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Hameed N, Keshri A, Manogaran RS, Muraleedharan M, Chidambaram KS, Jain R, Aqib M. Cochlear Implantation by Veria Technique in Abnormal Cochlea: Our Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:2646-2653. [PMID: 38883484 PMCID: PMC11169411 DOI: 10.1007/s12070-024-04492-3] [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: 11/20/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
This study describes the clinical profile, operative findings, surgical technique, type of implant and complications encountered in implantation of abnormal cochlea by the transcanal (veria) technique in a tertiary care centre. This is a retrospective study done amongst 337 patients who underwent cochlear implantation by veria technique between January 2013 to August 2023. Based on pre-operative imaging with high-resolution computed tomography and magnetic resonance imaging the cochleovestibular malformations in this study were classified according to Sennaroglu classification and the cochlear ossification was graded from I to IV. Amongst the 337 patients who underwent cochlear implantation during the study period there were 79 cases (23.4%) with abnormalities of cochlea. This included 45 patients (13.4%) with congenital malformations, 20 patients (5.9%) with cochlear fibrosis and 14 patients (4.2%) with cochlear ossification. The commonest cochlear malformation was Incomplete Partition 2 which was present in 21 patients (46.7%). The other common malformations were cochlear hypoplasia (31.1%), Incomplete Partition 1(13.3%) and common cavity (8.9%). Out of the 20 patients with cochlear fibrosis, 17 patients had fibrosis only in the basal turn. Out of the 14 patients with cochlear ossification 8 patients (57.1%) had a grade 1 ossification, 2 patients (14.3%) had a grade 2 ossification and 4 patients (28.6%) had a grade 3 ossification. One of the patients required re-exploration for correcting the placement of electrode. The type of implant were chosen depending on individual malformation or length of ossification and fibrosis. In the past, inner ear anomalies were considered as a contraindication for cochlear implantation however it is now possible to implant most of these abnormal cochlea by careful planning, a modification of the surgical technique and the type of electrode used.
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Affiliation(s)
- Nazrin Hameed
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Keshri
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Rajat Jain
- King George Medical College, Lucknow, India
| | - Mohd Aqib
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Jiang S, Tan X, Shu F, Xu M, Cai J, Zhang H. Cochlear implantation for rare Streptococcus suis meningitis with hearing loss. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08730-w. [PMID: 38758241 DOI: 10.1007/s00405-024-08730-w] [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: 02/27/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES This study aimed to explore the diagnostic sensitivity of 3D heavily weighted T2-weighted MRI (T2MRI) and high-resolution computed tomography (HRCT) in patients with cochlear fibrosis associated with Streptococcus suis (S. suis) meningitis and the practicality of Cochlear implantation (CI) treatments. METHODS Between January 2020 and December 2022, we enrolled four patients with rare cochlear S. suis meningitis with associated hearing loss despite aggressive or non-aggressive follow-up antibiotic treatment. Clinical imaging data, surgical performances and post-surgical-electrode impedance were evaluated. RESULTS Combined with HRCT and T2MRI, the cochlea had varying degrees of fibrosis and ossification in different cases. However, the electrodes were successfully and wholly inserted after intraoperative removal of the ossified and fibrotic foci. Post-surgical electrode impedance values of MP1 + 2 mode were normal in all 4 cases at initial activation. CONCLUSION In patients with S. suis meningitis and associated cochlear fibrosis, T2MRI examination of the inner ear was more sensitive than HRCT. This research highlights the feasibility of CI treatment in S. suis meningitis patients with severe cochlear fibrosis.
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Affiliation(s)
- Shanshan Jiang
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xinyuan Tan
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Fan Shu
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Muqing Xu
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Jieqing Cai
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Hongzheng Zhang
- Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Middle Road, Guangzhou, 510282, China.
- Ear Institude of Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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Lamounier P, Carasek N, Daher VB, Costa CC, Ramos HVL, Martins SDC, Borges ALDF, Oliveira LAT, Bahmad Jr F. Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests. J Pers Med 2024; 14:428. [PMID: 38673055 PMCID: PMC11050886 DOI: 10.3390/jpm14040428] [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: 02/23/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.
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Affiliation(s)
- Pauliana Lamounier
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Natalia Carasek
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
| | - Valeria Barcelos Daher
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Claudiney Cândido Costa
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Hugo Valter Lisboa Ramos
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Sergio de Castro Martins
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
- Otorhinolaryngology Department, Universidade Estadual de Goiás (UEG), Itumbiara 75536-100, Brazil
| | - Alda Linhares de Freitas Borges
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | | | - Fayez Bahmad Jr
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
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K ND, Sharma V, Goyal A. The Conundrum of Labyrinthitis Ossificans: An Etiology-Based Case Comparison and Review of Literature. Turk Arch Otorhinolaryngol 2023; 61:183-187. [PMID: 38784960 PMCID: PMC11110085 DOI: 10.4274/tao.2023.2023-4-11] [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] [Received: 05/11/2023] [Accepted: 07/18/2023] [Indexed: 05/25/2024] Open
Abstract
Labyrinthitis ossificans is the formation of pathological new bone within the membranous labyrinth of the inner ear due to various local and systemic pathologies. Most commonly it occurs as a sequelae of meningitis spreading to the labyrinth, from the subarachnoid space via the cochlear aqueduct and the internal auditory canal. We are comparing three different etiological presentations of labyrinthitis ossificans; namely, tympanogenic, meningitic, and traumatic, together with their management in the light of recent advances.
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Affiliation(s)
- Nidhin Das K
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
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Muacevic A, Adler JR, Alsalhi HS, Hagr A. Cochlear Implant Induced Labyrinthine Ossificans in Mondini Malformation: A Case Series. Cureus 2022; 14:e32648. [PMID: 36654620 PMCID: PMC9842388 DOI: 10.7759/cureus.32648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Cochlear implantation is relatively a safe procedure with a favorable outcome. Labyrinthine ossification is one of the rare complications that has been observed in some occasions post-cochlear implantation. This paper report two cases of Mondini inner ear malformation cochlear implant failure associated with labyrinthine ossification, mandating revision surgery, and a literature review focusing on the reported cases, risk factors, surgical and non-surgical measures to mitigate this complication and to improve overall cochlear implant outcomes.
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Histopathology of Labyrinthitis Ossificans From an Intralabyrinthine Surgical Specimen. Otol Neurotol 2022; 43:889-893. [PMID: 35970153 DOI: 10.1097/mao.0000000000003613] [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 Histologic characterization of labyrinthitis ossificans (LO) has mostly been limited to postmortem samples. In this report, we describe the histology of LO from a surgical specimen obtained from a patient undergoing labyrinthectomy with simultaneous cochlear implantation. PATIENT A 38-year-old woman initially presenting to the emergency room with acute vertigo, left-sided hearing loss, tinnitus, and aural fullness. INTERVENTIONS Contrast-enhanced magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for the patient before labyrinthectomy and cochlear implantation. Audiometric testing was performed before and after surgical intervention. Histologic analysis was performed on a specimen obtained from the left lateral semicircular canal (SCC) during surgery. MAIN OUTCOME MEASURES Preoperative CT and MRI findings, preoperative and postoperative hearing thresholds via air conduction and bone conduction, hematoxylin and eosin (H&E) stain of the surgical sample, and CD45 immunostain of the surgical sample. RESULTS Preoperative CT and MRI confirmed the diagnosis of isolated LO of the left lateral SCC. Audiometric testing revealed significant improvement in hearing after labyrinthectomy and cochlear implantation. H&E stain demonstrated fibrosis and ossification in the left lateral SCC, and CD45 immunostain was negative. CONCLUSIONS Histopathology of LO based on a surgical sample is comparable to heterotopic ossification (HO) seen in other human tissue. Given the similarities between LO and HO, agents effective in preventing HO may have utility in preventing LO.
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Garov EV, Kryukov AI, Zelikovich EI, Kurilenkov GV, Moseykina LA, Zelenkova VN, Mishchenko VV, Omarova MM. [A case of obliteration of a round window in otosclerosis]. Vestn Otorinolaringol 2021; 86:75-81. [PMID: 34783478 DOI: 10.17116/otorino20218605175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when using computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.
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Affiliation(s)
- E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Zelikovich
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G V Kurilenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - L A Moseykina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V N Zelenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V V Mishchenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M M Omarova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Trakimas DR, Knoll RM, Castillo-Bustamante M, Kozin ED, Remenschneider AK. Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans. Otolaryngol Head Neck Surg 2020; 164:175-181. [PMID: 32600100 DOI: 10.1177/0194599820934748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). STUDY DESIGN Retrospective review. SETTING Academic institution. METHODS Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. RESULTS Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. CONCLUSION In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. LEVEL OF EVIDENCE Retrospective review.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Renata M Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Yilmazer R, Karatay E, Akbulut S, Alkan Z, Sarikaya B. Anatomical landmarks for cochlear implantatıon in ossifıed cochleas. Eur Arch Otorhinolaryngol 2020; 277:3301-3306. [PMID: 32440899 DOI: 10.1007/s00405-020-06044-1] [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: 12/27/2019] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE In this study, we aimed to introduce the facial nerve as a new anatomical landmark which can be used in ossified cochleas during cochlear implantation. We also set out to define a safe line to preserve the internal auditory canal (IAC) while drilling the basal turn of the cochlea. METHODS Thirty patients who had temporal computed tomography (CT) were studied. The distances from the facial nerve and the round window to the IAC, carotid artery, and jugular bulb were measured in the reformatted CT images. We have created a line in the direction of the stapedial tendon from the round window to the IAC and called it ROWIAC (Round window-IAC) line. We have investigated whether this line intersects the IAC and measured the distances from this line to the IAC. RESULTS Fifty-four temporal CT scans were included to the study. The mean distances from the facial nerve to the IAC, carotid artery, and jugular bulb were 8.8 ± 0.9, 15.0 ± 2.0, and 12.2 ± 2.9 mm, respectively. The mean distances from the round window to these structures were 3.8 ± 0.7, 9.4 ± 2.2, and 8.3 ± 2.9 mm, respectively. ROWIAC line did not intersect the IAC in any of the patients. The mean distance between this line and the IAC was 0.8 ± 0.4 mm. CONCLUSION We propose that facial nerve and ROWIAC line can be used as potential landmarks during cochlear implantation in ossified cochleas to protect the adjacent neurovascular structures.
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Affiliation(s)
- Rasim Yilmazer
- Department of Otolaryngology, Demiroglu Bilim University Hospital, Istanbul, Turkey.
- Florence Nightingale Atasehir Hastanesi, Kulak Burun Bogaz Anabilim Dali, Kuçukbakkalkoy Mahallesi, Isiklar Cd. 35/A, 34750, Atasehir/Istanbul, Turkey.
| | - Emrah Karatay
- Department of Radiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Akbulut
- Department of Otolaryngology, Yeditepe University Hospital, Istanbul, Turkey
| | - Zeynep Alkan
- Department of Otolaryngology, Yeditepe University Hospital, Istanbul, Turkey
| | - Basar Sarikaya
- Department of Radiology, University of Washington, Seattle, WA, USA
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Pauna HF, Knoll RM, Lubner RJ, Brodsky JR, Cushing SL, Hyppolito MA, Nadol JB, Remenschneider AK, Kozin ED. Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis. Laryngoscope Investig Otolaryngol 2020; 5:256-266. [PMID: 32337357 PMCID: PMC7178454 DOI: 10.1002/lio2.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE While cochlear ossification is a common sequalae of meningitic labyrinthitis, less is known about the effects of meningitis on peripheral vestibular end organs. Herein, we investigate histopathologic changes in the peripheral vestibular system and cochlea in patients with a history of meningitic labyrinthitis. METHODS Temporal bone (TB) specimens from patients with a history of meningitis were evaluated and compared to age-matched controls. Specimens were evaluated by light microscopy and assessed for qualitative changes, including the presence of vestibular and/or cochlear endolymphatic hydrops, presence and location of inflammatory cells, new bone formation, and labyrinthitis ossificans; and quantitative changes, including Scarpa's ganglion neuron (ScGN) and spiral ganglion neuron (SGN) counts. RESULTS Fifteen TB from 10 individuals met inclusion and exclusion criteria. Presence of inflammatory cells and fibrous tissue was found in 5 TB. Of these, evidence of labyrinthitis ossificans was found in 2 TB. In the peripheral vestibular system, mild to severe degeneration of the vestibular membranous labyrinth was identified in 60% of cases (n = 9 TBs). There was a 21.2% decrease (range, 3%-64%) in the mean total count of ScGN in patients with meningitis, compared to age-matched controls. In the cochlea, there was a 45% decrease (range, 25.3%-80.9%) in the mean total count of SGN compared to age-matched controls (n = 14 TBs). CONCLUSIONS Otopathologic analysis of TB from patients with a history of meningitic labyrinthitis demonstrated distinct peripheral vestibular changes. Future research may help to delineate potential mechanisms for the observed otopathologic changes following meningitis. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Henrique F. Pauna
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryRibeirão Preto Medical School (FMRP‐USP), University of São PauloRibeirão PretoSão PauloBrazil
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
| | - Renata M. Knoll
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Rory J. Lubner
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Jacob R. Brodsky
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusetts
| | - Sharon L. Cushing
- Department of Otolaryngology, Head & Neck SurgeryHospital for Sick Children, University of TorontoTorontoOntarioCanada
| | - Miguel A. Hyppolito
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryRibeirão Preto Medical School (FMRP‐USP), University of São PauloRibeirão PretoSão PauloBrazil
| | - Joseph B. Nadol
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Aaron K. Remenschneider
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Elliott D. Kozin
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
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11
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Benson JC, Diehn F, Passe T, Guerin J, Silvera VM, Carlson ML, Lane J. The Forgotten Second Window: A Pictorial Review of Round Window Pathologies. AJNR Am J Neuroradiol 2019; 41:192-199. [PMID: 31831467 DOI: 10.3174/ajnr.a6356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 12/26/2022]
Abstract
The round window serves to decompress acoustic energy that enters the cochlea via stapes movement against the oval window. Any inward motion of the oval window via stapes vibration leads to outward motion of the round window. Occlusion of the round window is a cause of conductive hearing loss because it increases the resistance to sound energy and consequently dampens energy propagation. Because the round window niche is not adequately evaluated by otoscopy and may be incompletely exposed during an operation, otologic surgeons may not always correctly identify associated pathology. Thus, radiologists play an essential role in the identification and classification of diseases affecting the round window. The purpose of this review is to highlight the developmental, acquired, neoplastic, and iatrogenic range of pathologies that can be encountered in round window dysfunction.
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Affiliation(s)
- J C Benson
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - F Diehn
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - T Passe
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - J Guerin
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - V M Silvera
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - J Lane
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
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Abstract
Cochlear implant is the first approved cranial nerve stimulator that works by directly stimulating the cochlear nerve. The medical and societal impact of this revolutionary device cannot be understated. This article reviews the evolving indications for cochlear implant, patient assessment, surgical approach, and outcomes for pediatric and adult cochlear implant that demonstrate its impact. Future concepts in cochlear implant are introduced briefly. This article covers a breadth of information; however, it is not intended be entirely comprehensive. Rather, it should serve as a foundation for understanding cochlear implant.
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Trakimas DR, Ishai R, Kozin ED, Nadol JB, Remenschneider AK. Human Otopathology of Cochlear Implant Drill-out Procedures. Otolaryngol Head Neck Surg 2019; 161:658-665. [PMID: 31060442 DOI: 10.1177/0194599819847636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Human otopathology following drill-out procedures for cochlear implantation (CI) in cases with labyrinthitis ossificans (LO) has not been previously described. This study uses the high sensitivity of histopathology to (1) evaluate surgical drill-out technique with associated intracochlear findings and (2) quantify spiral ganglion neuron populations in a series of patients with LO who underwent CI. STUDY DESIGN Retrospective otopathology study. SETTING Otopathology laboratory. SUBJECTS AND METHODS Temporal bone (TB) specimens from cases with evidence of preoperative intracochlear fibroossification that required a drill-out procedure for CI electrode array insertion were included. All cases were histopathologically evaluated and 3-dimensional reconstructions of the cochleae were performed to interpret drilling paths and electrode trajectories. RESULTS Five TB specimens were identified, of which 4 underwent drill-out of the basal turn of the cochlea and 1 underwent a radical cochlear drill-out. In multiple TBs, drilling was imprecise with resultant damage to essential structures. Two TBs showed injury to the modiolus, which was associated with substantially decreased or even absent neuronal populations within these areas. In addition, 2 cases with inadequate drill-out or extensive LO of the basal turn resulted in extracochlear placement of electrode arrays into the vestibule due to persistent obstruction within the basal turn. CONCLUSION Otopathology highlights the challenges of drill-out procedures in cases of LO. Imprecise drilling paths, due to distortion of normal cochlear anatomy, risk injury to the modiolus and adjacent neurons as well as extracochlear placement of electrode arrays, both of which may contribute to poorer hearing outcomes.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Reuven Ishai
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph B Nadol
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Buch K, Baylosis B, Fujita A, Qureshi MM, Takumi K, Weber PC, Sakai O. Etiology-Specific Mineralization Patterns in Patients with Labyrinthitis Ossificans. AJNR Am J Neuroradiol 2019; 40:551-557. [PMID: 30792250 DOI: 10.3174/ajnr.a5985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to identify whether specific patterns of ossification in labyrinthitis ossificans are associated with the known risk factors. Labyrinthitis ossificans has been described as sequela of prior temporal bone trauma, prior infection, and other disorders including sickle cell disease. Specific patterns of mineralization in the membranous labyrinth associated with these risk factors has not been previously described. MATERIALS AND METHODS This was a retrospective study evaluating temporal bone CT scans at our institution from November 2005 to May 2018 in patients with labyrinthitis ossificans. Membranous labyrinthine structures evaluated for ossification included the following: basal, middle, and apical cochlear turns; lateral, posterior, and superior semicircular canals; and the vestibule for both ears in all patients. These structures were assigned a severity score, 0-4, based on degree of mineralization. Clinical records were reviewed for potential labyrinthitis ossificans risk factors. Basic descriptive statistics and a mixed model were used to correlate the degree and patterns of ossification with clinical history. RESULTS Forty-four patients (58 ears) with labyrinthitis ossificans were identified and evaluated. The most common risk factors were chronic otomastoiditis (n = 18), temporal bone surgery (n = 9), temporal bone trauma (n = 6), sickle cell disease (n = 5), and meningitis (n = 4). For all etiologies, the semicircular canals were most severely affected, and the vestibule was the least. In patients with prior temporal bone surgery, significantly greater mineralization was seen in the basal turn of the cochlea (P = .027), the vestibule (P = .001), and semicircular canals (P < .001-.008). No significant pattern was identified in patients with meningitis, sickle cell disease, or trauma. CONCLUSIONS Significant patterns of mineralization in labyrinthitis ossificans were observed in patients with prior temporal bone surgery. For all etiologies, the semicircular canals were most severely affected. No significant mineralization pattern was observed in patients with chronic otomastoiditis, meningitis, sickle cell disease, or prior temporal bone trauma.
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Affiliation(s)
- K Buch
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - B Baylosis
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - A Fujita
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Department of Radiology (A.F.), Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - M M Qureshi
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
| | - K Takumi
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - P C Weber
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
| | - O Sakai
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
- Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Salata TM, Ribeiro BNDF, Muniz BC, Antunes LDO, Rosas HB, Marchiori E. Hearing disorders - findings on computed tomography and magnetic resonance imaging: pictorial essay. Radiol Bras 2019; 52:54-59. [PMID: 30804617 PMCID: PMC6383528 DOI: 10.1590/0100-3984.2016.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hearing disorders are usually unilateral and are more common in women. They can be congenital or acquired, and hearing loss is categorized as sensorineural, conductive, or mixed. The onset of hearing loss can be progressive or sudden, and it is a common reason for seeking medical attention. In this context, computed tomography and magnetic resonance imaging have assumed critical roles in the search for an etiological diagnosis and in guiding the therapeutic approach. In this pictorial essay, we illustrate the common causes of hearing loss, discussing the possible differential diagnoses and highlighting the most relevant imaging findings.
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Affiliation(s)
- Tiago Medina Salata
- Hospital Casa de Portugal / Clínica 3D Diagnose, Rio de
Janeiro, RJ, Brazil.,Correspondence: Dr. Tiago Medina Salata. Hospital Casa de Portugal
/ Clínica 3D Diagnose. Rua do Bispo, 72, Rio Comprido. Rio de Janeiro,
RJ, Brazil, 22262-064.
| | | | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
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Facial Nerve Stimulation Patterns Associated With Cochlear Implantation in Labyrinthitis Ossificans. Otol Neurotol 2018; 39:e992-e995. [DOI: 10.1097/mao.0000000000002028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Cochlear Implantation in Cochlear Ossification: Retrospective Review of Etiologies, Surgical Considerations, and Auditory Outcomes. Otol Neurotol 2018; 39:17-28. [DOI: 10.1097/mao.0000000000001613] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaya S, Schachern PA, Tsuprun V, Paparella MM, Cureoglu S. Deterioration of Vestibular Cells in Labyrinthitis. Ann Otol Rhinol Laryngol 2016; 126:89-95. [PMID: 27881797 DOI: 10.1177/0003489416675356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantitatively assess the effect of serous labyrinthitis, suppurative labyrinthitis, and labyrinthitis ossificans on vestibular hair cells, dark cells, and transitional cells. METHODS We examined human temporal bone specimens with serous labyrinthitis, suppurative labyrinthitis, and labyrinthitis ossificans, then compared them with age-matched control groups without labyrinthitis. We evaluated the density of type I and II vestibular hair cells, dark cells, and transitional cells in the peripheral sensorial organs. RESULTS The mean density of type I vestibular hair cells in the maculae of the saccule significantly differed between the serous labyrinthitis group and its control group. The loss of type I and II vestibular hair cells in all of the peripheral sensorial organs was significantly higher in the suppurative labyrinthitis group than in its control group. The mean density of dark cells in the lateral and posterior semicircular canals was significantly lower in the suppurative labyrinthitis group than in its control group. The mean density of type I and II vestibular hair cells, dark cells, and transitional cells was significantly lower in the labyrinthitis ossificans group than in its control group. CONCLUSION The loss of vestibular hair cells and degenerative changes in dark cells and transitional cells could affect vestibular function in patients with labyrinthitis.
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Affiliation(s)
- Serdar Kaya
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.,2 Department of Otolaryngology-Head and Neck Surgery, Gebze Fatih State Hospital, Gebze, Kocaeli, Turkey
| | - Patricia A Schachern
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vladimir Tsuprun
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Sebahattin Cureoglu
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
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