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Muelleman TJ, Kavookjian H, Asmar J, Patel K, Nielsen D, Summers K, Tracy M, Noel-MacDonnell J, Staecker H, Ledbetter L, Weatherly R. Internal Auditory Canal Diverticula in Children: A Congenital Variant. Laryngoscope 2020; 131:E1683-E1687. [PMID: 33200834 DOI: 10.1002/lary.29278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Internal auditory diverticula in adults have been found to exist independent of otosclerosis, and in the presence of otosclerosis. We sought to determine the prevalence of internal auditory canal (IAC) diverticula in a pediatric cohort, to assess whether IAC diverticula are a risk factor for hearing loss, and the co-occurrence of otic capsule hypoattenuation. STUDY DESIGN Retrospective review. METHODS A single-site retrospective review of high-resolution temporal bones computed tomography (CT) scans including the presence and size of diverticula and hypoattenuation of the otic capsule. Demographic, imaging, and audiometric data were collected and descriptively analyzed. Bivariate analysis of collected variables was conducted. Comparisons between sides in unilateral cases were also performed. RESULTS 16/600 (2.7%; 95% CI [2.0%, 3.4%]) were found to have IAC diverticula. Six were bilateral. Thirty-one patients (5.2%) were found to have hypoattenuation of the otic capsule. There were no coincident cases of IAC diverticulum and hypoattenuation of the otic capsule. There was no association between the presence of IAC diverticula and age (P = .13). In six patients with unilateral diverticula, pure tone average (P = .42), and word recognition (P = .27) scores were not significantly different when compared to the normal, contralateral side. CONCLUSIONS The prevalence of IAC diverticula in children is lower than the prevalence in adults. IAC diverticula in children likely represent congenital variants of temporal bone anatomy. Similar to adult populations, there is evidence that IAC diverticula in children are likely not an independent risk factor for hearing loss. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1683-E1687, 2021.
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Affiliation(s)
| | - Hannah Kavookjian
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Julia Asmar
- Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, U.S.A
| | - Kirang Patel
- Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, U.S.A
| | - David Nielsen
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, U.S.A
| | - Kyle Summers
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Meghan Tracy
- Department of Otolaryngology- Head and Neck Surgery, Children's Mercy Kansas City, Kansas City, Missouri, U.S.A
| | - Janelle Noel-MacDonnell
- Department of Health Services and Outcomes, Children's Mercy Kansas City, Kansas City, Missouri, U.S.A.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, U.S.A
| | - Hinrich Staecker
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Luke Ledbetter
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Robert Weatherly
- Department of Otolaryngology- Head and Neck Surgery, Children's Mercy Kansas City, Kansas City, Missouri, U.S.A
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Muelleman T, Maxwell AK, Lopez I, Linthicum F, Ishiyama A, Ledbetter L, Lin J, Staecker H, Miller M. Histopathologic Characteristics of Internal Auditory Canal Diverticula. Otol Neurotol 2020; 40:e653-e656. [PMID: 31157724 DOI: 10.1097/mao.0000000000002256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS We hypothesize that internal auditory canal (IAC) diverticula occur independent of otosclerosis as demonstrated by temporal bone histopathology. BACKGROUND Diverticula at the anterior-inferior aspect of the IAC have been described histologically in the setting of cavitary otosclerosis. Recent radiographic studies show the prevalence of IAC diverticula that is higher than what can be accounted for by cavitary otosclerosis alone. METHODS We examined hematoxylin and eosin temporal bone histopathology slides with otosclerosis involving the IAC. We also examined bones from normal hearing subjects with normal histologic findings. Temporal bones were included if donors were more than 18 years of age at time of death and adequate horizontal cuts were available to evaluate the area of interest. RESULTS IAC diverticula were found in 33 of 47 (70%) temporal bones with IAC otosclerosis and in 5 of 20 (25%) normal temporal bones. The difference in mean pure tone averages (PTA) in the normal temporal bones with (PTA 7.3 ± 7) and without (PTA 8 ± 2) diverticula was not statistically significant (p = 0.86). CONCLUSION IAC diverticula which have been previously demonstrated to occur in the setting of cavitary otosclerosis can also occur independent from otosclerosis. Subjects with diverticula but without other temporal bone pathology have normal hearing thresholds.
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Affiliation(s)
| | | | - Ivan Lopez
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California
| | | | - Akira Ishiyama
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California
| | | | - James Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas
| | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas
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Muelleman TJ, Pippin K, Shew M, Villwock M, Lin J, Quesnel AM, Ledbetter L, Staecker H. The Size of Internal Auditory Canal Diverticula Is Unrelated to Degree of Hearing Loss. Laryngoscope 2019; 130:1011-1015. [PMID: 31233221 DOI: 10.1002/lary.28155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To explore the relationship between hearing loss and the internal auditory canal (IAC) diverticula. To determine whether diverticula exist within or medial to the otic capsule and the prevalence in a control population. METHODS Retrospective review of adult patients with radiologic evidence of an IAC diverticulum, no evidence of otosclerosis, and audiometric testing. Analyzed degree of hearing loss and width, length, height, and volume of diverticulum. Hounsfield unit (HU) measurements lateral and medial to the diverticulum. RESULTS Pure tone average (PTA), air-bone gap, and WRS (word recognition score) did not correlate with length, width, height, and volume of the diverticula. In patients with a unilateral diverticulum, there was no difference in mean PTA or WRS when comparing the diverticulum and nondiverticulum sides. Mean HU lateral to the diverticulum (2104 HU) was found to be significantly higher than medial to the diverticulum (1818 HU). There is a 5.6% prevalence of IAC diverticula in patients who underwent high-resolution computed tomography (CT) scans for chronic sinusitis (control group). CONCLUSION These data support the notion that hearing loss in this population is a product of sampling bias. The size of IAC diverticula does not correlate with the degree of hearing loss, and there is no statistically significant association between sensorineural hearing loss (SNHL) and the presence of an IAC diverticulum. IAC diverticula may exist medial to, rather than within, the otic capsule given the significant difference in mean HUs medial and lateral to the diverticula. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1011-1015, 2020.
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Affiliation(s)
| | - Kaley Pippin
- the Department of Radiology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Matthew Shew
- the Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Mark Villwock
- the Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - James Lin
- the Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Alicia M Quesnel
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Luke Ledbetter
- the Department of Radiology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Hinrich Staecker
- the Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
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Bloch SL, McKenna MJ, Adams J, Friis M. Labyrinthitis Ossificans: On the Mechanism of Perilabyrinthine Bone Remodeling. Ann Otol Rhinol Laryngol 2015; 124:649-54. [PMID: 25757630 DOI: 10.1177/0003489415573960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION It has been suggested that remodeling of the otic capsule is highly suppressed by the action of anti-resorptive signals emanating from structures of the inner ear space. Labyrinthitis ossificans (LO) is a severe complication to bacterial meningitis and is characterized by destruction of inner ear structures by the formation of new bone. The aim of this study was to explore the impact of LO on bone remodeling of the otic capsule. MATERIAL AND METHODS In 11 human temporal bones with extensive LO and 10 control specimens, the degree of bone remodeling was explored indirectly by estimating the viability of osteocytes in perilabyrinthine bone and the mastoid. RESULTS The viability of osteocytes was significantly lower in the perilabyrinthine bone compared to the mastoid in both groups. However, the loss of perilabyrinthine osteocytes was the same in the 2 groups, and the presence of cartilage remnants appeared to be the same. CONCLUSION This study indicates that the factors affecting bone remodeling of the otic capsule and the degeneration of osteocytes are not altered by wholesale destruction of inner ear soft tissue and its replacement by bone. Therefore, alternative mechanisms may be implicated in the suppression of capsular bone remodeling.
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Affiliation(s)
- Sune Land Bloch
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Michael John McKenna
- Massachusetts Eye & Ear Infirmary, Harvard University Medical School, Boston, MA, USA
| | - Joe Adams
- Massachusetts Eye & Ear Infirmary, Harvard University Medical School, Boston, MA, USA
| | - Morten Friis
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
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Swinnen FKR, Casselman JW, De Leenheer EMR, Cremers CWRJ, Dhooge IJM. Temporal bone imaging in osteogenesis imperfecta patients with hearing loss. Laryngoscope 2013; 123:1988-95. [DOI: 10.1002/lary.23963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/22/2012] [Accepted: 12/06/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Freya K. R. Swinnen
- Department of Otorhinolaryngology; Ghent University Hospital; Ghent; Belgium
| | - Jan W. Casselman
- Department of Medical Imaging; Sint-Jan Hospital; Bruges; Belgium
| | | | - Cor W. R. J. Cremers
- FC Donders Institute for Neurosciences; Radboud University Nijmegen Medical Centre; Department of Otorhinolaryngology; Nijmegen; The Netherlands
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Abstract
CONCLUSIONS The location and three-dimensional (3D) shapes of the otosclerotic foci suggest a general centripetal distribution of otosclerotic bone remodeling around the inner ear space, whereas the normal bone remodeling is distributed centrifugally. The existence of an inverse spatial relation between normal and otosclerotic bone remodeling suggests that inner ear mechanisms in control of bone remodeling may have a pathogenetic role in otosclerosis. OBJECTIVES To explore the 3D shape of otosclerotic lesions around the inner ear space by introducing the use of 3D reconstructions and to discuss the results in a new context of temporal bone dynamics and perilabyrinthine signaling pathways. METHODS Thirty-four otosclerotic lesions from 20 decalcified human temporal bones were rendered and visualized with the public 3D 'Reconstruct' software. RESULTS The majority of otosclerotic lesions were found close to the labyrinthine space at the well-established topographical sites of predilection with a smooth demarcation against the surrounding bone. However, in addition the virtual 3D technique revealed a new perilabyrinthine anisotropy of individual otosclerotic lesions, displaying a bulky end facing the inner ear space and a volumetric decline towards the capsular periphery.
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Affiliation(s)
- Sune Land Bloch
- Otopathological Laboratory, Department of Otorhinolaryngology Head and Neck Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Tringali S, Perrillas P, Pouget JF, Martin C, Dubreuil C. [How to interpret CT-scan in presence of conductive hearing loss or mixed hearing loss with normal tympanic membrane?]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2008; 125:234-240. [PMID: 18817905 DOI: 10.1016/j.aorl.2008.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 06/10/2008] [Indexed: 05/26/2023]
Affiliation(s)
- S Tringali
- Service d'oto-neurochirurgie, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
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Nakashima T, Sone M, Fujii H, Teranishi M, Yamamoto H, Otake H, Sugiura M, Naganawa S. Blood flow to the promontory in cochlear otosclerosis. Clin Otolaryngol 2008; 31:110-5. [PMID: 16620329 DOI: 10.1111/j.1749-4486.2006.01151.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate Schwartze sign with measurements of blood flow to the promontory in patients with cochlear otosclerosis. DESIGN Prospective clinical study. SETTING Tertiary referral centre. PARTICIPANTS Five patients with cochlear otosclerosis and five control subjects. Significant decalcification around the cochlea was observed by computed tomography (CT) in patients with cochlear otosclerosis. However, no recognizable lesion was observed at the oval window in two patients. One patient had mixed hearing loss and four patients had sensorineural hearing loss without an air-bone gap. MAIN OUTCOME MEASURES The relationship between CT findings and the presence or absence of Schwartze sign was investigated. Blood flow to the promontory was measured through the tympanic membrane using laser speckle flowgraphy and laser Doppler flowmetry. RESULTS The Schwartze sign correlated significantly with otosclerotic lesions invading the promontory. Patients with otosclerosis exhibited elevated and pulsating blood flow to the promontory with the Schwartze sign. CONCLUSIONS Computed tomography demonstrated that cochlear otosclerosis can exist without the oval window lesion. Schwartze sign can be used as a sign of the otosclerotic invasion to the promontory. The reddening of the Schwartze sign is likely due to increased blood flow.
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Affiliation(s)
- T Nakashima
- Department of Otorhinolaryngology, Nagoya University School of Medicine, Showa-ku, Japan.
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