Effects of Intralabyrinthine Hemorrhage on the Cochlear Elements: A Human Temporal Bone Study

Relationship Between Cochlear Lateral Wall Changes and Endolymphatic Hydrops in Otitis Media

OBJECTIVES

Despite otitis media and various disease processes being associated with endolymphatic hydrops (EH), an exact explanation of the pathophysiology has yet to be reported. This study aimed to investigate the changes in the cochlear lateral wall structures and their potential correlation with the presence and severity of cochlear EH in acute and chronic otitis media cases. The investigations were conducted in both chinchilla animal model and human temporal bone specimens.

METHODS

We studied a total of 15 chinchilla and 25 human temporal bones from our collection, which were categorized into acute otitis media, chronic otitis media (COM), and control groups. Through quantitative analysis, we measured the area of cochlear lateral wall structures and observed the presence and the degree of EH using light microscopy.

RESULTS

No significant changes were determined in the area of the spiral ligament (p > 0.05) across the species. However, a significant (p < 0.05) decrease in the mean area of the stria vascularis in the basal turn was identified in COM groups compared to controls of both species. Chinchilla model additionally exhibited pathology extending to the lower mid turn. A negative correlation was found between the mean strial area and the severity of EH in both the animal model and human samples.

CONCLUSIONS

COM associated with significant changes in the stria vascularis that may lead to significant increase in the degree of EH. The presented animal model exhibited parallel findings with human samples, suggesting its viability as a valuable model for future studies.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:5103-5108, 2024.

Bilateral intracochlear hemorrhage: A rare onset of chronic myelogenous leukemia

Acute onset of vertigo and hearing loss is rare in leukemic disorders. MRI can diagnose intracochlear hemorrhage as the underlying cause. The hearing can improve but if severe hearing loss preserves, cochlear implantation can be considered.

Sudden unilateral audiovestibular loss due to acute labyrinthine haemorrhage can be missed on early MRI brain sequences: case report

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.

Four-Point Impedance and Utricular Dysfunction Is Associated with Postoperative Dizziness after Cochlear Implantation

INTRODUCTION

Postimplantation dizziness is common, affecting approximately 50% of patients. Theories for dizziness include utricular inflammation, endolymphatic hydrops, and loss of perilymph. Four-point impedance (4PI) is a novel impedance measurement in cochlear implantation that shows potential to predict hearing loss, inflammation, and fibrotic tissue response. Here, we associate 4PI with dizziness after implantation and explore the link with utricular function.

METHODS

Subjective visual vertical (SVV) as a measure of utricular function was recorded preoperatively as a baseline. 4PI was measured immediately postinsertion. Ongoing follow-up was performed at 1 day, 1 week, and 1 month, postoperatively. At each follow-up, 4PI, SVV, and the patients' subjective experience of dizziness were assessed.

DISCUSSION

Thirty-eight adults were recruited. One-day 4PI was significantly higher in patients dizzy within the next week (254 Ω vs 171 Ω, p = 0.015). The optimum threshold on receiver operating characteristic curve was 190 Ω, above which patients had 10 times greater odds of developing dizziness (Fisher exact test, OR = 9.95, p = 0.0092). This suggests that 4PI varies with changes in the intracochlear environment resulting in dizziness, such as inflammation or hydrops. SVV significantly deviated away from the operated ear at 1 day (fixed effect estimate = 2.6°, p ≤ 0.0001) and 1 week (fixed effect estimate 2.7°, p ≤ 0.001).

CONCLUSION

One-day 4PI is a potentially useful marker for detecting postoperative dizziness after cochlear implantation. Of the current theories for postoperative dizziness, inflammation might explain the findings seen here, as would changes in hydrostatic pressure. Future research should focus on detecting and exploring these labyrinthine changes in further detail.

Labyrinthine lesions in presumed inner ear hemorrhage-related sudden deafness

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.

The Natural History of Labyrinthine Hemorrhage in Patients With Sudden Sensorineural Hearing Loss

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.

Audiological outcomes in sudden sensorineural hearing loss with presumed inner ear hemorrhage

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.

Delayed Recovery in Pediatric Sudden Sensorineural Hearing Loss Predicted via Magnetic Resonance Imaging

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.

Secondary Endolymphatic Hydrops

HYPOTHESIS

A review of the most recent literature will provide clinicians with an update of secondary endolymphatic hydrops, aiding in diagnosis and treatment of affected patients.

BACKGROUND

Secondary endolymphatic hydrops is a pathologic finding of the inner ear resulting in episodic vertigo and intermittent hearing loss. It is a finding for which extensive research is being performed.

METHODS

A review of the most recent literature on secondary endolymphatic hydrops was performed using PubMed literature search.

RESULTS

Recent investigation of secondary endolymphatic hydrops has brought attention to traumatic and inflammatory insults as causes for secondary endolymphatic hydrops. Such etiologies, including postsurgical effects of cochlear implantation and endolymphatic sac ablation; otosclerosis and its operative intervention(s); acoustic and mechanical trauma; medications; and systemic inflammatory processes, have been determined as causes of secondary lymphatic hydrops. Histopathological slides for many of the etiologies of secondary endolymphatic hydrops are presented.

CONCLUSION

Through an understanding of the pathophysiology and etiologies of secondary endolymphatic hydrops, clinicians will gain a better understanding of this complex disease process, which will aid in treatment of patients with this disease process.

Histopathologic Changes of Human Vestibular Epithelia in Intralabyrinthine Hemorrhage

Objective:

To determine whether intralabyrinthine hemorrhage affects vestibular hair cells, dark cells, and transitional cells in human temporal bones.

Methods:

We examined 9 temporal bone specimens from 9 deceased donors with unilateral intralabyrinthine hemorrhage (the hemorrhage group) along with their 9 contralateral temporal bone specimens without hemorrhage (the control group). We estimated the density of type I and type II hair cells in all peripheral sensorial organs (including the cristae of the superior, lateral, and posterior semicircular canals, as well as the maculae of the saccule and utricle). We also estimated the density of dark and transitional cells in the lateral and posterior semicircular canals.

Results:

The loss of type I hair cells in the cristae of the superior, lateral, and posterior semicircular canals and in the maculae of the saccule and utricle was significantly higher in the hemorrhage group, as compared with the control group ( P < .05). The density of type II hair cells in the cristae of the superior and posterior canals and in the macula of the saccule significantly differed between the hemorrhage group and the control group ( P < .05).

Conclusion:

The loss of vestibular hair cells might be the cause of vestibular symptoms in patients with intralabyrinthine hemorrhage.