplastic vestibule: a new computed tomographic finding in patients with large vestibular aqueduct syndrome. J Comput Assist Tomogr 2011; 35:674-8. [PMID: 22082534 DOI: 10.1097/rct.0b013e318232988b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Large vestibular aqueduct syndrome (LVAS) is one of the most common anomalies of the inner ear. The purpose of our study was to evaluate the vestibule for associated aberrations. In particular, we assessed the vestibular volume in patients with LVAS, compared it to an age-matched control population, and evaluated the relationship between the size of the vestibular aqueduct and the vestibule. METHODS We reviewed studies of high-resolution computed tomography of temporal bone of 24 consecutive patients with LVAS (15 girls and 9 boys; average age, 8.1 years). Of these, 21 patients had bilateral LVAS and 3 patients had unilateral LVAS. Each ear was evaluated for the size of the vestibular aqueduct and the volume of the vestibule. Similar measurements were obtained in an age-matched control population (28 girls and 18 boys; average age, 8.3 years). RESULTS The volume of the vestibule was found to be significantly enlarged in patients with LVAS compared to the control population (right ear, P < 0.0001; left ear, P < 0.0001). A linear correlation could be established between an enlarged vestibular aqueduct and corresponding increase in the volume of the vestibule (right side, P < 0.01; left side, P < 0.01). CONCLUSION A dilated dysplastic vestibule is a consistently associated finding in patients with LVAS.
Collapse
|
38
|
Griffith AJ, Wangemann P. Hearing loss associated with enlargement of the vestibular aqueduct: mechanistic insights from clinical phenotypes, genotypes, and mouse models. Hear Res 2011; 281:11-7. [PMID: 21669267 PMCID: PMC3183377 DOI: 10.1016/j.heares.2011.05.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 02/08/2023]
Abstract
Enlargement of the vestibular aqueduct (EVA) is one of the most common inner ear malformations associated with sensorineural hearing loss in children. The delayed onset and progressive nature of this phenotype offer a window of opportunity to prevent or retard progression of hearing loss. EVA is not the direct cause of hearing loss in these patients, but rather is a radiologic marker for some underlying pathogenetic defect. Mutations of the SLC26A4 gene are a common cause of EVA. Studies of an Slc26a4 knockout mouse demonstrate that acidification and enlargement of the scala media are early events in the pathogenesis of deafness. The enlargement is driven by fluid secretion in the vestibular labyrinth and a failure of fluid absorption in the embryonic endolymphatic sac. Elucidating the mechanism of hearing loss may offer clues to potential therapeutic strategies.
Collapse
Affiliation(s)
- Andrew J Griffith
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, 5 Research Court, Rockville, Maryland 20850-3320, USA.
| | | |
Collapse
|
39
|
Quan Y, Wu L, Xu Z, Gong W, Gong R. Detection of hypoplasia of bony cochlear nerve canal by virtual endoscopy: a pilot study. Acta Radiol 2011; 52:802-7. [PMID: 21565890 DOI: 10.1258/ar.2011.110020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dimensions of the bony cochlear nerve canal (BCNC) have been proposed as a potential diagnostic standard for hypoplasia of BCNC, but the standard remains inconsistent. We have previously found that a helix-like shape appears in normal BCNCs at VE images, whereas, the sign does not appear in some hypoplastic BCNCs. PURPOSE To retrospectively examine the feasibility of computed tomographic (CT) virtual endoscopy (VE) in the evaluation of hypoplasia of BCNC on the basis of absence of a helix-like shape. MATERIAL AND METHODS Twenty ears in 14 consecutive patients (mean age 5.5 years, range 1-15 years, 6 boys, 8 girls) diagnosed with hypoplasia of BCNC were included in this work. One hundred ears in 50 gender- and age-matched individuals (mean age 6.6 years, range 1-15 years, 29 boys, 21 girls) without inner ear disease and internal auditory canal (IAC) malformations served as controls. The presence or absence of a helix-like shape was evaluated by two independent reviewers. The value of VE for the diagnosis of hypoplasia of BCNC was assessed with clinical results and routine radiologic evaluation as the reference standard. Inter-observer agreement was calculated. Sensitivity, specificity, and accuracy were selected to test the diagnostic ability of the VE. RESULTS Absence of a helix-like shape was found in the cochlear area of 17 of 20 ears in patients with hypoplasia of BCNC but in none of the control subjects. Inter-observer agreement was substantial (к = 0.773). The diagnostic rates of absence of a helix-like shape for hypoplasia of BCNC in terms of sensitivity, specificity, and accuracy were 85%, 100%, and 98%, respectively. There were significant differences between the two groups with respect to VE findings for absence of a helix-like shape (P < 0.001). CONCLUSION The absence of a helix-like shape at VE images may be used as a potentially useful sign in the diagnosis of hypoplasia of BCNC.
Collapse
Affiliation(s)
- Yong Quan
- Shandong Medical Imaging Research Institute, Shandong Univeristy, Jinan, Shandong
| | - Lebin Wu
- Shandong Medical Imaging Research Institute, Shandong Univeristy, Jinan, Shandong
| | - Zushan Xu
- Department of Radiology, Wendeng Central Hospital, Weifang Medical College, Weihai, China
| | - Wuxian Gong
- Shandong Medical Imaging Research Institute, Shandong Univeristy, Jinan, Shandong
| | - Ruozhen Gong
- Shandong Medical Imaging Research Institute, Shandong Univeristy, Jinan, Shandong
| |
Collapse
|
40
|
Gopen Q, Zhou G, Whittemore K, Kenna M. Enlarged vestibular aqueduct: Review of controversial aspects. Laryngoscope 2011; 121:1971-8. [DOI: 10.1002/lary.22083] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/10/2011] [Indexed: 11/07/2022]
|
41
|
Ikezono T, Sugizaki K, Shindo S, Sekiguchi S, Pawankar R, Baba S, Yagi T. CTP (Cochlin-tomoprotein) detection in the profuse fluid leakage (gusher) from cochleostomy. Acta Otolaryngol 2010; 130:881-7. [PMID: 20105107 DOI: 10.3109/00016480903508910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS By testing 125 samples, we confirmed that Cochlin-tomoprotein (CTP) is present in the perilymph, not in cerebrospinal fluid (CSF). Perilymph and CSF exist in two distinct compartments, even in the case of a malformed inner ear with a bony defect in the lamina cribrosa, as described here. Cochleostomy might have suddenly decreased the perilymph pressure, allowing the influx of CSF into the inner ear resulting in profuse fluid leakage, first perilymph then CSF. OBJECTIVES The first purpose of this study was to further confirm the specificity of the perilymph-specific protein CTP that we reported recently. Secondly, we assessed the nature of the fluid leakage from the cochleostomy using the CTP detection test. METHODS A standardized CTP detection test was performed on 65 perilymph and 60 CSF samples. Samples of profuse fluid leakage collected from cochleostomy during cochlear implantation surgery of one patient with branchio-oto-renal (BOR) syndrome were also tested by the CTP detection test. RESULTS CTP was detected in 60 of 65 perilymph samples but not in any of the CSF samples. The leaked fluid was shown to contain CTP, i.e. perilymph, at the outset, and then the CTP detection signals gradually disappeared as time elapsed.
Collapse
Affiliation(s)
- Tetsuo Ikezono
- Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
42
|
Kawai H, Naganawa S, Ishihara S, Sone M, Nakashima T. MR imaging of the cochlear modiolus after intratympanic administration of Gd-DTPA. Magn Reson Med Sci 2010; 9:23-9. [PMID: 20339263 DOI: 10.2463/mrms.9.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We evaluated whether enhancement of the cochlear modiolus could be visualized 24 hours after intratympanic injection of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) using a 3-dimensional real inversion recovery sequence combined with a 32-channel head coil at 3 tesla. Intratympanic injection of Gd-DTPA has been reported for visualizing endolymphatic hydrops in Meniere's disease, and its use has shown communication between the cochlear perilymph and cerebrospinal fluid in the internal auditory canal. Although the cochlear modiolus has been considered the route for this communication, this has not been confirmed through direct visualization of its enhancement. MATERIALS AND METHODS We qualitatively and quantitatively evaluated the presence of contrast enhancement in the modiolus in 19 patients with clinically suspected endolymphatic hydrops or hearing loss who underwent imaging as described above. RESULTS The contrast ratio (CR) between the cochlear modiolus and cerebellar white matter on the injected side was 1.09+/-1.23, and that on the non-injected side was -0.48+/-0.38 (P<0.01). In all subjects, the CR value was larger on the injected than non-injected side, and enhancement of the cochlear modiolus was also recognized visually. CONCLUSIONS Intratympanic Gd-DTPA can be administered to visualize enhancement of the cochlear modiolus and may thereby reveal its functional anatomy.
Collapse
Affiliation(s)
- Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | |
Collapse
|
43
|
Teissier N, Van Den Abbeele T, Sebag G, Elmaleh-Berges M. Computed Tomography measurements of the normal and the pathologic cochlea in children. Pediatr Radiol 2010; 40:275-83. [PMID: 20012953 DOI: 10.1007/s00247-009-1423-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 06/10/2009] [Accepted: 08/31/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiological investigation is frequently undertaken to assess the aetiology of sensorineural hearing loss (SNHL). OBJECTIVE To establish the CT measurements of the normal cochlea in children and to determine radiological criteria correlated with SNHL. MATERIALS AND METHODS A retrospective study of temporal bone CT performed in 159 children, age range from 3 days to 16 years between February 1999 and July 2004. A control group (n = 88) comprised children without SNHL; the SNHL group comprised 71 children. The width of the second turn of the cochlea (CW), the cochlear height (CH), and the width of the bony canal for the cochlear nerve (WCN) were measured on a reference plane containing the modiolus, the posterior semicircular canal, the footplate, and the stapes arch. RESULTS Width of the canal measurements <or=1.7 mm or >or=2.5 mm supported the diagnosis of SNHL with a specificity of 97% and 91%, respectively. Cochlear width was found to be significantly smaller in the SNHL group (5.61 +/- 0.51 mm) than in the control group (5.75 +/- 0.31 mm, P < 0.02), a size <5.4 mm being highly suggestive of SNHL with a specificity of 90%. No significant variations of all measurements were found with age. CONCLUSION Appropriate measurements of WCN and CW are highly correlated with SNHL.
Collapse
Affiliation(s)
- Natacha Teissier
- Paediatric ENT, Robert Debré Hospital, 49 Bd Sérurier, Paris, France.
| | | | | | | |
Collapse
|
44
|
King KA, Choi BY, Zalewski C, Madeo AC, Manichaikul A, Pryor SP, Ferruggiaro A, Eisenman D, Kim HJ, Niparko J, Thomsen J, Butman JA, Griffith AJ, Brewer CC. SLC26A4 genotype, but not cochlear radiologic structure, is correlated with hearing loss in ears with an enlarged vestibular aqueduct. Laryngoscope 2010; 120:384-9. [PMID: 19998422 PMCID: PMC2811762 DOI: 10.1002/lary.20722] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Identify correlations among SLC26A4 genotype, cochlear structural anomalies, and hearing loss associated with enlargement of the vestibular aqueduct (EVA). STUDY DESIGN Prospective cohort survey, National Institutes of Health, Clinical Center, a federal biomedical research facility. METHODS Eighty-three individuals, 11 months to 59 years of age, with EVA in at least one ear were studied. Correlations among pure-tone hearing thresholds, number of mutant SLC26A4 alleles, and the presence of cochlear anomalies detected by computed tomography or magnetic resonance imaging were examined. RESULTS Linear mixed-effects model indicated significantly poorer hearing in ears with EVA in individuals with two mutant alleles of SLC26A4 than in those with EVA and a single mutant allele (P = .012) or no mutant alleles (P = .007) in this gene. There was no detectable relationship between degree of hearing loss and the presence of structural cochlear anomalies. CONCLUSIONS The number of mutant alleles of SLC26A4, but not the presence of cochlear anomalies, has a significant association with severity of hearing loss in ears with EVA. This information will be useful for prognostic counseling of patients and families with EVA.
Collapse
Affiliation(s)
- Kelly A. King
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
- Hearing and Speech Sciences Department, University of Maryland, College Park, Maryland, USA
| | - Byung Yoon Choi
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Christopher Zalewski
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Anne C. Madeo
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ani Manichaikul
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Shannon P. Pryor
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Anne Ferruggiaro
- Hearing and Speech Sciences Department, University of Maryland, College Park, Maryland, USA
| | - David Eisenman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - H. Jeffrey Kim
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC, USA
| | - John Niparko
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - James Thomsen
- Pediatric Ear, Nose and Throat of Atlanta, Atlanta, Georgia, USA
| | - John A. Butman
- Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew J. Griffith
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Carmen C. Brewer
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| |
Collapse
|
45
|
Ma X, Yang Y, Xia M, Li D, Xu A. Computed tomography findings in large vestibular aqueduct syndrome. Acta Otolaryngol 2009; 129:700-8. [PMID: 18841511 DOI: 10.1080/00016480802412813] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONCLUSIONS Patients with large vestibular aqueduct syndrome (LVAS) have disturbed morphogenesis of bony labyrinth. Semicircular canal anomalies are common in LVAS. OBJECTIVE To describe the additional inner ear anomalies on CT imaging in pediatric patients with LVAS, and to investigate the lateral semicircular canal (LSCC) anomalies associated with LVAS by measurement of the LSCC bony island width. PATIENTS AND METHODS We retrospectively reviewed the digitally stored temporal bone CT imaging obtained for 23 patients with LVAS, additional inner ear anomalies were noted, and measurements of the LSCC bony island width were made on axial CT scans on the workstation. Measurements were compared to the normative data obtained from 20 patients without sensorineural hearing loss. RESULTS Of the 23 patients (bilateral in 22 and unilateral in 1), additional inner ear malformations were identified in 21 cases presenting either singly or in combination. A small LSCC bony island (<3 mm in diameter) appeared highly typical; vestibule and LSCC anomalies were identified in 13 cases (26 ears) based on visual inspection combined with abnormal measurements. Dehiscence of the superior and/or posterior semicircular canal was identified in 19 ears, and Mondini deformity was identified in 6 ears.
Collapse
|
46
|
Gupta SS, Maheshwari SR, Kirtane MV, Shrivastav N. Pictorial review of MRI/CT Scan in congenital temporal bone anomalies, in patients for cochlear implant. Indian J Radiol Imaging 2009; 19:99-106. [PMID: 19881062 PMCID: PMC2765183 DOI: 10.4103/0971-3026.50825] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
High-resolution CT scan (HRCT) and MRI are routinely performed prior to cochlear implant surgery. These modalities help assess the status of the inner ear structures. A few patients have significant anomalies, which need to be assessed and understood in detail. We present a pictorial essay of these anomalies and described our HRCT and MRI techniques in patients being imaged prior to surgery.
Collapse
Affiliation(s)
- Santosh S Gupta
- Department of Radiology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Shailendra R Maheshwari
- Department of Radiology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Milind V Kirtane
- Department of ENT, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Nitin Shrivastav
- Department of ENT, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| |
Collapse
|
47
|
Naganawa S, Satake H, Iwano S, Sone M, Nakashima T. Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA. ACTA ACUST UNITED AC 2009; 26:597-602. [DOI: 10.1007/s11604-008-0286-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
|
48
|
NAGANAWA S, SONE M, OTAKE H, NAKASHIMA T. Endolymphatic Hydrops of the Labyrinth Visualized on Noncontrast MR Imaging: A Case Report. Magn Reson Med Sci 2009; 8:43-6. [DOI: 10.2463/mrms.8.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
49
|
Grimmer JF, Hedlund G, Park A. Steroid treatment of hearing loss in enlarged vestibular aqueduct anomaly. Int J Pediatr Otorhinolaryngol 2008; 72:1711-5. [PMID: 18817986 DOI: 10.1016/j.ijporl.2008.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 08/14/2008] [Accepted: 08/15/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE 1. Determine whether corticosteroid therapy improves hearing thresholds of patients with enlarged vestibular aqueduct (EVA) anomaly. 2. Determine sample size for a future prospective study. METHODS Retrospective chart review hearing loss in EVA patients comparing patients treated with corticosteroids and untreated patients. RESULTS Eighty percent (n=5) of patients treated with steroids for hearing loss demonstrated audiometric improvement, compared to 14.3% of patients (n=7) not treated. The pure tone average improved by 17.7dB in the steroid treated group. A prospective, placebo-controlled trial would need between 19 and 45 patients in each group, treatment versus no-treatment, to achieve statistical significance. CONCLUSION Patients with EVA who develop hearing loss have a high rate of hearing improvement when treated with corticosteroid therapy. The hearing improvement appears to be better than spontaneous recovery.
Collapse
Affiliation(s)
- Johannes Fredrik Grimmer
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | | | | |
Collapse
|
50
|
Kono T. Computed tomographic features of the bony canal of the cochlear nerve in pediatric patients with unilateral sensorineural hearing loss. ACTA ACUST UNITED AC 2008; 26:115-9. [DOI: 10.1007/s11604-007-0204-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|