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Abbas M, Wang J, Leboucq N, Mondain M, Blanc F. Cochlear Aqueduct Post-Natal Growth: A Computed Tomography Study. J Assoc Res Otolaryngol 2024:10.1007/s10162-024-00963-0. [PMID: 39294515 DOI: 10.1007/s10162-024-00963-0] [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: 03/02/2024] [Accepted: 08/10/2024] [Indexed: 09/20/2024] Open
Abstract
The cochlear aqueduct (CA) is a bony canal located at the base of the scala tympani of the cochlea. It connects the inner ear perilymph fluid to the cerebrospinal fluid of the posterior cerebral fossa. Its function is not well understood, as it seems to be patent in only a fraction of adult patients. Indirect observations argue in favor of the CA being more patent in children. To study the CA morphology in children, we performed a retrospective single-center study of 85 high-resolution temporal bone computed tomography (hrCT) scans of children with a mean age of 3.23 ± 3.07 years (13 days of life up to 18 years), and compared them with a group of 22 adult hrCT (mean age of 24.01 ± 3.58 years). The CA morphology measurements included its total length, its funnel (wider intracranial portion) length and width and its type (indicating its radiological patency), according to a previously published classification. The dimensions of the CA were significantly smaller in children compared with adults for the axial length (10.37 ± 2.58 versus 14.63 ± 2.40 mm, respectively, p < 0,001) and the funnel length (3.94 ± 1.59 versus 6.01 ± 1.77 mm, respectively, p < 0,001). The funnel width tended to be smaller but the difference was not significant: 3.49 ± 1,33 versus 3.89 ± 1.07 mm, p = 0,22. The repartition of types of CA was also statistically different. The CA appeared to be more identifiable in the children population. Type 1 (CA visible along its entire course) accounted for 42% (36/85) of children and only 5% (1/22) of adults, type 2 (visible in the medial two thirds) for 30% (25/85) versus 31% (7/22), type 3 (not visible completely along the medial two thirds) for 27% (23/85) versus 50% (11/22). Finally, type 4 (undetectable) was found in only 1% (1/85) of children and 14% (3/22) of adults (p < 0,001). Our study showed significant postnatal growth of the length of the CA, which was more rapid before the age of 2, and slowed after 6 years of age. Its width increased less, with children older than 2 years presenting a similar width to adults. The CA was more identifiable in hrCT in children, arguing for a more permeable tract. The number of completely ossified CA was significantly lower in the children population. These findings highlight the differences between the CA morphology in adults and children and raise the question of differences in function. Moreover, these differences may impact the pharmacodynamics of drugs or vectors delivered into the pediatric inner ear. Further studies are required, both on the anatomy of temporal bones and on the function of the CA in children.
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Affiliation(s)
- Maha Abbas
- Department of Otolaryngology and Head and Neck Surgery, Gui de Chauliac Hospital, CHRU Montpellier - Centre Hospitalier Régional Universitaire, Université de Montpellier, Montpellier, France
| | - Jing Wang
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM U1298, Montpellier, France
| | - Nicolas Leboucq
- Department of Neuroradiology, Gui de Chauliac Hospital, CHRU Montpellier - Centre Hospitalier Régional Universitaire, Université de Montpellier, Montpellier, France
| | - Michel Mondain
- Department of Otolaryngology and Head and Neck Surgery, Gui de Chauliac Hospital, CHRU Montpellier - Centre Hospitalier Régional Universitaire, Université de Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM U1298, Montpellier, France
| | - Fabian Blanc
- Department of Otolaryngology and Head and Neck Surgery, Gui de Chauliac Hospital, CHRU Montpellier - Centre Hospitalier Régional Universitaire, Université de Montpellier, Montpellier, France.
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM U1298, Montpellier, France.
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Cho KH, Kim JH, Honkura Y, Yamamoto M, Murakami G, Rodríguez-Vázquez JF, Katori Y. Cochlear aqueduct revisited: A histological study using human fetuses. Ann Anat 2024; 253:152236. [PMID: 38417484 DOI: 10.1016/j.aanat.2024.152236] [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: 04/23/2023] [Revised: 12/04/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND AIM The cochlear aqueduct (CA) connects between the perilymphatic space of the cochlea and the subarachnoid space in the posterior cranial fossa. The study aimed to examine 1) whether cavitation of the CA occurs on the subarachnoid side or the cochlear side and 2) the growth and/or degeneration of the CA and its concomitant vein. METHODS We examined paraffin-embedded histological sections from human fetuses: 15 midterm fetuses (crown-rump length or CRL, 39-115 mm) and 12 near-term fetuses (CRL, 225-328 mm). RESULTS A linear mesenchymal condensation, i.e., a likely candidate of the CA anlage, was observed without the accompanying vein at 9-10 weeks. The vein appeared until 15 weeks, but it was sometimes distant from the CA. At 10-12 weeks, the subarachnoid space (or the epidural space) near the glossopharyngeal nerve rapidly protruded into the CA anlage and reached the scala tympani, in which cavitation was gradually on-going but without epithelial lining. However, CA cavitation did not to occur in the anlage. At the opening to the scala, the epithelial-like lining of the CA lost its meningeal structure. At near-term, the CA was often narrowed and obliterated. CONCLUSION The CA develops from meningeal tissues when the cavitation of the scala begins. The latter cavitation seemed to reduce tissue stiffness leading, to meningeal protrusion. The so-called anlage of CA might be a phylogenetic remnant of the glossopharyngeal nerve branch. A course of cochlear veins appears to be determined by a rule different from the CA development.
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Affiliation(s)
- Kwang Ho Cho
- Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
| | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Republic of Korea.
| | - Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masahito Yamamoto
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, Japan.
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan.
| | | | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Engert J, Bauer D, Spahn B, Müller-Graff FT, Voelker J, Neun T, Althoff D, Hagen R, Hackenberg S, Rak K. Computed tomographic 3D analysis of the cochlear aqueduct-potential and limitations of clinical imaging. Acta Otolaryngol 2023; 143:931-935. [PMID: 38127466 DOI: 10.1080/00016489.2023.2294921] [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: 11/17/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Background: The cochlear aqueduct (CA), which connects the scala tympani and the subarachnoid space, and its accompanying structures appear to have a significant relevance during cochlear implantation and an accurate visualization in clinical imaging is of great interest. Aims and Objective: This study aims to determine which potential and limitations clinically available imaging modalities have in the visualization of the CA. Methods: Micro-CT, flat-panel volume computed tomography with and without secondary reconstruction (fpVCT, fpVCTseco) and multislice computed tomography (MSCT) of 10 temporal bone specimen were used for 3D analysis of the CA. Results: FpVCTseco proved superior in visualizing the associated structures and lateral portions of the CA, which merge into the basal turn of the cochlea. All clinical imaging modalities proved equal in analyzing the length, total volume of the CA and its area of the medial orifice. Conclusion: The choice of the most accurate clinical imaging modality to evaluate the CA and its associated structures depends on the clinical or scientific question. Furthermore, this study should provide a basis for further investigations analyzing the CA.
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Affiliation(s)
- Jonas Engert
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Daniel Bauer
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Bjoern Spahn
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Wuerzburg, Germany
| | - Daniel Althoff
- Fraunhofer Development Center for X-ray Technology, Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
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Nagururu NV, Jung D, Hui F, Pearl MS, Carey JP, Ward BK. Cochlear Aqueduct Morphology in Superior Canal Dehiscence Syndrome. Audiol Res 2023; 13:367-377. [PMID: 37218843 DOI: 10.3390/audiolres13030032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
The cochlear aqueduct (CA) connects the scala tympani to the subarachnoid space and is thought to assist in pressure regulation of perilymph in normal ears, however, its role and variation in inner ear pathology, such as in superior canal dehiscence syndrome (SCDS), is unknown. This retrospective radiographic investigation compared CA measurements and classification, as measured on flat-panel computerized tomography, among three groups of ears: controls, n = 64; anatomic superior canal dehiscence without symptoms (SCD), n = 28; and SCDS, n = 64. We found that in a multinomial logistic regression adjusted for age, sex, and BMI, an increase in CA length by 1 mm was associated with a lower odds for being in the SCDS group vs. control (Odds ratio 0.760 p = 0.005). Hierarchical clustering of continuous CA measures revealed a cluster with small CAs and a cluster with large CAs. Another multinomial logistic regression adjusted for the aforementioned clinical covariates showed an odds ratio of 2.97 for SCDS in the small CA cluster as compared to the large (p = 0.004). Further, no significant association was observed between SCDS symptomatology-vestibular and/or auditory symptoms-and CA structure in SCDS ears. The findings of this study lend support to the hypothesis that SCDS has a congenital etiology.
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Affiliation(s)
- Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Diane Jung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ferdinand Hui
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Monica S Pearl
- Department of Radiology, Children's National Hospital, Washington, DC 20010, USA
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Sensorineural hearing loss following lumbar puncture, spinal anaesthesia or epidural anaesthesia: a case series and literature review. The Journal of Laryngology & Otology 2022; 136:271-278. [DOI: 10.1017/s0022215122000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundSensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare phenomenon that is thought to occur when reduced cerebrospinal fluid pressure is transmitted to the inner ear through an enlarged cochlear aqueduct.MethodThis study presents two cases of sensorineural hearing loss following spinal anaesthesia for caesarean section as well as presenting results of a systemic review of the available literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. Risk factors associated with poorer outcomes and an approach to management of this rare condition are also discussed.ResultsTwenty-one cases were identified. The literature was systematically reviewed showing presentations, investigations performed, treatments offered and outcomes.ConclusionSensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare occurrence that requires a high degree of clinical suspicion and prompt investigation and treatment.
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Relationship Between the Cochlear Aqueduct and Internal Auditory Canal: Surgical Implications for Transcanal Transpromontorial Approaches to the Lateral Skull Base. Otol Neurotol 2021; 42:e227-e232. [PMID: 33273312 DOI: 10.1097/mao.0000000000002909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The cochlear aqueduct (CA) is subject to considerable anatomical variability. We hypothesize a topographical relationship between the CA and the internal auditory canal (IAC). BACKGROUND The CA represents the lower limit of dissection during transcanal transpromontorial approaches to the lateral skull base due to its close relationship to the lower cranial nerves and jugular vein. METHODS Three-dimensional models from high-resolution computed tomography scans of normal human temporal bones were created using threshold-based segmentation. The CA was classified into four categories. Five points were determined on the three-dimensional models to measure the surgically relevant relationships. RESULTS Segmentation was performed on 26 high-resolution computed tomography scans. The average length of the virtual and visual part of the CA was 6.6 mm (SD ±1.7 mm) and 5.5 mm (SD ±1.3 mm) respectively. The mean distance between the IAC and the medial end of the visual part of the CA was 3.8 mm (±0.7 mm), while the average distance between the IAC and the lateral end was 1.4 mm (±0.6 mm). The distance between the visual part of the CA and the IAC increased by 0.25 mm per from the fundus of the IAC. CONCLUSION A close relationship between the CA and the IAC could be established, despite the anatomical variability of the CA. The distance between CA and IAC increases by 0.25 per mm from the fundus to the porus of the IAC. These findings quantify the inferior limit of dissection of the transcanal transpromontorial approach to the lateral skull base.
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Varadarajan VV, Dayton OL, De Jesus RO, Antonelli PJ. Prevalence of occult cochlear basal turn patency. Acta Otolaryngol 2020; 140:889-892. [PMID: 32804558 DOI: 10.1080/00016489.2020.1800815] [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: 10/23/2022]
Abstract
BACKGROUND Perilymph gusher (PLG) is a rare complication of otologic surgery attributed to a communication between the cochlea and the internal auditory canal (IAC). Subtle patency between the cochlear basal turn and IAC has recently been identified on computed tomography (CT) as a risk factor, specifically when the defect is > 0.75 mm. OBJECTIVES Investigate the prevalence of radiographic cochlear basal turn patency. MATERIALS AND METHODS Patients with CT of the temporal bones and inner ears interpreted as "normal" were included. An otologist and a radiologist independently reviewed CTs to measure radiographic dehiscence in an oblique plane along the interface of the cochlea and IAC. Known PLGs were excluded. RESULTS Two hundred and ten ears were included (88 conductive or mixed hearing loss, 62 sensorineural hearing loss, 41 audiometrically normal ears). 71 ears (33.8%) were radiographically patent. Mean defect width was 0.41 mm (0.15-0.7 mm). Defect width was not associated with type of hearing loss, age, or gender. No defects were wider than 0.75 mm. CONCLUSIONS Radiographic patency of the cochlear basal turn may be present in patients with hearing loss and normal hearing, but patency > 0.75 mm (i.e. risk for PLG) is rare.
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Affiliation(s)
| | - Orrin L. Dayton
- Department of Radiology, University of Florida, Gainesville, FL, USA
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8
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Why did we encounter gusher in a stapes surgery case? Was it enlarged medial aperture of the cochlear aqueduct? Surg Radiol Anat 2020; 43:225-229. [PMID: 33111218 DOI: 10.1007/s00276-020-02602-8] [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: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative prediction of cerebrospinal fluid (CSF) gusher is important for stapes surgery. According to the current opinion settled among otologists and radiologists, the issues of whether enlarged cochlear aqueduct might be a cause of CSF gusher in stapes surgery and which segment of the aqueduct should be taken into account to diagnose enlarged cochlear aqueduct in computerized tomography (CT) are controversial. The case we encountered led us to hypothesize that enlarged cochlear aqueduct might cause CSF gusher in stapes surgery and that shape and diameter of medial aperture of the cochlear aqueduct are important in this prediction. METHODS AND RESULTS Enlarged medial aperture of the cochlear aqueduct with a shape differed from that of the other side was retrospectively diagnosed in thin-slice CT in a patient who had been undergone middle ear and stapes surgery for conductive hearing loss. This finding went unnoticed in preoperative CT. In the small fenestra stapedotomy operation, CSF gusher occurred through opening in the ill-defined, fixed and thickened stapes footplate. A piece of temporalis fascia and reshaped incus were appropriately placed which stopped the gusher. Re-evaluation of preoperatively taken CT showed that anterior-posterior and superior-inferior diameters of the medial aperture were 11.7 mm and 2.87 mm in CSF gusher side versus 2.95 mm and 1.88 mm on the other side, respectively. Its shape in gusher side differed from that of the other side. CONCLUSION This report is the first to show video-documented CSF gusher in a patient with enlarged medial aperture of the cochlear aqueduct. It appears to be plausible to propose that these findings have to change the otologists' and radiologists' perspective to the cochlear aqueduct. It can be deduced that difference in shapes of the medial aperture in both sides might be an indicator of potential CSF gusher.
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Affiliation(s)
- C. Xie
- Otolaryngology Department, Cochlear Implant Centre, St George’s Hospital, London, UK
| | - R. Harris
- Otolaryngology Department, Cochlear Implant Centre, St George’s Hospital, London, UK
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Benson JC, Eckel L, Guerin J, Silvera VM, Diehn F, Passe T, Carlson ML, Lane JI. Review of Temporal Bone Microanatomy : Aqueducts, Canals, Clefts and Nerves. Clin Neuroradiol 2020; 30:209-219. [PMID: 31807810 DOI: 10.1007/s00062-019-00864-3] [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] [Received: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
Temporal bone microanatomy is a common source of consternation for radiologists. Serpentine foramina, branching cranial nerves, and bony canals containing often clinically relevant but often miniscule arterial branches may all cause confusion, even among radiologists familiar with temporal bone imaging. In some cases, the tiniest structures may be occult or poorly visualized, even on thin-slice computed tomography (CT) images. Consequently, such structures are often either ignored or mistaken for pathologic entities. Yet even the smallest temporal bone structures have significant anatomic and pathologic importance. This paper reviews the anatomy and function of the temporal bone aqueducts, canals, clefts, and nerves, as well as the relevant developmental, inflammatory, and neoplastic processes that affect each structure.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA.
| | - Laurence Eckel
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
| | - Julie Guerin
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
| | - V Michelle Silvera
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
| | - Theodore Passe
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - John I Lane
- Department of Radiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA
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Spontaneous Intracranial Hypotension May Be an Under-recognized Cause of Endolymphatic Hydrops. Otol Neurotol 2020; 41:e860-e863. [PMID: 32472922 DOI: 10.1097/mao.0000000000002665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe three rare cases of spontaneous intracranial hypotension (SIH) presenting with symptoms of endolymphatic hydrops (EH) and perform a literature review to bring attention to a rare link between SIH and EH. PATIENT A 59-year-old female presented with postural headache, aural fullness, vertigo, hearing loss, and abnormal electrocochleography after being diagnosed with SIH by magnetic resonance imaging. The site of cerebrospinal fluid leak was identified in this individual. Two additional patients with vertigo, hearing loss, and SIH were identified by retrospective chart review. INTERVENTION All patients underwent blood patches. One patient also had diuretic treatment while another had fibrin glue injection. MAIN OUTCOME MEASURES The outcomes of interest were resolution of headache, vertigo, aural fullness, and hearing loss. RESULTS All patients eventually improved with time. Literature review suggests that overall outcome is excellent. CONCLUSIONS SIH may be an under-recognized cause of EH. We support the theory that negative intracranial pressure transmitted through the cochlear aqueduct and perilymph leads to EH. Despite the variations in treatments, the overall prognosis is excellent.
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rAAV-Mediated Cochlear Gene Therapy: Prospects and Challenges for Clinical Application. J Clin Med 2020; 9:jcm9020589. [PMID: 32098144 PMCID: PMC7073754 DOI: 10.3390/jcm9020589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Over the last decade, pioneering molecular gene therapy for inner-ear disorders have achieved experimental hearing improvements after a single local or systemic injection of adeno-associated, virus-derived vectors (rAAV for recombinant AAV) encoding an extra copy of a normal gene, or ribozymes used to modify a genome. These results hold promise for treating congenital or later-onset hearing loss resulting from monogenic disorders with gene therapy approaches in patients. In this review, we summarize the current state of rAAV-mediated inner-ear gene therapies including the choice of vectors and delivery routes, and discuss the prospects and obstacles for the future development of efficient clinical rAAV-mediated cochlear gene medicine therapy.
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Varadarajan VV, Dayton OL, De Jesus RO, Sarntinoranont M, Antonelli PJ. Cochlear basal turn patency in unrecognized perilymph gushers. Int J Pediatr Otorhinolaryngol 2019; 126:109601. [PMID: 31369970 DOI: 10.1016/j.ijporl.2019.109601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Perilymph gusher (PLG), an uncommon complication of otologic surgery, has been attributed to communication between the cochlea and the internal auditory canal (IAC). Subtle osseous defects may be missed on routine review of computed tomography (CT). This study aimed to quantify cochlear basal turn patency not seen on axial CT in patients with PLG and compare those against patients without intraoperative PLG. METHODS Ears that underwent cochlear implantation or stapedotomy with preoperative helical CT that was interpreted as "normal" at a tertiary referral center. An otologist and a radiologist independently and in a blinded fashion measured the dimensions of cochlear basal turn patency on CT images in oblique plane and parasagittal planes along the interface of the cochlea and IAC fundus. RESULTS Sixty-one ears were reviewed, including 3 with surgically confirmed PLGs and 12 with apparent dehiscence without a PLG. Mean defect width with PLG was 0.83 mm (range 0.75-0.9 mm) and without PLG was 0.43 mm (range 0.3-0.65 mm, p = 0.011). A greater proportion of PLGs occurred in ears with defects (3 of 15) than in ears without (0 of 46, p = 0.013). Using a cutoff of 0.75 mm, a greater proportion of PLGs occurred with defect width >0.75 mm (3 of 3) than in defects <0.75 mm (0 of 12, p = 0.022). CONCLUSIONS CT dehiscence between the IAC and cochlear basal turn, particularly with a width > 0.75 mm, should be considered a risk for PLG with stapedotomy or cochlear implantation.
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Affiliation(s)
| | - Orrin L Dayton
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | | | - Malisa Sarntinoranont
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
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Brotto D, Uberti A, Manara R. From Mondini to the latest inner ear malformations’ classifications: an historical and critical review. HEARING, BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1663041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Davide Brotto
- Neurosciences Department, ENT Unit, Università Degli Studi di Padova, Padova, Italy
| | - Andrea Uberti
- Neurosciences Department, ENT Unit, Università Degli Studi di Padova, Padova, Italy
| | - Renzo Manara
- Neurosciences Department, ENT Unit, Università Degli Studi di Padova, Padova, Italy
- Department of Neuroradiology, Università Degli Studi di Padova, Padova, Italy
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Abstract
OBJECTIVE The aim of this study is to evaluate the treatment of cerebrospinal fluid (CSF) leaks from cochleostomy after cochlear implantation intraoperatively and postoperatively. METHODS Three hundred seven patients (age ranges 13 months to 18 years) were undergone cochlear implantation and 14 (4.56%) of them had CSF leakage intraoperatively (2 normal, 12 anomalous cochlea). Complete packing of the around electrode in cochleostomy with muscle had performed to control CSF leak intraoperatively for primary surgery in 10 patients. Cerebrospinal fluid leakage was observed in 3 patients after cochlear implantation postoperatively. Revision surgeries for CSF leakage with fat tissue sealing were performed for them also. Fat tissue packing was performed for the last 4 patients in primary surgery. Outcomes of management methods for sealing were evaluated. RESULTS Sealing the cochleostomy with muscle was performed for 10 patients. Fibrin glue applications were used for excessive leakage for 5 patients with cochlear anomalies and 3 of these patients had CSF leak from cochleostomy postoperatively (Patients I, II, III). Secondary surgeries with fat tissue sealing were performed. But CSF leakage also was occurred in Patient III. Subtotal petrosectomy and obliteration of cavity with fat tissue had been performed for Patient III. Cerebrospinal fluid leakage has not been seen in primary surgeries with fat tissue packing in other 5 patients. CONCLUSION Cerebrospinal fluid leakage may occur in cochlear implantation patients with inner ear anomalies postoperatively. Sealing of the cochleostomy with fat tissue is more useful than muscle intraoperatively.
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Sensorineural Hearing Loss in the Nonimplanted Ear Following Cochlear Implantation in a Patient With Bilateral Enlarged Vestibular Aqueducts. Otol Neurotol 2019; 40:e782-e786. [PMID: 31348130 DOI: 10.1097/mao.0000000000002319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations. PATIENTS One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center. INTERVENTION(S) Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion. MAIN OUTCOME MEASURE(S) Bone conduction hearing thresholds, word recognition scores. RESULTS The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation. CONCLUSION As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
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Alicandri-Ciufelli M, Molinari G, Rosa MS, Monzani D, Presutti L. Gusher in stapes surgery: a systematic review. Eur Arch Otorhinolaryngol 2019; 276:2363-2376. [PMID: 31273448 DOI: 10.1007/s00405-019-05538-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to perform a systematic literature review on the occurrence of gusher during stapes surgery, to understand its surgical management and outcomes. METHODS The PRISMA standard was applied to identify English, Italian or French-language studies, related to stapes surgery and mentioning gusher or perilymphatic leak. Full-texts lacking information on the management of gusher and/or the post-operative hearing outcome were excluded. RESULTS Twenty-four articles were eventually included. Seventy-six patients were involved in the qualitative synthesis. The management of gusher mostly consisted in covering the oval window and/or filling the tympanic cavity, with absorbable and autologous graft materials. Packing of the external auditory canal was reported in 51 patients (67%). Gusher was related to complete/profound loss of hearing in 25% of the cases and to a worsening of hearing function in 31% of patients. In 19% of patients an improvement in hearing tests was reported; in 28% the hearing function was unchanged. Post-operative vestibular symptoms were reported in 7 patients, and were mainly mild and transient. The absence of vestibular symptoms was underlined in 9 cases, while in 79% of the patients the authors did not provide information. CONCLUSION The unexpected occurrence of gusher during stapes surgery represents a relevant issue for the otologic surgeon. Its management most commonly consists in plugging the oval window and the tympanic cavity. In most of the cases, a stapes prosthesis could be positioned. The results on hearing and vestibular functions are widely variable.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Giulia Molinari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Maria Silvia Rosa
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.
| | - Daniele Monzani
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Livio Presutti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
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McFadden MD, Wilmoth JG, Mancuso AA, Antonelli PJ. Preoperative Computed Tomography May Fail to Detect Patients at Risk for Perilymph Gusher. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130508401212] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael D. McFadden
- Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine, Gainesville
| | - Jason G. Wilmoth
- Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine, Gainesville
| | - Anthony A. Mancuso
- Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine, Gainesville
- Department of Radiology, University of Florida College of Medicine, Gainesville
| | - Patrick J. Antonelli
- Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine, Gainesville
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Wichova H, Alvi S, Boatright C, Ledbetter L, Staecker H, Lin J. High-Resolution Computed Tomography of the Inner Ear: Effect of Otosclerosis on Cochlear Aqueduct Dimensions. Ann Otol Rhinol Laryngol 2019; 128:749-754. [PMID: 30971097 DOI: 10.1177/0003489419842579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The cochlear aqueduct is a bony duct connecting the scala tympani with the subarachnoid space. Given the pathophysiology of otosclerosis, including bone resorption and new bone deposition, we hypothesize that the cochlear aqueduct in otosclerotic ears is narrowed. METHODS A retrospective review of patients with otosclerosis who have undergone high-resolution computed tomography (HRCT) of the temporal bone was completed. The control cohort included 20 patients with the diagnosis of noise-induced hearing loss, without the diagnosis of otosclerosis. Uniform measurements of cochlear aqueduct dimensions were performed using the axial plane. RESULTS The otosclerosis cohort included 25 males and 52 females with mean age of 52.2 ± 17.6 years. The control group included 10 males and 10 females with mean age of 64.0 ± 18.5 years. The mean cochlear aqueduct length, width mid canal, aperture base, aperture widest diameter, and funnel diameter in millimeters were 12.19 ± 1.66, 0.68 ± 0.28, 4.21 ± 1.67, 3.23 ± 1.47, and 2.70 ± 1.05 in the ears with otosclerotic foci and 11.57 ± 1.66, 0.69 ± 0.29, 2.56 ± 1.59, 2.77 ± 1.67, and 2.58 ± 1.03 in control group, respectively. Statistical difference was seen in length of cochlear aqueduct, aperture base, and aperture widest diameters (P = .017, <.001, .007). CONCLUSIONS The length of the cochlear aqueduct and the funnel width are statistically longer in the otosclerotic population compared to control. The width of the cochlear aqueduct is not statistically different.
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Affiliation(s)
- Helena Wichova
- 1 Department of Otolaryngology, Head & Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sameer Alvi
- 1 Department of Otolaryngology, Head & Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christine Boatright
- 2 Department of Radiology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Luke Ledbetter
- 2 Department of Radiology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hinrich Staecker
- 1 Department of Otolaryngology, Head & Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - James Lin
- 1 Department of Otolaryngology, Head & Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Quesada JL, Cammaroto G, Bonanno L, Galletti F, Quesada P. Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena. EAR, NOSE & THROAT JOURNAL 2018; 96:302-310. [PMID: 28846785 DOI: 10.1177/014556131709600817] [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] Open
Abstract
Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients-23 men and 15 women, aged 23 to 71 years (mean: 47)-who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.
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Affiliation(s)
- Juan Luis Quesada
- Department of Otorhinolaryngology, Vall d'Hebron University Hospital, Barcelona, Spain
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Micro-CT study of the human cochlear aqueduct. Surg Radiol Anat 2018; 40:713-720. [DOI: 10.1007/s00276-018-2020-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
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Bianchin G, Polizzi V, Formigoni P, Russo C, Tribi L. Cerebrospinal Fluid Leak in Cochlear Implantation: Enlarged Cochlear versus Enlarged Vestibular Aqueduct (Common Cavity Excluded). Int J Otolaryngol 2016; 2016:6591684. [PMID: 27847516 PMCID: PMC5101390 DOI: 10.1155/2016/6591684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To share our experience of cerebrospinal fluid gusher in cochlear implantation in patients with enlarged cochlear or vestibular aqueduct. Study Design. Case series with comparison and a review of the literature. Methods. A retrospective study was performed. Demographic and radiological results of patients with enlarged cochlear aqueduct or enlarged vestibular aqueduct in 278 consecutive cochlear implant recipients, including children and adults, were evaluated between January 2000 and December 2015. Results. Six patients with enlarged cochlear aqueduct and eight patients with enlarged vestibular aqueduct were identified. Cerebrospinal fluid gusher occurs in five subjects with enlarged cochlear aqueduct and in only one case of enlarged vestibular aqueduct. Conclusion. Based on these findings, enlarged cochlear aqueduct may be the best risk predictor of cerebrospinal fluid gusher at cochleostomy during cochlear implant surgery despite enlarged vestibular aqueduct.
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Affiliation(s)
- Giovanni Bianchin
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Valeria Polizzi
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Patrizia Formigoni
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Carmela Russo
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Lorenzo Tribi
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
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Abstract
Objectives: We sought to determine normative data for the radiologic presentation of the cochlear aqueduct (CA), hypothesizing that increasing the scanner's resolution could enhance detection capability. Methods: Axial sections of 502 high-resolution computed tomography (CT) images of temporal bones (488 patients) were reviewed. A type 1 CA was visualized on CT scans up to the vestibule, and its portion in the otic capsule segment could be seen as a thin (<1 mm) streak. In type 2, we were able to detect the medial Two thirds of the structure, but we failed to see the whole otic capsule portion. In type 3, only the external aperture of the aqueduct and/or the medial third was seen. We defined undetectable CAs as type 4. Results: We obtained CT scans with 0.6-, 1.1-, or 1.3-mm-thick slices through the petrous bones in 9.5%, 58.8%, and 31.7% of cases, respectively. The CA was visible and bilaterally symmetric in 49% of the images, and type 2 was the most commonly detected CA type (36%). The CA was invisible on either side in 21.9% of scans, irrespective of CT resolution, and was asymmetric in 53 of the 502 images. The CA types varied with changes in resolution, although type 3 appeared unchanged independent of alterations in resolution in most cases. Conclusions: There was no significant difference in CT detection capability between CA types at different resolutions. Computed tomography failed to demonstrate any CAs ≥1 mm in width in the otic capsule segment.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pierce NE, Parell GJ, Jesus ROD, Ojano-Dirain CP, Antonelli PJ. Magnetic resonance imaging in a guinea pig model of inner ear decompression sickness and barotrauma. Laryngoscope 2015; 126:2106-9. [PMID: 26649994 DOI: 10.1002/lary.25811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Scuba diving may cause severe hearing loss and vertigo due to inner ear barotrauma and decompression sickness. These may be difficult to differentiate clinically. Decompression sickness requires costly and potentially dangerous hyperbaric therapy, whereas such treatment may worsen barotrauma. The objective of this study was to assess the potential utility of magnetic resonance imaging to identify and distinguish blood from air in the inner ear, manifestations of barotrauma and decompression sickness, using a guinea pig model. STUDY DESIGN Prospective animal trial. METHODS Magnetic resonance of the head was performed at 3 Tesla, pre- and postinjection of 2, 4, or 10 μL of air or blood through the round window into the perilymph. With this model, 2 μL has been shown to cause hearing loss. Images were reviewed by a neuroradiologist blinded to the treatment. RESULTS All 14 normal ears, five of seven blood- and five of seven air-injected ears, were correctly interpreted. Two blood- and one air-injected ear were interpreted as indeterminate. One air-injected ear was incorrectly interpreted as blood. CONCLUSIONS Magnetic resonance reliably distinguishes small volumes of air and blood in the guinea pig inner ear. Magnetic resonance should be evaluated for its utility in the diagnosis of inner ear barotrauma and decompression sickness in scuba divers. LEVEL OF EVIDENCE NA Laryngoscope, 126:2106-2109, 2016.
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Affiliation(s)
- Nathan E Pierce
- Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A
| | - G Joseph Parell
- Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A
| | - Reordan O De Jesus
- Department of Radiology, University of Florida, Gainesville, Florida, U.S.A
| | | | - Patrick J Antonelli
- Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A
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Anatomical variations of the temporal bone on high-resolution computed tomography imaging: how common are they? The Journal of Laryngology & Otology 2015; 129:634-7. [PMID: 26072959 DOI: 10.1017/s0022215115001115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prevalence of normal variations of temporal bone anatomy on high-resolution computed tomography imaging and report their clinical importance. METHODS A retrospective review was conducted of high-resolution temporal bone computed tomography imaging performed at NHS Greater Glasgow and Clyde over an eight-year period. The presence of five variants was determined. These variants were: a high dehiscent jugular bulb, an anteriorly located sigmoid sinus, a deep sinus tympani, an enlarged cochlear aqueduct and a large internal auditory meatus. RESULTS A total of 339 temporal bones were examined. The incidences of a high dehiscent jugular bulb, anteriorly located sigmoid sinus, deep sinus tympani, enlarged cochlear aqueduct and an enlarged internal auditory meatus were 2.76 per cent, 2.94 per cent, 5.01 per cent, 0.58 per cent and 1.76 per cent respectively. CONCLUSION Anatomical variations of the temporal bone are not uncommon and it is important for the investigating otologist to be aware of such variations prior to undertaking surgery.
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Park JJH, Shen A, Keil S, Kraemer N, Westhofen M. Radiological findings of the cochlear aqueduct in patients with Meniere’s disease using high-resolution CT and high-resolution MRI. Eur Arch Otorhinolaryngol 2014; 271:3325-31. [DOI: 10.1007/s00405-014-3199-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
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Cabbarzade C, Sennaroglu L, Süslü N. CSF gusher in cochlear implantation: The risk of missing CT evidence of a cochlear base defect in the presence of otherwise normal cochlear anatomy. Cochlear Implants Int 2014; 16:233-6. [DOI: 10.1179/1754762813y.0000000048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Reith W, Yilmaz U, Heumüller I. [Malformations and abnormalities of the petrous portion of the temporal bone]. Radiologe 2014; 54:327-35. [PMID: 24706250 DOI: 10.1007/s00117-013-2615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
High-resolution computed tomography (HRCT) is the procedure of choice in the diagnostics of abnormalities of the middle and inner ear. It allows a detailed presentation of anatomical features and achieves the prerequisites for selection of the various therapeutic options. The highly diverse abnormalities can be described using detailed imaging analyses. Malformations with an abnormally developed modiolus are assumed to be early embryological defects, such as the classical Mondini dysplasia. The essential therapeutic option for middle ear deformities is still a cochlear implant. The domain of magnetic resonance imaging (MRI) is not only in the analysis of the cochlear nerve and for exclusion of fibrosis or ossification of the labyrinth but is also able to visualize details of isolated malformations, such as an extended vestibular aqueduct or subtle alterations to the vestibule or can visualize them better in comparison to CT. Radiological diagnostics are used not only for classification but also to recognize typical clinical problem situations and play a key role in the diagnostics of hearing disorders and selection of the optimal therapeutic procedure.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland,
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Lim HW, Shim BS, Yang CJ, Kim JH, Cho YH, Cho YS, Kong DS, Koo JW, Han JH, Chung JW. Hearing loss following ventriculoperitoneal shunt in communicating hydrocephalus patients: a pilot study. Laryngoscope 2014; 124:1923-7. [PMID: 24318317 DOI: 10.1002/lary.24553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/21/2013] [Accepted: 12/03/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Hearing loss can be associated with a decrease in cerebrospinal fluid (CSF) pressure because changes in CSF pressure induce changes in perilymph pressure. Hearing loss after neurosurgical procedures have been reported, but clinical information on hearing loss after the placement of ventriculoperitoneal (VP) shunts, the most commonly used CSF shunt for hydrocephalus patients, is limited. This study is aimed to show the relationship between VP shunt and hearing loss. STUDY DESIGN Prospective study. METHODS Pure tone threshold and electrocochleography were preoperatively performed in nine patients (18 ears) undergoing elective VP shunt placement. Five-day and 1-month post-shunt placement hearing thresholds were compared with baseline data. A correlation analysis was conducted between the threshold and summating potential/action potential (SP/AP) ratio changes at 5 days and 1 month after shunt placement. Cochlear aqueduct dimensions measured by high-resolution CT were compared between ears with and without hearing loss. RESULTS About 40% of subject ears showed hearing loss with a threshold elevation of at least 15 dB in one or more frequencies. After VP shunt placement, the mean threshold of all ears showed a significant increase in most frequencies and the pure tone average. The change in the SP/AP ratios was significantly correlated with the change in the pure tone average at both 5 days and 1 month after shunt placement. Cochlear aqueduct dimensions were not correlated with hearing loss occurrence. CONCLUSIONS Hearing thresholds may increase following VP shunt placement, possibly due to secondary endolymphatic hydrops.
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Affiliation(s)
- Hyun Woo Lim
- Department of Otolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
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Recurrent Contralateral Hearing Loss After 2 Craniotomies for Vestibular Schwannoma. Otol Neurotol 2013; 34:1237-40. [DOI: 10.1097/mao.0b013e318298dedc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A perspective from magnetic resonance imaging findings of the inner ear: Relationships among cerebrospinal, ocular and inner ear fluids. Auris Nasus Larynx 2012; 39:345-55. [DOI: 10.1016/j.anl.2011.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 02/06/2023]
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Heman-Ackah SE, Roland JT, Haynes DS, Waltzman SB. Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria. Otolaryngol Clin North Am 2012; 45:41-67. [PMID: 22115681 DOI: 10.1016/j.otc.2011.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.
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Affiliation(s)
- Selena E Heman-Ackah
- Department of Otolaryngology, New York University Cochlear Implant Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA
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Stimmer H. Enlargement of the cochlear aqueduct: does it exist? Eur Arch Otorhinolaryngol 2011; 268:1655-61. [DOI: 10.1007/s00405-011-1527-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 02/02/2011] [Indexed: 01/09/2023]
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Ikezono T, Sugizaki K, Shindo S, Sekiguchi S, Pawankar R, Baba S, Yagi T. CTP (Cochlin-tomoprotein) detection in the profuse fluid leakage (gusher) from cochleostomy. Acta Otolaryngol 2010; 130:881-7. [PMID: 20105107 DOI: 10.3109/00016480903508910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS By testing 125 samples, we confirmed that Cochlin-tomoprotein (CTP) is present in the perilymph, not in cerebrospinal fluid (CSF). Perilymph and CSF exist in two distinct compartments, even in the case of a malformed inner ear with a bony defect in the lamina cribrosa, as described here. Cochleostomy might have suddenly decreased the perilymph pressure, allowing the influx of CSF into the inner ear resulting in profuse fluid leakage, first perilymph then CSF. OBJECTIVES The first purpose of this study was to further confirm the specificity of the perilymph-specific protein CTP that we reported recently. Secondly, we assessed the nature of the fluid leakage from the cochleostomy using the CTP detection test. METHODS A standardized CTP detection test was performed on 65 perilymph and 60 CSF samples. Samples of profuse fluid leakage collected from cochleostomy during cochlear implantation surgery of one patient with branchio-oto-renal (BOR) syndrome were also tested by the CTP detection test. RESULTS CTP was detected in 60 of 65 perilymph samples but not in any of the CSF samples. The leaked fluid was shown to contain CTP, i.e. perilymph, at the outset, and then the CTP detection signals gradually disappeared as time elapsed.
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Affiliation(s)
- Tetsuo Ikezono
- Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
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Thalen E, Wit H, Segenhout J, Albers F. Dynamics of Inner Ear Pressure Change Caused by Intracranial Pressure Manipulation in the Guinea Pig. Acta Otolaryngol 2009. [DOI: 10.1080/00016480117641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ciuman RR. Communication routes between intracranial spaces and inner ear: function, pathophysiologic importance and relations with inner ear diseases. Am J Otolaryngol 2009; 30:193-202. [PMID: 19410125 DOI: 10.1016/j.amjoto.2008.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/09/2008] [Accepted: 04/07/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVE There exist 3 communication routes between the intracranial space and the inner ear, the vestibular aqueduct, the cochlear aqueduct, and the internal auditory canal. They possess a key role in inner ear pressure regulation and fluid homeostasis and are related to inner ear diseases. REVIEW METHODS Relevant literature was reviewed, and the current knowledge of the anatomy, physiologic importance, and relations to inner ear diseases were described. Pathologic communication routes such as semicircular canal dehiscence syndrome were highlighted as well. CONCLUSION Abnormalities in all 3 communication routes may predispose or be the cause of distinct inner ear pathologic condition and involved in other cochlear and vestibular syndromes, in which their role is not completely clear. The increasing knowledge of the underlying mechanisms encourages promising approaches for possible intervention in the future.
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Migirov L, Kronenberg J. Petromastoid canal and cochlear aqueduct in cochlear implant candidates. Otolaryngol Head Neck Surg 2009; 140:419-22. [DOI: 10.1016/j.otohns.2008.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
Abstract
Objective: To present temporal bone fine channels in cochlear implantation candidates. Methods: Review of the axial sections of 108 temporal bone CTs. In type I, the petromastoid canal (PMC) was invisible but appeared as channels in type II and type III, <0.5 and 0.5-1 mm wide, respectively, and in type IV was >1 mm wide. The cochlear aqueduct (CA) was visualized up to the vestibule in type 1, the medial two thirds in type 2, the external aperture and/or the medial third in type 3, and was undetectable in type 4. Results: The PMC size and shape differed significantly between the young (aged <5 years) and older (aged 5-16 years) children and between the young children and adults. A wide PMC (>2 mm) was found in only children younger than 2 years. Children up to 2 years of age and those aged 2 to 5 years demonstrated similar findings. The CA types differed among the pediatric and adult CI candidates, with the main difference appearing after the age of 16 years. There was no correlation between CA and PMC types. Conclusions: It is likely that the age-related changes in CA and PMC are attributable to the developmental or age-related changes in skull base growth.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jona Kronenberg
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Torkos A, Czigner J, Jarabin J, Tóth F, Szamosközi A, Kiss JG, Jóri J. Recurrent bacterial meningitis after cochlear implantation in a patient with a newly described labyrinthine malformation. Int J Pediatr Otorhinolaryngol 2009; 73:163-71. [PMID: 19027967 DOI: 10.1016/j.ijporl.2008.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 10/03/2008] [Accepted: 10/07/2008] [Indexed: 11/30/2022]
Abstract
Authors report on a so far undescribed bilateral inner ear malformation with congenital deafness where a defect of both the medial and lateral bony labyrinthine wall allowed the herniation of a cerebrospinal fluid-filled endosteum sac into the tympanic cavity. The story of cochlear implantation in this ear and the series of following meningitis demonstrates the dilemma of indicating implantation in labyrinthine dysplasia and the difficulties of treating postimplantation meningitis. Routes of bacterial invasion from inner ear to intracranium is discussed regarding normal, dysplastic and surgically "disturbed" inner ear anatomy.
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Affiliation(s)
- Attila Torkos
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Szeged, Tisza Lajos krt. 111, Szeged 6725, Hungary.
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Lee SH, Park SH, Park J, Hwang SK. Unilateral hearing loss following shunt placement for normal pressure hydrocephalus with a unilateral patent cochlear aqueduct. Clin Neurol Neurosurg 2007; 109:799-802. [PMID: 17643785 DOI: 10.1016/j.clineuro.2007.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 06/12/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
Hearing loss in patients who have undergone shunt placement for a hydrocephalus is perhaps an underestimated complication rather than a rare event. There appears to be a correlation between the occurrence of hearing loss and patient characteristics consistent with excessive drainage of cerebrospinal fluid (CSF) and patent cochlear aqueduct (CA). We present the case of a 77-year-old man with unilateral dominant sensorineural hearing loss after a shunt placement for normal pressure hydrocephalus (NPH) combined with a patent cochlear aqueduct. Based on our experience and a review of the literature, we suggest an early restoration of the reduced CSF pressure using a programmable valve as a treatment strategy, which might prevent the persistent hearing loss.
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Affiliation(s)
- Sun-Ho Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, 50 Samduk-2-ga, Jung-gu, Daegu, 700-721, Republic of Korea
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Abstract
OBJECTIVE To present two cases of recurrent diving-related inner ear barotrauma (IEB) and to discuss the possible cause and pathogenesis of the increased inner ear vulnerability. STUDY DESIGN Case series. SETTING Tertiary referral center. PATIENTS Two scuba divers suffering from repeated cochleovestibular barotrauma. INTERVENTIONS Neurotological evaluation, perilymphatic fistulae repair, and conservative treatment. MAIN OUTCOME MEASURE The increasing popularity of scuba diving expose the individuals involved in this sport to unique pathologies that are not common under terrestrial conditions. The otolaryngologist who is involved in the care of these patients is required to diagnose and treat diving-related ear injuries and to consider the risk for recurrent inner ear injury when diving is resumed. CONCLUSION IEB carries a risk for permanent hearing loss and chronic vestibulopathy. We recommend complete neurotological evaluation including high-resolution CT of the temporal bones as a routine workup for IEB. The presence of a significant residual sensorineural hearing loss, evidence for noncompensated vestibular damage, and CT findings of possible enhanced cerebrospinal fluid-perilymph connection should be considered when a return to diving activity is considered.
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Affiliation(s)
- Avi Shupak
- The Otoneurology Unit, Lin and Carmel Medical Centers, Haifa, Israel.
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Connor SEJ, Tan G, Fernando R, Chaudhury N. Computed tomography pseudofractures of the mid face and skull base. Clin Radiol 2005; 60:1268-79. [PMID: 16291308 DOI: 10.1016/j.crad.2005.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 05/17/2005] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Abstract
Thin-section multislice CT delineates numerous normal skull-base and mid-facial bony discontinuities. These represent sutures, fissures and neurovascular foramina or channels, and should be differentiated from fractures. This pictorial review describes and illustrates the characteristic location and multiplanar CT appearances of these structures. Their clinical significance in terms of pathological processes and surgical planning are discussed.
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Affiliation(s)
- S E J Connor
- Department of Neuroradiology, Kings College Hospital, London, UK.
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Nakaya M, Morita I, Horiuchi M. Recurrent hearing loss after myelography treated with epidural blood patch. Auris Nasus Larynx 2005; 32:399-401. [PMID: 16183232 DOI: 10.1016/j.anl.2005.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 05/31/2005] [Accepted: 07/22/2005] [Indexed: 11/22/2022]
Abstract
Transient hearing impairment is a known sequel after various procedures that result in loss of cerebrospinal fluid, such as lumbar puncture, spinal anesthesia and myelography. But persistent or recurrent hearing loss after dural puncture is a rare entity. We present a case with recurrent low-frequency sensorineural hearing loss after myelography. The patient was treated successfully by means of an epidural blood patch, although the conservative treatment was ineffective.
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Affiliation(s)
- Muneo Nakaya
- Department of Otolaryngology, Central Hospital of Self-Defence Agency, Faculty of Medicine, University of Tokyo, Hongo 7-3-1 Bunkyo-ku, Tokyo 113-8655, Japan.
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Swartz JD. An overview of congenital/developmental sensorineural hearing loss with emphasis on the vestibular aqueduct syndrome. Semin Ultrasound CT MR 2005; 25:353-68. [PMID: 15497615 DOI: 10.1053/j.sult.2004.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The evaluation of children with congenital/developmental hearing loss has undergone substantial transformation in recent years. This communication focuses on the most common cause of this type of hearing loss for which there are imaging findings: the vestibular aqueduct syndrome. The normal anatomy of the vestibular aqueduct is discussed in detail. The cochlear aqueduct with which it is commonly confused is also discussed. An overview of other congenital defects and abnormal middle/inner ear communications is also included. A brief discussion of cochlear implants is also included for completeness.
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Cosar A, Yetiser S, Sizlan A, Yanarates O, Yildirim A. Hearing impairment associated with spinal anesthesia. Acta Otolaryngol 2004; 124:1159-64. [PMID: 15768810 DOI: 10.1080/00016480410017143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Hearing loss after spinal anesthesia has been reported to be related to the transmission of a reduced subarachnoid pressure to the inner ear via the cochlear aqueduct due to loss of spinal fluid. However, there are also some controversies related to this phenomenon, which require systematic investigation. MATERIAL AND METHODS The effect of spinal needle diameter on hearing loss was investigated using audiometric tests in a prospective comparative study of 30 patients who were scheduled for surgery with spinal anesthesia. The bony structure of the cochlear and vestibular aqueducts was determined from temporal bone CT scans. RESULTS Four out of 15 patients (26.67%) treated with a 22 G spinal needle demonstrated hearing loss the day after surgery, which recovered within 2-5 weeks. However, none of the patients treated with a 27 G spinal needle had statistically significant hearing loss in either ear at any frequency. Three out of four patients with hearing loss had an acute-onset balance problem. There was no difference between the two groups in terms of the widths of the vestibular and cochlear aqueducts. CONCLUSIONS It has been shown audiometrically that the diameter of the spinal needle used to induce spinal anesthesia seems to have an effect on subsequent hearing loss. The patency of the bony canal determines the transmission of pressure changes to the inner ear. However, the individual risk of this complication is not predictable as there is no radiological abnormality of the canal.
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Affiliation(s)
- Ahmet Cosar
- Department of Anaesthesiology, Gulhane Medical School, Etlik, Ankara, Turkey
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Huang F, Sweet R, Tewfik TL. Apert syndrome and hearing loss with ear anomalies: a case report and literature review. Int J Pediatr Otorhinolaryngol 2004; 68:495-501. [PMID: 15013619 DOI: 10.1016/j.ijporl.2003.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Accepted: 11/19/2003] [Indexed: 10/26/2022]
Abstract
Acrocephalosyndactyly Type I, or Apert syndrome is a congenital disorder characterized by craniosynostosis and syndactyly. When hearing loss occurs, it is usually bilateral and conductive, often attributable to congenital stapes fixation. In determining treatment, the risk of gusher with stapedectomy becomes an important consideration. We present an adult with Apert syndrome and hearing loss, with particular emphasis on a progressive conductive component in one ear. Surgical exploration failed to reveal any definite middle ear abnormality and no stapedectomy was performed. A theory on the pathogenesis of the conductive loss in our patient follows a brief review of the literature on gusher in patients with ear malformations.
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Affiliation(s)
- Fleur Huang
- Department of Otolaryngology, McGill University Health Center, McGill University, Montreal, Que., Canada
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Witte RJ, Lane JI, Driscoll CLW, Lundy LB, Bernstein MA, Kotsenas AL, Kocharian A. Pediatric and adult cochlear implantation. Radiographics 2003; 23:1185-200. [PMID: 12975509 DOI: 10.1148/rg.235025046] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The frequency of cochlear implantation has increased tremendously over the past decade. Cochlear implantation is often performed as an outpatient procedure and is considered an acceptable treatment for severe to profound sensorineural hearing loss in patients who are refractory to conventional hearing augmentation. Imaging plays an important part in the work-up of cochlear implant candidates, and an understanding of imaging evaluation procedures is essential. The radiologist must be familiar with imaging findings that contraindicate implantation (absence of the cochlea or cochlear nerve) and with those that could significantly alter surgery (facial nerve dehiscence, cochlear ossification). It is also imperative to be familiar with the growing number of imaging options (particularly magnetic resonance [MR] imaging pulse sequences) to optimize evaluation of cochlear implant candidates. Imaging choices will be substantially influenced by the manufacturer of the computed tomographic scanner or MR imager. Radiologists will assume an expanding role in evaluating affected patients as the frequency of cochlear implantation continues to increase.
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Affiliation(s)
- Robert J Witte
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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