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Kim K, Park S, Lee S, Park E, Kim B, Kim B, Kim J. Four-hour-delayed 3D-FLAIR MRIs in patients with acute unilateral peripheral vestibulopathy. Ann Clin Transl Neurol 2024; 11:2030-2039. [PMID: 38874375 PMCID: PMC11330212 DOI: 10.1002/acn3.52123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN. METHODS We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared. RESULTS Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement. INTERPRETATION Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.
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Affiliation(s)
- Keun‐Tae Kim
- Department of NeurologyKorea University Medical CenterSeoulSouth Korea
| | - Sangeun Park
- Department of RadiologyKorea University Medical CenterSeoulSouth Korea
| | - Sun‐Uk Lee
- Department of NeurologyKorea University Medical CenterSeoulSouth Korea
- Neurotology and Neuro‐ophthalmology LaboratoryKorea University Medical CenterSeoulSouth Korea
| | - Euyhyun Park
- Neurotology and Neuro‐ophthalmology LaboratoryKorea University Medical CenterSeoulSouth Korea
- Department of Otorhinolaryngology‐Head and Neck SurgeryKorea University Medical CenterSeoulSouth Korea
| | - Byungjun Kim
- Department of RadiologyKorea University Medical CenterSeoulSouth Korea
| | - Byung‐Jo Kim
- Department of NeurologyKorea University Medical CenterSeoulSouth Korea
- BK21 FOUR Program in Learning Health SystemsKorea UniversitySeoulSouth Korea
| | - Ji‐Soo Kim
- Dizziness Center, Clinical Neuroscience CenterSeoul National University Bundang HospitalSeongnamSouth Korea
- Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
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Abouzari M, Abiri A, Tawk K, Tsang C, Patel B, Khoshsar A, Djalilian HR. White Matter Hyperintensity in Patients with Sudden Sensorineural Hearing Loss. Diagnostics (Basel) 2024; 14:1109. [PMID: 38893635 PMCID: PMC11171904 DOI: 10.3390/diagnostics14111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To compare white matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) and analyze subpopulations with age-matched controls. METHODS T2-weighted MRI scans of 150 patients with SSNHL were assessed for WMHs and compared with the data of 148 healthy age-matched adults. Assessments of WMHs included independent grading of deep white matter hyperintensities (DWMHs) and periventricular hyperintensities (PVHs). WMH severity was visually rated using the Fazekas and Mirsen scales by two independent observers. RESULTS Fazekas grades for PVHs (p < 0.001) and DWMHs (p < 0.001) of SSNHL patients were found to be significantly greater than those of healthy participants. The average Mirsen grades for DWMHs of healthy and SSNHL patients were evaluated to be 0.373 ± 0.550 and 2.140 ± 0.859, respectively. Mirsen grades for DWMHs of SSNHL patients were found to be significantly greater (p < 0.001) than those of healthy participants. The Mirsen scale was found to have higher sensitivity (p < 0.001) than the Fazekas scale in grading PVHs and DWMHs. No significant difference (p = 0.24) was found in specificities between the two scales. CONCLUSIONS Patients with sudden hearing loss have a much higher likelihood of having periventricular and deep white matter hyperintensities compared to age-matched controls. These findings indicate that sudden hearing loss patients are more likely to have microvascular changes in the brain, which may indicate a vascular and/or migraine origin to sudden sensorineural hearing loss.
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Affiliation(s)
- Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Karen Tawk
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Cynthia Tsang
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Beenish Patel
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Avissa Khoshsar
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
- Department of Neurological Surgery, University of California, Irvine, CA 92697, USA
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Harrison P, Blazak J, Richmond J, Fraser-Kirk K, Hoffmann A, Collins G, Tsang BKT. Sudden unilateral audiovestibular loss due to acute labyrinthine haemorrhage can be missed on early MRI brain sequences: case report. BMJ Neurol Open 2024; 6:e000563. [PMID: 38268758 PMCID: PMC10806776 DOI: 10.1136/bmjno-2023-000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Labyrinthine haemorrhage is a rare vascular disorder often presenting with the triad of acute vertigo, sudden sensorineural hearing loss and tinnitus. There are minimal reports on imaging progression over the acute period. Index case A woman in her mid-40s presented with acute vertigo, sudden left-sided hearing loss and tinnitus, consistent with acute unilateral audiovestibular loss. Left peripheral vestibular hypofunction was confirmed acutely on video head impulse testing, and pure tone audiometry showed a profound left sensorineural hearing loss. An MRI brain including diffusion-weighted imaging within 24 hours was normal. Delayed MRI brain and internal acoustic canal after 7 days demonstrated increased 3D fluid-attenuated inversion recovery and T1 signal throughout the left cochlea and semicircular canals, without contrast enhancement. This was consistent with labyrinthine haemorrhage. She received early oral prednisone followed by three doses of intratympanic dexamethasone. At 12 months follow-up the patient remained profoundly deaf, however, balance and vestibular symptoms improved with early vestibular physical rehabilitation. Conclusion We report a case of acute labyrinthine haemorrhage missed on an early MRI brain sequence. This diagnosis should be considered in presentations of acute audiovestibular loss, and delayed MRI including internal auditory canal sequences may be important for diagnosis.
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Affiliation(s)
- Patrick Harrison
- Department of Neurology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia
| | - John Blazak
- Department of Radiology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Joshua Richmond
- Department of Haematology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Kristy Fraser-Kirk
- Department of Ear, Nose and Throat Surgery, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Aliese Hoffmann
- Department of Physiotherapy, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Grant Collins
- Queensland Vestibular Cochlear Clinic, Sunshine Coast, Queensland, Australia
| | - Benjamin K-T Tsang
- Department of Neurology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia
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Kurata N, Kawashima Y, Ito T, Fujikawa T, Nishio A, Honda K, Kanai Y, Terasaki M, Endo I, Tsutsumi T. Advanced Magnetic Resonance Imaging Sheds Light on the Distinct Pathophysiology of Various Types of Acute Sensorineural Hearing Loss. Otol Neurotol 2023:00129492-990000000-00324. [PMID: 37400150 DOI: 10.1097/mao.0000000000003930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To compare the findings of magnetic resonance imaging (MRI) with advanced protocols in patients with various types of acute sensorineural hearing loss (ASNHL). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Two hundred eighty-seven patients with ASNHL. INTERVENTIONS All patients underwent MRI scanning, including heavily T2-weighted three-dimensional fluid-attenuated inversion recovery before and 4 hours after the intravenous administration of gadolinium contrast medium (delayed 3D-FLAIR). A hybrid of the reversed image of the positive endolymph signal and the native image of the perilymph signal image was constructed to visualize the endolymphatic space. RESULTS The detection rates of abnormal MRI findings vary significantly among different types of ASNHL. A hyperintense signal on delayed 3D-FLAIR was observed in all patients with intralabyrinthine schwannoma or vestibular schwannoma and 20.5% of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) but was rarely observed in definite Ménière's disease (MD, 2.6%). In contrast, endolymphatic hydrops (EH) was frequently observed in patients with definite MD (79.5%) but was observed much less frequently in patients with ISSNHL (11.0%). In patients with cochlear MD and ALHL, detection rates of cochlear EH were similar to those with definite MD, whereas detection rates of vestibular EH were significantly lower than in patients with definite MD. CONCLUSIONS The significantly different detection rates of abnormal MRI findings among various types of ASNHL shed light on the distinct pathophysiology of each disorder. A diagnosis based on MRI findings with advanced protocols may help select treatment strategies and provide prognostic information for patients.
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Affiliation(s)
- Natsuko Kurata
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yoshiyuki Kawashima
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taku Ito
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taro Fujikawa
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ayako Nishio
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Keiji Honda
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yasuhisa Kanai
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Mariko Terasaki
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Ikuyo Endo
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. J Vestib Res 2022; 32:205-222. [PMID: 35367974 PMCID: PMC9249306 DOI: 10.3233/ves-210169] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper presents diagnostic criteria for vascular vertigo and dizziness as formulated by the Committee for the Classification of Vestibular Disorders of the Bárány Society. The classification includes vertigo/dizziness due to stroke or transient ischemic attack as well as isolated labyrinthine infarction/hemorrhage, and vertebral artery compression syndrome. Vertigo and dizziness are among the most common symptoms of posterior circulation strokes. Vascular vertigo/dizziness may be acute and prolonged (≥24 hours) or transient (minutes to < 24 hours). Vascular vertigo/dizziness should be considered in patients who present with acute vestibular symptoms and additional central neurological symptoms and signs, including central HINTS signs (normal head-impulse test, direction-changing gaze-evoked nystagmus, or pronounced skew deviation), particularly in the presence of vascular risk factors. Isolated labyrinthine infarction does not have a confirmatory test, but should be considered in individuals at increased risk of stroke and can be presumed in cases of acute unilateral vestibular loss if accompanied or followed within 30 days by an ischemic stroke in the anterior inferior cerebellar artery territory. For diagnosis of vertebral artery compression syndrome, typical symptoms and signs in combination with imaging or sonographic documentation of vascular compromise are required.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David E Newman-Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kevin A Kerber
- Department of Neurology, University of Michigan Health System, Ann Arbor, USA
| | - Klaus Jahn
- Department of Neurology Schoen Clinic Bad Aibling and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | | | - John Waterston
- Monash Department of Neuroscience, Alfred Hospital, Melbourne, Australia
| | - Hyung Lee
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
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Chen K, Sun J, Huang B, Liang Y, Liu M, Wu X. Labyrinthine lesions in presumed inner ear hemorrhage-related sudden deafness. Am J Otolaryngol 2022; 43:103331. [PMID: 34952417 DOI: 10.1016/j.amjoto.2021.103331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/20/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Inner ear hemorrhage (IEH) is a rare cause of sudden sensorineural hearing loss (SSNHL). This study aimed to evaluate the lesional patterns in patients with presumed IEH from morphological and functional aspects. METHODS Seventeen patients with SSNHL and presumed IEH who completed audio-vestibular tests were included. The main outcome measures included clinical characteristics, radiology, and functional test results. RESULTS The morphological findings and functional tests revealed differences in locations and lesional spectrums. The magnetic resonance imaging (MRI) hyperintensity was likely to involve the vestibule (88.2%), the cochlea (76.5%), and the posterior and lateral semicircular canals (76.5% and 70.6%, respectively). Furthermore, 70.6% of cases showed abnormality in the entire labyrinth, and abnormalities in the vestibule/semicircular canals were observed in 17.6% of cases. Meanwhile, dysfunction was sequentially detected in the cochlea (100%), semicircular canals (94.1%), and vestibule (70.6%); 64.7% of cases showed combined deficit in the entire labyrinth, and 29.4% of cases showed combined deficit in the cochlea/semicircular canals. Although lesions in the labyrinth were frequently detected, the results of the radiological and functional tests did not always match and significantly differed in either cochlear or superior semicircular canal damage detection (p < 0.05 each). CONCLUSIONS In this cohort, IEH preferentially caused sudden audio-vestibular impairment, which was well demonstrated by a combination of MRI and functional tests. The specific lesional configurations revealed in this study may suggest a possible pathomechanism that could be further explored as a therapeutic target.
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Affiliation(s)
- Kaitian Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Jincangjian Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Bixue Huang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Yue Liang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China
| | - Min Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China.
| | - Xuan Wu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, China.
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Clinical usefulness of labyrinthine three-dimensional fluid-attenuated inversion recovery magnetic resonance images in idiopathic sudden sensorineural hearing loss. Curr Opin Otolaryngol Head Neck Surg 2021; 29:349-356. [PMID: 34459797 DOI: 10.1097/moo.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Literature on the use of current magnetic resonance imaging (MRI) for patients with idiopathic sudden sensorineural hearing loss (ISSNHL) is reviewed, emphasizing the role of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI. The discussion focuses on the diagnostic role of temporal bone MRI using 3D-FLAIR and the relationship between MRI findings, clinical symptoms, and hearing outcome. RECENT FINDINGS The currently suggested MRI protocol for SSNHL includes a 3D T2-weighted steady-state free procession sequence or its equivalent, pre and postcontrast T1-weighted, and pre and postcontrast 3D-FLAIR sequences. The 3D-FLAIR image identifies an underlying labyrinthine condition in 24-57% of patients with ISSNHL, contributing to understanding the pathophysiologic mechanisms (e.g., labyrinthitis or labyrinthine hemorrhage). Recent studies demonstrated consistent results that initial hearing loss could be related to the signal change on the 3D-FLAIR image. Various results on 3D-FLAIR image value prediction for the final hearing outcome were shown. SUMMARY 3D-FLAIR MRI application identifies an underlying labyrinthine condition. Abnormal MRI findings correlate with initial hearing loss and accompanying symptoms and hearing outcome. Performing temporal bone MRI with 3D-FLAIR sequence may clarify probable ISSNHL pathophysiology, improve diagnostic accuracy, provide prognostic information to physicians, and possibly guide toward a more specific treatment.
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Gao FS, Jia X, Ma X, Bi J, Shu Q. Diagnostic value of 3D-FLAIR MRI in children with sudden deafness caused by inner ear hemorrhage. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000280. [PMID: 36475234 PMCID: PMC9716951 DOI: 10.1136/wjps-2021-000280] [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: 04/26/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the diagnostic value of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI in children with sudden deafness caused by inner ear hemorrhage. Methods The diagnostic efficacies of three different MRI sequences in the examination of the inner ear for 32 children with sudden deafness were compared. Hearing examination results and 3-month follow-up outcomes were analyzed. Results The age of 32 children with sudden deafness ranged from 5 to 18 years. MRI was performed from 1 to 18 days after onset. Six cases of sudden deafness caused by inner ear hemorrhage were finally diagnosed clinically. For different MRI sequences, the 3D-FLAIR sequence detected five positive cases; the conventional T1-weighted image sequence also detected five positive cases; but the conventional T2-weighted image sequence only detected three positive cases. The sensitivity and specificity of the 3D-FLAIR sequence in the diagnosis of inner ear hemorrhage were 83.3% (5/6) and 96.2% (25/26), respectively, and the area under the curve value of the receiver operating characteristic curve was 0.897. In the hemorrhage group, all six cases had extremely severe sensorineural hearing loss, and the hearing recovery was ineffective after 3 months of follow-up. The degree of hearing impairment, 3-month short-term treatment efficacy, and 3D-FLAIR MRI in the diagnosis of inner ear hemorrhage between hemorrhage group and non-hemorrhage group were statistically significant (p=0.043, p=0.000, p=0.000). Conclusions 3D-FLAIR MRI is helpful for the diagnosis of inner ear hemorrhage in children with sudden deafness. Besides, short-term treatment indicates poor effects on children with severe hearing impairment.
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Affiliation(s)
- Fu Sheng Gao
- Department of Radiology, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, Zhejiang, China
| | - Xuan Jia
- Department of Radiology, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, Zhejiang, China
| | - XiaoHui Ma
- Department of Radiology, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, Zhejiang, China
| | - Jing Bi
- Department of Otorhinolaryngology, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, Zhejiang, China
| | - Qiang Shu
- Department of Cardio-Thoracic Surgery, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, Zhejiang, China
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Labyrinthine Hemorrhage in Relapsing Polychondritis. Otol Neurotol 2021; 42:e240-e243. [PMID: 33252367 DOI: 10.1097/mao.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benson JC, Carlson ML, Lane JI. MRI of the Internal Auditory Canal, Labyrinth, and Middle Ear: How We Do It. Radiology 2020; 297:252-265. [PMID: 32960730 DOI: 10.1148/radiol.2020201767] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
MRI is firmly established as an essential modality in the imaging of the temporal bone and lateral skull base. It is used to evaluate normal anatomic structures, evaluate for vestibular schwannomas, assess for inflammatory and/or infectious processes, and detect residual and/or recurrent cholesteatoma. It is also extensively used in pre- and postoperative evaluations, particularly in patients with vestibular schwannomas and candidates for cochlear implantation. Nevertheless, despite the widespread use of MRI for these purposes, many radiologists remain unfamiliar with the complex anatomy and expected imaging findings with such examinations. The purpose of this review is to provide an overview of the most useful MRI sequences for internal auditory canal and labyrinthine imaging, review the relevant anatomy, and discuss the expected appearances of the most commonly encountered pathologic entities. In addition, the features at pre- and postprocedural MRI will be discussed to help ensure that diagnostic radiologists may be of greatest use to the ordering physicians. © RSNA, 2020.
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Affiliation(s)
- John C Benson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Matthew L Carlson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John I Lane
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Lammers MJW, Young E, Fenton D, Lea J, Westerberg BD. The prognostic value and pathophysiologic significance of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis. Clin Otolaryngol 2019; 44:1017-1025. [PMID: 31532907 DOI: 10.1111/coa.13432] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/27/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown. However, an increasing number of observational studies report intralabyrinthine signal alterations in patients with ISSNHL using three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI). These findings warrant a meta-analysis. OBJECTIVE OF REVIEW To conduct a meta-analysis assessing the value of 3D-FLAIR MRI in identifying possible underlying labyrinthine pathophysiologic mechanisms and prognostication in patients with ISSNHL. SEARCH STRATEGY Two reviewers independently searched the Pubmed, Embase and Cochrane Library from inception until October 10, 2018 and evaluated eligibility based on titles and abstracts of all retrieved studies. All studies reporting on 3D-FLAIR imaging in ISSNHL were included. Subsequently, the full text of eligible studies were evaluated. EVALUATION METHOD Adhering to the MOOSE guideline, two independent reviewers extracted data, assessed risk of bias and evaluated the relevance and quality of evidence. Data on the number of patients and events were extracted and hearing levels were converted to standardised mean differences (SMD) for conducting meta-analyses. Random effects models for meta-analyses were applied. RESULTS Eight observational studies met our inclusion criteria (n = 638 patients). In 29%, high signal intensity was found on 3D-FLAIR imaging, suggesting labyrinthine pathology (labyrinthitis [79%], intralabyrinthine haemorrhage [21%]). High signal intensity on 3D-FLAIR was associated with poorer hearing (SMD: 14 dB, 95% CI 5.67-22.94) and vertigo (RR: 1.92, 95% CI 1.16-3.17) at baseline. Multivariate analyses demonstrated that patients with high 3D-FLAIR signal intensity had 21 dB lower final hearing pure-tone averages (SMD: 21 dB, 95% CI 9.08-33.24). CONCLUSIONS Three-dimensional fluid-attenuated inversion recovery MR imaging can identify an underlying labyrinthine condition in up to 29% of patients with sudden hearing loss in whom previously no cause could be identified. Their final pure-tone averages are more than 20 dB worse than 3D-FLAIR-negative patients, suggesting more severe labyrinthine damage. Findings such as these may contribute to our understanding of pathophysiologic mechanisms of ISSNHL.
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Affiliation(s)
- Marc J W Lammers
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Emily Young
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David Fenton
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jane Lea
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Brian D Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Chen XH, Zeng CJ, Fang ZM, Zhang R, Cheng JM, Lin C. The Natural History of Labyrinthine Hemorrhage in Patients With Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2019; 98:E13-E20. [PMID: 30909739 DOI: 10.1177/0145561319834862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the application of inner ear 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL) accompanied by inner ear hemorrhage. A total of 1252 SSNHL patients who were admitted from January 2010 to April 2018 were included in the study. The patients' clinical features, complete blood counts, coagulation profiles, audiometry data, and MRI scans were retrospectively reviewed. Twenty-four patients had high labyrinth signals on inner ear 3D-FLAIR MRI (24/1252, 1.9%) that were diagnosed as inner ear hemorrhage. One patient had endolymphatic hydrops on the contralesional side. In the 24 patients, pure tone audiometry curves revealed profound deafness (19/24) and flat moderate hearing loss (5/24); most patients had associated vertigo (23/24) and tinnitus (19/24). Patients with SSNHL (N = 24) were treated. Sixteen patients had invalid improvement, 3 patients were markedly improved, 4 patients had effective treatment, and only 1 patient was cured, for a therapeutic efficacy of 33.3% (8/24). Follow-up 3D-FLAIR MRI in patients showed absorbance of labyrinthine hemorrhage and disappearance of the high signal intensity in the inner ear within 2 weeks to 4 months. Inner ear 3D-FLAIR MRI indicate that most cases of inner ear hemorrhage are spontaneous and that high labyrinth signals are absorbed within 4 months. The site of labyrinth hemorrhage is irregular and independent of hearing loss. Conventional treatment is not very effective, and an appropriate therapy for SSNHL requires further investigation.
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Affiliation(s)
- Xi-Hang Chen
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Chao-Jun Zeng
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Zhe-Ming Fang
- 2 Department of Radiology, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Rong Zhang
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Jin-Mei Cheng
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Chang Lin
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
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Chen K, Wen L, Zong L, Liu M, Sun J, Wu X. Audiological outcomes in sudden sensorineural hearing loss with presumed inner ear hemorrhage. Am J Otolaryngol 2019; 40:274-278. [PMID: 30473168 DOI: 10.1016/j.amjoto.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the hearing outcomes and prognostic factors in patients with sudden sensorineural hearing loss resulting from inner ear hemorrhage. METHODS 42 patients (22 male and 20 female) were recruited from January 2016 to December 2017. Intravenous methylprednisolone and/or intratympanic corticosteroid were used as salvage therapy. The main measures included systemic risk factors and audiometric outcomes as proposed by American Academy of Otolaryngology-Head and Neck Surgery Hearing Loss Scale. All individuals were assessed at baseline, discharge (2 weeks post-treatment) and at 1, 3 and 6 months. RESULTS The mean ages of patients were 39.3 ± 14.8 yrs. Cardiovascular disorders were seen in 19.0-33.3% of cases. Restoration of hearing and speech discrimination abilities were assessed at the first month post-treatment versus initial levels (95.5 ± 15.5 vs. 109.2 ± 9.6 dB, p = 0.000; and 17.6 ± 24.4 vs. 1.3 ± 4.0%, p = 0.003, respectively). Word recognition scores continued to recover at month 6 (38.7 ± 35.4%, p = 0.000), whereas puretone ceased to change (90.8 ± 16.2 dB, p = 0.139). The final percentages of complete, partial and no recovery were 0%, 57.1% and 42.9% respectively. The prognosis was independent of accompanying systemic risk factors as analyzed in this study. Intratympanic intervention was associated with improved word recognition scores, although intravenous corticosteroid was not. CONCLUSIONS Profound sudden sensorineural hearing loss caused by inner ear hemorrhage often has an unsatisfactory prognosis. However, this cohort did experience partial audiological recovery with delayed onset. Immediate and effective intratympanic corticosteroid may have therapeutic potential for this intractable disease.
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MESH Headings
- Adrenal Cortex Hormones/administration & dosage
- Adult
- Auditory Perception
- Cohort Studies
- Female
- Hearing
- Hearing Loss, Sensorineural/drug therapy
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/rehabilitation
- Hearing Loss, Sudden/drug therapy
- Hearing Loss, Sudden/etiology
- Hearing Loss, Sudden/physiopathology
- Hearing Loss, Sudden/rehabilitation
- Hemorrhage/complications
- Humans
- Infusions, Intravenous
- Injection, Intratympanic
- Labyrinth Diseases/complications
- Male
- Methylprednisolone/administration & dosage
- Middle Aged
- Prognosis
- Risk Factors
- Salvage Therapy
- Treatment Outcome
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Affiliation(s)
- Kaitian Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Lanying Wen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Ling Zong
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, PR China
| | - Min Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Jincangjian Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Xuan Wu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China.
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Jambawalikar S, Liu MZ, Moonis G. Advanced MR Imaging of the Temporal Bone. Neuroimaging Clin N Am 2019; 29:197-202. [DOI: 10.1016/j.nic.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wu X, Jiang H, Wen L, Zong L, Chen K. Delayed Recovery in Pediatric Sudden Sensorineural Hearing Loss Predicted via Magnetic Resonance Imaging. Ann Otol Rhinol Laryngol 2018; 127:373-378. [PMID: 29717656 DOI: 10.1177/0003489418769942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To evaluate the potential origins via magnetic resonance imaging and the relevant hearing recovery course of pediatric sudden sensorineural hearing loss. Methods: We retrospectively analyzed data of 25 pediatric patients from our center with sudden sensorineural hearing loss from January 2011 to December 2016. All individuals were closely followed up at baseline and 1 and 6 months. Results: Magnetic resonance imaging identified presumed causes in 9 cases, 5 of which showed intralabyrinthine hyperintensity, suggesting presumptive intralabyrinthine hemorrhage. The remaining 20 patients showed no hyperintensity. Restoration of hearing and speech discrimination abilities were noted in these 25 children at 6 months versus the initial levels (74.2 ± 22.6 vs 93.5 ± 20.5 dB, p = .000, and 45.8 ± 36.0 vs. 18.3 ± 22.1%, p = .004, respectively). The prognosis of the individuals with intralabyrinthine hemorrhage were superior in terms of frequency and hearing threshold at 6 months compared with that of the no-hemorrhage participants. Word recognition scores improved in either studied group. Conclusion: The potential recovery of hearing in children raises concerns about very early surgical intervention within the first 6 months. Rational imaging and sequential audiometric evaluation to monitor the progression of recovery may be beneficial.
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Affiliation(s)
- Xuan Wu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, PR China
| | - Hongyan Jiang
- Department of Otorhinolaryngology, Hainan General Hospital, Haikou, PR China
| | - Lanying Wen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, PR China
| | - Ling Zong
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Kaitian Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, PR China
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