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Ivanauskaite J, Ivanauskaite J, Matin-Mann F, Giesemann AM, Lenarz T, Lesinski-Schiedat A. A New Methodology for Evaluation of Large Vestibular Aqueduct in CT and MRI Images. Otol Neurotol 2024; 45:440-446. [PMID: 38478413 DOI: 10.1097/mao.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
HYPOTHESIS Development of a new method for large vestibular aqueduct (LVA)/large endolymphatic sac anomaly (LESA) assessment using magnetic resonance imaging (MRI) and computed tomography (CT)/cone beam CT (CBCT) images. The secondary objective was to compare both modalities. BACKGROUND The gold standard for LVA diagnosis is the analysis of CT images using Valvassori and Clemis or Cincinnati criteria. The previous studies showed inconclusive results regarding the correlation between audiological and radiological data. METHODS Retrospective analysis of radiological images from 173 patients (315 ears), who were diagnosed with LVA/LESA based on CT/CBCT and/or MRI images of the temporal bone. The images obtained using both techniques were used to measure the following dimensions of vestibular aqueduct (VA)/endolymphatic duct (ED)/intraosseous endolymphatic sac (ES): width of the opening, length, and width at external aperture. In MRI images, the maximal contact diameters of the extraosseous or intraosseous ES and dura mater were measured as well. RESULTS LVA has been reported to be bilateral in 82% (142 patients) and unilateral in 18% (31 patients) of cases. Comparison of MRI and CT/CBCT measurements showed a moderate correlation (0.64) in external aperture, a moderate correlation (0.57) in the width of the VA opening, and a weak correlation (0.34) in length measurements (p < 0.05). CONCLUSION We developed a new method to identify the heterogeneous pathology of LVA/LESA using reconstruction along the VA/ED/intraosseous ES axis, three measurements on two planes, and focus on the maximal contact diameter between the extraosseous or intraosseous ES and dura mater.
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Affiliation(s)
- Jurgita Ivanauskaite
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | | | - Farnaz Matin-Mann
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Anja Maria Giesemann
- Institute for Interventional and Diagnostic Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Anke Lesinski-Schiedat
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
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Saliba I, Alshehri S, Fournier I, Altamami N. Large Vestibular Aqueduct-Associated Symptoms: Endolymphatic Duct Blockage as a Surgical Treatment. Audiol Res 2024; 14:304-316. [PMID: 38525688 PMCID: PMC10961693 DOI: 10.3390/audiolres14020027] [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: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of endolymphatic duct blockage (EDB) on dizziness control in patients with a large vestibular aqueduct (LVA) and to evaluate its effect on hearing. STUDY DESIGN This is a prospective nonrandomized study. SETTING Five adults and one child with dizziness and five children with progressive hearing loss were referred to our tertiary centers. METHODS The dizziness handicap inventory (DHI) and DHI-PC (dizziness handicap inventory-patient caregiver) questionnaires were used before and after surgery. All patients underwent a preoperative temporal bone HRCT scan and pure tone audiometry one day before surgery, then four and twelve months after surgery and at the last follow-up. The mean follow-up time was 5.6 years. Student's t-test was used to compare DHI/-PC results. RESULTS The DHI scores were 44, 24, 84, 59 and 56 before surgery, respectively, for Patients 1 to 5. The DHI scores at four months was significantly different, i.e., 4, 6, 0, 7 and 18 (p = 0.001). No differences were found between 4 and 12 months. Patient 6 (child) had Trisomy 21; their DHI-PC score dropped from 38 (preoperative score) to 8 (postoperative score), showing no activity limitations; clinical evaluation showed the complete resolution of symptoms. We found no significant differences between hearing loss before the surgery and at 1 and 12 months post operation for four adult patients. Our fifth adult patient's hearing changed from severe to profound SNHL. For 5 out of 6 pediatric patients, preoperative PTA and mean ABG were 63 dB and 20 dB, respectively; postoperatively, they improved to 42 dB and 16 dB, respectively. The hearing loss level for the sixth pediatric patient dropped from moderate (PTA = 42 dB) to severe (PTA = 85 dB) due to an opening of the endolymphatic sac and a sudden leak of the endolymph. CONCLUSIONS EDB, using two titanium clips, seems to be helpful for controlling vestibular symptoms and for stabilizing hearing or even to improve hearing in 82% of cases. Nevertheless, there is a risk of hearing worsening.
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Affiliation(s)
- Issam Saliba
- Division of Otorhinolaryngology and Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
- University of Montreal Health Center (CHUM), Department of Otorhinolaryngology and Head & Neck Surgery, Montreal, QC H2X 3E4, Canada
- University of Montreal Health Center Research Center (CRCHUM), Montreal, QC H2X 0A9, Canada
- Sainte-Justine University Hospital Center (CHU-SJ), Otorhinolaryngology and Head & Neck Surgery, Montreal, QC H3T 1C5, Canada
| | - Sarah Alshehri
- Division of Otorhinolaryngology and Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Isabelle Fournier
- Division of Otorhinolaryngology and Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Nasser Altamami
- Division of Otorhinolaryngology and Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
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Perry J, Sher E, Kawai K, Redfield S, Sun T, Kenna M. Newborn Hearing Screening Results in Patients with Enlarged Vestibular Aqueduct. Laryngoscope 2023; 133:2786-2791. [PMID: 36762450 DOI: 10.1002/lary.30605] [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: 07/03/2022] [Revised: 11/29/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Enlarged vestibular aqueduct (EVA) is the most common anatomic abnormality contributing to permanent hearing loss (HL) in children. Although the association between EVA and HL is well-documented, the pass rate for the newborn hearing screening (NBHS) for patients with EVA-related HL is not. Our objective was to investigate the association between NBHS results and audiologic and clinical outcomes in a large cohort of pediatric patients with EVA. METHODS This was a retrospective chart review of patients seen in the Boston Children's Hospital (BCH) Department of Otolaryngology and Communication Enhancement with confirmed HL, known NBHS results, and confirmed EVA. Demographic, clinical, audiologic, and imaging data were collected from the medical record. Frequency-specific data points from pure-tone audiograms and/or automated auditory brainstem response tests were recorded, and four-frequency pure tone average was calculated using air conduction thresholds at 500, 1000, 2000, and 4000 Hz. RESULTS Of the 183 patients included in the study, 84 (45.9%) passed their NBHS, whereas 99 (54.1%) did not pass. Compared with patients who did not pass, patients who passed were more likely to have unilateral EVA and unilateral HL, whereas they were less likely to undergo cochlear implantation and to have causative SLC26A4 variants. CONCLUSIONS EVA-associated HL may be identified at birth or during childhood, with nearly half the patients in this cohort passing their NBHS. Our results provide prognostic information for patients with EVA who pass their NBHS and highlight the importance of regular hearing monitoring for children not initially suspected of having HL. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2786-2791, 2023.
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Affiliation(s)
- Julia Perry
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erica Sher
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelby Redfield
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tieqi Sun
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Huang Y, Li L, Pan L, Ling X, Wang C, Huang C, Huang Y. Non-syndromic enlarged vestibular aqueduct caused by novel compound mutations of the SLC26A4 gene: a case report and literature review. Front Genet 2023; 14:1240701. [PMID: 37745850 PMCID: PMC10512862 DOI: 10.3389/fgene.2023.1240701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Enlarged vestibular aqueduct is an autosomal genetic disease mainly caused by mutations in the SLC26A4 gene and includes non-syndromic and syndromic types. This study aimed to identify genetic defects in a Chinese patient with non-syndromic enlarged vestibular aqueduct (NSEVA) and to investigate the impact of variants on the severity of non-syndromic enlarged vestibular aqueduct. A male patient with NSEVA, aged approximately 6 years, was recruited for this study. The clinical characteristics and results of auxiliary examinations, including laboratory and imaging examinations, were collected, and 127 common hereditary deafness genes were detected by chip capture high-throughput sequencing. Protein structure predictions, the potential impact of mutations, and multiple sequence alignments were analyzed in silico. Compound heterozygote mutations c.1523_1528delinsAC (p.Thr508Asnfs*3) and c.422T>C (p.Phe141Ser) in the SLC26A4 gene were identified. The novel frameshift mutation c.1523_1528delinsAC produces a severely truncated pendrin protein, and c.422T>C has been suggested to be a disease-causing mutation. Therefore, this study demonstrates that the novel mutation c.1523_1528delinsAC in compound heterozygosity with c.422T>C in the SLC26A4 gene is likely to be the cause of NSEVA. Cochlear implants are the preferred treatment modality for patients with NSEVA and severe-to-profound sensorineural hearing loss Genetic counseling and prenatal diagnosis are essential for early diagnosis. These findings expand the mutational spectrum of SLC26A4 and improve our understanding of the molecular mechanisms underlying NSEVA.
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Affiliation(s)
- Yunhua Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Linlin Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Liqiu Pan
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoting Ling
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Chenghan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Chaoyu Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
| | - Yifang Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi Medical University, Nanning, Guangxi, China
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Burkett BJ, Oien MP, Benson JC, Nassiri AM, Carlson ML, Lane JI. Absent Stapedial Tendon: Imaging Features of an Underrecognized Entity : Clinical Neuroradiology. Clin Neuroradiol 2023; 33:645-651. [PMID: 36593357 DOI: 10.1007/s00062-022-01251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Congenital absence of the stapedial tendon is a rare entity with characteristic imaging findings, which can go unrecognized due the scarcity of the diagnosis and limited previous description in the imaging literature. We aim to characterize the imaging features of this entity. METHODS A series of 9 cases with surgical confirmation of stapedial tendon absence were retrospectively reviewed and the most common abnormalities on high resolution computed tomography (CT) of the temporal bone described. RESULTS Congenital fixation of the stapes footplate was present in nearly all cases of stapedial tendon absence (n = 8, 89%), a clinically important association because the stapes footplate abnormality was not detectable on preoperative CT. Absence or hypoplasia of the pyramidal eminence and aperture was identified in almost all cases (n = 8, 89%), which may be the sole imaging finding to suggest stapedial tendon absence and associated stapes footplate fixation prior to surgery. CONCLUSION The most reliable indicator of stapedial muscle absence on temporal bone CT is the absence or hypoplasia of the pyramidal eminence and aperture. Importantly, most patients had congenital stapes footplate fixation confirmed intraoperatively with a normal stapes footplate on CT, meaning the pyramidal eminence/aperture abnormality was the only preoperative imaging finding that could have suggested the footplate fixation.
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Affiliation(s)
- Brian J Burkett
- Department of Radiology, Mayo Clinic, 200 1st St SW, MN 55901, Rochester, MN, USA.
| | - Michael P Oien
- Department of Radiology, Mayo Clinic, 200 1st St SW, MN 55901, Rochester, MN, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, 200 1st St SW, MN 55901, Rochester, MN, USA
| | | | - Matthew L Carlson
- Department of Neurologic Surgery, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - John I Lane
- Department of Radiology, Mayo Clinic, 200 1st St SW, MN 55901, Rochester, MN, USA
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Deep NL, Carlson ML, Hoxworth JM, Driscoll CLW, Lohse CM, Lane JI, Ho ML. Classifying the Large Vestibular Aqueduct: Morphometry to Audiometry. Otol Neurotol 2023; 44:47-53. [PMID: 36509439 DOI: 10.1097/mao.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Large vestibular aqueduct (LVA) is the most common inner ear dysplasia identified in patients with hearing loss. Our objective was to systematically quantify LVA morphologies and correlate imaging findings with established audiometric outcomes. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Patients with large vestibular aqueduct identified radiographically, with or without hearing loss. INTERVENTIONS Diagnostic only. MAIN OUTCOME MEASURES Vestibular aqueduct (VA) width at midpoint, width at external aperture, and length were measured on cross-sectional imaging. Morphology was classified as type I (borderline), type II (tubular), or type III (funneled). Audiometric endpoints included air/bone conduction, pure tone averages, and air-bone gaps at 250 and 500 Hz. Statistical associations were evaluated using linear regression models, adjusted for age at first audiogram and sex. RESULTS One hundred seventeen patients (197 ears) were included, with mean age at first audiogram of 22.2 years (standard deviation, 21.7 yr). Imaging features associated with poor audiometric outcomes were increasing VA width at midpoint and external aperture, decreasing VA length, dilated extraosseous endolymphatic sac, cochleovestibular malformations, and increasing VA type (III > II > I). CONCLUSIONS Quantitative LVA measurements and a standardized morphologic classification system aid in prediction of early audiometric endpoints.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Matthew L Carlson
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph M Hoxworth
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Colin L W Driscoll
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - John I Lane
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
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Alahmadi A, Abdelsamad Y, Salamah M, Alenzi S, Badr KM, Alghamdi S, Alsanosi A. Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance. Eur Arch Otorhinolaryngol 2022; 279:5497-5509. [PMID: 35771280 DOI: 10.1007/s00405-022-07511-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/13/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to review the surgical and clinical outcomes of cochlear implantation among patients with EVA. MATERIALS AND METHODS A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900). RESULTS A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients. CONCLUSION Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia.
| | | | - Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
| | - Saad Alenzi
- King Fahad Specialist Hospital, MOH, Tabuk, Saudi Arabia
| | | | | | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
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Shakrawal N, Sonkhya N, Agarwal S, Grover M. Outcomes of Acoustic and Linguistic Performances Following Cochlear Implantation in Large Vestibular Aqueduct Syndrome (LVAS). Indian J Otolaryngol Head Neck Surg 2022; 74:4013-4019. [PMID: 36742600 PMCID: PMC9895467 DOI: 10.1007/s12070-021-02804-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023] Open
Abstract
AIM This study aims to collate the outcomes in acoustic and linguistic performances after cochlear implantation in LVAS. METHODS In a hospital-based prospective interventional study, seven prelingual children with bilateral profound sensorineural hearing loss (SNHL) with LVAS were recruited. They underwent unilateral cochlear implantation between December 2013 and December 2015 in the Department of Otorhinolaryngology and Head Neck Surgery at a tertiary care center. Outcomes of auditory and speech performances were assessed in the form of revised categories of auditory perception (CAP), infant toddler meaningful auditory integration scale (IT-MAIS) and speech intelligibility rating (SIR) scores preoperatively, at one and two years follow up. RESULTS The mean age of implantation was 4 years. The median revised CAP, IT-MAIS, and SIR scores after one and two years of follow-up were 6, 27, 3, and 11, 36, 5 respectively. The mean follow-up duration was 21.3 months. CONCLUSION Pre op median revised CAP, IT-MAIS, and SIR scores of 0, 1, 1 showed improvement to 11, 36, 5 at two years follow up which was statistically significant. Hence, we conclude that good functional outcomes post-operatively advocate the significance of cochlear implantation in LVAS.
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Affiliation(s)
- Neha Shakrawal
- Department of Otorhinolaryngology and Head-Neck Surgery, Sawai Man Singh Medical College, Jaipur, India
- Department of Otorhinolaryngology and Head-Neck Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan 342001 India
| | - Nishi Sonkhya
- Department of Otorhinolaryngology and Head-Neck Surgery, Sawai Man Singh Medical College, Jaipur, India
| | - Sunita Agarwal
- Department of Otorhinolaryngology and Head-Neck Surgery, Sawai Man Singh Medical College, Jaipur, India
| | - Mohnish Grover
- Department of Otorhinolaryngology and Head-Neck Surgery, Sawai Man Singh Medical College, Jaipur, India
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Deeds K, Lucas J, Jassal J, Gonik N. Investigating the significance of vestibular aqueduct pneumatization and pediatric hearing loss. Int J Pediatr Otorhinolaryngol 2022; 162:111311. [PMID: 36126487 DOI: 10.1016/j.ijporl.2022.111311] [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: 07/06/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Vestibular aqueduct enlargement on imaging is associated with pediatric hearing loss, though the mechanism is not well understood. After reviewing temporal bone imaging in pediatric patients from our institution with no obvious cause of hearing loss, we postulate that pneumatization of bone surrounding the vestibular aqueduct may also be associated with hearing loss. METHODS 342 temporal bone CT scans performed at Children's Hospital of Michigan between January 2018 and December 2020 were reviewed. Scans were assessed for the presence, laterality, and degree of vestibular aqueduct pneumatization (PVA). Electronic medical record data was collected on age, gender, hearing status, medical comorbidities, and otologic comorbidities. Cases were secondarily reviewed to ensure validity. 159 patients were included in the final analysis; excluded scans included duplicates, patients with unknown hearing status, patients older than 21 years old, and patients with another known cause of hearing loss including inner ear malformations. RESULTS 17.6% of patients demonstrated vestibular aqueduct pneumatization. Hearing loss percentage was comparable between the PVA and non-pneumatized group (42.9% vs 42.0%), but hearing loss was more likely to be sensorineural in the PVA group (91.7% vs 80.0%). When patients with only newborn hearing data available were excluded from the PVA group, hearing loss percentage was higher in the PVA group (50% vs 42.0%). Patients with hearing loss in the PVA group were older than those without hearing loss (14.92 years old vs 10.67 years old). CONCLUSION Hearing loss in enlarged vestibular aqueduct syndrome is typically progressive, bilateral, and sensorineural. Our preliminary findings suggest that vestibular aqueduct pneumatization may be another anomaly associated with a primarily sensorineural hearing loss. Further studies are needed to strengthen this postulated link.
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Affiliation(s)
- Kathryn Deeds
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jordyn Lucas
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Japnam Jassal
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Nathan Gonik
- Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, MI, USA
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Volumetry improves the assessment of the vestibular aqueduct size in inner ear malformation. Eur Arch Otorhinolaryngol 2022; 280:2155-2163. [PMID: 36216913 PMCID: PMC10066110 DOI: 10.1007/s00405-022-07681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Enlarged vestibular aqueduct (EVA) is a common finding associated with inner ear malformations (IEM). However, uniform radiologic definitions for EVA are missing and various 2D-measurement methods to define EVA have been reported. This study evaluates VA volume in different types of IEM and compares 3D-reconstructed VA volume to 2D-measurements. METHODS A total of 98 high-resolution CT (HRCT) data sets from temporal bones were analyzed (56 with IEM; [cochlear hypoplasia (CH; n = 18), incomplete partition type I (IPI; n = 12) and type II (IPII; n = 11) and EVA (n = 15)]; 42 controls). VA diameter was measured in axial images. VA volume was analyzed by software-based, semi-automatic segmentation and 3D-reconstruction. Differences in VA volume between the groups and associations between VA volume and VA diameter were assessed. Inter-rater-reliability (IRR) was assessed using the intra-class-correlation-coefficient (ICC). RESULTS Larger VA volumes were found in IEM compared to controls. Significant differences in VA volume between patients with EVA and controls (p < 0.001) as well as between IPII and controls (p < 0.001) were found. VA diameter at the midpoint (VA midpoint) and at the operculum (VA operculum) correlated to VA volume in IPI (VA midpoint: r = 0.78, VA operculum: r = 0.91), in CH (VA midpoint: r = 0.59, VA operculum: r = 0.61), in EVA (VA midpoint: r = 0.55, VA operculum: r = 0.66) and in controls (VA midpoint: r = 0.36, VA operculum: r = 0.42). The highest IRR was found for VA volume (ICC = 0.90). CONCLUSIONS The VA diameter may be an insufficient estimate of VA volume, since (1) measurement of VA diameter does not reliably correlate with VA volume and (2) VA diameter shows a lower IRR than VA volume. 3D-reconstruction and VA volumetry may add information in diagnosing EVA in cases with or without additional IEM.
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Ruthberg JS, Kocharyan A, Farrokhian N, Stahl MC, Hicks K, Scarborough J, Murray GS, Wu S, Manzoor N, Otteson T. Hearing loss patterns in enlarged vestibular aqueduct syndrome: Do fluctuations have clinical significance? Int J Pediatr Otorhinolaryngol 2022; 156:111072. [PMID: 35276529 DOI: 10.1016/j.ijporl.2022.111072] [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: 07/18/2021] [Revised: 12/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To reveal hearing loss patterns in patients with enlarged vestibular aqueduct (EVA) syndrome according to demographic and clinical characteristics. METHODS A retrospective, longitudinal study design was utilized to identify patients with EVA. Ears of patients were categorized into one of four cohorts: progressive fluctuating, progressive non-fluctuating, stable fluctuating, and stable non-fluctuating patterns. Pairwise and group comparisons were performed with non-parametric tests to assess vestibular aqueduct (VA) morphology, clinical, and demographic variables between hearing loss pattern cohorts. Rates of hearing loss in the subgroups were determined utilizing a mixed linear effects model. RESULTS 44 patients (25 female, 19 male, median diagnosis age: 8.06 years) met inclusion criteria. 16 individuals demonstrated unilateral EVA and 29 had bilateral EVA, resulting in 74 total ears with EVA. Amongst the four cohorts, differences in operculum widths amongst groups were statistically significant (p = 0.049) while VA midpoint widths were not (p = 0.522). Progressive hearing loss ears without fluctuations demonstrated a 3.20 dB per year (p < 0.001) progression while progressive hearing loss ears with fluctuations reported a rate of 3.52 dB loss per year (p < 0.001). CONCLUSION Hearing fluctuations occur similarly in EVA patients with stable and progressive hearing loss. With the exception of increased rates of hearing loss progression for fluctuating progressive hearing loss patients, vestibular aqueduct morphology, demographic, and clinical characteristics commonly reported are likely not strong predictors for whether patients will or will not experience fluctuating patterns of hearing loss.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nathan Farrokhian
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Kayla Hicks
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Gail S Murray
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shannon Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nauman Manzoor
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Todd Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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12
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Byun JC, Lee KY, Hwang SK. Atypical Presentation of Enlarged Vestibular Aqueducts Caused by SLC26A4 Variants. CHILDREN 2022; 9:children9020165. [PMID: 35204885 PMCID: PMC8869968 DOI: 10.3390/children9020165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
Enlarged vestibular aqueduct is the most common inner ear malformation in pediatric patients with sensorineural hearing loss. Here, we report a new presentation of enlarged vestibular aqueduct in a Korean family. The family consists of two parents and five daughters, and the first and second daughters were diagnosed with bilateral enlarged vestibular aqueducts. The third daughter, who showed no signs of hearing deterioration, came to medical attention with incomplete Horner syndrome. Evaluations for localization of Horner syndrome on the patient and Sanger sequencing of SLC26A4 on the family members were performed. Although auditory brainstem response and pure tone audiometry of the third daughter were normal, temporal bone computed tomography demonstrated bilateral enlarged vestibular aqueducts. Sanger sequencing of SLC26A4 revealed compound heterozygous variants c.2168A>G and c.919-2A>G in the first, second, and third daughters. Diagnosis of enlarged vestibular aqueduct is often delayed because the degree of hearing loss can vary, and a considerable phenotypic variability can be shown even in family members with the same SLC26A4 variations. Fluctuations of CSF pressure into the cochlear duct and recurrent microruptures of the endolymphatic membrane could result in damage of sympathetic nerve supplying to the inner ear, which could explain the mechanism of Horner syndrome associated with enlarged vestibular aqueduct.
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Affiliation(s)
- Jun Chul Byun
- Department of Pediatrics, School of Medicine, Keimyung University Dongsan Medical Center, Daegu 42601, Korea;
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Su-Kyeong Hwang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-200-5704; Fax: +82-53-425-6683
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13
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Nakano A, Arimoto Y, Mutai H, Nara K, Inoue S, Matsunaga T. Clinical and genetic analysis of children with hearing loss and bilateral enlarged vestibular aqueducts. Int J Pediatr Otorhinolaryngol 2022; 152:110975. [PMID: 34801268 DOI: 10.1016/j.ijporl.2021.110975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/28/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the clinical and genetic features of children with hearing loss associated with one of the most common malformations of the inner ear: bilateral enlargement of vestibular aqueducts (EVA). METHODS Clinical and genetic features were investigated in 28 children with hearing loss diagnosed with bilateral EVA by computed tomography from January 2008 to September 2019. RESULTS Fourteen subjects had undergone newborn hearing screening (NHS). Nine subjects (64.3%) were referred in both ears, 4 subjects (28.6%) were referred in one ear, and one subject (7.1%) passed in both ears. Nineteen of 26 subjects (73.1%) who were followed for more than 3 years had hearing fluctuations, while 17 (65.4%) had hearing loss progression. Eleven of 28 subjects (39.2%) had vertigo attacks. Pathogenic variants were identified in two alleles of the SLC26A4 gene in 24 of 27 subjects (88.9%) by sequencing of all exons and flanking introns, leading to genetic diagnosis of Pendred syndrome/DFNB4. Our results indicate that genetic screening for specific SLC26A4 variants using a commercial clinical laboratory test in Japan would have achieved genetic diagnoses in 13 of the 27 subjects (54.2%). Although there was no statistically significance in the frequency of hearing fluctuation or progression depending on the presence or absence of the gene variant, mean hearing level was severe in subjects with two pathogenic variants in SLC26A4 gene. The most common variant detected in our subjects was p.His723Arg (13 alleles, 27.1%), followed by c. 919-2A > G (four alleles, 8.3%). Two novel variants were detected in this study: c.1544+1G > T and c.1614+5G > A. CONCLUSIONS Our data suggest that some subjects may present with bilateral EVA that cannot be detected by NHS. We estimated that genetic diagnosis for SLC264 gene would not have been made in almost half subjects with the commercial genetic screening approach used in the present study in Japan. Although there were some limitations in this study, the subjects with pathogenic variants in two alleles of the SLC26A4 gene could have more severe hearing loss.
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Affiliation(s)
- Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, 579-1 Heta-cho, Chiba-shi, Chiba, 266-0007, Japan.
| | - Yukiko Arimoto
- Division of Otorhinolaryngology, Chiba Children's Hospital, 579-1 Heta-cho, Chiba-shi, Chiba, 266-0007, Japan
| | - Hideki Mutai
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Kiyomitsu Nara
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Satomi Inoue
- Medical Genetics Center, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Tatsuo Matsunaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Medical Genetics Center, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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14
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Bouhadjer K, Tissera K, Farris CW, Juliano AF, Cunnane ME, Curtin HD, Mankarious LA, Reinshagen KL. Retrospective Review of Midpoint Vestibular Aqueduct Size in the 45° Oblique (Pöschl) Plane and Correlation with Hearing Loss in Patients with Enlarged Vestibular Aqueduct. AJNR Am J Neuroradiol 2021; 42:2215-2221. [PMID: 34737185 DOI: 10.3174/ajnr.a7339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular aqueduct measurements in the 45° oblique (Pöschl) plane provide a reliable depiction of the vestibular aqueduct; however, adoption among clinicians attempting to counsel patients has been limited due to the lack of correlation with audiologic measures. This study aimed to determine the correlation between midpoint vestibular aqueduct measurements in the Pöschl plane in patients with an enlarged vestibular aqueduct with repeat audiologic measures. MATERIALS AND METHODS Two radiologists independently measured the midpoint vestibular aqueduct diameter in the Pöschl plane reformatted from CT images in 54 pediatric patients (77 ears; mean age at first audiogram, 5 years) with an enlarged vestibular aqueduct. Four hundred nineteen audiograms were reviewed, with a median of 6 audiograms per patient (range, 3-17; mean time between first and last audiograms, 97.4 months). The correlation between midpoint vestibular aqueduct size and repeat audiologic measures (pure tone average, speech-reception threshold, and word recognition score) using a linear mixed-effects model was determined. RESULTS The mean midpoint vestibular aqueduct size was 1.78 mm (range, 0.81-3.46 mm). There was excellent interobserver reliability with intraclass correlation coefficients for the 2 readers measuring 0.92 (P < .001). Each millimeter increase in vestibular aqueduct size was associated with an increase of 10.5 dB (P = .006) in the pure tone average, an increase of 14.0 dB (P = .002) in the speech-reception threshold, and a decrease in the word recognition score by 10.5% (P = .05). CONCLUSIONS Midpoint vestibular aqueduct measurements in the Pöschl plane are highly reproducible and demonstrate a significant correlation with audiologic data in this longitudinal study with repeat measures. These data may be helpful for clinicians who are counseling patients with an enlarged vestibular aqueduct using measurements obtained in the Pöschl plane.
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Affiliation(s)
- K Bouhadjer
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - K Tissera
- Otolaryngology (K.T., L.A.M.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - C W Farris
- Department of Radiology (C.W.F.), Massachusetts General Hospital, Boston, Massachusetts
| | - A F Juliano
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - M E Cunnane
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - H D Curtin
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - L A Mankarious
- Otolaryngology (K.T., L.A.M.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - K L Reinshagen
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
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15
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Parlak S, Akgoz Karaosmanoglu A, Ozbal Batuk M, Sennaroglu L, Ozgen B. 3 Tesla MR imaging of the large endolymphatic duct and sac anomaly with audiological correlation. Eur J Radiol 2021; 145:110064. [PMID: 34839211 DOI: 10.1016/j.ejrad.2021.110064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/06/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Large endolymphatic duct and sac (LEDS) is one of the most common imaging abnormalities in congenital sensorineural hearing loss and is frequently seen with coexistent cochlear anomalies, especially incomplete partition type II. However, MRI findings of accompanying cochlear and especially modiolar dysplasias may be subtle. The purpose of this study is to evaluate the imaging findings of LEDS with high-resolution imaging at 3 T and correlate with the audiological data. METHODS 3 T temporal bone MRIs of 54 ears in 30 LEDS patients were retrospectively evaluated. The cochlear dysmorphism and modiolar deficiency were assessed qualitatively and quantitatively. The severity of LEDS anomaly, the signal changes within the LEDS and cochlea were also noted. The imaging findings were correlated to the audiological data. RESULTS The cochlea was abnormal in 77.8% of the ears with an isolated modiolar deficiency in 11.1%. Cochlea and modiolus were completely normal in 11.1% of the ears. In 63% of the ears X-distance was increased. T2 hypointensity within LEDS and cochlea were detected in 42.6%, and 7.4% of the ears, respectively. The median diameters of LEDS were higher in ears with severe to profound HL than ears with normal to moderate HL (p < 0.05). The X-distance, presence of T2 hypointensity within LEDS, and diameters of modiolus did not show statistical correlation with the audiographic data. CONCLUSION High-resolution 3 T imaging of patients with LEDS anomaly revealed a spectrum of cochlear anomalies, but up to 11.1% of the ears had no underlying anomaly despite severe (endolymphatic duct/sac) dilatation and/or profound HL.
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Affiliation(s)
- Safak Parlak
- Hacettepe University, Faculty of Medicine, Department of Radiology, Turkey.
| | | | - Merve Ozbal Batuk
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Turkey
| | - Levent Sennaroglu
- Hacettepe University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Burce Ozgen
- University of Illinois at Chicago, Department of Radiology, United States
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16
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Honda K, Griffith AJ. Genetic architecture and phenotypic landscape of SLC26A4-related hearing loss. Hum Genet 2021; 141:455-464. [PMID: 34345941 DOI: 10.1007/s00439-021-02311-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022]
Abstract
Mutations of coding regions and splice sites of SLC26A4 cause Pendred syndrome and nonsyndromic recessive hearing loss DFNB4. SLC26A4 encodes pendrin, a transmembrane exchanger of anions and bases. The mutant SLC26A4 phenotype is characterized by inner ear malformations, including an enlarged vestibular aqueduct (EVA), incomplete cochlear partition type II and modiolar hypoplasia, progressive and fluctuating hearing loss, and vestibular dysfunction. A thyroid iodine organification defect can lead to multinodular goiter and distinguishes Pendred syndrome from DFNB4. Pendred syndrome and DFNB4 are each inherited as an autosomal recessive trait caused by biallelic mutations of SLC26A4 (M2). However, there are some EVA patients with only one detectable mutant allele (M1) of SLC26A4. In most European-Caucasian M1 patients, there is a haplotype that consists of 12 variants upstream of SLC26A4, called CEVA (Caucasian EVA), which acts as a pathogenic recessive allele in trans to mutations affecting the coding regions or splice sites of SLC26A4. This combination of an M1 genotype with the CEVA haplotype is associated with a less severe phenotype than the M2 genotype. The phenotype in EVA patients with no mutant alleles of SLC26A4 (M0) has a very low recurrence probability and is likely to be caused by other factors.
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Affiliation(s)
- Keiji Honda
- Department of Otorhinolaryngology, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| | - Andrew J Griffith
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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17
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Absence of Endolymphatic Sac Ion Transport Proteins in Large Vestibular Aqueduct Syndrome-A Human Temporal Bone Study. Otol Neurotol 2021; 41:e1256-e1263. [PMID: 32890293 DOI: 10.1097/mao.0000000000002832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Epithelial ion transport pathologies of the endolymphatic sac (ES) are associated with large vestibular aqueduct syndrome (LVAS). BACKGROUND LVAS is defined by the pathognomonic features of a widened bony vestibular aqueduct (VA) and an enlarged ES. The underlying cause of its associated cochleovestibular symptoms remains elusive. Disturbances in epithelial ion transport in the enlarged ES, affecting inner ear fluid regulation, were proposed as a possible pathophysiology. However, although respective epithelial ion transport pathologies have been demonstrated in the enlarged ES from transgenic LVAS mouse models, these pathologies have not been investigated in human LVAS cases. METHODS Histological and immunohistochemical analysis of the enlarged ES epithelium in postmortem temporal bones from two individuals with a clinical diagnosis of LVAS. RESULTS The enlarged ES epithelium demonstrated an overall atypical epithelial differentiation and a lack of the immunolocalization of signature ion transport proteins. Notably, in both cases, a rudimentary branch of the ES with a typically differentiated ES epithelium was present. CONCLUSIONS The described cellular and molecular pathologies of the enlarged ES in humans provide evidence of epithelial transport pathology as one potential cause of cochleovestibular symptoms in LVAS. The present findings also emphasize the clinical relevance of already established LVAS mouse models.
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18
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Morimoto K, Yoshida T, Kobayashi M, Sugimoto S, Nishio N, Teranishi M, Naganawa S, Sone M. Significance of high signal intensity in the endolymphatic duct on magnetic resonance imaging in ears with otological disorders. Acta Otolaryngol 2020; 140:818-822. [PMID: 32646259 DOI: 10.1080/00016489.2020.1781927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High signal intensity in the endolymphatic duct (ED) is occasionally observed on magnetic resonance imaging (MRI) in ears that have otological disorders. OBJECTIVE The signal intensity (SI) in the ED on post-contrast MRI was investigated in subjects with various otological disorders, and the meaning of high SI in the ED was evaluated. MATERIAL AND METHODS 392 patients with otological disorders and 21 controls without otological symptoms underwent 3 T MRI. The SIs of the ED and the cerebellum were measured, the SI ratio (SIR) was calculated, and ears with SIR ≥4 were identified. RESULTS A high SIR was identified in the ED of 3.7% of ears affected by definite Meniere's disease (dMD), 100% of ears affected by large vestibular aqueduct syndrome (LVAS), and 7.1% of ears with no otological symptoms. On the whole, a significant relationship was found between the existence of vestibular or cochlear EH and the SIR in the ED. CONCLUSION The MRI finding of high SI in the ED may indicate the mechanism of inner ear disturbances in ears with otological disorders, especially in those with LVAS, and it may suggest an underlying disorder in some ears in which otological symptoms are not apparent.
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Affiliation(s)
- Kyoko Morimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Riggs WJ, Hiss MM, Varadarajan VV, Mattingly JK, Adunka OF. Enlarged vestibular aqueduct: Intraoperative electrocochleography findings during cochlear implantation. Int J Pediatr Otorhinolaryngol 2020; 134:110065. [PMID: 32361253 DOI: 10.1016/j.ijporl.2020.110065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Enlarged vestibular aqueduct (EVA) is the most frequent inner ear abnormality found on computed tomography in children with sensorineural hearing loss. The effects EVA abnormalities have on electrocochleography (ECochG) are unknown. Positive deflections in summation potential evoked by tone bursts were observed in 3/5 subjects, while a large negative deflection, similar to endolymphatic hydrops (EH), was observed for 2/5 subjects. The presence of an enlarged summation potential, with and without a compound action potential, was observed in response to a broadband click stimulus. Results suggest likely effects of a third window on ECochG responses and presence of EH in EVA.
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Affiliation(s)
- William J Riggs
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Audiology, Columbus, OH, USA.
| | - Meghan M Hiss
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Varun V Varadarajan
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Jameson K Mattingly
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Oliver F Adunka
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA
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20
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Thai A, Sayyid ZN, Hosseini DK, Swanson A, Ma Y, Aaron KA, Vaisbuch Y. Ambient Pressure Tympanometry Wave Patterns in Patients With Superior Semicircular Canal Dehiscence. Front Neurol 2020; 11:379. [PMID: 32547469 PMCID: PMC7270346 DOI: 10.3389/fneur.2020.00379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/15/2020] [Indexed: 12/29/2022] Open
Abstract
Importance: Superior semicircular canal dehiscence (SSCD) is a treatable condition, but current diagnostic modalities have numerous limitations. Clinicians would benefit from an additional tool for diagnostic workup that is both rapid and widely available. Objective: To assess the utility of ambient pressure tympanometry (APT) in the diagnostic workup of SSCD by determining the sensitivity and specificity of APT for SSCD in comparison to other diagnostic modalities. Design: Retrospective cohort study of patients who underwent APT and temporal bone computerized tomography (CT) scans from May 2017 to July 2018. Setting: Tertiary referral center. Participants: APT was performed as part of routine audiological testing on adult patients. We retrospectively analyzed all patients who received both APT and temporal bone CT scans, and divided ears into SSCD and non-SSCD groups based on the presence or absence of radiographic SSCD. Ears with other radiographic findings that could affect tympanic membrane compliance were excluded. Exposures: All patients in this study underwent APT and temporal bone CT scans. Some patients also underwent pure tone audiometry and vestibular evoked myogenic potentials (VEMPs). Main Outcomes and Measures: The primary outcome measures were sensitivity, specificity, and risk ratio of APT for SSCD. Secondary outcome measures include sensitivity of VEMPs and supranormal hearing thresholds. Results: We describe 52 patients (70 ears) who underwent APT and CT imaging (mean age 47.1 years, 67.1% female). APT detected SSCD with 66.7% sensitivity and 72.1% specificity. In symptomatic patients, sensitivity was 71.4% and specificity was 75%. VEMPs performed best at detecting SSCD when defining a positive test as oVEMP amplitude >17 μV, with a sensitivity of 68.2%, similar to APT (p > 0.99). The combination of APT and VEMPs increased sensitivity to 88.9%, better than APT alone (p = 0.031) and trending toward better than VEMPs alone (p = 0.063). Conclusions and Relevance: Rhythmic wave patterns on APT are associated with SSCD and may raise suspicion for this condition in conjunction with consistent results on other diagnostic modalities. Although clinical utility requires confirmation in a larger prospective study, APT is a simple, rapid, and widely available tool warranting further study.
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Affiliation(s)
- Anthony Thai
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Zahra N. Sayyid
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Davood K. Hosseini
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Austin Swanson
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Yifei Ma
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ksenia A. Aaron
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Yona Vaisbuch
- Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Otolaryngology Head and Neck Department, Rambam Medical Center, Haifa, Israel
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21
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Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome-Should We Provide Cochlear Implants Earlier? Otol Neurotol 2020; 40:e769-e773. [PMID: 31348128 DOI: 10.1097/mao.0000000000002314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center. STUDY DESIGN Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed. SETTING Tertiary referral center. PATIENTS Patients with a diagnosis of LVAS who received a cochlear implant (CI). Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis. INTERVENTION(S) Therapeutic. MAIN OUTCOME MEASURE(S) Postoperative speech perception scores. RESULTS Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford-Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98%. Smaller numbers were available for post-CI City University of New York (CUNY) and Consonant-Nucleus-Consonant (CNC) word scores yet similar excellent results were seen. CONCLUSIONS Our study results suggest the CI should be considered when BKB scores have dropped to 85%. We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.
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Zhang L, Wang J, Zhao F, Li Y. Inner ear pressure evaluation using wideband tympanometry in children with Large Vestibular Aqueduct Syndrome (LVAS): A pilot study. Int J Pediatr Otorhinolaryngol 2020; 128:109690. [PMID: 31678622 DOI: 10.1016/j.ijporl.2019.109690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate middle ear function in children with Large Vestibular Aqueduct Syndrome (LVAS) to explore the feasibility of measuring inner ear pressure using Wideband tympanometry (WBT). METHODS 13 young children with LVAS were recruited. WBT and other audiological measurements i.e., Auditory Steady State Response (ASSR), Auditory Brain Stem Response (ABR), and Distorted Product Otoacoustic Emissions (DPOAE) were performed. Absorbance under ambient and peak pressure were compared with normative data, and analyzed using a one sample t-test. RESULTS Average absorbance in children with LVAS was significantly lower than normative data under ambient pressure at 1000, 1189, 1296, 2000 Hz and 4000 Hz. Absorbance under peak pressure was also significantly lower at 707, 794, 917, 1000, 1189, 1297, 1498 and 2000 Hz. However, absorbance was higher than standard values above 4000 Hz under ambient and peak pressure. It was also higher under ambient pressure at frequencies below 500 Hz. CONCLUSION The special characteristics of middle ear function found in children with Large Vestibular Aqueduct Syndrome (LVAS) indicate that WBT offers a sensitive and non-invasive method to evaluate inner ear pressure indirectly.
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Affiliation(s)
- Lifang Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China; Beijing Engineering Research Center of Audiology Technology, Beijing, 100730, China
| | - Fei Zhao
- Centre for SLT and Hearing Sciences, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, CF5 2YB, Wales, UK; Department of Hearing-Speech Sciences, Sun Yat-sen University, Guangzhou, 510520, China
| | - Yongxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Sensorineural Hearing Loss in the Nonimplanted Ear Following Cochlear Implantation in a Patient With Bilateral Enlarged Vestibular Aqueducts. Otol Neurotol 2019; 40:e782-e786. [PMID: 31348130 DOI: 10.1097/mao.0000000000002319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations. PATIENTS One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center. INTERVENTION(S) Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion. MAIN OUTCOME MEASURE(S) Bone conduction hearing thresholds, word recognition scores. RESULTS The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation. CONCLUSION As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
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Liu H, Zhou K, Zhang X, Peng KA. Fluctuating Sensorineural Hearing Loss. Audiol Neurootol 2019; 24:109-116. [PMID: 31315108 DOI: 10.1159/000500658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several otologic conditions can present with fluctuating sensorineural hearing loss, including Ménière's disease, autoimmune inner ear disease, and enlarged vestibular aqueduct. Although these 3 etiologies vary greatly, distinguishing between these conditions at initial presentation can be challenging. Furthermore, initial treatment of these conditions is often similar. In this review, we discuss historical and current perspectives on diagnosis and treatment of these conditions. SUMMARY A literature search was performed regarding fluctuating hearing loss, and current treatment of these etiologies of fluctuating hearing loss was summarized. Immediate measures at the onset of acute hearing loss include corticosteroid therapy, while preventative and chronic therapies, which can limit disease severity and frequency, vary based on the specific condition treated. Key Messages: Fluctuating hearing loss can represent a range of pathologies, but the precise etiology may not be clear at initial presentation. Timely treatment and long-term follow-up, along with appropriate diagnostics, are necessary to optimize long-term hearing.
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Affiliation(s)
- Hui Liu
- First Hospital of Shijiazhuang City, Shijiazhuang City, China,
| | - Kunpeng Zhou
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Xuemei Zhang
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Kevin A Peng
- House Clinic and House Ear Institute, Los Angeles, California, USA
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Sex-specific enlarged vestibular aqueduct morphology and audiometry. Am J Otolaryngol 2019; 40:473-477. [PMID: 31060752 DOI: 10.1016/j.amjoto.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/16/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest. MATERIALS AND METHODS A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds. RESULTS Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB). CONCLUSIONS Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.
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Macielak RJ, Mattingly JK, Findlen UM, Moberly AC, Malhotra PS, Adunka OF. Audiometric findings in children with unilateral enlarged vestibular aqueduct. Int J Pediatr Otorhinolaryngol 2019; 120:25-29. [PMID: 30753978 DOI: 10.1016/j.ijporl.2019.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the prevalence of bilateral hearing loss in children with unilateral enlarged vestibular aqueduct (EVA) at a single institution. METHODS A retrospective case review was performed at a tertiary care pediatric referral center involving children with radiologic findings of unilateral EVA and normal labyrinthine anatomy of the contralateral ear diagnosed via CT and/or MRI. The main outcome measure of interest is the number of patients with unilateral EVA who were diagnosed with bilateral hearing loss. RESULTS Sixty-one pediatric patients were identified. The mean audiometric follow-up was 48.2 months (0-150). Three (4.9%) patients with unilateral EVA were noted to have bilateral hearing loss, and this rate was not significantly different (p = 1.0) from the rate reported in a comparison group of patients with contralateral hearing loss (6.0%) without an EVA. The pure-tone average (defined as the average dB HL at 500, 1000, 2000, and 4000 Hz) in the group with bilateral hearing loss was 31.3 dB HL in the better hearing ear and 79.6 dB HL in the worse hearing ear, with the difference being statistically significant (p = 0.02). In the unilateral EVA patients without contralateral hearing loss (n = 56, 91.8%), the PTA was 9.4 dB HL in the better hearing ear and 51.9 dB HL in the worse hearing ear, with the difference being statistically significant (p < 0.001). Two patients (3.3%) with unilateral EVA were found to have hearing within normal limits bilaterally. The EVA was ipsilateral to the worse hearing ear in all cases. CONCLUSION The prevalence of bilateral hearing loss in children with unilateral EVA appears to be low. Specifically, it may be no different than the rate of contralateral hearing loss in children with unilateral hearing loss without an EVA. The present report is somewhat different than the previously described prevalence in the literature. This difference could be related to the imaging type and diagnostic criteria used, the patients included, the source of the identified patents, and the overall population of patients studied.
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Affiliation(s)
- Robert J Macielak
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH, 43210, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Jameson K Mattingly
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Ursula M Findlen
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Aaron C Moberly
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Prashant S Malhotra
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Oliver F Adunka
- The Hearing Program in the Pediatric Otolaryngology Department, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA
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Sun W, Liang Q, Kuang S, Zhou S, Wang W. 3D-real IR MRI detects serendipity of inner ear in enlarged vestibular aqueduct syndrome. Acta Otolaryngol 2019; 139:233-237. [PMID: 30882266 DOI: 10.1080/00016489.2018.1563719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although, the diagnostic criteria for enlarged vestibular aqueduct syndrome (EVAS) were determined by years. On the shoulders of predecessors, we still detected some new discoveries about EVAS by using 3D-real IR MRI. AIMS/OBJECTIVES To analyze the signal intensity of membranous and osseous labyrinths of vestibular aqueduct (VA) and endolymphatic sac (ES) in EVAS using three-dimensional real inversion recovery (3D-Real-IR) magnetic resonance imaging (MRI) after intratympanic injection of gadolinium. MATERIAL AND METHODS The study is a prospective trial, diagnosed EVAS patients (n = 10) and none- patients (n = 10) were included. 3D-real-IR MRIs were performed to assess the endolymphatic hydrops (EH) and differentiated the endolymphatic and perilymphatic signal intensities of VA and ES. RESULTS Compared to control group, EVAS group had VA osseous labyrinths middle diameter >1.5 mm different from membranous labyrinths. The cochlear EH was correlated with Mondini malformation and irrelation with the level of hearing loss (HL). CONCLUSIONS AND SIGNIFICANCE Interspace of osseous labyrinths of VA and ES are much larger than their membranous labyrinths, which is not consistance with previous research. And cochlear Mondini malformation may cause endolymphatic fluid malabsorption, inducing cochlear EH. Osteal ampliative of VA and ES and cochlear EH, which are morphogenetic anomalies, may not the direct cause of HL in EVAS.
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Affiliation(s)
- Wenfang Sun
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
- Research Center, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission (NHFPC), Beijing, PR China
- Department of Otolaryngology, Chongqing General Hospital, Chongqing, PR China
| | - Qiong Liang
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
- Research Center, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission (NHFPC), Beijing, PR China
| | - Shaojing Kuang
- Department of Otolaryngology, Chongqing General Hospital, Chongqing, PR China
| | - Shitong Zhou
- Department of Otolaryngology, Chongqing General Hospital, Chongqing, PR China
| | - Wuqing Wang
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
- Research Center, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission (NHFPC), Beijing, PR China
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Patel ND, Ascha MS, Manzoor NF, Gupta A, Semaan M, Megerian C, Otteson TD. Morphology and cochlear implantation in enlarged vestibular aqueduct. Am J Otolaryngol 2018; 39:657-663. [PMID: 30153950 DOI: 10.1016/j.amjoto.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this work is to explore audiometry following cochlear implantation (CI) in patients with enlarged vestibular aqueduct (EVA) and to investigate the effects of inner ear morphological variation on post CI audiometry. METHODS This was a retrospective review of both natural and cochlear-implant-aided audiometry results, using all available measurements in a mixed-effects model accounting for longitudinal change and the grouping structure of ears. Patients who visited our tertiary academic medical center between 2000 and 2016 were identified as having EVA according to Cincinnati criteria on radiological examination; patients eligible for CI were then selected for analysis. RESULTS Multivariable modeling showed a statistically significant hearing improvement in ears with EVA undergoing CI with regards to pure tone average (-64.0 dB, p < 0.0001), speech reception threshold (-57.90 dB, p < 0.0001), and word score (34.8%, p > 0.0001). Vestibular aqueduct midpoint size and the presence of incomplete partition type II (IP II) did not have significant independent associations with audiometric findings. However, multivariable modeling revealed a statistically significant interaction between IP II and CI such that IP II ears demonstrated a decrease in WS improvement of 30.2% (p = 0.0059) compared to non-IP II ears receiving CI. CONCLUSION There is a statistically significant audiometric benefit to ears with EVA receiving CI. Morphology, specifically the presence of IP II, may hinder CI benefit in terms of word score however this finding needs clinical validation. This data improves personalization of surgical counseling and planning for patients with EVA considering CI.
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Affiliation(s)
- Nilam D Patel
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, USA
| | - Mustafa S Ascha
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Center for Clinical Investigation, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nauman F Manzoor
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amit Gupta
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maroun Semaan
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Center for Clinical Investigation, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Cliff Megerian
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Center for Clinical Investigation, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Todd D Otteson
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Center for Clinical Investigation, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Swinburne IA, Mosaliganti KR, Upadhyayula S, Liu TL, Hildebrand DGC, Tsai TYC, Chen A, Al-Obeidi E, Fass AK, Malhotra S, Engert F, Lichtman JW, Kirchhausen T, Betzig E, Megason SG. Lamellar projections in the endolymphatic sac act as a relief valve to regulate inner ear pressure. eLife 2018; 7:37131. [PMID: 29916365 PMCID: PMC6008045 DOI: 10.7554/elife.37131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/09/2018] [Indexed: 01/23/2023] Open
Abstract
The inner ear is a fluid-filled closed-epithelial structure whose function requires maintenance of an internal hydrostatic pressure and fluid composition. The endolymphatic sac (ES) is a dead-end epithelial tube connected to the inner ear whose function is unclear. ES defects can cause distended ear tissue, a pathology often seen in hearing and balance disorders. Using live imaging of zebrafish larvae, we reveal that the ES undergoes cycles of slow pressure-driven inflation followed by rapid deflation. Absence of these cycles in lmx1bb mutants leads to distended ear tissue. Using serial-section electron microscopy and adaptive optics lattice light-sheet microscopy, we find a pressure relief valve in the ES comprised of partially separated apical junctions and dynamic overlapping basal lamellae that separate under pressure to release fluid. We propose that this lmx1-dependent pressure relief valve is required to maintain fluid homeostasis in the inner ear and other fluid-filled cavities. The most internal part of the human ear, the inner ear, is essential for us to hear and have a sense of balance. It is formed by a complex series of connected cavities filled by a liquid. When sound waves and changes in the position of the body make this liquid move, specialized ‘hair’ cells can detect these subtle movements; neurons then relay this information to the brain where it is decoded and interpreted. For the inner ear to work properly, the body needs to finely regulate the pressure created by the liquid inside the cavities. For example, people with unstable pressure in their ears can experience deafness or problems with balance. A structure known as the endolymphatic sac, which is a balloon-like chamber connected to the rest of the inner ear by a thin tube, helps with this regulation. However, scientists are still unsure about how exactly the sac performs its role. One problem is that the inner ear is difficult to study because it is encased in one of the densest bones in the body. Many other animals also have inner ears, from fish to birds and mammals. Here, Swinburne et al. examine the inner ear of zebrafish embryos because, in this fish, the ear starts working before the bones around it form; the structure is therefore accessible for injections and microscopy. Experiments show that when the pressure in the inner ear rises, the endolymphatic sac slowly fills up with the ear liquid, and then it rapidly deflates. Fish with mutations that stop the sac from deflating have overinflated sacs, which is a symptom also found in certain patients with hearing and balance disorders. Looking into the details of these inflation-deflation cycles, Swinburne et al. found that the cells that form the sac have gaps between them, unlike a normal sheet of cells. A flap covers these gaps to keep the liquid in, but under pressure, the flap opens and the liquid can escape. These results show that the endolymphatic sac works as a pressure relief valve for the inner ear. Ultimately, understanding how pressure is regulated in the ear could help patients with inner ear disorders. It could also serve as a template to investigate how eyes, kidneys and the brain, which all have liquid-filled cavities, control their internal pressure.
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Affiliation(s)
- Ian A Swinburne
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | | | - Srigokul Upadhyayula
- Department of Pediatrics, Harvard Medical School, Boston, United States.,Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, United States.,Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, United States
| | - Tsung-Li Liu
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, United States
| | - David G C Hildebrand
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Tony Y-C Tsai
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Anzhi Chen
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Ebaa Al-Obeidi
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Anna K Fass
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Samir Malhotra
- Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Florian Engert
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Jeff W Lichtman
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Tomas Kirchhausen
- Department of Pediatrics, Harvard Medical School, Boston, United States.,Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, United States.,Department of Cell Biology, Harvard Medical School, Boston, United States
| | - Eric Betzig
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, United States
| | - Sean G Megason
- Department of Systems Biology, Harvard Medical School, Boston, United States
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Abstract
HYPOTHESIS The human vestibular aqueduct (VA) shows great anatomical variations, and imaging can be difficult, so we need more data on the normal anatomy of the VA for better radiologic evaluation of large vestibular aqueduct syndrome (LVAS). BACKGROUND The normal anatomy of the human VA was analyzed in micro-dissected human temporal bones. METHODS The study is based on two sets of human temporal bones. One set of 32 human temporal bones was selected from a collection of 50 micro-dissected specimens. The outline of the intraosseous portion of the VA was drawn and digitized, and dimensions were assessed. The other set of 20 plastic molds were randomly selected from a collection of 324 specimens, and the VA dimensions were assessed. RESULTS Measurements from this study are presented in means, standard deviations, and ranges. The results from these measurements are considered normal and compared with previously published data. The variations in the normal anatomy of the VA are presented and discussed. CONCLUSION The VA courses sagittal in the human skull. Therefore, we recommend the lateral projection (reformatted) to demonstrate the VA in LVAS patients. We advocate assessing: 1) the width (or height) of the external aperture (EA), 2) the width at the half distance between the EA and the common crus (CC), and if possible 3) the width of the proximal portion of the VA. Based on the measurements, our criteria for enlargement are 2.0 mm or greater, 1.5 mm or greater, and more than 1 mm at these sites.
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Large vestibular aqueduct syndrome and endolymphatic hydrops: two presentations of a common primary inner-ear dysfunction? The Journal of Laryngology & Otology 2017; 123:919-21. [DOI: 10.1017/s0022215108004088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To present the theory that large vestibular aqueduct syndrome (i.e. the recognised existence of an enlarged vestibular aqueduct with progressive sensorineural hearing loss) and endolymphatic hydrops are due to a common primary dysfunction of inner-ear fluid homeostasis.Method:Case report and review of the world literature concerning large vestibular aqueduct syndrome and endolymphatic hydrops.Results:We report a family in which one sibling suffered from large vestibular aqueduct syndrome while the other had classic Ménière's disease. This suggests that large vestibular aqueduct syndrome and endolymphatic hydrops, in some cases, may be due to a common primary dysfunction of inner-ear fluid homeostasis.Conclusion:To our knowledge, this is the first report in the world literature to postulate that variation in the relative compliance of inner-ear membranes could be the factor that determines the manifestation of the disorder as either endolymphatic hydrops or large vestibular aqueduct syndrome.
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Noguchi Y, Fukuda S, Fukushima K, Gyo K, Hara A, Nakashima T, Ogawa K, Okamoto M, Sato H, Usami SI, Yamasoba T, Yokoyama T, Kitamura K. A nationwide study on enlargement of the vestibular aqueduct in Japan. Auris Nasus Larynx 2017; 44:33-39. [DOI: 10.1016/j.anl.2016.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
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Clarós P, Fokouo JVF, Clarós A. Cochlear implantation in patients with enlarged vestibular aqueduct. A case series with literature review. Cochlear Implants Int 2017; 18:125-129. [DOI: 10.1080/14670100.2016.1268754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pedro Clarós
- Clarós Clinic, C/Los Vergós, 31, 08017 Barcelona, Spain
| | - Jean Valentin F. Fokouo
- Clarós Clinic, C/Los Vergós, 31, 08017 Barcelona, Spain
- Regional Hospital of Bertoua, PO Box 664, Bertoua, Cameroon
| | - Andrés Clarós
- Clarós Clinic, C/Los Vergós, 31, 08017 Barcelona, Spain
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Jung J, Suh MJ, Kim SH. Discrepancies between video head impulse and caloric tests in patients with enlarged vestibular aqueduct. Laryngoscope 2016; 127:921-926. [DOI: 10.1002/lary.26122] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jinsei Jung
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Michelle J. Suh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul Republic of Korea
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Boston M, Halsted M, Meinzen-Derr J, Bean J, Vijayasekaran S, Arjmand E, Choo D, Benton C, Greinwald J. The large vestibular aqueduct: A new definition based on audiologic and computed tomography correlation. Otolaryngol Head Neck Surg 2016; 136:972-7. [PMID: 17547990 DOI: 10.1016/j.otohns.2006.12.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
Objective The study goal was to determine the prevalence and clinical significance of a large vestibular aqueduct (LVA) in children with sensorineural hearing loss (SNHL). Study Design and Setting We conducted a retrospective review of a pediatric SNHL database. One hundred seven children with SNHL were selected and their radiographic and audiometric studies were evaluated. Radiographic comparisons were made to a group of children without SNHL. Results A vestibular aqueduct (VA) larger than the 95th percentile of controls was present in 32% of children with SNHL. Progressive SNHL was more likely to occur in ears with an LVA and the rate of progressive hearing loss was greater than in ears without an LVA. The risk of progressive SNHL increased with increasing VA size as determined by logistic regression analysis. Conclusions An LVA is defined as one that is ≥2mm at the operculum and/or ≥1 mm at the midpoint in children with nonsyndromic SNHL. An LVA appears to be more common than previously reported in children with SNHL. A linear relationship is observed between VA width and progressive SNHL. Significance The finding of an LVA in children with SNHL provides diagnostic as well as prognostic information. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- Mark Boston
- Ear and Hearing Center, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Slc26a4 expression prevents fluctuation of hearing in a mouse model of large vestibular aqueduct syndrome. Neuroscience 2016; 329:74-82. [PMID: 27155149 DOI: 10.1016/j.neuroscience.2016.04.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 12/13/2022]
Abstract
SLC26A4 mutations cause fluctuating and progressive hearing loss associated with enlargement of the vestibular aqueduct (EVA). SLC26A4 encodes a transmembrane anion exchanger called pendrin expressed in nonsensory epithelial cells of the lateral wall of cochlea, vestibular organs and endolymphatic sac. We previously described a transgenic mouse model of EVA with doxycycline (dox)-inducible expression of Slc26a4 in which administration of dox from conception to embryonic day 17.5 (DE17.5) resulted in hearing fluctuation between 1 and 3months of age. In the present study, we hypothesized that Slc26a4 is required to stabilize hearing in DE17.5 ears between 1 and 3months of age. We tested our hypothesis by evaluating the effect of postnatal re-induction of Slc26a4 expression on hearing. Readministration of dox to DE17.5 mice at postnatal day 6 (P6), but not at 1month of age, resulted in reduced click-evoked auditory brainstem response (ABR) thresholds, less fluctuation of hearing and a higher surface density of pendrin expression in spindle-shaped cells of the stria vascularis. Pendrin expression in spindle-shaped cells was inversely correlated with ABR thresholds. These findings suggest that stabilization of hearing by readministration of dox at P6 is mediated by pendrin expression in spindle-shaped cells. We conclude that early re-induction of Slc26a4 expression can prevent fluctuation of hearing in our Slc26a4-insufficient mouse model. Restoration of SLC26A4 expression and function could reduce or prevent fluctuation of hearing in EVA patients.
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Vestibular function is associated with residual low-frequency hearing loss in patients with bi-allelic mutations in the SLC26A4 gene. Hear Res 2016; 335:33-39. [DOI: 10.1016/j.heares.2016.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/20/2016] [Accepted: 02/15/2016] [Indexed: 11/22/2022]
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El-Badry MM, Osman NM, Mohamed HM, Rafaat FM. Evaluation of the radiological criteria to diagnose large vestibular aqueduct syndrome. Int J Pediatr Otorhinolaryngol 2016; 81:84-91. [PMID: 26810296 DOI: 10.1016/j.ijporl.2015.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The main objective of the current work is to increase the sensitivity of the radiological diagnosis of the large vestibular aqueduct syndrome (LVAS). The specific aims were to compare between the two famous criteria to diagnose large vestibular aqueduct (LVA), (i.e., Valvassori and Cincinnati), to correlate between vestibular aqueduct (VA) measurements in the axial view and those in 45° oblique reformate in children with LVAS, and to define radiological criteria to diagnose LVA in the 45° oblique reformate. METHODS The study group included 61 children with LVAS according to Cincinnati criteria (greater than 0.9mm at the midpoint or greater than 1.9mm at the operculum in the axial view). All participants were subjected to full Audiological evaluation and CT scanning in axial plane. The axial data were then transferred to workstation for post-processing with 3D reformatting software (Baxara 3D) in order to obtain the 45° oblique reformates. VA measurements were done at 4 points: midpoint and operculum in both the axial plane and the 45° oblique reformate. RESULTS Only 81% of ears of children with LVAS (99 ears) fit Valvassori criterion (i.e., larger than 1.5mm at midpoint), while 19% (23 ears) of them were missed. There were statistically significant correlations among the diameters of the VA in the axial view (both in the midpoint and operculum) and their counterparts in the 45° oblique reformate. Values equal to or greater than 1.2mm in the midpoint and 1.3mm in the operculum are proposed to be the criteria to diagnose LVA in the 45° oblique reformate. Finally, no significant correlations were found between the degree of hearing loss and VA diameters at the axial or 45° oblique reformate. CONCLUSION Cincinnati criteria are more sensitive than Valvassori criterin in the diagnosis of LVAS. We recommend the application of Cincinnati criteria instead of Valvassori criteria in order not miss cases with LVAS. Measurement of VA in the 45° oblique reformate is a reliable method to diagnose LVA. Criteria to diagnose LVA in the 45° oblique reformate were proposed.
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Affiliation(s)
- Mohamed M El-Badry
- Otolaryngology Department, Audiology Unit, Minia University, Minia, Egypt.
| | - Nasr M Osman
- Radiology Department, Minia University, Minia, Egypt
| | | | - Fatma M Rafaat
- Otolaryngology Department, Audiology Unit, Minia University, Minia, Egypt
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Jallu AS, Jehangir M, Ul Hamid W, Pampori RA. Imaging Evaluation of Pediatric Sensorineural Hearing Loss in Potential Candidates for Cochlear Implantation. Indian J Otolaryngol Head Neck Surg 2015; 67:341-6. [PMID: 26693449 PMCID: PMC4678264 DOI: 10.1007/s12070-015-0819-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022] Open
Abstract
Computerized tomography (CT) and magnetic resonance (MR) are complementary in the imaging of the labyrinth, the internal auditory canal and the brain in children with sensorineural hearing loss who are being evaluated for cochlear implantation. An accurate anatomical description of the inner ear is essential in the preoperative work up. Computerized tomography visualizes the bony structures, whereas MR can discern soft-tissue components including intra labyrinthine fluid, cerebrospinal fluid (CSF), nerves, and vessels within the IAC. This prospective study was conducted in the Department of Otorhinolaryngology, Head & Neck Surgery, Government Medical College, Srinagar. 40 children in the age group of 1-16 years with unidentified causes of bilateral SNHL were analysed radiologically over the period of 2 years from Dec 2011 to Jan 2014. Each patient underwent MRI and high resolution CT scanning of temporal bone in axial and coronal planes. Out of the 40 patients 22 were males (55 %) and 18 were females (45 %). 30 patients (72.5 %)in our study had normal radiological scans. Five patients (12.5 %) had B/L large vestibular aqueduct and two patients (5 %) had internal auditory canal stenosis with cochlear nerve hypoplasia on CT and MR imaging. Cochlear dysplasia was present in two patients (5 %) and semicircular canal dysplasia was present in one patient (2.5 %) as an isolated finding on HRCT. In addition isolated cochlear nerve hypoplasia was present in one patient (2.5 %). Hyperintense basal ganglia lesion suggestive of kernicterus was present in one patient (2.5 %) and hyperintense posterior parietal and occipital white matter lesions suggestive of congenital CMV infection was present in one patient (2.5 %) on MR imaging. Arachnoid cysts of middle cranial fossa was an incidental finding present in one patient. Radiological abnormalities of the inner ear are not uncommon. Computerized tomography and MRI are important modalities to analyze the inner ear in children with unexplained SNHL. MRI with an extremely small field of view should be used to study possible abnormalities of the vestibulocochlear nerves.
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Affiliation(s)
- Aleena Shafi Jallu
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Majid Jehangir
- />Department of Radiology, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Waqar Ul Hamid
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
| | - Rafiq Ahmad Pampori
- />Department of Otolaryngology, Head & Neck Surgery, Government Medical College, Srinagar, Jammu & Kashmir India
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Ito T, Nishio A, Wangemann P, Griffith AJ. Progressive irreversible hearing loss is caused by stria vascularis degeneration in an Slc26a4-insufficient mouse model of large vestibular aqueduct syndrome. Neuroscience 2015; 310:188-97. [PMID: 26363152 DOI: 10.1016/j.neuroscience.2015.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
Hearing loss of patients with enlargement of the vestibular aqueduct (EVA) can fluctuate or progress, with overall downward progression. The most common detectable cause of EVA is mutations of SLC26A4. We previously described a transgenic Slc26a4-insufficient mouse model of EVA in which Slc26a4 expression is controlled by doxycycline administration. Mice that received doxycycline from conception until embryonic day 17.5 (DE17.5; doxycycline discontinued at embryonic day 17.5) had fluctuating hearing loss between 1 and 6 months of age with an overall downward progression after 6 months of age. In this study, we characterized the cochlear functional and structural changes underlying irreversible hearing loss in DE17.5 mice at 12 months of age. The endocochlear potential was decreased and inversely correlated with auditory brainstem response thresholds. The stria vascularis was thickened and edematous in ears with less severe hearing loss, and thinned and atrophic in ears with more severe hearing loss. There were pathologic changes in marginal cell morphology and gene expression that were not observed at 3 months. We conclude that strial dysfunction and degeneration are the primary causes of irreversible progressive hearing loss in our Slc26a4-insufficient mouse model of EVA. This model of primary strial atrophy may be used to explore the mechanisms of progressive hearing loss due to strial dysfunction.
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Affiliation(s)
- T Ito
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - A Nishio
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - P Wangemann
- Anatomy and Physiology Department, Kansas State University, Manhattan, KS 66506, USA
| | - A J Griffith
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
CONCLUSION X-ray CT of an Asian elephant's skull suggest that elephants do not have a labyrinthine 3(rd) mobile window. This excludes the concept that elephants benefit from enhancement of bone conducted vibration by an extra opening of the labyrinth. This finding does not, however, exclude that elephants use bone conducted hearing for seismic detection, nor that other species may use an extra labyrinthine opening for improved detection of seismic signals. OBJECTIVES In man, a pathologic extra opening of the bony labyrinth causes altered hearing with supranormal bone conduction. Theoretically, this variation in auditory performance could be advantageous for detection of seismic waves. METHOD The skull of an adult Asian elephant was examined by X-ray computed tomography to investigate whether a natural '3(rd) mobile window' mechanism for enhanced sensitivity of body sounds exist in elephants. RESULTS Although the entire elephant's skull was otherwise broadly aerated, the labyrinth areas were surrounded by dense bone.
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Affiliation(s)
- Krister Brantberg
- a 1 Department of Audiology and Neurotology, Karolinska University Hospital , Stockholm, Sweden
| | - Babak Falahat
- b 2 Department of Radiology, Karolinska University Hospital , Stockholm, Sweden
| | - Daniela C Kalthoff
- c 3 Department of Zoology, Swedish Museum of Natural History , Stockholm, Sweden
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Alemi AS, Chan DK. Progressive Hearing Loss and Head Trauma in Enlarged Vestibular Aqueduct. Otolaryngol Head Neck Surg 2015. [DOI: 10.1177/0194599815596343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Enlarged vestibular aqueduct is the most common radiographically identified cause of congenital sensorineural hearing loss and is frequently progressive. Imaging is often ordered during the workup of children with congenital sensorineural hearing loss in part to identify enlarged vestibular aqueduct given concern for progression with head trauma. However, this association has not been systematically evaluated. We aimed to determine the rate of progression and association with head trauma in individuals with enlarged vestibular aqueduct. Data Sources Systematic review of primary studies identified through PubMed, Embase, Cochrane, and Web of Science. Review Methods Meta-analysis was performed on patient-level data describing enlarged vestibular aqueduct, progressive sensorineural hearing loss, and head trauma extracted from articles identified on systematic review according to PRISMA guidelines. Results Twenty-three studies (1115 ears with enlarged vestibular aqueduct) met inclusion criteria. Progressive sensorineural hearing loss was found in 39.6% of ears, with trauma-associated progression in 12%. Limited case-control data show no difference in the incidence of progression between patients with and without head trauma. Conclusions Long-term progressive sensorineural hearing loss is common in enlarged vestibular aqueduct, but its association with head trauma is not strongly supported.
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Affiliation(s)
- A. Sean Alemi
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Dylan K. Chan
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
- Division of Pediatric Otolaryngology, University of California, San Francisco, California, USA
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Prognostic Factors for Sudden Drops in Hearing Level After Minor Head Injury in Patients With an Enlarged Vestibular Aqueduct. Otol Neurotol 2015; 36:4-11. [DOI: 10.1097/mao.0000000000000659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reith W, Yilmaz U, Heumüller I. [Malformations and abnormalities of the petrous portion of the temporal bone]. Radiologe 2014; 54:327-35. [PMID: 24706250 DOI: 10.1007/s00117-013-2615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
High-resolution computed tomography (HRCT) is the procedure of choice in the diagnostics of abnormalities of the middle and inner ear. It allows a detailed presentation of anatomical features and achieves the prerequisites for selection of the various therapeutic options. The highly diverse abnormalities can be described using detailed imaging analyses. Malformations with an abnormally developed modiolus are assumed to be early embryological defects, such as the classical Mondini dysplasia. The essential therapeutic option for middle ear deformities is still a cochlear implant. The domain of magnetic resonance imaging (MRI) is not only in the analysis of the cochlear nerve and for exclusion of fibrosis or ossification of the labyrinth but is also able to visualize details of isolated malformations, such as an extended vestibular aqueduct or subtle alterations to the vestibule or can visualize them better in comparison to CT. Radiological diagnostics are used not only for classification but also to recognize typical clinical problem situations and play a key role in the diagnostics of hearing disorders and selection of the optimal therapeutic procedure.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland,
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Abou-Elew M, El-Khousht M, El-Minawi MS, Selim M, Kamel AI. Enlarged vestibular aqueduct in congenital non-syndromic sensorineural hearing loss in egypt. Indian J Otolaryngol Head Neck Surg 2014; 66:88-94. [PMID: 24533365 PMCID: PMC3918291 DOI: 10.1007/s12070-011-0327-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/02/2011] [Indexed: 10/14/2022] Open
Abstract
To estimate the frequency of isolated enlarged vestibular aqueduct (EVA) in patients with non-syndromic sensorineural hearing loss (SNHL) in an Egyptian population sample and to correlate its size with the degree of hearing loss. The study group comprised 16 patients (32 ears) suffering from non-syndromic SNHL since childhood. After a complete basic audiological evaluation, all patients were submitted to non contrast CT scan of the petrous bone in both axial & coronal planes. Vestibular aqueduct (VA) was measured at two points (midpoint & operculum) on right & left sides. The study group was divided according to VA size into three groups: group A, B and C. Group A included 6 ears (4 patients) with EVA, group B included 11 ears (7 patients) with borderline EVA and group C included 15 ears (9 patients) with normal VA size. There were no statistically significant differences between the three groups as regards laterality, degree of hearing loss and audiometric configuration. There was no correlation between VA midpoint & operculum and different variables (age and average pure tone thresholds). However, a significant correlation between VA midpoint & operculum was found. EVA was diagnosed in 6 out of 32 ears (18.75%) in the study sample. EVA size was not related to the degree of hearing loss or configuration. Despite the insignificant findings, moderate and high frequency sloping SNHL were considered the most common findings seen in patients with EVA.
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Affiliation(s)
- Maha Abou-Elew
- />Audio-Vestibular Unit of ENT Department, Kasr Al-Aini El-Manial University Hospital, Cairo University, Cairo, 11562 Egypt
| | - Mostafa El-Khousht
- />Audio-Vestibular Unit of ENT Department, Kasr Al-Aini El-Manial University Hospital, Cairo University, Cairo, 11562 Egypt
| | - Mohamed Sherif El-Minawi
- />Audio-Vestibular Unit of ENT Department, Kasr Al-Aini El-Manial University Hospital, Cairo University, Cairo, 11562 Egypt
| | - Mona Selim
- />Audio-Vestibular Unit of ENT Department, Kasr Al-Aini El-Manial University Hospital, Cairo University, Cairo, 11562 Egypt
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Okamoto Y, Mutai H, Nakano A, Arimoto Y, Sugiuchi T, Masuda S, Morimoto N, Sakamoto H, Ogahara N, Takagi A, Taiji H, Kaga K, Ogawa K, Matsunaga T. Subgroups of enlarged vestibular aqueduct in relation toSLC26A4mutations and hearing loss. Laryngoscope 2013; 124:E134-40. [DOI: 10.1002/lary.24368] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Yasuhide Okamoto
- Department of Otolaryngology; National Hospital Organization Tokyo Medical Center; Tokyo Japan
- Department of Otorhinolaryngology; Inagi Municipal Hospital; Tokyo Japan
- Department of Otolaryngology; Keio University Hospital; Tokyo Japan
| | - Hideki Mutai
- Department of Otolaryngology; National Hospital Organization Tokyo Medical Center; Tokyo Japan
| | - Atsuko Nakano
- Division of Otorhinolaryngology; Chiba Children's Hospital; Chiba Japan
| | - Yukiko Arimoto
- Division of Otorhinolaryngology; Chiba Children's Hospital; Chiba Japan
| | - Tomoko Sugiuchi
- Department of Otolaryngology; Kanto Rosai Hospital; Kanagawa Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology; National Mie Hospital; Mie Japan
| | - Noriko Morimoto
- Department of Otorhinolaryngology; National Center for Children and Development; Tokyo Japan
| | - Hirokazu Sakamoto
- Department of Otorhinolaryngology; Kobe Children's Hospital; Hyogo Japan
| | - Noboru Ogahara
- Department of Otorhinolaryngology; Kanagawa Children's Medical Center; Kanagawa Japan
| | - Akira Takagi
- Department of Otorhinolaryngology; Shizuoka General Hospital Shizuoka Japan
| | - Hidenobu Taiji
- Department of Otorhinolaryngology; National Center for Children and Development; Tokyo Japan
| | - Kimitaka Kaga
- Department of Otolaryngology; National Hospital Organization Tokyo Medical Center; Tokyo Japan
| | - Kaoru Ogawa
- Department of Otolaryngology; Keio University Hospital; Tokyo Japan
| | - Tatsuo Matsunaga
- Department of Otolaryngology; National Hospital Organization Tokyo Medical Center; Tokyo Japan
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Song MH, Shin JW, Park HJ, Lee KA, Kim Y, Kim UK, Jeon JH, Choi JY. Intrafamilial phenotypic variability in families with biallelic SLC26A4 mutations. Laryngoscope 2013; 124:E194-202. [PMID: 24338212 DOI: 10.1002/lary.24504] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/26/2013] [Accepted: 10/30/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Enlarged vestibular aqueduct (EVA) and hearing loss are known to be caused by SLC26A4 mutations, but large phenotypic variability exists among patients with biallelic SLC26A4 mutations. Intrafamilial phenotypic variability was analyzed in multiplex EVA families carrying biallelic SLC26A4 mutations to identify the contribution of SLC26A4 mutations and other genetic or environmental factors influencing the clinical manifestations. STUDY DESIGN Retrospective case series. METHODS Eleven multiplex Korean families with EVA and hearing loss that carry biallelic mutations of the SLC26A4 gene were included. Genetic analysis for SLC26A4 and other genes including FOXI1, FOXI1-DBD, and KCNJ10 was performed. The auditory and other phenotypes were compared among siblings with the same SLC26A4 mutations. RESULTS The difference in the auditory phenotypes was identified between siblings in approximately half of the EVA families. Families with SLC26A4 mutations other than H723R homozygous mutations demonstrated more phenotypic variability, especially in those carrying IVS7-2A>G splice site mutation. Cochlear malformation was a consistent finding among siblings with the same SLC26A4 mutations. No mutation was identified in the FOXI1, FOXI1-DBD, and KCNJ10 genes in the tested families. CONCLUSIONS The possibility of variability concerning auditory phenotype should be considered even within family members carrying the same SLC26A4 mutations when providing genetic counseling to multiplex EVA families. Mutations in the currently known genes associated with EVA other than SLC26A4 were not found to be responsible for the intrafamilial phenotypic variability. Modifier genes or environmental factors other than the currently known genes seem to play a role in the phenotypic expressions of EVA patients.
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Affiliation(s)
- Mee Hyun Song
- Department of Otorhinolaryngology, Kwandong University College of Medicine, Myongji Hospital, Goyang, South Korea
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Huang S, Wang G, Jiang Y, Yuan Y, Han D, Song Y, Dai P. Phenotype and genotype of deaf patients with combined genomic and mitochondrial inheritance models. Mitochondrion 2013; 13:791-4. [DOI: 10.1016/j.mito.2013.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/03/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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