101
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Westerhof JP, Rademaker J, Weber BP, Becker H. Congenital malformations of the inner ear and the vestibulocochlear nerve in children with sensorineural hearing loss: evaluation with CT and MRI. J Comput Assist Tomogr 2001; 25:719-26. [PMID: 11584231 DOI: 10.1097/00004728-200109000-00009] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this work was to study the diagnostic value of CT and MRI in children with sensorineural hearing loss and to analyze anatomic abnormalities of the inner ear and the vestibulocochlear nerve in this patient group. METHOD We evaluated 42 inner ears in 21 children with congenital deafness who had congenital inner ear malformations and who were candidates for cochlear implants. All patients were studied with high resolution MR and helical CT examinations. The MR study included a T2-weighted 3D fast SE sequence. We describe and tabulate the anatomic abnormalities. Special attention was given to abnormalities of the vestibulocochlear nerve. The field of view in the plane according to the length axis of the internal auditory canal (IAC) was 4 cm. Additional continuous parasagittal reformations perpendicular to the length axis of the IAC were studied with a field of view of 3 cm. RESULTS CT and MRI allowed accurate identification of malformations of the inner ear in children with congenital deafness. We identified 99 malformations, with a majority of patients demonstrating multiple abnormalities. Common imaging findings were Mondini abnormality and Mondini variants (12/42) and fusion of the lateral or superior semicircular canal with the vestibule (12/42). MRI demonstrated in 9 of 21 patients a rudimentary or absent vestibulocochlear nerve in the auditory canal. CONCLUSION CT and MRI are important modalities to analyze the inner ear in children who are candidates for cochlear implants. MRI with an extremely small field of view should be used to study possible abnormalities of the vestibulocochlear nerves. This may alter clinical care and allow cochlear implant placement in patients whose electrodiagnostic studies suggest that the implant should not be performed. The detailed analysis of abnormalities of the inner ear might establish prognostic factors.
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Affiliation(s)
- J P Westerhof
- Department of Radiology, Elkerliek Ziekenhuis, The Netherlands.
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102
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Kemperman MH, Stinckens C, Kumar S, Huygen PL, Joosten FB, Cremers CW. Progressive fluctuant hearing loss, enlarged vestibular aqueduct, and cochlear hypoplasia in branchio-oto-renal syndrome. Otol Neurotol 2001; 22:637-43. [PMID: 11568672 DOI: 10.1097/00129492-200109000-00014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study the results of petrosal bone imaging and audiometric long-term follow-up of two patients with branchio-oto-renal (BOR) syndrome and relate them to the clinical features, including caloric responses. STUDY DESIGN Longitudinal case study. SETTING Tertiary referral center. PATIENTS A father and son with the BOR syndrome. MAIN OUTCOME MEASURES Both patients underwent imaging studies to detect and evaluate inner ear anomalies. Longitudinal audiometric analysis of the hearing threshold data over the previous 23 years was performed. Caloric tests were performed at various ages. RESULTS The son had a short, wide internal acoustic canal, a hypoplastic cochlea, a plump vestibule, and a wide vestibular aqueduct on both sides; the semicircular canals and endolymphatic sac were of normal size. He showed progressive fluctuant sensorineural hearing loss. Caloric tests disclosed hyporeflexia on the left side. The father had a plump internal acoustic canal and hypoplastic cochlea on both sides. The left vestibule was hypoplastic, and the left vestibular aqueduct was marginally enlarged. He showed severe hearing impairment, without substantial progression or fluctuation, and caloric areflexia on the left side. CONCLUSION These findings suggest a correlation between progressive fluctuant sensorineural hearing loss with caloric hypofunction and the presence of an enlarged vestibular aqueduct in the BOR syndrome. Additional longitudinal case studies are needed to further evaluate such a correlation.
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Affiliation(s)
- M H Kemperman
- Department of Otorhinolaryngology, University Medical Center Nijmegen, The Netherlands
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103
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Fahy CP, Carney AS, Nikolopoulos TP, Ludman CN, Gibbin KP. Cochlear implantation in children with large vestibular aqueduct syndrome and a review of the syndrome. Int J Pediatr Otorhinolaryngol 2001; 59:207-15. [PMID: 11397503 DOI: 10.1016/s0165-5876(01)00487-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Children with Large Vestibular Aqueduct Syndrome (LVAS) frequently develop speech and language skills prior to deterioration of their hearing. Operations designed to halt the progression of hearing loss have largely failed so the question of Cochlear Implantation in these children has arisen. It had been suggested that there would be technical difficulties in implanting these patients and, therefore, there had been an initial reluctance to proceed to implantation. The aim of the present paper is to assess surgical and functional outcomes in implanted children with LVAS and review the related literature. MATERIAL AND METHODS From the 170 children assessed by MRI in the Nottingham Paediatric Cochlear Implant Programme, seven (4%) were identified as having LVAS. Four of these children were implanted and had at least 12 months follow up. Two of the children are on the waiting list for implantation and one child was not implanted because of absence of the cochlear nerve. Operative findings, complications and outcome measures were recorded. The auditory skills of the children were assessed before implantation and 1 year following implantation. A literature search was done to identify other series with experience in implanting children with LVAS. RESULTS Full insertion of the electrode array was achieved in all our cases. After cochleostomy two patients experienced a mild CSF leak that was easily controlled by the muscle graft. On the first day post-operation two patients were nauseous and one had an episode of vomiting, however, all were discharged within 24 h of surgery. Initial outcome measures at 12 months post-implantation were encouraging showing significant progress in children's auditory skills. CONCLUSIONS The results of the present study and the review of the literature suggest that LVAS is not a contraindication to implantation as initial concerns about severe perilymph leaks and surgical complications have proved to be unfounded. The post-operative progress of these children in listening skills also suggest that these children are suitable for cochlear implantation
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Affiliation(s)
- C P Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, Queen's Medical Centre, NG7-2UH, Nottingham, UK.
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104
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Abstract
Enlarged vestibular aqueduct syndrome is a clinical disease entity associated with anatomic abnormality of the bony canal in the temporal bone containing the endolymphatic duct and sac. The definition of this syndrome is progressive sensorineural hearing loss with an isolated enlarged vestibular aqueduct. Familial inheritance of enlarged vestibular aqueduct syndrome is rare, and the correct mode of inheritance has not been discovered. This report is the study of familial inheritance with enlarged vestibular aqueduct syndrome. Clinical audiological, radiographic, and chromosomal analyses were performed in this case, which reports on two female probands who are offspring of normal parents. According to the study of pedigree, familial inheritance of enlarged vestibular aqueduct syndrome is strongly suspected as an autosomal recessive trait. Further study should be focused on discovering the genetic evaluation of familial inheritance of enlarged vestibular aqueduct syndrome.
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Affiliation(s)
- E K Goh
- Department of Otolaryngology, College of Medicine, Pusan National University, Pusan, Korea
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105
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Abstract
The imaging evaluation of patients with sensorineural hearing loss (SNHL) focuses on the acoustic pathways from the cochlea to the auditory cortex. Magnetic resonance imaging (MRI) is the modality of choice for most patients with SNHL, though computed tomography (CT) also plays an important role in the evaluation of bony changes and in patients for whom MRI is contraindicated. Conventional enhanced MRI is the most commonly used technique in this clinical setting. High-resolution fast spin-echo T2 MRI is an adjunctive technique that provides exquisite evaluation of the cerebellopontine angle (CPA), internal auditory canal (IAC), cranial nerves, and membranous labyrinth, and plays a significant role in the diagnosis and surgical evaluation of SNHL. Categories of lesions that cause SNHL include brain lesions involving central auditory pathways; neoplasms of the CPA and IAC, the most common being schwannoma; other neoplastic, congenital, and cystic masses of the CPA and IAC; congenital anomalies of the inner ear; intrinsic cochlear nerve defects, inflammatory processes of the inner ear; and temporal bone trauma.
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Affiliation(s)
- H C Davidson
- VA Salt Lake City Health Care System, Department of Radiology, University of Utah Health Sciences Center, 84148, USA
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106
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107
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Abstract
This paper presents the second case in the literature of large vestibular aqueduct syndrome without associated cochlear anomalies in 2 members of the same family. The syndrome is frequently associated with sensorineural hearing loss presenting in childhood. The onset is commonly sudden, following an event causing increased intracranial pressure. On the basis of an emerging pattern of inheritance, we recommend screening siblings of an affected child. We also discuss the importance of characterizing the extent of disease of the inner ear.
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Affiliation(s)
- K C Nowak
- Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, California, USA
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108
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Govaerts PJ, Casselman J, Daemers K, De Ceulaer G, Somers T, Offeciers FE. Audiological findings in large vestibular aqueduct syndrome. Int J Pediatr Otorhinolaryngol 1999; 51:157-64. [PMID: 10628541 DOI: 10.1016/s0165-5876(99)00268-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An enlarged vestibular aqueduct is a congenital disorder causing early onset and progressive hearing loss in children. This paper presents the audiological findings at first presentation and the audiological evolution in 10 consecutive cases presenting with hearing loss and showing a large vestibular aqueduct on imaging. The reported onset of the hearing loss is within the first few years of life. Most of the cases (80%) showed bilateral involvement. The sex ratio was 1. Patients presented on average at age 5 with a median hearing loss of 62 dB at the speech frequencies. The hearing loss was essentially asymmetrical with an interaural difference, of 33 dB and it was a mixed type of hearing loss in 90% of the cases. The authors claim that the conductive component of this hearing loss is a pure cochlear conductive loss which may be pathognomonic for the disease. The presence of a conductive component in a child is easily misinterpreted as a middle ear ventilation problem or in case of good ventilation as an ossicular problem (type otosclerosis). In addition and in contrast to most literature data, the authors did not find evidence for stabilization of the hearing loss but they found a steady decrease of the hearing at an average rate of 4 dB/year.
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Affiliation(s)
- P J Govaerts
- University Department of Otolaryngology, St-Augustinus Hospital (University of Antwerp), Antwerp-Wilrijk, Belgium.
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109
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Yetiser S, Kertmen M, Ozkaptan Y. Vestibular disturbance in patients with large vestibular aqueduct syndrome (LVAS). Acta Otolaryngol 1999; 119:641-6. [PMID: 10586995 DOI: 10.1080/00016489950180568] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Large vestibular aqueduct syndrome (LVAS) is a common inner ear anomaly responsible for some unusual vestibular and audiological symptoms. The gross appearance of CT scan of the inner ear is generally normal. However, precise measurement of the inner ear components reveals abnormal dimensions, which may account for accompanying auditory or vestibular dysfunction. It has been reported that sudden increase in cerebrospinal fluid pressure can cause further deterioration of hearing due to transmission of pressure to the inner ear through the enlarged vestibular aqueduct. However, vestibular function is not often studied. In this report, audiovestibular function of 10 patients with large vestibular aqueducts was analysed and compared with the severity of the radiological deformity. The literature was reviewed and typical findings were discussed to emphasize varying aspects of audiovestibular function. It was found that some patients with LVAS have some spontaneous or provoked vestibular disturbance such as vertigo after watching revolving objects. The mean value of electronystagmographic abnormality in patients with hearing loss is greater than in patients with normal hearing. However, there is no statistical correlation between the level of hearing loss, electronystagmographic abnormality and severity of radiological deformity.
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Affiliation(s)
- S Yetiser
- Department of Otorhinolaryngology and Head anad Neck Surgery, Gulhane Medical School, Ankara, Turkey
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110
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Bamiou DE, Savy L, O'Mahoney C, Phelps P, Sirimanna T. Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management. Int J Pediatr Otorhinolaryngol 1999; 51:91-9. [PMID: 10619622 DOI: 10.1016/s0165-5876(99)00261-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to identify factors correlated with the CT outcome and to examine the contribution of the CT scan in the aetiological diagnosis and management of unilateral sensorineural hearing loss in childhood. METHODS The records of 35 consecutively investigated patients by the Audiology Department of Great Ormond Street Hospital between January 1996 and June 1998 were reviewed. The CT results, population sample characteristics, initiation of further investigations after the CT results and management decisions based on the CT results were tabulated and analysed. RESULTS In a series of 35 consecutively investigated children with unilateral sensorineural hearing loss, 11 CT scans were identified as abnormal. The CT findings were: labyrinthitis ossificans (3), unilaterally dilated vestibular aqueduct (2), bilaterally dilated vestibular aqueduct (2), unilateral deformity of the cochlea ('Mondini') (1), unilateral severe labyrinthine dysplasia (1), unilateral markedly narrow internal acoustic meatus (1), bilaterally dilated lateral semicircular canals (1). The presence of progressive hearing loss was a significant predictor of abnormal CT outcome, while the severity of hearing loss was not. The CT scans offered valuable information regarding the aetiological diagnosis in all cases and, in addition, prompted the appropriate vestibular rehabilitation in three cases, further investigations in four (with dilated vestibular aqueduct) and hearing preservation counselling in two (bilateral DVA) (seven out of 35 = 20%). CONCLUSION All children with unilateral sensorineural hearing loss should have a CT scan of the petrous pyramids/IAMs performed at some stage, as not only aetiology but also prognosis and management of these cases may be significantly influenced by the CT outcome.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Cochlea/abnormalities
- Cochlea/diagnostic imaging
- Decision Making
- Dilatation, Pathologic/complications
- Dilatation, Pathologic/diagnostic imaging
- Ear, Inner/abnormalities
- Ear, Inner/diagnostic imaging
- Female
- Forecasting
- Hearing Loss, Sensorineural/diagnostic imaging
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/therapy
- Humans
- Labyrinth Diseases/complications
- Labyrinth Diseases/diagnostic imaging
- Labyrinthitis/complications
- Labyrinthitis/diagnostic imaging
- Male
- Ossification, Heterotopic/complications
- Ossification, Heterotopic/diagnostic imaging
- Patient Care Planning
- Petrous Bone/diagnostic imaging
- Prognosis
- Retrospective Studies
- Semicircular Canals/diagnostic imaging
- Tomography, X-Ray Computed
- Vestibular Aqueduct/diagnostic imaging
- Vestibular Diseases/complications
- Vestibular Diseases/diagnostic imaging
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Affiliation(s)
- D E Bamiou
- Audiology Department, Great Ormond Street Hospital for Sick Children, London, UK.
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111
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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] [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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112
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Antonelli PJ, Varela AE, Mancuso AA. Diagnostic yield of high-resolution computed tomography for pediatric sensorineural hearing loss. Laryngoscope 1999; 109:1642-7. [PMID: 10522936 DOI: 10.1097/00005537-199910000-00018] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS In recent years, relatively subtle inner ear anomalies have become apparent using high-resolution computed tomography (CT). The purpose of this study was to determine the diagnostic yield of high-resolution CT for pediatric sensorineural hearing loss (HL) (SNHL). METHODS A review was performed on the records of all children (<18 y of age) who had undergone CT of the temporal bones over a 5-year period, since the introduction of current CT techniques. RESULTS Three hundred eighty-three studies were performed in 351 subjects. The indication for the CT was SNHL or mixed HL in 157 children. Forty-nine (31%) of these studies revealed significant inner ear findings. Large vestibular aqueducts (LVAs) were reported in 15%, commonly in association with cochlear modiolar deficiencies. Modiolar deficiencies (11%) and other cochlear dysplasias (12%) followed LVA in frequency. The incidence of inner ear dysplasia in children with perinatal or postnatal risk factors was only slightly lower than those without (22% vs. 32%, P > .05). The rate of dysplasias did not correlate with SNHL severity, pattern of HL, or type of HL (mixed vs. sensorineural). CONCLUSIONS These findings suggest that radiographic imaging has a relatively high diagnostic yield in children with SNHL. These findings may be of value in counseling patients and guiding the management of their SNHL.
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Affiliation(s)
- P J Antonelli
- Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.
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113
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Temple RH, Ramsden RT, Axon PR, Saeed SR. The large vestibular aqueduct syndrome: the role of cochlear implantation in its management. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 1999; 24:301-6. [PMID: 10472464 DOI: 10.1046/j.1365-2273.1999.00260.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years the large vestibular aqueduct syndrome has become an increasingly recognized cause of a progressive sensorineural hearing loss. Cochlear implantation, although not correcting the bony abnormality, does offer an avenue for rehabilitation for affected individuals and initial results are encouraging. Of 15 patients identified with the large vestibular aqueduct syndrome we have implanted seven (five adults and two children). All patients underwent an uneventful electrode insertion with uncomplicated postoperative periods. Three of our adult patients are showing very good initial results with BKB speech recognition scores of 100%, 74% and 66% with the implant alone. It is still early days with the children, but initial results are encouraging. A full review of the large vestibular aqueduct syndrome is given along with our results.
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Affiliation(s)
- R H Temple
- Department of Otolaryngology, Manchester Royal Infirmary, UK
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114
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Abstract
OBJECTIVES This report details our experience with cochlear implantation in children with both profound sensorineural HL (SNHL) and enlarged vestibular aqueducts (EVAs). It seeks to determine if the abnormal anatomy of EVA predisposes to any adverse events during or after cochlear implantation. STUDY DESIGN A retrospective review. METHODS Charts were reviewed for details of the procedure, complications, and audiologic outcome. RESULTS Between 8/25/93 and 9/16/98, 10 children with EVAs received cochlear implants, of whom 8 children (5 males, 3 females; mean age 7.8 y) had audiologic follow-up of at least 6 months. The implant was inserted without difficulty in all patients. Pulsatile clear fluid via the cochleostomy was observed in five patients, but was easily controlled in each instance. There have been no major complications, although two patient had short-lived postoperative vestibular symptoms and one child has experienced an intermittent pulsing sensation in her head. Speech perception measures were obtained using a battery of tests that assessed the children's ability to perceive speech in both open- and closed-set formats. Two patients were excluded because the implant was placed within the last 6 months. Of the remaining eight children identified with EVAs, seven (86%) demonstrated open-set word recognition. CONCLUSIONS These favorable results may be attributed in part to HL that occurs relatively late in childhood, allowing implantation in postlingual candidates. Cochlear implantation can be safely and effectively performed in children with SNHL associated with EVAs.
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Affiliation(s)
- J P Bent
- Lenox Hill Hospital, New York, New York, USA
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115
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Harker LA, Vanderheiden S, Veazey D, Gentile N, McCleary E. Multichannel cochlear implantation in children with large vestibular aqueduct syndrome. THE ANNALS OF OTOLOGY, RHINOLOGY & LARYNGOLOGY. SUPPLEMENT 1999; 177:39-43. [PMID: 10214800 DOI: 10.1177/00034894991080s409] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the postoperative performance of multichannel cochlear implantation in children with severe-to-profound sensorineural hearing loss secondary to large vestibular aqueduct syndrome. Five children between ages 4 and 13 years who had large vestibular aqueducts confirmed by computed tomography scans underwent implantation of a CLARION Multi-Strategy Cochlear Implant between January 1995 and June 1996 at Boys Town National Research Hospital. In addition to preoperative evaluations, they were examined postoperatively with their implants on a battery of open-set speech recognition tests at 3, 6, 12, and 18 months following initial stimulation. Results indicated a noticeable improvement in open-set speech recognition within the first 3 months of implant use compared to preimplant performance with hearing aids. All 5 patients demonstrated substantial benefit from their implants, but there was variation among the children in the rate and amount of improvement in speech recognition skills.
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Affiliation(s)
- L A Harker
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
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116
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Abe S, Usami SI, Hoover DM, Cohn E, Shinkawa H, Kimberling WJ. Fluctuating sensorineural hearing loss associated with enlarged vestibular aqueduct maps to 7q31, the region containing the pendred gene. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990212)82:4<322::aid-ajmg9>3.0.co;2-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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117
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Brookhouser PE, Beauchaine KL, Osberger MJ. Management of the child with sensorineural hearing loss. Medical, surgical, hearing aids, cochlear implants. Pediatr Clin North Am 1999; 46:121-41. [PMID: 10079795 DOI: 10.1016/s0031-3955(05)70086-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optimal comprehensive management of a child with SNHL involves constructive dialogue and coordination with the child's family and teachers. Not all children with SNHL benefit from conventional amplification, even after parents have invested significant amounts of money in hearing aids. Parents may encounter frustration and disappointment if their children fail to achieve communicative and academic goals they have established in their own mind. If the child is a potential candidate for cochlear implantation, this decision not only involves the risks (albeit modest) of surgery but also often a substantial financial commitment to help defray the cost of this sophisticated electronic device. The parents may encounter conflicting advice from friends and members of the adult deaf community about the benefit of cochlear implantation. Throughout the course of all of these difficult considerations, the health professionals caring for a child with hearing loss should be a source for information, guidance, and support to the family.
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118
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Tharpe AM, Bess FH. Minimal, progressive, and fluctuating hearing losses in children. Characteristics, identification, and management. Pediatr Clin North Am 1999; 46:65-78. [PMID: 10079790 DOI: 10.1016/s0031-3955(05)70081-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Referring to specific types of hearing loss as "minimal" or "mild" seems to imply that their effects are equally mild or negligible. A growing body of literature, however, supports the notion that such losses can have a significant impact on the communicative and educational development of young children. Although OME is considered a common childhood ailment, mounting evidence suggests that it is not always benign and may contribute to significant educational and communicative difficulties in some young children when accompanied by conductive hearing loss. Even very mild bilateral and unilateral SNHL seems to contribute to problems in the areas of social and emotional function, educational achievement, and communication in some children. Because these hearing losses are so mild, they may not be immediately recognized as the source of such difficulties. The purpose of this report is to heighten the general pediatrician's awareness of the significance of even very mild or minimal hearing losses in children. As the gatekeepers for children's health care, pediatricians are typically the primary recipients of parental expressions of concern and the initiators of evaluations or referrals to address such.
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Affiliation(s)
- A M Tharpe
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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119
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Manolis EN, Eavey RD, Cunningham MJ, Weber AL. Enlarged vestibular aqueduct as a marker for hearing loss in children. Clin Pediatr (Phila) 1998; 37:689-91. [PMID: 9825214 DOI: 10.1177/000992289803701108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E N Manolis
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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120
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Abe S, Usami S, Shinkawa H. Three familial cases of hearing loss associated with enlargement of the vestibular aqueduct. Ann Otol Rhinol Laryngol 1997; 106:1063-9. [PMID: 9415602 DOI: 10.1177/000348949710601210] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present report describes three familial cases of recessive hearing loss associated with enlargement of the vestibular aqueduct (EVA). Six siblings from three families showed EVA. The common characteristic of these patients was the presence of congenital, high-frequency, fluctuating sensorineural hearing loss. These cases suggest that EVA may be a useful discriminator between different types of recessive hearing loss.
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Affiliation(s)
- S Abe
- Department of Otorhinolaryngology, Hirosaki University School of Medicine, Japan
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121
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Phelps PD, Mahoney CF, Luxon LM. Large endolymphatic sac. A congenital deformity of the inner ear shown by magnetic resonance imaging. J Laryngol Otol 1997; 111:754-6. [PMID: 9327016 DOI: 10.1017/s0022215100138538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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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Woolley AL, Oser AB, Lusk RP, Bahadori RS. Preoperative temporal bone computed tomography scan and its use in evaluating the pediatric cochlear implant candidate. Laryngoscope 1997; 107:1100-6. [PMID: 9261015 DOI: 10.1097/00005537-199708000-00017] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Preoperative computed tomography (CT) scan evaluation of the temporal bones in cochlear implant candidates plays a crucial role in determining candidacy and the side of implantation. The CT scans allow the surgeon to carefully review the anatomy of the inner ear and mastoid cavity in order to predict any potential difficulties or complications that may be encountered during the implant insertion. We retrospectively reviewed 50 preoperative CT scans of the temporal bone in children who have been successfully implanted. In these scans, we assessed the degree of mastoid pneumatization, cochlear anatomy and patency, size of the vestibular aqueduct, cochlear aqueduct, and internal auditory canal. We analyzed our findings and measurements and compared our results with the degree of difficulty noted in the insertion of the implant, the number of electrodes inserted in each case, and the overall complication rate. From this radiographic review, we have created a checklist for cochlear implant surgeons in order to highlight key features that need to be recognized in the temporal bone scan in preoperative evaluation of cochlear implant candidates.
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Affiliation(s)
- A L Woolley
- Department of Surgery, University of Alabama at Birmingham, The Children's Hospital of Alabama, 35233, U.S.A
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Okumura T, Takahashi H, Honjo I, Takagi A, Azato R. Magnetic resonance imaging of patients with large vestibular aqueducts. Eur Arch Otorhinolaryngol 1996; 253:425-8. [PMID: 8891488 DOI: 10.1007/bf00168496] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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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125
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Griffith AJ, Arts A, Downs C, Innis JW, Shepard NT, Sheldon S, Gebarski SS. Familial large vestibular aqueduct syndrome. Laryngoscope 1996; 106:960-5. [PMID: 8699909 DOI: 10.1097/00005537-199608000-00009] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The large vestibular aqueduct syndrome (LVAS) is a distinct clinical entity characterized by stepwise progressive sensorineural hearing loss associated with isolated enlargement of the vestibular aqueduct. A correlative clinical, audiologic, vestibular, cytogenetic, and radiographic analysis of a family with inherited LVAS was performed. The male proband and his affected brother are offspring of unaffected parents, and have no other abnormalities. Pedigree analysis suggests autosomal recessive or X-linked inheritance with variable expressivity of LVAS in this family. This study is the first description of familial inheritance of LVAS. LVAS may account for a significant number of patients with nonsyndromal, genetic sensorineural hearing loss. Future molecular analyses of this study family may identify the causative gene(s) in LVAS.
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Affiliation(s)
- A J Griffith
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor., USA
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126
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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] [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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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] [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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Okumura T, Takahashi H, Honjo I, Takagi A, Mitamura K. Sensorineural hearing loss in patients with large vestibular aqueduct. Laryngoscope 1995; 105:289-93; discussion 293-4. [PMID: 7877418 DOI: 10.1288/00005537-199503000-00012] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In examining 181 patients (327 ears) with sensorineural hearing loss of unknown etiology and 25 people (50 ears) with normal hearing by high-resolution computed tomography (CT), the image of the large vestibular aqueduct (VA) was defined as being a visible large aperture (> or = 4 mm), and small distance between vestibule and traceable part of the VA nearest to the vestibule (> or = 1 mm). The large VA was found in 13 patients (23 ears, 7.0%); it was relatively frequent following hypoplastic cochlea (33 ears, 10.1%) in all the inner ear anomalies detected. In patients with large VA, high-frequency hearing was affected more than low frequency, and history of sudden hearing loss was observed frequently (61% of ears with large VA), which was found to be triggered by characteristic episodes such as minor head trauma, etc. Those clinical features were observed more in those without cochlear anomaly than in those accompanying cochlear anomaly. Pathogenesis of sensorineural hearing loss and characteristic fluctuation of hearing in those patients are discussed.
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Affiliation(s)
- T Okumura
- Department of Otolaryngology, Otsu Red Cross Hospital, Nagara, Japan
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129
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Okumura T, Takahashi H, Honjo I, Naito Y, Takagi A, Tuji J, Ito J. Vestibular function in patients with a large vestibular aqueduct. ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 1995; 520 Pt 2:323-6. [PMID: 8749153 DOI: 10.3109/00016489509125262] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Four patients (7 ears) with a large vestibular aqueduct (VA) were examined for history of vertigo and vestibular function. Vertigo was observed in all the 4 patients. The caloric responses were significantly poorer in ears with a large VA than in the controls. On a patient with a large VA who had several attacks of sudden hearing loss and vertigo following minor head trauma, long-time exposure to sunshine, common cold, and exercise, vestibular function tests were performed several times; the caloric responses were found to fluctuate and direction changing apogeotropic positional nystagmus was observed. These findings suggest that in patients with a large VA, not only hearing but also the vestibular function are generally impaired. We believe than direct transmission of intracranial pressure changes to the inner ear or subsequent inner ear fluid movement through the large endolymphatic sac and duct have an influence on the cochlea and vestibule.
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Affiliation(s)
- T Okumura
- Department of Otolaryngology, Kobe City General Hospital, Japan
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130
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Papadopoulos A, Vlahos L, Xenelis J, Papafragou C, Adamopoulos G. Value of Gd-DTPA-enhanced MR imaging of the labyrinth in patients with sudden hearing loss. Magn Reson Imaging 1995; 13:387-91. [PMID: 7791548 DOI: 10.1016/0730-725x(94)00131-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent reports describe labyrinthine enhancement on MRI as a highly specific sign of labyrinthine disease. This paper reports 44 patients with unilateral sensorineural hearing loss (SNHL) and laboratory evidence of cochlear damage investigated with Gd-enhanced MR imaging. Enhancement of the cochlea was observed in only one patient with a lesion at the fundus of the internal auditory canal (IAC) that extended into the cochlea after Gd-DTPA administration. In one more patient, MR imaging demonstrated large vestibular aqueducts as underlying cause for his hearing loss, but no enhancement of the labyrinth was observed. No abnormal signal intensity on precontrast MR scans nor pathologic enhancement of the membranous labyrinth were identified in the other 42 patients. Gd-enhanced MR imaging appears to be insensitive in demonstrating labyrinthine disease and normal examination findings in a patient with sudden SNHL cannot exclude damage at the cochlear level.
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Affiliation(s)
- A Papadopoulos
- Department of Radiology, Medical School of Athens University, Greece
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131
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Abstract
An abnormally large vestibular aqueduct has a well recognized association with inner ear anomalies and it has been assumed previously to be a variant of a Mondini type of deformity (Shuknecht, 1980; Emmett, 1985). The sole radiological finding in some patients with progressive sensorineural loss has been a large vestibular aqueduct (Valvassori and Clemis, 1978; Valvassori, 1983), which is now accepted as a separate clinical entity, i.e. the large vestibular aqueduct syndrome (LVAS). A case is presented which is believed to be the first reported with unilateral LVAS and stapes fixation and also the first stapes gusher described in association with LVAS.
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Affiliation(s)
- A Shirazi
- Department of Otology and Neuro-Otology, St Vincents Hospital, Darlinghurst, Sydney, Australia
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132
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Meyerhoff WL, Cass S, Schwaber MK, Sculerati N, Slattery WH. Progressive sensorineural hearing loss in children. Otolaryngol Head Neck Surg 1994; 110:569-79. [PMID: 8208575 DOI: 10.1177/019459989411000617] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- W L Meyerhoff
- University of Texas Southwestern Medical Center, Department of Otolaryngology, Dallas 75235-9025
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134
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Belenky WM, Madgy DN, Leider JS, Becker CJ, Hotaling AJ. The Enlarged Vestibular Aqueduct Syndrome (EVA Syndrome). EAR, NOSE & THROAT JOURNAL 1993. [DOI: 10.1177/014556139307201113] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The presentation to the Department of Pediatric Otolaryngology at the Children's Hospital of Michigan of a series of patients with sensorineural hearing loss and enlargement of the vestibular aqueduct prompted exploratory tympanotomy in three patients (two unilateral and one bilateral), for a total of four ears. These explorations were prompted by progression and/or fluctuation of hearing levels. The discovery of abnormal round windows in all four ears with a post-traumatic fistula present in one ear suggested the presence of a new association. A previously undescribed association of an enlarged vestibular aqueduct, sensorineural hearing loss and round window abnormality with potential fistula formation was identified. A review of the anatomy and physiology, literature review, and a prospective analysis with discussion of eight patients with enlarged vestibular aqueduct syndrome evaluated and treated at Children's Hospital of Michigan, is presented. We conclude that all children with sensorineural hearing loss should undergo extensive evaluation to determine etiology, including radiographic studies of the temporal bone. Further, the presence of an enlarged vestibular aqueduct should prompt the otolaryngologist to consider the presence of a round window abnormality and the potential for predisposition to perilymph fistula.
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Affiliation(s)
- Walter M. Belenky
- From the Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan
| | - David N. Madgy
- From the Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan
| | - Jeffrey S. Leider
- From the Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan
| | | | - Andrew J. Hotaling
- From the Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan
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135
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Abstract
Enlargement of the cochlear aqueduct (CA) is often mentioned in the otologic literature, usually in its purported association with sensory hearing loss, stapes gusher, and transotic cerebrospinal fluid leak. In CT scans of 100 ears, the diameter of the CA medial aperture was found to be highly variable, ranging from 0 to 11 mm, with a mean of 4.5 mm. In contrast, the otic capsule segment was very narrow in every case. It could be visualized in only 56% of cases, none of which exceeded 2 mm in diameter. Several published reports of supposed CA enlargement presented images of a dilated medial aperture that was well within the range of normal variability according to the present study. In a thorough review of the literature on radiology of the CA, we were unable to find a single published image that convincingly demonstrated enlargement of the otic capsule portion. As radiographic CA enlargement has not been convincingly reported to date, it appears to be an exceedingly rare or perhaps even nonexistent malformation. It is important to recognize than even a radiographically normal CA may be hyperpatent. It is theoretically possible for increased fluid flow to result from either deficiencies in intraluminal membrane baffles or subtle canal enlargement beneath the resolution limits of CT scanning. However, as fluid flow through a tube is regulated by its narrowest point, it is extremely improbable that stapes gusher, transotic CSF leak, and vigorous perilymphatic fistula are generated by the CA when CT scans show any portion of it to be very narrow. A substantial body of evidence points to a deficient partition between the internal auditory canal and inner ear as causative in such cases. We propose that the criteria for the diagnosis of CA enlargement on high-resolution CT scan be a diameter exceeding 2 mm throughout its course from the posterior fossa to the vestibule.
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Affiliation(s)
- R K Jackler
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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136
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Abstract
The authors emphasize the importance of early identification and early intervention concerning the management of children with Sensorineural Hearing Loss. The pediatrician plays a critical role in initiating the necessary clinical and audiological evaluations. Guidelines and treatment options are reviewed.
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Affiliation(s)
- S Epstein
- George Washington University School of Medicine, Washington, DC
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