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Connor SEJ, Dudau C, Pai I, Gaganasiou M. Is CT or MRI the optimal imaging investigation for the diagnosis of large vestibular aqueduct syndrome and large endolymphatic sac anomaly? Eur Arch Otorhinolaryngol 2019; 276:693-702. [PMID: 30635710 PMCID: PMC6411674 DOI: 10.1007/s00405-019-05279-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/02/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE We explored whether there was a difference between measurements obtained with CT and MRI for the diagnosis of large vestibular aqueduct syndrome or large endolymphatic sac anomaly, and whether this influenced diagnosis on the basis of previously published threshold values (Valvassori and Cincinnati). We also investigated whether isolated dilated extra-osseous endolymphatic sac occurred on MRI. Secondary objectives were to compare inter-observer reproducibility for the measurements, and to investigate any mismatch between the diagnoses using the different criteria. MATERIALS/METHODS Subjects diagnosed with large vestibular aqueduct syndrome or large endolymphatic sac anomalies were retrospectively analysed. For subjects with both CT and MRI available (n = 58), two independent observers measured the midpoint and operculum widths. For subjects with MRI (± CT) available (n = 84), extra-osseous sac widths were also measured. Results There was no significant difference between the width measurements obtained with CT versus MRI. CT alone diagnosed large vestibular aqueduct syndrome or large endolymphatic sac anomalies in 2/58 (Valvassori) and 4/58 (Cincinnati), whilst MRI alone diagnosed them in 2/58 (Valvassori). There was 93% CT/MRI diagnostic agreement using both criteria. Only 1/84 demonstrated isolated extra-osseous endolymphatic sac dilatation. The MRI-based LVAS/LESA diagnosis was less dependent on which criteria were used. Midpoint measurements are more reproducible between observers and between CT/MR imaging modalities. CONCLUSION Supplementing MRI with CT results in additional diagnoses using either criterion, however, there is no net increased diagnostic sensitivity for CT versus MRI when applying the Valvassori criteria. Isolated enlargement of the extra-osseous endolymphatic sac is rare.
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Affiliation(s)
- S E J Connor
- School of Biomedical Engineering and Imaging Sciences Clinical Academic Group, King's College, London, UK.
- Department of Radiology, Guy's and St. Thomas' Hospital, London, UK.
- Department of Neuroradiology, Ruskin Wing, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - C Dudau
- Department of Radiology, Guy's and St. Thomas' Hospital, London, UK
- Department of Neuroradiology, Ruskin Wing, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - I Pai
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, UK
| | - M Gaganasiou
- 251 General and VA Air Force Hospital, Athens, Greece
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Abstract
AbstractObjective:The objective of this study was to identify a pattern of signs, symptoms and neuroradiological findings which would assist investigation of vestibular function (especially otolith function) in a group of adult patients with anatomical alterations of the endolymphatic aqueduct and sac.Methods:Fifteen subjects affected by volumetric abnormalities of the vestibular aqueduct were selected from a cohort of patients referred to a tertiary referral neurotological centre between 1 January 2004 and 30 June 2006. All patients underwent accurate clinical history-taking and were evaluated using a standardised set of bedside and instrumental neurotological tests (i.e. audiometry, auditory brainstem response and vestibular evoked myogenic potentials). After these tests, each patient underwent computed tomography and magnetic resonance imaging in order to accurately evaluate the middle ear, labyrinthine capsule and internal auditory canals. These evaluations confirmed clinical suspicion of volumetric abnormalities of the vestibular aqueduct and endolymphatic sac.Results:All the patients with a defined volumetric alteration in the region of the vestibular aqueduct and endolympatic sac reported a typical pattern of symptoms and signs. The most obvious and frequent symptoms in these patients were migraine-related vertigo (using the Neuhauser criteria, 10 of 15, 66.6 per cent), ‘motion sickness’ (12 of 15, 80 per cent), oscillopsia (nine of 15, 60 per cent) and dizziness (14 of 15, 93.3 per cent). Clinical examination results for the selected patients allowed some useful speculative conclusions. During neurotological evaluation, two instrumental methodologies were especially useful diagnostically: vestibular evoked myogenic potentials of the neck, and the mastoid vibration test at 100 Hz.Conclusions:Dysfunction of the vestibular aqueduct is suggested by symptomatology characterised by: migraine-related vertigo, unstable or recurring oscillopsia, lowering of the vestibular evoked myogenic potential threshold, hypoacusis, anamnestic report of motion sickness, and nystagmus induced by mastoid vibration and head-shaking. Computed tomography and magnetic resonance imaging are needed in order to confirm clinical suspicions.
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Affiliation(s)
- L Manzari
- Department of Experimental Medicine and Pathology, La Sapienza University, Rome, Italy.
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Legeais M, Haguenoer K, Cottier JP, Sirinelli D. Can a fixed measure serve as a pertinent diagnostic criterion for large vestibular aqueduct in children? Pediatr Radiol 2006; 36:1037-42. [PMID: 16865391 DOI: 10.1007/s00247-006-0263-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 05/16/2006] [Accepted: 06/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND A vestibular aqueduct midpoint width greater than 1.50 mm is currently considered to be pathognomonic for a large vestibular aqueduct syndrome. OBJECTIVE To analyse the diameter of the vestibular aqueduct in children as a function of age and consequently to determine if a fixed measure could serve as a pertinent diagnostic criterion. MATERIALS AND METHODS This was a retrospective study of 200 high-resolution CT scans of the ear in 100 patients aged 0-16 years and from various paediatric medical departments. On each CT scan, the lateral semicircular canal diameter, the vestibular aqueduct midpoint width between the external aperture and common crus, and the vestibular aqueduct external aperture diameter were measured. Spearman's rank test and the Mann-Whitney correlation test were used for an integrated statistical analysis. RESULTS There was no statistically significant variability in vestibular aqueduct diameter as a function of age or sex of patients. CONCLUSION A CT scan threshold value, fixed and independent of age and sex, is thus legitimate for the diagnosis of vestibular aqueduct dilatation.
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Affiliation(s)
- Marc Legeais
- Department of Neuroradiology, CHU de TOURS, 2 Boulevard Tonnelé, 37044, Tours cedex, France.
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Abstract
Patients with a large vestibular aqueduct (LVA) suffer from a loss of hearing in childhood at an early onset. An acute loss of hearing can be precipitated by minor head trauma. Until now there seems to be no sufficient therapy for stopping the progression of a loss of hearing. It has been shown that a cochlear implantation is a worthwhile procedure if the patient is almost deaf. We report the case of a patient with a bilateral LVA. A loss of hearing was confirmed at the age of 16 months. Exposure to loud noise triggered an acute progression of the hearing loss. At the age of 18 years, LVA was confirmed radiologically, revealing an enlarged endolymphatic duct and sac in MRI scans and an enlarged vestibular aqueduct in the CT scan. We successfully performed a cochlear implant (MED-EL, Combi 40+ flex). Proceeding from this case report, the paper reviews the literature on LVA.
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Affiliation(s)
- Silke Steinbach
- Department of Otolaryngology-Head and Neck Surgery, Klinikum rechts der Isar, Munich, Germany
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Koesling S, Rasinski C, Amaya B. Imaging and clinical findings in large endolymphatic duct and sac syndrome. Eur J Radiol 2005; 57:54-62. [PMID: 16289429 DOI: 10.1016/j.ejrad.2005.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 09/20/2005] [Accepted: 09/23/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Large endolymphatic duct and sac syndrome (LEDS) is known as the most common kind of inner ear malformations, which is radiologically detectable. Nevertheless, nowadays many questions are not fully cleared and LEDS is relatively unknown among general radiologists. The aim of this study was to evaluate the incidence of LEDS in the own patient population and to present our experiences regarding imaging findings, clinical presentation and follow up. MATERIALS AND METHODS Based on a complete recording of all patients, sent from ENT department to radiology, we identified all radiological diagnosed cases of inner ear malformations including LEDS and all patients in whom an inner ear malformation was clinically suspected. The retrospective study included clinical records, HR-CT and MRI performed between 1994 and 2002. RESULTS Among 169 patients (338 ear), 17 of patients (median age: 12 years) and 28 ears, respectively, had enlarged endolymphatic structures. In 10 patients - 6% - (15 ears), no other abnormalities were detected, called isolated LEDS, seven patients showed additional inner ear abnormalities. One patient showed a labyrinthine hemorrhage after sudden hearing loss. Audiometric data revealed sensorineural hearing loss in 22 ears, deafness in 5 ears and normal hearing in 1 case of 28 ears. In 10 (67%) of 15 ears with isolated LEDS, the hearing loss was downward-fluctuating progressive. Twelve patients (eight with isolated LEDS) had partly repeated sudden hearing losses. A trigger for worsening of hearing was found in five patients. A correlation between the severity of morphological changes on imaging and the degree of hearing disturbances could not be detected. Only four young patients underwent a radiological examination within the first or second year after onset of hearing loss. Three patients received a cochlear implant. CONCLUSIONS LEDS might be the cause of progressive hearing loss and repeated acute hearing losses in children and young adults. Imaging plays an important role in making the diagnosis.
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Abstract
CONCLUSIONS Hearing loss and equilibrium dysfunction have different etiologies in patients with large vestibular aqueduct syndrome. We suggest that all children with distal renal tubular acidosis (dRTA) should be subjected to an equilibrium study and audiological evaluation, as well as to a CT or MRI scan. OBJECTIVE dRTA has been described in association with sensorineural hearing loss, but there are no reported cases that have been examined in detail using audiological and equilibrium studies. We report here a case of progressive sensorineural hearing loss with a large vestibular aqueduct and dRTA, and the results of audiological and equilibrium studies. MATERIAL AND METHODS A 31-year-old female presented with hearing loss, tinnitus and vertigo. She had been treated with oral sodium citrate, potassium citrate and potassium chloride supplementation because of dRTA since the age of 1 month. RESULTS The pure-tone audiogram of the patient was off the scale for the right ear and showed progressive sensorineural hearing loss for the left ear. Ice-water caloric testing showed canal paresis on the left side. Temporal bone CT and inner ear MRI revealed a large vestibular aqueduct and a large endolymphatic sac on both sides.
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Affiliation(s)
- Yukiko Shinjo
- Department of Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Naganawa S, Koshikawa T, Fukatsu H, Ishigaki T, Sato E, Sugiura M, Yoshino T, Nakashima T. Enlarged endolymphatic duct and sac syndrome: relationship between MR findings and genotype of mutation in pendred syndrome gene. Magn Reson Imaging 2004; 22:25-30. [PMID: 14972391 DOI: 10.1016/j.mri.2003.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2003] [Revised: 07/21/2003] [Accepted: 07/22/2003] [Indexed: 11/18/2022]
Abstract
Pendred syndrome (PDS) is characterized by profound deafness in childhood, positive perchlorate challenge, and goiter. PDS is often associated with enlarged endolymphatic duct and sac (EEDS), and recently, PDS gene mutations have been reported even in those patients with EEDS without classic Pendred syndrome. In a previous report, the number of mutant alleles was correlated with the degree of subclinical thyroid abnormality, but not with hearing loss, in patients with missense mutation H723R. It also has been reported that the hearing loss in EEDS was not correlated with the EEDS volume, cochlear modiolar area, or signal intensity of the endolymphatic sac. We evaluated the correlations between the number of mutant alleles and these parameters in patients with EEDS to investigate the mechanisms underlying this condition. The study group was comprised of 16 Japanese patients with EEDS diagnosed by MR imaging. The H723R mutation was homozygous in six patients and heterozygous in six patients, with no mutation found in four patients. The modiolar area, EEDS volume, and signal intensity ratio (sac signal/cerebrospinal fluid signal) were not significantly correlated with the number of mutant alleles. PDS gene mutations may not be the only cause of EEDS, and the mechanisms underlying EEDS remain unclear.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University School of Medicine, Nagoya, Japan.
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Naganawa S, Koshikawa T, Fukatsu H, Ishigaki T, Nakashima T. Serial MR imaging studies in enlarged endolymphatic duct and sac syndrome. Eur Radiol 2002; 12 Suppl 3:S114-7. [PMID: 12522618 DOI: 10.1007/s00330-002-1525-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2002] [Revised: 04/23/2002] [Accepted: 05/02/2002] [Indexed: 11/25/2022]
Abstract
Large vestibular aqueduct syndrome (LVAS) is a congenital disorder characterized by progressive or fluctuating sensorineural hearing loss of unknown etiology. Serial MR examinations were performed before and after the development of hearing loss in two patients with LVAS. The signal and volume of the enlarged endolymphatic sac (EES) vary even in ears with stable hearing. In ears with fluctuating hearing, changes in EES signals were observed in only one of two patients. The finding that the EES volume and signal intensity vary dynamically independently of hearing is important for future research into the pathophysiology of hearing loss in this syndrome.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 466-8550, Japan.
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Abstract
This report describes the case history of two male siblings with sensorineural hearing loss and an enlarged vestibular aqueduct (EVA). Sibling 1 presented with a history of intermittent self-limiting ataxia and hearing loss at the age of 25 months and sibling 2 presented with a similar history at the age of 18 months. MRI showed an enlarged endolymphatic duct and sac bilaterally in both children. Perchlorate discharge tests were positive in both infants leading to a diagnosis of Pendred syndrome. A number of conditions associated with EVA are discussed with a view to devising management strategies.
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Naganawa S, Koshikawa T, Iwayama E, Fukatsu H, Ishiguchi T, Ishigaki T, Ikeda M, Nakashima T, Ichinose N. MR imaging of the enlarged endolymphatic duct and sac syndrome by use of a 3D fast asymmetric spin-echo sequence: volume and signal-intensity measurement of the endolymphatic duct and sac and area measurement of the cochlear modiolus. AJNR Am J Neuroradiol 2000; 21:1664-9. [PMID: 11039347 PMCID: PMC8174870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND PURPOSE In enlarged endolymphatic duct (EED) and sac (EES) syndrome, deformity of the EED and EES is congenital; however, hearing loss is acquired. To investigate the pathophysiology of progressive sensorineural hearing loss in EED and EES syndrome, we measured the volume of the EED and EES, the diameter of the EED and EES, the area of the cochlear modiolus, and the signal intensity of the EES and compared our findings against degree of hearing loss. METHODS Thin-section MR images of 33 ears in 17 patients with EED and EES syndrome were studied. All studies were obtained on a 1.5-T MR unit using a quadrature surface phased-array coil. Heavily T2-weighted 3D fast asymmetric spin-echo images were obtained with a voxel size of 0.3 x 0.3 x 0.8 mm without zero-fill interpolation. Two radiologists traced the areas of the EED and EES manually, and the volume was calculated. The area of the cochlear modiolus, diameter of the EED and EES, and signal intensity of the EES were also measured by drawing regions of interest manually. The signal intensity ratio of EES/CSF was calculated. These measured values were compared against audiographic data, and the degree of linear correlation was determined. RESULTS The volume of the EED and EES, the area of the modiolus, the diameter of the EED and EES, and the signal intensity of the EES did not show significant correlation with degree of hearing loss. CONCLUSION These findings suggest that there is a microscopic area of damage or fragility in the inner ear not visible even with thin-section heavily T2-weighted MR imaging.
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Affiliation(s)
- S Naganawa
- Department of Radiology, Nagoya University School of Medicine, Japan
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Naganawa S, Ito T, Iwayama E, Fukatsu H, Ishigaki T, Nakashima T, Ichinose N. MR imaging of the cochlear modiolus: area measurement in healthy subjects and in patients with a large endolymphatic duct and sac. Radiology 1999; 213:819-23. [PMID: 10580960 DOI: 10.1148/radiology.213.3.r99dc05819] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the cochlear modiolus with thin-section magnetic resonance (MR) imaging in healthy subjects and patients with a large endolymphatic duct and sac, and to assess whether the cochlea is normal or abnormal in patients with a large endolymphatic duct and sac. MATERIALS AND METHODS MR images were obtained in 10 ears in five volunteers (group 1), 40 ears in 20 patients with bilateral sensory hearing loss (group 2), three ears in two patients with Mondini malformation (group 3), and 12 ears in seven patients with a large endolymphatic duct and sac (group 4). RESULTS In groups 1 and 2, all modiolar areas were larger than 4.0 mm2. In group 3, each modiolus was smaller than 2.0 mm2. In group 4, modiolar areas were smaller than 2.0 mm2 in eight ears and were larger than 4.0 mm2 in four ears. CONCLUSION Findings in this study confirm that a large endolymphatic duct and sac is frequently associated with modiolar deficiency, but the modiolar area is normal in some cases. This result does not support the recently proposed hypothesis that hearing loss with a large endolymphatic duct and sac is caused by the transmission of subarachnoid pressure forces into the labyrinth through a deficient modiolus.
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Affiliation(s)
- S Naganawa
- Department of Radiology, Nagoya University School of Medicine, Japan
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Davidson HC, Harnsberger HR, Lemmerling MM, Mancuso AA, White DK, Tong KA, Dahlen RT, Shelton C. MR evaluation of vestibulocochlear anomalies associated with large endolymphatic duct and sac. AJNR Am J Neuroradiol 1999; 20:1435-41. [PMID: 10512225 PMCID: PMC7657744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE Large endolymphatic duct and sac (LEDS) is one of the most common anomalies seen in patients with congenital sensorineural hearing loss (SNHL), and is known to occur with other inner ear findings. Our purpose was to use high-resolution T2-weighted fast spin-echo (FSE) MR imaging to describe the features and prevalence of specific anomalies that occur in association with LEDS. METHODS We retrospectively reviewed MR images of the inner ear obtained in 63 patients with LEDS and in 60 control subjects. We evaluated each image for features of cochlear and vestibular dysplasia, including deficiency of the cochlear modiolus, gross cochlear dysmorphism, asymmetry of the cochlear scalar chambers, enlargement of the membranous vestibule, gross vestibular dysmorphism, and abnormality of the semicircular canals (SCC). RESULTS Cochlear anomalies were present in 76% of ears with LEDS. Modiolar deficiency, gross dysmorphism, and scalar asymmetry were seen in 94%, 71%, and 65% of abnormal cochleas, respectively. Vestibular abnormalities were present in 40% of ears with LEDS. Simple enlargement, gross dysmorphism, and distortion of the lateral SCC were seen in 84%, 16%, and 32% of abnormal vestibules, respectively. CONCLUSION Coexistent cochlear anomalies, vestibular anomalies, or both are present in most ears with LEDS, and appear as a spectrum of lesions, ranging from subtle dymorphism to overt dysplasia. The presence of coexistent anomalies in LEDS affects treatment decisions and prognosis. Newer techniques of high-resolution FSE MR imaging provide a means of exquisite characterization of LEDS, as well as more sensitive detection of associated vestibulocochlear anomalies.
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Affiliation(s)
- H C Davidson
- Department of Radiology, 1A 71 Medical Center, University of Utah, Salt Lake City 84132, USA
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Lo WW. What is a 'Mondini' and what difference does a name make? AJNR Am J Neuroradiol 1999; 20:1442-4. [PMID: 10512226 PMCID: PMC7657761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- W W Lo
- St Vincent Medical Center, Los Angeles, CA 90057, USA
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Tan TY. Large endolymphatic duct and sac syndrome--a case report. Singapore Med J 1999; 40:359-61. [PMID: 10489497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 17-year-old girl with a history of hearing loss, presented with recurrent episodes of vomiting. CT scan revealed bilateral enlarged vestibular aqueducts and MR scanning confirmed the diagnosis of large endolymphatic duct and sac syndrome. This article looks into the anatomy and physiology of the endolymphatic duct and sac as well as possible explanations for the hearing loss associated with this syndrome.
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Affiliation(s)
- T Y Tan
- Department of Radiology, Changi General Hospital, Singapore
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Welling DB, Slater PW, Martyn MD, Antonelli PJ, Gantz BJ, Luxford WM, Shelton C. Sensorineural hearing loss after occlusion of the enlarged vestibular aqueduct. Am J Otol 1999; 20:338-43. [PMID: 10337975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study aimed to report the hearing results of endolymphatic sac occlusion in patients with enlarged vestibular aqueduct syndrome. STUDY DESIGN The study design was a multiinstitutional retrospective case series. SETTING The study was conducted at tertiary otologic referral centers. PATIENTS The study included 10 previously unreported patients with progressive sensorineural hearing loss and vestibular aqueducts greater than 1.5 mm in diameter on computerized tomography. INTERVENTION Occlusion of the enlarged vestibular aqueduct was performed by means of a transmastoid surgical approach. Either intraluminal endolymphatic sac obliteration (five patients) or extraluminal extradural endolymphatic sac obliteration (five patients) was accomplished with temporalis fascia. MAIN OUTCOME MEASURES The postoperative pure tone average (PTA) and speech discrimination scores were compared with the preoperative levels using conventional audiometry. RESULTS Nine of 10 patients experienced some degree of sensorineural hearing loss. The median change in PTA was a loss of 21 decibels (dB), and 50% of the patients experienced a sensorineural hearing loss greater than 25 dB. Postoperative change in PTA ranged from +10 dB to -59 dB. The median change in speech discrimination score was a loss of 27.5%. Only one patient had an improvement in both speech discrimination score and pure tone averages after surgery. Patients who underwent extraluminal occlusion had a median PTA loss of 12 dB, and patients who underwent open sac occlusion had a median PTA loss of 34 dB. These were not statistically different. CONCLUSION In this series of 10 patients, 5 had a greater than 25 dB decrease in hearing after occlusion of the enlarged vestibular aqueduct. Surgical occlusion of the enlarged vestibular aqueduct showed no significant benefit in hearing preservation. The otologic surgeon is alerted to the potential for severe sensiorineural hearing loss after occlusion of the enlarged vestibular aqueduct.
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Affiliation(s)
- D B Welling
- Department of Otolaryngology, The Ohio State University, Columbus, USA
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Abstract
Fluctuant and progressive hearing impairment in a patient with a wide vestibular aqueduct has been called the 'large vestibular aqueduct syndrome'. Recently reports of magnetic resonance imaging (MRI) studies describe enlargement of the endolymphatic sac and duct in patients shown to have large vestibular aqueducts by computed tomography (CT). A patient with progressive deafness was shown to have borderline or slightly enlarged vestibular aqueducts by re-formatted sagittal CT. However, MRI in axial and sagittal planes gave a more satisfactory demonstration of both aqueduct and endolymphatic sac enlargement.
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Affiliation(s)
- P D Phelps
- Department of Radiology, Royal National Throat, Nose and Ear Hospital, London, UK
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Okamoto K, Ito J, Furusawa T, Sakai K, Tokiguchi S. Large vestibular aqueduct syndrome with high CT density and high MR signal intensity. AJNR Am J Neuroradiol 1997; 18:482-4. [PMID: 9090407 PMCID: PMC8338408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of large vestibular aqueduct syndrome with a markedly dilated endolymphatic sac bilaterally. The density and signal intensity of the extraosseous portion of the sac were higher than those of cerebrospinal fluid on CT and MR studies. The findings may represent protein-rich and hyperosmolar fluid within the endolymphatic sac.
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Affiliation(s)
- K Okamoto
- Department of Radiology, School of Medicine, Niigata University, Japan
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Dahlen RT, Harnsberger HR, Gray SD, Shelton C, Allen R, Parkin JL, Scalzo D. Overlapping thin-section fast spin-echo MR of the large vestibular aqueduct syndrome. AJNR Am J Neuroradiol 1997; 18:67-75. [PMID: 9010522 PMCID: PMC8337878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate a high-resolution, thin-section fast spin-echo MR imaging technique of the inner ear to identify the large vestibular aqueduct syndrome seen on temporal bone CT scans. METHODS We retrospectively reviewed the temporal bone CT scans of 21 patients with hearing loss and enlarged bony vestibular aqueducts by CT criteria. High-resolution fast spin-echo MR imaging was then performed on these patients using dual 3-inch phased-array receiver coils fixed in a temporomandibular joint holder and centered over the temporal bones. MR imaging included axial and oblique sagittal fast spin-echo sequences. The diameter of the midvestibular aqueduct on CT scans and the signal at the level of the midaqueduct on MR images were measured on axial sequences, then compared. High-resolution MR imaging with the same protocol was performed in 44 control subjects with normal ears, and similar measurements were taken. RESULTS The average size of the enlarged bony vestibular aqueduct on CT scans was 3.7 mm, and the average width of the signal from within the enlarged aqueduct on MR images was 3.8 mm. Statistical analysis showed excellent correlation. MR images alone displayed the enlarged extraosseous endolymphatic sac, which accompanies the enlarged aqueduct in this syndrome. Five ears in three patients with enlarged bony vestibular aqueducts on CT scans showed no evidence of an enlarged endolymphatic duct or sac on MR images. An enlarged endolymphatic sac was seen on MR images in one patient with a bony vestibular aqueduct, which had normal measurements on CT scans. MR imaging alone identified a single case of mild cochlear dysplasia (Mondini malformation). In the 88 normal ears studied, the average size of the endolymphatic sac at its midpoint between the common crus and the external aperture measured on MR images was 0.8 mm (range, 0.5 to 1.4 mm). In 25% of the normal ears, no signal was seen from within the vestibular aqueduct. CONCLUSION Thin-section, high-resolution fast spin-echo MR imaging of the inner ear is complementary to CT in studying patients with the large vestibular aqueduct syndrome, as MR imaging better displays the soft tissue and fluid of the membranous labyrinth.
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Affiliation(s)
- R T Dahlen
- Department of Radiology, University of Utah Health Sciences Center, Salt Lake City 84132, USA
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Abstract
The vestibular aqueduct (VA) and endolymphatic sac (ES) were examined by magnetic resonance imaging in eight patients (14 ears) with large VAs, and the results were compared with those obtained in five normal volunteers (10 ears). It was not possible to identify either the VA or ES in any of the control ears. However, in all the 14 ears with a large VA, the VA was detected as a fluid-filled structure. In 12 ears the ES was seen to be markedly enlarged and also filled with fluid. In one ear, the volume of the fluid-filled space within the VA and ES was measured as 912 mm3 on serial images. Five patients (ten ears) were observed to have a fluid-filled VA and enlarged ES without cochlear anomalies and reported frequent episodes of sudden hearing loss and vertigo following exercise, long exposure to sunshine, minor trauma and the like. Two other patients (three ears) also had enlarged VA and ES as well as cochlear anomalies, but did not have episodes of sudden hearing loss and vertigo. These findings suggest that direct transmission of intracranial pressure changes to the inner ear or subsequent movement of endolymph in patients with a large VA may adversely influence a seemingly normal cochlea and vestibule.
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Affiliation(s)
- T Okumura
- Department of Otolaryngology, Kobe City General Hospital, Japan
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22
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Casselman JW, Kuhweide R, Ampe W, D'Hont G, Offeciers EF, Faes WK, Pattyn G. Inner ear malformations in patients with sensorineural hearing loss: detection with gradient-echo (3DFT-CISS) MRI. Neuroradiology 1996; 38:278-86. [PMID: 8741202 DOI: 10.1007/bf00596549] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The sensitivity of different MRI sequences in the detection of inner ear malformations in patients presenting with sensorineural hearing loss (SNHL) and/or vertigo was evaluated. We studied 650 patients presenting with SNHL and/or vertigo, clinically not suspected of having inner ear malformations. The sensitivity of T1-weighted, Gd-enhanced T1-weighted and (when available) T2-weighted spin-echo images, and three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) gradient-echo images, to unexpected malformations was assessed. Inner ear malformations were found in 15 (2.3%) of these patients. Enlargement of the endolymphatic duct and sac was the most frequent malformation, found in 11 patients. The 3DFT-CISS images showed all lesions; the other sequences were less sensitive and the pathology was missed, partially or only retrospectively seen in 11 of the 15 patients. Therefore, in addition to the routine unenhanced and Gd-enhanced T1-weighted and T2-weighted images, thin gradient-echo (3DFT-CISS) images are necessary to detect all clinically unexpected inner ear malformations in patients presenting with vertigo and/or SNHL.
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Affiliation(s)
- J W Casselman
- Department of Radiology, A. Z. St.-Jan Brugge, Belgium
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23
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Harnsberger HR, Dahlen RT, Shelton C, Gray SD, Parkin JL. Advanced techniques in magnetic resonance imaging in the evaluation of the large endolymphatic duct and sac syndrome. Laryngoscope 1995; 105:1037-42. [PMID: 7564831 DOI: 10.1288/00005537-199510000-00005] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this report is to compare temporal bone computed tomography (CT) to high-resolution magnetic resonance (MR) imaging using a novel thin-section fast spin echo (FSE) pulse sequence in identifying and characterizing patients with large vestibular aqueduct syndrome. Sixteen patients with sensorineural hearing loss and a CT diagnosis of large vestibular aqueduct(s) underwent high-resolution fast spin echo magnetic resonance imaging with dual, 3-in phased array receiver coils centered over the external auditory canals. Magnetic resonance imaging parameters included axial and oblique sagittal fast spin echo with an effective slice thickness of 1 mm contiguous. Thirty-eight patients with 76 normal inner ears who underwent MR imaging using this technique had their endolymphatic duct measured. MR alone identified the enlarged endolymphatic sac seen along with the large endolymphatic duct in all cases. Three cases (five inner ears) with enlarged bony vestibular aqueducts on CT showed no evidence of endolymphatic duct or sac enlargement on MR. MR alone identified a single case of mild cochlear anomaly in conjunction with an enlarged endolymphatic duct and sac. In the normal population the size of the normal endolymphatic duct at its midpoint measured from 0.1 to 1.4 mm. Thin-section, high-resolution fast spin echo MR imaging of the inner ear may be superior to CT in the evaluation of patients with the large vestibular aqueduct syndrome.
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Affiliation(s)
- H R Harnsberger
- Department of Radiology, University of Utah Health Sciences Center, Salt Lake City 84132, USA
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24
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Abstract
Three dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging (MRI) allows a detailed visualization of the membranous labyrinth of the inner ear. In this study the endolymphatic duct and sac is investigated in patients with Menière's disease using 3DFT-CISS MRI. In addition, the distance between the vertical part of the posterior semicircular canal and the fossa posterior is quantified.
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Affiliation(s)
- F W Albers
- Department of Otorhinolaryngology, University Hospital, Groningen, The Netherlands
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25
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Abstract
The Mondini deformity of the inner ear is usually associated with a large vestibular aqueduct and endolymphatic sac. The authors present a case with a hypoplastic sac and endolymphatic hydrops, which are presumed to be the cause of the Meniere's syndrome symptoms that occurred in mid-life.
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Affiliation(s)
- A A Hamed
- House Ear Institute, University of Southern California School of Medicine, Los Angeles
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26
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Abstract
A patient with bilateral Menière's disease who had progressive hearing loss and intractable vertigo was treated at ages 60 and 62 with parenteral streptomycin to ablate vestibular function, and at age 74 by a left endolymphatic shunt procedure. He was confined to a wheelchair because of ataxia from age 75 until the time of his death at age 81. Both temporal bones show congenitally hypoplastic endolymphatic sacs and severe endolymphatic hydrops consistent with Meniere's disease. There was atrophy of the striae vasculares and loss of cochlear neurons consistent with presbycusis. A loss of hair cells in the cristae and saccules was consistent with streptomycin ototoxicity. In the left ear the Silastic strip that was intended to function as an endolymphatic shunt into the mastoid lies encased in fibrous tissue and failed by 4.5 mm to reach the hypoplastic endolymphatic sac.
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Affiliation(s)
- U Khetarpal
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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27
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Abstract
The temporal bones of a newborn infant with hydantoin syndrome showed multiple middle ear and inner ear anomalies. There was a constellation of bony and membranous defects involving the oval and round windows, cochlear ducts, cochlear aqueducts, endolymphatic ducts and sacs, and vestibular labyrinths. To the authors' knowledge, supernumerary vestibular sensory epithelial structures and an inner ear epidermoid cyst have not been previously reported. Wide communications between the subarachnoid space and inner ear were of surgical relevance.
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28
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Arenberg IK. Abnormalities, congenital anomalies, and unusual anatomic variations of the endolymphatic sac and vestibular aqueduct: clinical, surgical, and radiographic correlations. Group 3, 4, and 5 abnormalities. Am J Otol 1982; 3:221-40. [PMID: 7055236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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29
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Arenberg IK. Abnormalities, congenital anomalies and unusual anatomic variations of the endolymphatic sac and vestibular aqueduct: clinical surgical, and radiographic correlations. Am J Otol 1981; 2:368-86. [PMID: 6973283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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30
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Arenberg IK. Abnormalities, congenital anomalies and unusual anatomic variations of the endolymphatic sac and vestibular aqueduct: clinical, surgical, and radiographic correlations. Group I abnormalities. Am J Otol 1981; 2:248-68. [PMID: 6974502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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Arenberg IK. Abnormalities, congenital anomalies, and unusual anatomic variations of the endolymphatic sac and vestibular aqueduct: clinical, surgical, and radiographic correlations. Am J Otol 1980; 2:118-49. [PMID: 7011045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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