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Szleper A, Lachowska M, Wojciechowski T, Pronicka-Iwanicka K. Detailed analysis of inner ear malformations in CHARGE syndrome patients - correlation with audiological results and proposal for computed tomography scans evaluation methodology. Braz J Otorhinolaryngol 2024; 90:101383. [PMID: 38219448 PMCID: PMC10826126 DOI: 10.1016/j.bjorl.2023.101383] [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: 09/02/2023] [Revised: 11/12/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES The aim was to describe the spectrum of inner ear malformations in CHARGE syndrome and propose a Computed Tomography (CT) detailed scan evaluation methodology. The secondary aim was to correlate the CT findings with hearing thresholds. METHODS Twenty ears of ten patients diagnosed with CHARGE syndrome were subjected to CT analysis focusing on the inner ear and internal acoustic canal. The protocol used is presented in detail. ASSR results were analyzed and correlated with inner ear malformations. RESULTS Cochlear hypoplasia type III was the most common malformation found in 12 ears (60%). Cochlear hypoplasia type II, aplasia with a dilated vestibule, and rudimentary otocyst were also identified. In 20%, no cochlear anomaly was found. The lateral Semicircular Canal (SCC) absence affected 100% of ears, the absence of the posterior SCC 95%, and the superior SCC 65%. Better development of cochlea structures and IAC correlated significantly with the lower hearing thresholds. CONCLUSION This study demonstrated that rudimentary SCC or a complete absence of these SCCs was universally observed in all patients diagnosed with CHARGE syndrome. This finding supports the idea that inner ear anomalies are a hallmark feature of the CHARGE, contributing to its distinct clinical profile. The presence of inner ear malformations has substantial clinical implications. Audiological assessments are crucial for CHARGE syndrome, as hearing loss is common. Early detection of these malformations can guide appropriate interventions, such as hearing aids or cochlear implants, which may significantly improve developmental outcomes and communication for affected individuals. Recognizing inner ear malformations as a diagnostic criterion presents implications beyond clinical diagnosis. A better understanding of these malformations can advance the knowledge of CHARGE pathophysiology. It may also help guide future research into targeted therapies to mitigate the impact of inner ear anomalies on hearing and balance function. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Agata Szleper
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland
| | - Magdalena Lachowska
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Memorial Health Institute, Warsaw, Poland.
| | - Tomasz Wojciechowski
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Poland
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Ionescu EC, Reynard P, Idriss SA, Ltaief-Boudriga A, Joly CA, Thai-Van H. The "Near"-Narrowed Internal Auditory Canal Syndrome in Adults: Clinical Aspects, Audio-Vestibular Findings, and Radiological Criteria for Diagnosis. J Clin Med 2023; 12:7580. [PMID: 38137649 PMCID: PMC10743808 DOI: 10.3390/jcm12247580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Vestibular Paroxysmia (VP) refers to short attacks of vertigo, spontaneous or triggered by head movements, and implies the presence of a compressive vascular loop in contact with the cochleovestibular nerve (CVN). Classically, a narrowed internal auditory canal (IAC) corresponds to a diameter of less than 2 mm on CT, usually associated with a hypoplastic CVN on MRI. The aim of this study was to discuss a distinct clinical entity mimicking VP in relation to a "near"-narrowed IAC (NNIAC) and to propose radiological criteria for its diagnosis. METHODS Radiological measurements of the IAC were compared between three groups: the study group (SG, subjects with a clinical presentation suggestive of VP, but whose MRI of the inner ear and pontocerebellar angle excluded a compressive vascular loop) and two control groups (adult and children) with normal vestibular evaluations and no history of vertigo. RESULTS 59 subjects (18 M and 41 F) were included in the SG. The main symptoms of NNIAC were positional vertigo, exercise- or rapid head movements-induced vertigo, and dizziness. The statistical analysis in the study group showed that the threshold values for diagnosis were 3.3 mm (in tomodensitometry) and 2.9 mm (in MRI) in coronal sections of IAC. Although a significantly lower mean value for axial IAC diameter was found in SG compared with controls, the statistics did not reveal a threshold due to the large inter-individual variations in IAC measurements in normal subjects. There was no significant difference in IAC diameter between the adult and pediatric controls. CONCLUSIONS In the present study, we report a new anatomopathological condition that appears to be responsible for a clinical picture very similar-but not identical-to VP in association with the presence of an NNIAC. The diagnosis requires a careful analysis of the IAC's shape and diameters in both axial and coronal planes.
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Affiliation(s)
- Eugen C. Ionescu
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
| | - Pierre Reynard
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
- Department of Physiology, Claude Bernard University, 69003 Lyon, France
| | - Samar A. Idriss
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Department of Otolaryngology, Dar Al Shifa Hospital, Hawally 13034, Kuwait
- Department of Otolaryngology and Head and Neck Surgery, Eye and Ear Hospital, Holy Spirit University of Kaslik, Beirut 1201, Lebanon
| | | | - Charles-Alexandre Joly
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
- Department of Physiology, Claude Bernard University, 69003 Lyon, France
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