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Luo W, Zhu H, Chen L, Shi K, Hou X, Sun J, Sun J, Guo X. Electrically evoked auditory brainstem responses in deaf children with cochlear nerve canal stenosis. Acta Otolaryngol 2024; 144:130-135. [PMID: 38634540 DOI: 10.1080/00016489.2024.2333785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Deaf children with cochlear nerve canal stenosis (CNCs) are always considered poor candidates for cochlear implantation. OBJECTIVES To investigate the function of the peripheral auditory pathway in deaf children with CNCs, as revealed by the electrically evoked auditory brainstem response (EABR), and postoperative cochlear implants (CIs) outcomes. MATERIALS AND METHODS Thirteen children with CNCs and 13 children with no inner ear malformations (IEMs) who received CIs were recruited. The EABR evoked by electrical stimulation from the CI electrode was recorded. Postoperative CI outcomes were assessed using Categories of Auditory Performance (CAP) and Speech Intelligibility Rate (SIR). RESULTS Compared with children with no IEMs, children with CNCs showed lower EABR extraction rates, higher thresholds, a longer wave V (eV) latency and lower CAP and SIR scores. The auditory and speech performance was positively correlated with the diameter of the cochlear nerve canal and the number of channels showing wave III (eIII) and eV in children with CNCs. CONCLUSIONS AND SIGNIFICANCE The physiological function of the peripheral auditory pathway in children with CNCs is poorer than that in children with no IEMs. Postoperative auditory and speech abilities may depend on the severity of cochlear nerve malformation and auditory conduction function.
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Affiliation(s)
- Wenyun Luo
- Wannan Medical College, Wuhu, Anhui, China
| | - Hanyu Zhu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Kai Shi
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaoyan Hou
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jingwu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jiaqiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaotao Guo
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Robson CD, Lewis M, D'Arco F. Non-Syndromic Sensorineural Hearing Loss in Children. Neuroimaging Clin N Am 2023; 33:531-542. [PMID: 37741656 DOI: 10.1016/j.nic.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Pediatric hearing loss is common with significant consequences in terms of language, communication, social and emotional development, and academic advancement. Radiological imaging provides useful information regarding hearing loss etiology, prognosis, therapeutic options, and potential surgical pitfalls. This review provides an overview of temporal bone imaging protocols, an outline of the classification of inner ear anomalies associated with sensorineural hearing loss and illustrates some of the more frequently encountered and/or important causes of non-syndromic hearing loss.
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Affiliation(s)
- Caroline D Robson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.
| | - Martin Lewis
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Talaat M, Hamad AH, AbdelSalam M, Sadek AA, Tantawy R, Osman NM. The effect of bony cochlear nerve canal (BCNC) diameter on the degree of sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2023; 166:111483. [PMID: 36774737 DOI: 10.1016/j.ijporl.2023.111483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE This study investigated the correlation between the diameter of the bony cochlear nerve canal (BCNC), as determined by Temporal bone CT, and MRI findings of cochlear nerves (CN) in children with sensorineural hearing loss (SNHL). MATERIALS AND METHODS A prospective study design was followed. Radiological data (Temporal bone CT and MRI) of fifty children with sensorineural hearing loss (age <18 y) were included in the study. All patients (100 ears) underwent routine MRI protocol in addition to 3D CISS (3-D constructive interference in steady state). RESULTS Based on CT findings, the BCNC was classified according to its diameter into three groups; group 1 (<1.4 mm), group 2 (1.4-2.0 mm), and group 3 (>2.0 mm). A significant difference between the three groups at degrees of SNHL (p < 0.001) was observed. Significant difference (p < 0.001) was also observed in the mean level of pure tone audiometry (PTA) average in group 1 compared to group 2. The CN was absent in 20 ears of group 1 CT results (29%), CN hypoplasia was noticed in 40 ears of group 1 CT (58%). However, CN was present in 9 ears of group 1 CT (13%), while in group 2 and 3, CN was present in 100% of the cases (27, and 4 ears, respectively, p < 0.001). CONCLUSIONS MRI and CT imaging are valuable in the diagnosis of SNHL in children. Moreover, with BCNC stenosis, there was a high probability of CN aplasia or hypoplasia.
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Affiliation(s)
- Mostafa Talaat
- Department of Otorhinolaryngology, Minia University, Egypt.
| | | | | | | | - Ranan Tantawy
- Department of Otorhinolaryngology, Minia University, Egypt
| | - Nasr M Osman
- Department of Radiology, Minia University, Egypt
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Liang W, Wang L, Zheng W, Han S, Peng KA. Heterozygous MYH9 Mutations in 2 Children With Cochlear Nerve Canal Stenosis. EAR, NOSE & THROAT JOURNAL 2022:1455613221135644. [PMID: 36282680 DOI: 10.1177/01455613221135644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
MYH9 is a gene that encodes for a subunit of the myosin heavy chain IIA protein. Mutations in MYH9 are associated with hematologic abnormalities, renal dysfunction, and hearing loss. Bony cochlear nerve canal stenosis (CNCS), which is diagnosed on computed tomography (CT) imaging, has been associated with congenital deafness, cochlear nerve aplasia/hypoplasia, and inner ear malformations. We report two cases of CNCS presenting with profound congenital hearing loss whom we diagnosed with mutations in MYH9 and discuss the genotype-phenotype association and implications for management.
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Affiliation(s)
- Wenqi Liang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Line Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenrui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuguang Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kevin A Peng
- House Clinic and House Institute Foundation, Los Angeles, CA, USA
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吴 海, 李 同. [Cochlear nerve canal stenosis: a review of recent research]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:643-647. [PMID: 35959587 PMCID: PMC10128201 DOI: 10.13201/j.issn.2096-7993.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 06/15/2023]
Abstract
Some patients with severe-profound sensorineural hearing loss (SNHL) with normal cochlear anatomical structure received cochlear implantation (CI) and the hearing and speech rehabilitation effect was not ideal. Through retrospective analysis, it was found that some of these patients had cochlear never canal (CNC) stenosis, or atresia in severe cases.This article reviews the development of the CNC, the diagnostic criteria of CNC stenosis and the results of hearing and speech rehabilitation in these patients after CI.
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Affiliation(s)
- 海娟 吴
- 山西医科大学第五临床医学院(太原,030001)The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China
| | - 同丽 李
- 山西医科大学第五医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Fifth Hospital of Shanxi Medical University
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Alburaiky S, Taylor J, O'Grady G, Thomson G, Perry D, England EM, Yap P. Cochlear nerve deficiency in SOX11-related Coffin-Siris syndrome. Am J Med Genet A 2022; 188:2460-2465. [PMID: 35642566 DOI: 10.1002/ajmg.a.62851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022]
Abstract
The phenotypic spectrum of SOX11-related Coffin-Siris syndrome (CSS) is expanding with reports of new associations. SOX11 is implicated in neurogenesis and inner ear development. Cochlear nerve deficiency, absence or hypoplasia, is commonly associated with cochlear canal stenosis or with CHARGE syndrome, a monogenic condition that affects inner ear development. SOX11 is a transcription factor essential for neuronal identity, highly correlated with the expression of CHD7, which regulates SOX11. We present two unrelated probands, each with novel de novo SOX11 likely pathogenic variants and phenotypic manifestations of CSS including global developmental delay, growth deficiency, and hypoplastic nails. They have unilateral sensorineural hearing loss due to cochlear nerve deficiency confirmed on MRI. SOX11 is implicated in sensory neuron survival and maturation. It is highly expressed in the developing inner ear. Homozygous ablation of SOX11 in a mouse model resulted in a reduction in sensory neuron survival and decreased axonal growth. A heterozygous knockout mice model had hearing impairment with grossly normal inner ear structures like the two probands reported. We propose cochlear nerve deficiency as a new phenotypic feature of SOX11-related CSS. Magnetic resonance imaging is useful in delineating the cochlear nerve deficiency and other CSS-related brain malformations.
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Affiliation(s)
- Salam Alburaiky
- Genetic Health Service New Zealand-Northern Hub, Auckland, New Zealand
| | - Juliet Taylor
- Genetic Health Service New Zealand-Northern Hub, Auckland, New Zealand
| | - Gina O'Grady
- Department of Paediatric Neurology, Starship Children's Hospital, Auckland, New Zealand
| | - Glen Thomson
- Department of Paediatric Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - David Perry
- Department of Paediatric Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - Eleina M England
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Patrick Yap
- Genetic Health Service New Zealand-Northern Hub, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Vos TG, Park LR, Noxon AS, Brown KD. Cochlear Nerve Deficiency in Pediatric Unilateral Hearing Loss and Asymmetric Hearing Loss. Audiol Neurootol 2022; 27:328-335. [PMID: 35344959 DOI: 10.1159/000522566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The rates of cochlear nerve abnormalities and cochlear malformations in pediatric unilateral hearing loss (UHL) are conflicting in the literature, with important implications on management. The aim of this study was to investigate the incidence of cochlear nerve deficiency (CND) in pediatric subjects with UHL or asymmetric hearing loss (AHL). METHODS A retrospective chart review of pediatric subjects <18 years of age evaluated for UHL or AHL with fine-cut heavily T2-weighted magnetic resonance imaging (MRI) between January 2014 and October 2019 (n = 291) at a tertiary referral center was conducted. MRI brain and computed tomography temporal bone were reviewed for the presence of inner ear malformations and/or CND. Status of the ipsilateral cochlear nerve and inner ear was evaluated. Pure tone average (PTA) at 500, 1,000 and 2,000 Hz was assessed. RESULTS 204 subjects with UHL and 87 subjects with AHL were included. CND (aplasia or hypoplasia) was demonstrated in 61 pediatric subjects with UHL (29.9%) and 10 with AHL (11.5%). Ipsilateral cochlear malformations were noted in 25 subjects with UHL (12.3%) and 11 with AHL (12.6%), and ipsilateral vestibular malformations in 23 (11.3%) and 12 (13.8%) ears, respectively. Median PTA was statistically significantly higher in ears with CND (98.33) than ears with normal nerves (90.84). DISCUSSION/CONCLUSION Imaging demonstrated a high incidence of inner ear malformations, particularly CND, in pediatric subjects with UHL. Auditory findings indicated CND cannot be ruled out by thresholds alone as some CND ears did demonstrate measurable hearing. Radiologic evaluation by MRI should be performed in all patients within this population to guide counseling and management of hearing loss based on etiology, with implications on candidacy for cochlear implantation.
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Affiliation(s)
- Teresa G Vos
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa R Park
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy S Noxon
- Division of Speech & Hearing Sciences, Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin D Brown
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Pao J, D’Arco F, Clement E, Picariello S, Moonis G, Robson C, Juliano A. Re-Examining the Cochlea in Branchio-Oto-Renal Syndrome: Genotype-Phenotype Correlation. AJNR Am J Neuroradiol 2022; 43:309-314. [PMID: 35058298 PMCID: PMC8985666 DOI: 10.3174/ajnr.a7396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Temporal bone imaging plays an important role in the work-up of branchio-oto-renal syndrome. Previous reports have suggested that the unwound or offset cochlea is a highly characteristic marker for branchio-oto-renal syndrome. Our goals were to examine the prevalence of this finding in a branchio-oto-renal syndrome cohort and analyze genetic-phenotypic associations not previously established. MATERIALS AND METHODS This multicenter retrospective study included 38 ears in 19 unrelated individuals with clinically diagnosed branchio-oto-renal syndrome and confirmed mutations in the EYA1 or SIX1 genes. Two blinded neuroradiologists independently reviewed and documented temporal bone imaging findings in 13 categories for each ear. Imaging phenotypes were correlated with genotypes. RESULTS There was excellent interrater agreement for all 13 phenotypic categories (κ ≥ 0.80). Of these, 9 categories showed statistically significant differences between patients with EYA1-branchio-oto-renal syndrome and SIX1-branchio-oto-renal syndrome. Cochlear offset was present in 100% of patients with EYA1-branchio-oto-renal syndrome, but in only 1 ear (12.5%) among patients with SIX1-branchio-oto-renal syndrome. A short thorny appearance of the cochlear apical turn was observed in most patients with SIX1-branchio-oto-renal syndrome. CONCLUSIONS An offset cochlea is associated with the EYA1-branchio-oto-renal syndrome genotype. The SIX1-branchio-oto-renal syndrome genotype is associated with a different cochlear phenotype that almost always is without offset and has a short thorny tip as the apical turn. Therefore, cochlear offset is not a characteristic marker for all patients with branchio-oto-renal syndrome. The lack of a cochlear offset in a patient with clinically suspected branchio-oto-renal syndrome does not exclude the diagnosis and, in fact, may be predictive of the SIX1 genotype.
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Affiliation(s)
- J. Pao
- From the Department of Radiology (J.P.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - E. Clement
- Department of Clinical Genetics (E.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S. Picariello
- Department of Women, Child and General and Specialized Surgery (S.P.), University of Campania “Luigi Vanvitelli,” Naples, Italy,Department of Paediatric Oncology (S.P.), Neuro-Oncology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - G. Moonis
- Department of Radiology (G.M.), Columbia University Irving Medical Center, New York, New York
| | - C.D. Robson
- Department of Radiology (C.D.R.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - A.F. Juliano
- Department of Radiology (A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Surgical Outcomes With Cochlear Implantation in Patients With Enlarged Cochlear Aperture: A Systematic Review. Otol Neurotol 2021; 42:638-645. [PMID: 33492060 DOI: 10.1097/mao.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate surgical outcomes in patients with enlarged cochlear aperture (ECA) after cochlear implantation. DATABASES REVIEWED PubMed, EMBASE, and Scopus. METHODS A systematic review was performed using standardized methodology. Studies were included if they included subjects with ECA who underwent cochlear implantation. Exclusion criteria included non-English articles, abstracts, letters/commentaries, case reports, and reviews. Bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. RESULTS Out of 1,688 identified articles, 7 articles representing 23 subjects with ECA were included. Publication rates increased between the period of study from 2009 to 2018. Four studies were level 4 evidence and three studies were level 3 evidence. In total, 20 subjects underwent cochlear implantation. Cerebrospinal fluid gushers were encountered in the majority of cases that reported complications (16/17, 94.1%); one patient developed postoperative meningitis, and another experienced postimplantation facial nerve stimulation. No study provided measurements on cochlear aperture size or defined size criteria used to identify ECA. Four studies recognized X-linked deafness to be associated with ECA, and the most common mutation was in POU3F4 gene. CONCLUSION An association exists between ECA and cerebrospinal fluid gusher, underscoring the importance of reviewing preoperative imaging. Size criteria are not well defined, and there is a paucity of data with respect to normative measurements. Many cases of ECA may give a genetic link. Although level of evidence of current studies remains modest, ECA reports have increased and will likely continue to expand with advancements in imaging and genetic testing.
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Cochlear nerve canal stenosis and associated semicircular canal abnormalities in paediatric sensorineural hearing loss: a single centre study. The Journal of Laryngology & Otology 2020; 134:603-609. [PMID: 32713375 DOI: 10.1017/s0022215120001334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between cochlear nerve canal dimensions and semicircular canal abnormalities and to determine the distribution of bony labyrinth anomalies in patients with cochlear nerve canal stenosis. METHOD This was a retrospective study in which high-resolution computed tomography images of paediatric patients with severe-to-profound sensorineural hearing loss were reviewed. A cochlear nerve canal diameter of 1.5 mm or less in the axial plane was classified as stenotic. Semicircular canals and other bony labyrinth morphology and abnormality were evaluated. RESULTS Cochlear nerve canal stenosis was detected in 65 out of 265 ears (24 per cent). Of the 65 ears, 17 ears had abnormal semicircular canals (26 per cent). Significant correlation was demonstrated between cochlear nerve canal stenosis and semicircular canal abnormalities (p < 0.01). Incomplete partition type II was the most common accompanying abnormality of cochlear nerve canal stenosis (15 out of 65, 23 per cent). CONCLUSION Cochlear nerve canal stenosis is statistically associated with semicircular canal abnormalities. Whenever a cochlear nerve canal stenosis is present in a patient with sensorineural hearing loss, the semicircular canal should be scrutinised for presence of abnormalities.
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Abstract
OBJECTIVES Perilymphatic gusher (PLG) is an uncommon complication of stapedectomy and cochlear implant placement. Computerized tomography (CT) may reveal congenital dysplasia responsible for PLG but may also be (incorrectly) interpreted as normal. The aim of this study was to review CT findings in patients with PLG reported to have normal temporal bones. PATIENTS Patients in which a PLG was encountered and preoperative CT imaging had been interpreted as normal. INTERVENTION Collaborative review of temporal bone computed tomography by neurotologist and neuroradiologist. MAIN OUTCOME MEASURE Identification of undetected inner ear anomalies that may predispose to PLG. RESULTS Unanticipated PLG was encountered during stapes surgery in two patients and cochlear implantation in one. A focal bony dehiscence between the basal turn of the cochlea and internal auditory canal (IAC) was identified on a few oblique reformatted images in all patients. CONCLUSIONS High resolution CT with oblique image reformatting is essential to identify focal communication between the IAC and basal turn of the cochlea in ears with PLG.
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12
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Error in Data Reporting. JAMA Otolaryngol Head Neck Surg 2019; 145:1083. [DOI: 10.1001/jamaoto.2019.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wang DT, Ramakrishnaiah R, Kanfi A. Sensorineural Hearing Loss Through the Ages. Semin Roentgenol 2019; 54:207-214. [PMID: 31376862 DOI: 10.1053/j.ro.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David T Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH; Department of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Raghu Ramakrishnaiah
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Alisa Kanfi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH; Department of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH
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Vilchez-Madrigal LD, Blaser SI, Wolter NE, James AL, Papsin BC, Gordon KA, Cushing SL, Propst EJ. Children with unilateral cochlear nerve canal stenosis have bilateral cochleovestibular anomalies. Laryngoscope 2018; 129:2403-2408. [PMID: 30353559 DOI: 10.1002/lary.27559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/18/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the cochleovestibular apparatus bilaterally in children with isolated unilateral bony cochlear nerve canal (bCNC) stenosis. STUDY DESIGN Retrospective review. METHODS Imaging studies of children with unilateral bCNC stenosis (<1.0 mm) on computed tomography imaging (N = 36) were compared with controls imaged due to trauma without temporal bone injury (N = 32). Twenty-six measurements were obtained in each ear, assessing the bony internal auditory canal (IAC), cochlea, and vestibular end-organs, and were analyzed using one-way analysis of variance for intersubject comparisons and paired t tests for intrasubject comparisons with a Bonferroni adjustment for multiple comparisons (P = .0006). RESULTS Patients with bCNC stenosis had a smaller IAC (P < .000) and cochlea (P < .000) on the stenotic side as compared with controls. Although the vestibular end-organ was also smaller in bCNC ears, this difference was not significant. The contralateral ear also had a smaller bCNC (P < .000) and cochlea (P < .000) as compared with controls, although to a lesser degree than the stenotic side. CONCLUSIONS Children with unilateral bCNC stenosis have abnormal biometry of both the cochlea and the vestibular end-organ in the affected and the normal contralateral ear as compared with controls. LEVEL OF EVIDENCE 3b Laryngoscope, 129:2403-2408, 2019.
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Affiliation(s)
- Luis D Vilchez-Madrigal
- Department of Otolaryngology-Head and Neck Surgery, National Children's Hospital, San Jose, Costa Rica
| | - Susan I Blaser
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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15
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Wang Z, Liu Y, Wang L, Shen X, Han S, Wang W, Gao F, Liang W, Peng KA. Characteristics of electrically evoked auditory brainstem responses in patients with cochlear nerve canal stenosis receiving cochlear implants. Int J Pediatr Otorhinolaryngol 2018; 104:98-103. [PMID: 29287891 DOI: 10.1016/j.ijporl.2017.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the characteristics of the electrically evoked auditory brainstem responses (EABR) in children with cochlear nerve canal stenosis (CNCs) following cochlear implantation (CI), and the EABR thresholds in children with stenotic versus normal cochlear nerve canals. METHOD Sixteen children with profound sensorineural hearing loss were included in this study: 8 with CNCs (CNCs group) and 8 with normal cochlear nerve canals (control group). All children underwent cochlear implantation with full insertion of all electrodes. EABR was performed 6 months postoperatively in both groups. RESULTS The EABR extraction rate was 100% in children with normal cochlear nerve canals and only 50% in children with CNCs. EABR thresholds were significantly higher in children with CNCs of electrodes No. 11and 22 than in children with normal cochlear nerve canals (P < 0.05 for both comparisons). There was no significant difference in EABR thresholds among electrode No. 1, 11 and 22 in CNCs group (P > 0.05 for all comparisons); while in the control group, the EABR threshold at electrode No 22 was lower than those at both electrodes No. 11 and 1 (P < 0.05 for both comparisons), and the EABR threshold at electrode No. 11 was also lower than that at electrode No. 1 (P < 0.05). CONCLUSION The EABR thresholds in children with normal cochlear nerve canals vary according to the different locations of electrodes in the cochlea; while in children with CNCs, there was no significant difference among different electrode locations. The EABR thresholds in CNCs children were higher than those of children with normal cochlear nerve canals at electrode 11 and 22.
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Affiliation(s)
- Zhenxiao Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yun Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Line Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Xixi Shen
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Shuguang Han
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fenqi Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wenqi Liang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Kevin A Peng
- House Clinic, 2100 W 3rd St. Suite 111, Los Angeles, CA 90057, USA
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Sokolov M, Cushing SL, Polonenko M, Blaser SI, Papsin BC, Gordon KA. Clinical Characteristics of Children With Single-Sided Deafness Presenting for Candidacy Assessment for Unilateral Cochlear Implantation. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Morphologically congenital sensorineural hearing loss can be investigated under two categories. The majority of congenital hearing loss causes (80%) are membranous malformations. Here, the pathology involves inner ear hair cells. There is no gross bony abnormality and, therefore, in these cases high-resolution computerized tomography and magnetic resonance imaging of the temporal bone reveal normal findings. The remaining 20% have various malformations involving the bony labyrinth and, therefore, can be radiologically demonstrated by computerized tomography and magnetic resonance imaging. The latter group involves surgical challenges as well as problems in decision-making. Some cases may be managed by a hearing aid, others need cochlear implantation, and some cases are candidates for an auditory brainstem implantation (ABI). During cochlear implantation, there may be facial nerve abnormalities, cerebrospinal fluid leakage, electrode misplacement or difficulty in finding the cochlea itself. During surgery for inner ear malformations, the surgeon must be ready to modify the surgical approach or choose special electrodes for surgery. In the present review article, inner ear malformations are classified according to the differences observed in the cochlea. Hearing and language outcomes after various implantation methods are closely related to the status of the cochlear nerve, and a practical classification of the cochlear nerve deficiency is also provided.
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Affiliation(s)
- Levent Sennaroğlu
- Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Münir Demir Bajin
- Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
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18
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Han S, Wang L, Zhang D, Peng K. Neural Response Telemetry Thresholds in Patients with Cochlear Nerve Canal Stenosis. Otolaryngol Head Neck Surg 2015; 153:447-51. [PMID: 26138606 DOI: 10.1177/0194599815592365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
Objective To explore neural response telemetry (NRT) thresholds in patients with stenotic versus normal cochlear nerve canals. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Thirty pediatric patients with profound sensorineural hearing loss in at least 1 ear and no benefit from amplification underwent computed tomography imaging of the temporal bones. They were divided into 3 groups according to the diameter of the cochlear nerve canal: group A, <1.5 mm; group B, 1.5 to 1.7 mm; group C, 1.8 to 2.1 mm. All patients underwent cochlear implantation with full insertion of all electrodes. NRT was performed both intraoperatively and 6 months postoperatively in all patients; thresholds of electrodes 1, 11, and 22 were compared. Results Per analysis of variance, intraoperative and 6-month postoperative NRT thresholds were both significantly different among groups A, B, and C at electrodes 1 and 22 but not at electrode 11. On intergroup analysis, group A showed statistically higher thresholds than those of groups B and C; however, no difference was found between groups B and C. Conclusion Cochlear nerve canal stenosis, defined as a canal diameter <1.5 mm, is associated with significantly increased NRT thresholds, which may play a role in postimplant performance.
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Affiliation(s)
- Shuguang Han
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Line Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Daoxing Zhang
- Department of Otorhinolaryngology–Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kevin Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Purcell PL, Iwata AJ, Phillips GS, Paladin AM, Sie KCY, Horn DL. Bony cochlear nerve canal stenosis and speech discrimination in pediatric unilateral hearing loss. Laryngoscope 2015; 125:1691-6. [PMID: 25878020 DOI: 10.1002/lary.25087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine the relationship between bony cochlear nerve canal (BCNC) width, degree of hearing loss, and speech discrimination in children with unilateral sensorineural hearing loss (USNHL). STUDY DESIGN Retrospective chart review (case-control study). METHODS Audiometric database was cross-referenced with radiologic database at pediatric tertiary care facility to identify children with USNHL and temporal bone computed tomography. BCNC widths were measured independently by two radiologists blinded to affected ear. Regression analyses investigated associations among variables. RESULTS One hundred and sixty children with USNHL had temporal bone imaging. Mean BCNC width was significantly smaller in affected ears, P = 0.0001. Narrower width was associated with more severe hearing loss, P = 0.01. Among children who had narrower cochlear nerve canals in affected ears compared to unaffected ears, smaller width was associated with lower speech discrimination score, P = 0.03. Increasing asymmetry in BCNC width between affected and unaffected ears was associated with poorer discrimination scores, P = 0.02. Among ears with asymmetrically smaller cochlear nerve canals, a 1-mm reduction in cochlear canal width between the normal and affected ear was associated with 30.4% lower word recognition score percentage in the affected ear, P = < 0.001. CONCLUSION There is a significant association between BCNC stenosis and impaired speech discrimination, independent of degree of hearing loss. Further investigation is needed to determine whether BCNC stenosis is a poor prognostic factor for auditory rehabilitation.
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Affiliation(s)
- Patricia L Purcell
- Department of Otolaryngology, University Of Washington, Seattle, Washington
| | - Ayaka J Iwata
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Grace S Phillips
- Department of Radiology, University Of Washington, Seattle, Washington
| | | | - Kathleen C Y Sie
- Department of Otolaryngology, University Of Washington, Seattle, Washington.,Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington
| | - David L Horn
- Department of Otolaryngology, University Of Washington, Seattle, Washington.,Department of Speech and Hearing Sciences, University Of Washington, Seattle, Washington.,Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington
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Kachniarz B, Chen JX, Gilani S, Shin JJ. Diagnostic yield of MRI for pediatric hearing loss: a systematic review. Otolaryngol Head Neck Surg 2014; 152:5-22. [PMID: 25389321 DOI: 10.1177/0194599814555837] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform a systematic review to analyze the diagnostic yield of magnetic resonance imaging (MRI) for pediatric hearing loss, including comparison to computed tomography (CT) and subgroup evaluation according to impairment severity and specific diagnostic findings (cochlear anomalies, enlarged vestibular aqueduct, cochlear nerve abnormalities, and brain findings). DATA SOURCES Pubmed, EMBASE, and the Cochrane library were assessed from their inception through December 2013. Manual searches were also performed, and topic experts were contacted. REVIEW METHODS Data from studies describing the use of MRI with or without comparison to CT in the diagnostic evaluation of pediatric patients with hearing loss were evaluated, according to a priori inclusion/exclusion criteria. Two independent evaluators corroborated the extracted data. Heterogeneity was evaluated according to the I(2) statistic. RESULTS There were 29 studies that evaluated 2434 patients with MRIs and 1451 patients with CTs that met inclusion/exclusion criteria. There was a wide range of diagnostic yield from MRI. Heterogeneity among studies was substantial but improved with subgroup analysis. Meta-analysis of yield differences demonstrated that CT had a greater yield than MRI for enlarged vestibular aqueduct (yield difference 16.7% [95% CI, 9.1%-24.4%]) and a borderline advantage for cochlear anomalies (4.7% [95% CI, 0.1%-9.5%]). Studies were more likely to report brain findings with MRI. CONCLUSIONS These data may be utilized in concert with that from studies of risks of MRI and risk/yield of CT to inform the choice of diagnostic testing.
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Affiliation(s)
| | - Jenny X Chen
- Harvard Medical School, Boston, Massachusetts, USA
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21
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Chen JX, Kachniarz B, Shin JJ. Diagnostic yield of computed tomography scan for pediatric hearing loss: a systematic review. Otolaryngol Head Neck Surg 2014; 151:718-39. [PMID: 25186339 DOI: 10.1177/0194599814545727] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomography (CT) has been used in the assessment of pediatric hearing loss, but concern regarding radiation risk and increased utilization of magnetic resonance imaging (MRI) have prompted us toward a more quantitative and sophisticated understanding of CT's potential diagnostic yield. OBJECTIVE To perform a systematic review to analyze the diagnostic yield of CT for pediatric hearing loss, including subgroup evaluation according to impairment severity and laterality, as well as the specific findings of enlarged vestibular aqueduct and narrow cochlear nerve canal. DATA SOURCES PubMed, EMBASE, and the Cochrane Library were assessed from the date of their inception to December 2013. In addition, manual searches of bibliographies were performed and topic experts were contacted. REVIEW METHODS Data from studies describing the use of CT in the diagnostic evaluation of pediatric patients with hearing loss of unknown etiology were evaluated, according to a priori inclusion/exclusion criteria. Two independent evaluators corroborated the extracted data. Heterogeneity was evaluated according to the I(2) statistic. RESULTS In 50 criteria-meeting studies, the overall diagnostic yield of CT ranged from 7% to 74%, with the strongest and aggregate data demonstrating a point estimate of 30%. This estimate corresponded to a number needed to image of 4 (range, 2-15). The most commonly identified findings were enlarged vestibular aqueduct and cochlear anomalies. The largest studies showed a 4% to 7% yield for narrow cochlear nerve canal. CONCLUSION These data, along with similar analyses of radiation risk and risks/benefits of sedated MRI, may be used to help guide the choice of diagnostic imaging.
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Affiliation(s)
- Jenny X Chen
- Harvard Medical School, Boston, Massachusetts, USA
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22
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Vaid S, Vaid N. Imaging for cochlear implantation: Structuring a clinically relevant report. Clin Radiol 2014; 69:e9-e24. [DOI: 10.1016/j.crad.2014.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/19/2014] [Accepted: 03/13/2014] [Indexed: 11/25/2022]
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23
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Clemmens CS, Guidi J, Caroff A, Cohn SJ, Brant JA, Laury AM, Bilaniuk LT, Germiller JA. Unilateral cochlear nerve deficiency in children. Otolaryngol Head Neck Surg 2013; 149:318-25. [PMID: 23678279 DOI: 10.1177/0194599813487681] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cochlear nerve deficiency (CND) is increasingly diagnosed in children with sensorineural hearing loss (SNHL). We sought to determine the prevalence of CND, its imaging characteristics, and correlations with audiologic phenotype in children with unilateral SNHL. DESIGN Case series with chart review. SETTING Tertiary pediatric hospital. SUBJECTS/METHODS In 128 consecutive children with unilateral SNHL who underwent high-resolution magnetic resonance imaging, the diameters, area, and signal intensity of the cochlear nerve (CN) were measured and normalized to the ipsilateral facial nerve. Presence of CND was determined by comparison to normative data. Relationships among hearing loss severity, progression, and nerve size were investigated. RESULTS Cochlear nerve deficiency was present in 26% of children with unilateral SNHL. Its prevalence was higher (48%) in severe to profound SNHL, especially when in infants (100%). Width of the bony cochlear nerve canal (BCNC) correlated strongly with relative CN diameter, density, and area (R = 0.5); furthermore, a narrow BCNC (<1.7 mm) strongly predicted CND. Severity of hearing loss modestly correlated with nerve size, although significant variability was observed. Progression never occurred unless there were other inner ear malformations, whereas in the non-CND group, it occurred in 22%. Ophthalmologic abnormalities were very common (67%) in CND children, particularly oculomotor disturbances. CONCLUSION Cochlear nerve deficiency is a common cause of unilateral SNHL, particularly in congenital unilateral deafness. Width of the BCNC effectively predicts CND, a finding useful when only computed tomography imaging is available. In an ear with CND, hearing can be expected to remain stable over time. Diagnosis should prompt evaluation by an ophthalmologist.
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Affiliation(s)
- Clarice S Clemmens
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Masuda S, Usui S, Matsunaga T. High prevalence of inner-ear and/or internal auditory canal malformations in children with unilateral sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2013. [PMID: 23200870 DOI: 10.1016/j.ijporl.2012.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Radiological and genetic examination has recently advanced for diagnosis of congenital hearing loss. The aim of this study was to elucidate the prevalence of inner-ear and/or internal auditory canal malformations in children with unilateral sensorineural hearing loss (USNHL) for better management of hearing loss and genetic and lifestyle counseling. METHODS We conducted a retrospective study of charts and temporal bone computed tomography (CT) findings of 69 consecutive patients 0-15 years old with USNHL. In two cases, genetic examination was conducted. RESULTS Of these patients, 66.7% had inner-ear and/or internal auditory canal malformations. The prevalence of malformations in infants (age <1 year) was 84.6%, which was significantly higher than that in children 1-15 years old (55.8%; p<0.01). Almost half of the patients (32; 46.4%) had cochlear nerve canal stenosis; 13 of them had cochlear nerve canal stenosis alone, and in 19 it accompanied other malformations. Internal auditory canal malformations were observed in 22 subjects (31.8%), 14 (20.3%) had cochlear malformations, and 5 (7.2%) had vestibular/semicircular canal malformations. These anomalies were seen only in the affected ear, except in two of five patients with vestibular and/or semicircular canal malformations. Two patients (2.9%) had bilateral enlarged vestibular aqueducts. Mutations were found in SLC26A4 in one of the two patients with bilateral large vestibular aqueducts. The prevalence of a narrow internal auditory canal was significantly higher in subjects with cochlear nerve canal stenosis (50.0%) than in subjects with normal cochlear nerve canals (11.1%; p<0.01). There were no correlations between the type and number of malformations and hearing level. CONCLUSIONS The prevalence of inner-ear and/or internal auditory canal malformations detected by high-resolution temporal bone CT in children with USNHL was very high. Radiological and genetic examination provided important information to consider the pathogenesis and management of hearing loss. Temporal bone CT should be recommended to children with USNHL early in life. SLC26A4 mutation also should be examined in cases with bilateral enlarged vestibular aqueduct.
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Affiliation(s)
- Sawako Masuda
- Department of Otorhinolaryngology, Institute for Clinical Research, National Mie Hospital, Tsu, Mie, Japan.
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