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Brown A, Zhu M, Rohani A, Ladak H, Agrawal SK, Stankovic KM, Welling DB. Surgical Considerations in Inner Ear Gene Therapy from Human Temporal Bone Anatomy. Laryngoscope 2024; 134:2879-2888. [PMID: 38197496 DOI: 10.1002/lary.31259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE(S) Recently directed methods of inner ear drug delivery underscore the necessity for understanding critical anatomical dimensions. This study examines anatomical measurements of the human middle and inner ear relevant for inner ear drug delivery studied with three different imaging modalities. METHODS Post-mortem human temporal bones were analyzed using human temporal bone histopathology (N = 24), micro computerized tomography (μCT; N = 4), and synchrotron radiation phase-contrast imaging (SR-PCI; N = 7). Nine measurements involving the oval and round windows were performed when relevant anatomical structures were visualized for subsequent age-controlled analysis, and comparisons were made between imaging methods. RESULTS Combined human temporal bone histopathology showed the mean distance to the saccule from the center of the stapes footplate (FP) was 2.07 ± 0.357 mm and the minimum distance was 1.23 mm. The mean distance from the round window membrane (RWM) to the osseous spiral lamina (OSL) was 1.75 ± 0.199 mm and the minimum distance was 1.43 mm. Instruments inserted up to 1 mm past the center of the FP are unlikely to cause saccular damage, provided there are no endolymphatic hydrops. Similarly, instruments inserted up to 1 mm through the RWM in the trajectory toward the OSL are unlikely to cause OSL damage. CONCLUSION The combined analyses of inner-ear dimensions of age-controlled groups and imaging modalities demonstrate critical dimensions of importance to consider when inserting delivery vehicles into the human cochlea. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2879-2888, 2024.
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Affiliation(s)
- Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
| | - MengYu Zhu
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Otopathology Laboratory, Boston, Massachusetts, U.S.A
| | - Alireza Rohani
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hanif Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Konstantina M Stankovic
- Department of Otolaryngology Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Division of Otology and Neurotology, Harvard Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, Massachusetts, U.S.A
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Aksoy DO, Meltem E, Karagoz Y, Ulusan MB, Mahmutoglu O, Mahmutoglu AS. The Cochlear Size Variations in Incomplete Partitions with Multiplanar Images on Pediatric Temporal Bone CT. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:426-433. [PMID: 37900333 PMCID: PMC10600602 DOI: 10.14744/semb.2023.65725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/06/2023] [Accepted: 08/04/2023] [Indexed: 10/31/2023]
Abstract
Objectives The purpose of the study was to evaluate cochlea dimensions by the multiplanar reconstruction of high-resolution computed tomography that could be useful in diagnosing incomplete partition (IP) malformations. Methods This study included 32 patients with 64 side cochleae diagnosed with IP defect and 38 cochleae as the control without any defect. Basal turn length (BL), cochlear height (CH), Mid-apical length (MAL), Mid-apical height, Cochlear length (A), and Cochlear width (B) were measured on reformat images. Results Twenty cochleae of these patients have been diagnosed with IP type I, 34 with IP type II, and 10 with IP type III. The MAL values are shorter than the control group in IP types I and III (p<0.001, p<0.001). BL values are shorter in IP type III cases (p<0.001). In IP II cases, BL and MAL values overlapped with the control group. CH did not differ significantly from the control group in any IP type. A and B values were significantly lower than the control group for IP I and III (p<0.01). There is a positive correlation between A and B values for all IP types (p<0.01). Conclusion Quantitative data about differences in the size and shape of the cochlea in IP cases would help differentiate them from the normal cochlea. Since A and B values showed a positive correlation, it is suggested that A and B values can be used to estimate CDL for IP types.
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Affiliation(s)
- Direnc Ozlem Aksoy
- Department of Radiology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Emine Meltem
- Department of Radiology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Yesim Karagoz
- Department of Radiology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Melis Baykara Ulusan
- Department of Radiology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Ozdes Mahmutoglu
- Department of Radiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Abdullah Soydan Mahmutoglu
- Department of Radiology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye
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Curtis DP, Baumann AN, Jeyakumar A. Variation in cochlear size: A systematic review. Int J Pediatr Otorhinolaryngol 2023; 171:111659. [PMID: 37459768 DOI: 10.1016/j.ijporl.2023.111659] [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: 03/15/2023] [Revised: 06/22/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Advancements in imaging and implantation technology have invited reexamination of the classic teaching that the human cochlea maintains uniform size across demographics. Yet, studies yield conflicting results and relatively few broad systematic reviews have examined cochlear size variation. PURPOSE The purpose of this study is to quantify cochlear variability across eight different measurement categories and suggest normative values and ranges for each with consideration of disease state and gender where possible. METHODS A systematic search was conducted up to October 1, 2022, using the search terms "Cochlea/anatomy and histology"[Mesh]) AND 'size'" with filters "Humans" and "English" across three databases (PubMed, CINAHL, Medline). Further inclusion criteria involved reporting of numerical measurements in any of the eight included categories. RESULTS Of the 625 articles manually reviewed for relevance by title and abstract, 91 were selected for full-text review and 33 met all eligibility criteria. 5,791 cochleae were included and weighted means and ranges were calculated: "A" value (defined as the distance from the round window, through the modiolus, to the oppsite lateral wall) = 9.23 mm (8.43-10.4 mm, n = 2559); cochlear duct length (CDL) = 33.04 mm (range 28.2-36.4 mm, n = 2252); cochlear height = 5.14 mm (2.8-6.9 mm, n = 2098); the basal turn lumen diameter = 2.09 mm (1.7-2.2 mm, n = 617); "B" value (defined as perpendicular to "A" value and in the same plane) = 6.52 mm (5.73-6.9 mm, n = 908); width of the basal turn = 6.4 mm (6.22-6.86 mm, n = 356); height of the basal turn = 1.96 mm (1.77-2.56 mm, n = 204); length of the basal turn 21.87 mm (21.03-22.5 mm, n = 384). CONCLUSION A notable size range exists across the eight different cochlear parameters considered and we provide normative values for each measurement. Females tend to have smaller CDL and "A" value than males and the sensorineural hearing loss patients had smaller CDL and "A" value but larger cochlear height than the general population.
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Affiliation(s)
| | | | - Anita Jeyakumar
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, OH, 44512, USA
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Eser MB, Atalay B, Dogan MB, Gündüz N, Kalcioglu MT. Measuring 3D Cochlear Duct Length on MRI: Is It Accurate and Reliable? AJNR Am J Neuroradiol 2021; 42:2016-2022. [PMID: 34593380 DOI: 10.3174/ajnr.a7287] [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: 04/21/2021] [Accepted: 07/25/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prior studies have evaluated cochlear length using CT to select the most suitable cochlear implants and obtain patient-specific anatomy. This study aimed to test the accuracy and reliability of cochlear lateral wall length measurements using 3D MR imaging. MATERIALS AND METHODS Two observers measured the cochlear lateral wall length of 35 patients (21 men) with postlingual hearing loss using CT and MR imaging. The intraclass correlation coefficient (with 95% confidence intervals) was used to evaluate intraobserver and interobserver reliability for the 3D cochlear measurements. RESULTS The mean age of the participants was 39.85 (SD, 16.60) years. Observer 1 measured the mean lateral wall length as 41.52 (SD, 2.25) mm on CT and 41.44 (SD, 2.18) mm on MR imaging, with a mean difference of 0.08 mm (95% CI, -0.11 to 0.27 mm), while observer 2 measured the mean lateral wall length as 41.74 (SD, 2.69) mm on CT and 42.34 (SD, 2.53) mm on MR imaging, with a mean difference of -0.59 mm (95% CI, -1.00 to -0.20 mm). An intraclass correlation coefficient value of 0.90 (95% CI, 0.84-0.94) for CT and 0.69 (95% CI, 0.46-0.82) for MR imaging was obtained for the interobserver reliability for the full-turn cochlear lateral wall length. CONCLUSIONS CT-based 3D cochlear measurements show excellent intraobserver and interobserver reliability, while MR imaging-based lateral wall length measurements have good-to-excellent intraobserver reliability and moderate interobserver reliability. These results corroborate the use of CT for 3D cochlear measurements as a reference method and demonstrate MR imaging to be an alternative acquisition technique with comparably reliable results.
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Affiliation(s)
- M B Eser
- From the Departments of Radiology (M.B.E., B.A., M.B.D., N.G.)
| | - B Atalay
- From the Departments of Radiology (M.B.E., B.A., M.B.D., N.G.)
| | - M B Dogan
- From the Departments of Radiology (M.B.E., B.A., M.B.D., N.G.)
| | - N Gündüz
- From the Departments of Radiology (M.B.E., B.A., M.B.D., N.G.)
| | - M T Kalcioglu
- Otorhinolaryngology-Head and Neck Surgery (M.T.K.), Faculty of Medicine, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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Neves CA, Tran ED, Cooperman SP, Blevins NH. Fully Automated Measurement of Cochlear Duct Length From Clinical Temporal Bone Computed Tomography. Laryngoscope 2021; 132:449-458. [PMID: 34536238 DOI: 10.1002/lary.29869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present and validate a novel fully automated method to measure cochlear dimensions, including cochlear duct length (CDL). STUDY DESIGN Cross-sectional study. METHODS The computational method combined 1) a deep learning (DL) algorithm to segment the cochlea and otic capsule and 2) geometric analysis to measure anti-modiolar distances from the round window to the apex. The algorithm was trained using 165 manually segmented clinical computed tomography (CT). A Testing group of 159 CTs were then measured for cochlear diameter and width (A- and B-values) and CDL using the automated system and compared against manual measurements. The results were also compared with existing approaches and historical data. In addition, pre- and post-implantation scans from 27 cochlear implant recipients were studied to compare predicted versus actual array insertion depth. RESULTS Measurements were successfully obtained in 98.1% of scans. The mean CDL to 900° was 35.52 mm (SD, 2.06; range, [30.91-40.50]), the mean A-value was 8.88 mm (0.47; [7.67-10.49]), and mean B-value was 6.38 mm (0.42; [5.16-7.38]). The R2 fit of the automated to manual measurements was 0.87 for A-value, 0.70 for B-value, and 0.71 for CDL. For anti-modiolar arrays, the distance between the imaged and predicted array tip location was 0.57 mm (1.25; [0.13-5.28]). CONCLUSION Our method provides a fully automated means of cochlear analysis from clinical CTs. The distribution of CDL, dimensions, and cochlear quadrant lengths is similar to those from historical data. This approach requires no radiographic experience and is free from user-related variation. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Caio A Neves
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Emma D Tran
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Shayna P Cooperman
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Nikolas H Blevins
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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