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Khandalavala KR, Dornhoffer JR, Farnsworth PJ, Staricha KL, Benson JC, Lane JI, Carlson ML. Third window lesions of the inner ear: A pictorial review. Am J Otolaryngol 2024; 45:104192. [PMID: 38104470 DOI: 10.1016/j.amjoto.2023.104192] [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: 10/29/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Radiographic review of pathologies that associate with third window syndrome. METHODS Case series and literature review. RESULTS Eight unique third window conditions are described and illustrated, including superior, lateral, and posterior semicircular canal dehiscence; carotid-cochlear, facial-cochlear, and internal auditory canal-cochlear dehiscence, labyrinthine erosion from endolymphatic sac tumor, and enlarged vestibular aqueduct. CONCLUSION The present study highlights the characteristic imaging features and symptoms to differentiate third window pathologies for expedient diagnosis and management planning.
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Affiliation(s)
- Karl R Khandalavala
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - James R Dornhoffer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Paul J Farnsworth
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelly L Staricha
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - John C Benson
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States of America
| | - John I Lane
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew L Carlson
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America.
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Wells D, Knoll RM, Kozin E, Chen JX, Reinshagen KL, Staecker H, Curtin HD, McKenna MJ, Nadol JB, Quesnel AM. Otopathologic and Computed Tomography Correlation of Internal Auditory Canal Diverticula in Otosclerosis. Otol Neurotol 2022; 43:e957-e962. [PMID: 36075107 PMCID: PMC9771591 DOI: 10.1097/mao.0000000000003665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology. METHODS One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC. RESULTS Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001). CONCLUSION IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.
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Affiliation(s)
- Dawson Wells
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Renata M. Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Elliott Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Jenny X. Chen
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | | | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear, Boston, MA
| | | | - Joseph B. Nadol
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Alicia M. Quesnel
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
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The Prevalence of Internal Auditory Canal Diverticula Is Constant Over a Large Age Range Among Patients Not Imaged for Hearing Loss. J Comput Assist Tomogr 2021; 45:142-145. [PMID: 33186176 DOI: 10.1097/rct.0000000000001113] [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
OBJECTIVE The objective of this study is to establish the prevalence of internal auditory canal diverticula spanning all age groups imaged for reasons other than hearing loss and to investigate changes in prevalence with age to determine if it is a finding that develops over time. METHODS We retrospectively evaluated 1000 cervical spine computed tomographies obtained in patients age 0-99 years for presence of internal auditory canal diverticula. RESULTS A total of 405 patients (208 men; 197 women) were included. Internal auditory canal diverticula were identified in 23 patients (5.7%). No statistically significant association between internal auditory canal diverticula and patient age was found (P = 0.68). CONCLUSIONS The prevalence of internal auditory canal diverticula on cervical spine computed tomographies is 5.7%. No change in prevalence was observed with increasing age supporting the hypothesis that internal auditory canal diverticula represent a normal anatomic variant rather than acquired pathology.
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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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Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
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Bunch PM, Zapadka ME, Lack CM, Kiell EP, Kirse DJ, Sachs JR. Internal Auditory Canal Diverticula among Pediatric Patients: Prevalence and Assessment for Hearing Loss and Anatomic Associations. AJNR Am J Neuroradiol 2020; 41:1712-1717. [PMID: 32763898 DOI: 10.3174/ajnr.a6691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/22/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Internal auditory canal diverticula are focal lucencies along the anterior-inferior aspect of the internal auditory canal fundus. Studies in adults report conflicting data on the etiology and clinical relevance of this finding. We would expect a pediatric study to help elucidate the significance of internal auditory canal diverticula. The primary goals of this study were to determine the temporal bone CT prevalence of diverticula among pediatric patients and to assess possible hearing loss and anatomic associations. MATERIALS AND METHODS For this retrospective study including 283 pediatric temporal bone CTs, 4 neuroradiologists independently assessed for diverticula. Discrepancies were resolved by consensus. One neuroradiologist assessed for an enlarged vestibular aqueduct, labyrinthine dysplasia, cochlear cleft, and otospongiosis. Patient demographics, audiologic data, and pertinent clinical history were recorded. One-way analysis of variance and the Fisher exact test were used to assess possible associations between diverticula and specific patient characteristics. RESULTS Diverticula were observed in 42/283 patients (14.8%) and were more commonly bilateral. There was no significant association with age, sex, hearing loss, enlarged vestibular aqueduct, labyrinthine dysplasia, or cochlear cleft. A statistically significant association was observed with otospongiosis (P = .013), though only 1 study patient had this disease. CONCLUSIONS Internal auditory canal diverticula are a common finding on pediatric temporal bone CT. In the absence of clinical or imaging evidence for otospongiosis, diverticula likely fall within the range of a normal anatomic variation. Familiarity with these findings may prevent neuroradiologists from recommending unnecessary additional testing in pediatric patients with isolated internal auditory canal diverticula.
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Affiliation(s)
- P M Bunch
- From the Departments of Radiology (P.M.B., M.E.Z., C.M.L., J.R.S.)
| | - M E Zapadka
- From the Departments of Radiology (P.M.B., M.E.Z., C.M.L., J.R.S.)
| | - C M Lack
- From the Departments of Radiology (P.M.B., M.E.Z., C.M.L., J.R.S.)
| | - E P Kiell
- Otolaryngology, Head and Neck Surgery (E.P.K., D.J.K.)
| | - D J Kirse
- Otolaryngology, Head and Neck Surgery (E.P.K., D.J.K.).,Pediatrics (D.J.K.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - J R Sachs
- From the Departments of Radiology (P.M.B., M.E.Z., C.M.L., J.R.S.)
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