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Sun H, Yang R, Jiang H, Tian X, Zhao Y, Gao Z, Wu H. Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator. Ear Hear 2023; 44:1430-1436. [PMID: 37171375 PMCID: PMC10583909 DOI: 10.1097/aud.0000000000001382] [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: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Typewriter tinnitus refers to a special kind of staccato tinnitus, which is mostly described by patients as Morse code, popcorn, or machine-gun. It has been accepted that the mechanism of typewriter tinnitus is caused by the neurovascular compression of the cochleovestibular nerve. Patients who suffered from typewriter tinnitus have exhibited a good response to carbamazepine or oxcarbazepine, but there is a risk of recurrence after treatment cessation. The present study aims to determine the value of auditory brainstem response (ABR) in diagnosing typewriter tinnitus and predicting relapse after drug withdrawal. METHODS Patients who presented with typewriter tinnitus from March 2019 to March 2022 were included for the present retrospective study. The auditory and vestibular test results and drug treatment effects were collected and analyzed. Patients with idiopathic unilateral subjective tinnitus, who were matched by age to patients with typewriter tinnitus at a ratio of 2:1, were consecutively recruited for the control group. RESULTS Eighteen patients with typewriter tinnitus and 38 controls were included. Ears with typewriter tinnitus had longer interpeak latency (IPL) I-III, and wave III and V latencies, and a higher ratio of IPL I-III ≥2.3 ms based on ABR, when compared to the unaffected side and controls ( p <0.05). Seventeen patients with typewriter tinnitus responded positively to medication. Among these patients, seven patients had a relapse after drug cessation, while 10 patients did not have a relapse. The relapse group had significantly longer IPL I-III and wave V latency, older age, and poorer hearing, when compared to the nonrelapse group ( p < 0.05). Furthermore, IPL I-III had the largest area under the receiver operating characteristic curve, and the optimal cutoff was 2.4 ms (sensitivity, 100.0%; specificity, 66.7%). There were no significant differences in other demography or other clinical test results between the relapse and nonrelapse groups ( p > 0.05). Ramsay Hunt syndrome and neuromyelitis optica spectrum disorders were identified in two cases. CONCLUSION Prolonged IPL I-III based on ABR can help in the diagnosis of typewriter tinnitus and its prognosis after treatment cessation. Patients with IPL I-III greater than 2.4 ms, older age and poorer hearing are more likely to relapse. In addition to the neurovascular conflict of the cochleovestibular nerve, the etiologies of neuroinflammation and demyelinating diseases are also possible for typewriter tinnitus.
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Affiliation(s)
- Huiying Sun
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruizhe Yang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chen CC, Lee TY, Lee HH, Kuo YH, Bery AK, Chang TP. Vestibular paroxysmia: Long-term clinical outcome after treatment. Front Neurol 2022; 13:1036214. [PMID: 36313490 PMCID: PMC9614226 DOI: 10.3389/fneur.2022.1036214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo study the long-term treatment outcome of vestibular paroxysmia (VP).Study designRetrospective study.SettingTertiary referral hospital.MethodsWe analyzed records of 29 consecutive patients who were diagnosed with VP and who were treated with VP-specific anticonvulsants for at least 3 months. Patients were followed for a minimum of 6 months. We recorded and assessed starting and target dosage of medications, time to achieve adequate therapeutic response, adverse effects, and the rates of short-term and long-term remission without medication.ResultsAll 29 patients were started on oxcarbazepine as first-line treatment, and 93.1% and 100% of patients reported good-to-excellent therapeutic response within 2 and 4 weeks, respectively. Three patients switched to other anticonvulsants at 3 months. At long-term follow-up (8–56 months), most (84.6%) oxcarbazepine-treated patients maintained good therapeutic response at doses between 300 and 600 mg/day. Eleven (37.9%) patients experienced complete remission without medication for more than 1 month, of which six (20.7%) had long-term remission off medication for more than 12 months. Nineteen (65.5%) patients had neurovascular compression (NVC) of vestibulocochlear nerve on MRI, but its presence or absence did not predict treatment response or remission.ConclusionLow-dose oxcarbazepine monotherapy for VP is effective over the long term and is generally well-tolerated. About 20% of patients with VP in our study had long-term remission off medication.
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Affiliation(s)
- Chih-Chung Chen
- Dizziness and Balance Disorder Center, Taipei Medical University–Shuang Ho Hospital, New Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Yi Lee
- Dizziness and Balance Disorder Center, Taipei Medical University–Shuang Ho Hospital, New Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsun-Hua Lee
- Dizziness and Balance Disorder Center, Taipei Medical University–Shuang Ho Hospital, New Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Anand K. Bery
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tzu-Pu Chang
- Department of Neurology, Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
- *Correspondence: Tzu-Pu Chang
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Mejía-Quiñones V, Valderrama-Chaparro J, Paredes-Padilla S, Orejuela-Zapata J, Granados-Sánchez A. Vascular loop in the cerebellopontine angle: Clinical-radiological correlation. RADIOLOGIA 2022; 64:407-414. [DOI: 10.1016/j.rxeng.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
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King S, Dahlem K, Karmali F, Stankovic KM, Welling DB, Lewis RF. Imbalance and dizziness caused by unilateral vestibular schwannomas correlate with vestibulo-ocular reflex precision and bias. J Neurophysiol 2022; 127:596-606. [PMID: 35080420 PMCID: PMC8858680 DOI: 10.1152/jn.00725.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Imbalance and dizziness are disabling symptoms for many patients with vestibular schwannomas (VS) but symptom severity typically does not correlate with the vestibulo-ocular reflex (VOR) amplitude-based metrics used to assess peripheral vestibular damage. In this study, we tested the hypothesis that imbalance and dizziness in patients with VS relate to VOR metrics that are not based on response amplitude. Twenty-four patients with unilateral, sporadic VS tumors were studied, and objective (balance) and subjective (dizziness) vestibular dysfunction was quantified. The VOR was tested using two yaw-axis motion stimuli, low-frequency en-bloc sinusoidal, and high-frequency head-on-body impulsive rotations. Imbalance correlated with VOR precision (the inverse of the trial-to-trial variability) and with low-frequency VOR dynamics (quantified with the time constant), and these two metrics were also strongly correlated. Dizziness correlated with the VOR bias caused by an imbalance in static central vestibular tone, but not with dynamic VOR metrics. VOR accuracy (mean response amplitude relative to the ideal response) was not correlated with the severity of imbalance or dizziness or with measures of VOR precision or time constant. Imbalance in patients with VS, therefore, scales with VOR precision and time constant, both of which appear to reflect the central vestibular signal-to-noise ratio, but not with VOR slow-phase accuracy, which is based on the magnitude of the central vestibular signals. Dizziness was related to the presence of a static central tone imbalance but not to any VOR metrics, suggesting that abnormal perception in VS may be affected by factors that are not captured by yaw-axis VOR measurements.NEW & NOTEWORTHY The severity of symptoms associated with unilateral vestibular schwannomas (VS) is poorly correlated with standard yaw-axis vestibulo-ocular reflex (VOR) metrics that are based on response amplitude. In this study, we show that the balance and perceptual dysfunction experienced by patients with VS scales with VOR metrics that capture information about the central signal-to-noise ratio (balance) and central static tone (dizziness), but are not correlated with the VOR gain, which reflects central signal amplitude.
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Affiliation(s)
- Susan King
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Kilian Dahlem
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Faisal Karmali
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts,2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | | | - D. Bradley Welling
- 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Richard F. Lewis
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts,2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts,3Department of Neurology, Harvard Medical School, Boston, Massachusetts
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Koo YJ, Kim HJ, Choi JY, Kim JS. Vestibular paroxysmia associated with typewriter tinnitus: a case report and literature review. J Neurol 2021; 268:2267-2272. [PMID: 33744979 DOI: 10.1007/s00415-021-10525-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yu Jin Koo
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Microvascular compression of the vestibulocochlear nerve. Eur Arch Otorhinolaryngol 2021; 278:3625-3631. [PMID: 33452921 DOI: 10.1007/s00405-020-06586-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Vascular compression of cranial nerves has been widely accepted as a cause for trigeminal neuralgia and hemifacial spasm. In contrast, vascular compression of the vestibulocochlear nerve remains controversial. METHOD A comprehensive literature review including 175 articles between 1960 and 2020 was performed in an attempt to summarise the published hypotheses of the pathophysiological mechanisms of vascular compression of the vestibulocochlear nerve and their management strategies. RESULTS Vascular loops in the cerebellopontine angle (CPA) and internal auditory meatus (IAM) are very common and should be regarded primarily as a normal variant. Advances in anatomical understanding with the development of models for the tonotopy of the vestibulocochlear nerve help explain the complexity of symptoms created by possible neurovascular interaction. CONCLUSION Widely accepted, validated and sensitive diagnostic criteria and outcome measures need to be established in order to evaluate the role of surgery in vestibulocochlear nerve vascular compression.
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Mejía-Quiñones V, Valderrama-Chaparro JA, Paredes-Padilla S, Orejuela-Zapata JF, Granados-Sánchez AM. Vascular loop in the cerebellopontine angle: clinical-radiological correlation. RADIOLOGIA 2020; 64:S0033-8338(20)30113-2. [PMID: 33041072 DOI: 10.1016/j.rx.2020.06.005] [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: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.
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Affiliation(s)
- V Mejía-Quiñones
- Médico generalista y asistente de investigación, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia.
| | - J A Valderrama-Chaparro
- Médico generalista y asistente de investigación, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | | | - J F Orejuela-Zapata
- Ingeniero biomédico, Departamento de Radiología, Hospital Universitario Fundación Valle del Lili, Cali, Colombia
| | - A M Granados-Sánchez
- Neurorradiólogo, Departamento de Radiología, Hospital Universitario Fundación Valle del Lili, Cali, Colombia
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Lee SA, Lee ES, Kim BG, Lee TK, Sung KB, Hwang K, Lee JD. Acute vestibular asymmetry disorder: a new disease entity in acute vestibular syndrome? Acta Otolaryngol 2019; 139:511-516. [PMID: 31035836 DOI: 10.1080/00016489.2019.1599142] [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: 10/26/2022]
Abstract
BACKGROUND Acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea, vomiting and gait unsteadiness, which lasts for days. AIMS/OBJECTIVES We report cases as acute vestibular asymmetry disorder (AVAD), with presentations that mimic vestibular neuritis (VN) but without central lesions. MATERIALS AND METHODS We retrospectively reviewed records of patients presenting with acute spontaneous vertigo lasting more than 24 h from January 2011 to June 2016. Among 341 patients, five showed different findings that did not indicate either VN or stroke. We analyzed the clinical features and vestibular assessments of these patients. RESULTS All five patients showed spontaneous nystagmus continuing for several days. However, head impulse tests (HITs) did not reveal a corrective saccade. Brain magnetic resonance imaging showed no abnormal lesions. The bithermal caloric test revealed directional preponderance without canal paresis. Finally, the slow harmonic test of the rotatory chair revealed unilateral high gain and phase within the normal range, but a significantly asymmetric response was observed. No patients showed recurrence during follow-up. CONCLUSIONS AND SIGNIFICANCE Our study suggests that a normal HIT in AVS is not always a dangerous sign indicating an acute stroke. From our observations, we propose that AVAD would be a new disease entity within AVS.
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Affiliation(s)
- Se A. Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Bo Gyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Tae-Kyeong Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Ki-Bum Sung
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Kyurin Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Sunwoo W, Jeon YJ, Bae YJ, Jang JH, Koo JW, Song JJ. Typewriter tinnitus revisited: The typical symptoms and the initial response to carbamazepine are the most reliable diagnostic clues. Sci Rep 2017; 7:10615. [PMID: 28878303 PMCID: PMC5587715 DOI: 10.1038/s41598-017-10798-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/15/2017] [Indexed: 12/25/2022] Open
Abstract
Although neurovascular compression of the cochlear nerve (NVC-C) presenting as typewriter tinnitus is a discrete disease category, verified diagnostic criteria are lacking. We sought to refine the diagnostic criteria for NVC-C by reference to a relatively large case series. The medical records of 22 NVC-C patients were retrospectively reviewed. Psychoacoustic characteristics, the results of diagnostic work-up (including audiovestibular neurophysiological tests and radiological evaluations), and the initial treatment response to carbamazepine were investigated. All subjects described their tinnitus as a typical “typewriter” or “staccato” sound. Of the 22 subjects, 11 (50%) had histories of vertiginous spells, but none had ipsilesional hearing loss. Vestibular function tests in 11 subjects tested revealed only 2 (18.2%) isolated cervical vestibular evoked myogenic potential abnormalities. Radiological comparisons of the symptomatic and asymptomatic sides, regarding the type of the vascular loop and neurovascular contact, revealed no significant differences. However, all 22 subjects exhibited immediate and marked responses to short-term carbamazepine treatment. Meticulous history-taking in terms of the psychoacoustic characteristics and the response to initial carbamazepine, are more reliable diagnostic clues than are radiological or neurophysiological data in NVC-C subjects. Therefore, the typical psychoacoustic characteristics and the response to initial carbamazepine should be included in the diagnostic criteria.
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Affiliation(s)
- Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Yung Jin Jeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Hun Jang
- Department of Otolaryngology-Head and Neck Surgery, Ajou University Hospital, Suwon, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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Kazawa N, Togashi K, Ito J. The anatomical classification of AICA/PICA branching and configurations in the cerebellopontine angle area on 3D-drive thin slice T2WI MRI. Clin Imaging 2013; 37:865-70. [PMID: 23751264 DOI: 10.1016/j.clinimag.2011.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 11/21/2011] [Indexed: 10/26/2022]
Abstract
BACKGROUND With the technical advance of magnetic resonance imaging (MRI), we have been able to observe not only the small cranial nerves arising from the brain stem but also the branches of vertebrobasilar artery in the cerebellopontine angle (CPA) cistern. PURPOSE The purpose was to demonstrate the courses and configurations of the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA) branch including the internal auditory artery in the CPA cistern and evaluate the relationship between the facial-vestibulocochlear (VIIth-VIIIth) nerves and AICA/PICA on high-resolution, thin-slice, three-dimensional T2-weighted MRI using driven equilibrium pulse. MATERIAL AND METHODS Thirty-three men and 27 women aged 8-85 years old with sensory hearing loss or vertigo, and/or tinnitus were evaluated by thin-slice (0.75 mm) T2-weighted MRI. Five subjects (3 men, 2 women) without any auditory symptoms were also examined. RESULTS Thin-slice T2WI drive MRI revealed several variations of the AICA/PICA coursing, such as a loop formation (n=30, 48 sides) or the IAC extension (n=19, 30 sides). Contact with the vestibulocochlear nerve was seen in 31.7% subjects (n=19, 27 sides). The AICA/PICA branching and shape patterns relative to the CPA and IAC were classified into four major types: type 1A, nonloop AICA/PICA in the CPA cistern; type 1 B, nonloop AICA/PICA (internal auditory artery) entering the IAC; type 2A, loop-type AICA/PICA in the CPA cistern; and type 2B, loop-type AICA/PICA entering the IAC. CONCLUSION There was statistically significant association between types 1A and 2A (P<.01) regarding the existence of any auditory 3 symptoms. The results of our study suggest that this classification is simple and very useful for the elucidation of the mechanism of auditory symptoms and deciding the therapeutic strategies.
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Affiliation(s)
- Nobukata Kazawa
- Department of Radiology, Kyoto University Hospital, Kyoto-City, Kyoto 606-8507, Japan.
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Singh N, Singh P, Usha M, Akshay M. Audio-vestibular findings in Vestibular Paroxysmia. INDIAN JOURNAL OF OTOLOGY 2013. [DOI: 10.4103/0971-7749.113509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Colletti V, Fiorino FG, Carner M, Turazzi S. Vestibular Neurectomy and Microvascular Decompression of the Cochlear Nerve in Meniere's Disease. Skull Base Surg 2011; 4:65-71. [PMID: 17170929 PMCID: PMC1656475 DOI: 10.1055/s-2008-1058972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vestibular neurectomy (VN) results in a high success rate in the control of vertigo in Meniere's disease, although the subsequent fate of auditory function is fairly unpredictable. The present investigation reports the postoperative results obtained in a group of 30 subjects with a clinical diagnosis of Meniere's disease and vascular cross-compression of cranial nerve VIII. All subjects underwent VN using a retrosigmoid approach, and in half of them microvascular decompression (MVD) of the cochlear nerve with interposition of autogenous muscle was performed at the same time. All patients had complete relief from vertigo. Hearing was significantly improved in the VN-MVD group (46.7% of subjects). In this group tinnitus and aural fullness also improved significantly, with values of 62.6% and 66.6%, respectively.
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Clift JM, Wong RD, Carney GM, Stavinoha RC, Boyev KP. Radiographic analysis of cochlear nerve vascular compression. Ann Otol Rhinol Laryngol 2009; 118:356-61. [PMID: 19548385 DOI: 10.1177/000348940911800507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We analyzed whether radiographically demonstrated anterior inferior cerebellar artery (AICA) vascular compression of the cochleovestibular nerve in asymmetric hearing loss could be correlated to either the symptomatic ear or to cochlear nerve diameter. METHODS We undertook a retrospective case-control study in which patients were enrolled into a database if audiometry demonstrated asymmetry of 20 dB at one frequency, asymmetry of 10 dB at two frequencies, or a difference of 20% on word recognition scores. If AICA vascular contact was demonstrated on subsequent magnetic resonance imaging of the cerebellopontine angle, patients were included in the study. Patients with vestibular schwannoma or Meniere's disease were excluded. The AICA contact was graded by a blinded neuroradiologist according to criteria proposed by McDermott et al. The cross-sectional area of the cochlear nerve was measured. RESULTS Symptomatic ears could be correlated to a decreased cochlear nerve diameter, but not to the degree of AICA penetration into the internal auditory canal. CONCLUSIONS AICA vascular compression of the cochleovestibular nerve does not appear to correlate to hearing loss or to cochlear nerve diameter. The finding of decreased cochlear nerve diameter in symptomatic ears implies an alternative mechanism for asymmetric hearing loss.
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Affiliation(s)
- Julie M Clift
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida 33612, USA
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Yap L, Pothula VB, Lesser T. Microvascular decompression of cochleovestibular nerve. Eur Arch Otorhinolaryngol 2008; 265:861-9. [PMID: 18389269 DOI: 10.1007/s00405-008-0647-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
Abstract
The role of microvascular decompression (MVD) in the management of trigeminal neuralgia, hemifacial spasms and glossopharyngeal neuralgia is well-established. However, controversy persisted as to the use of MVD in cochleovestibular neurovascular compression syndrome. This report provides a review of all the published studies on MVD of the eighth (8th) nerve in alleviating cochleovestibular symptoms and presents three additional patients who underwent MVD of the eighth nerve for tinnitus or vertigo. Nineteen studies were identified. Five were case reports. The remaining have sample sizes ranging from 4 to 207 patients. Quantitative and qualitative reviews of all studies were performed, focusing on the selection criteria for surgery, efficacy and safety of the procedure. Selection criteria for surgery were variable. No standardised outcome measures were used and all studies rely on patient subjective assessment of surgical outcome. Nonetheless, the results suggest that MVD of the eighth nerve produces good outcome with low morbidity in selected cases.
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Affiliation(s)
- L Yap
- The Walton Centre for Neurology and Neurosurgery, Department of Otorhinolaryngology, University Hospital Aintree, Liverpool, UK.
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Wang SJ, Chen JW, Young YH. Three-dimensional visualization of vertebrobasilar system aneurysms in a vertigo patient. Eur Arch Otorhinolaryngol 2007; 265:369-71. [PMID: 17879096 DOI: 10.1007/s00405-007-0443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 09/04/2007] [Indexed: 10/22/2022]
Abstract
Cerebral artery fenestration refers to a division in the lumen of an artery leading to two distinct endothelium-lined channels. At the site of turbulent flow, fenestration may predispose to an aneurysm formation. In this study, a 45-year-old woman suffered an acute vertiginous attack after cervical manipulation. The MRI scan demonstrated basilar artery duplication and tortuous left distal vertebral artery impinging on the cisternal segment of the cochleovestibular nerve. Subsequent three-dimensional (3D) reconstruction by MR imaging showed vertebrobasilar artery fenestrations with aneurysms. Unfortunately, subarachnoid hemorrhage occurred 6 days later, and the patient became comatose one year after presentation. In summary, subarachnoid hemorrhage caused by vertebrobasilar system aneurysms is a life-threatening event. Delineating the configuration by 3D-reconstruction of MR images allows more accurate diagnosis and more effective management.
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Affiliation(s)
- Shou-Jen Wang
- Department of Otolaryngology, Catholic Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
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De Ridder D, Heijneman K, Haarman B, van der Loo E. Tinnitus in vascular conflict of the eighth cranial nerve: a surgical pathophysiological approach to ABR changes. PROGRESS IN BRAIN RESEARCH 2007; 166:401-11. [DOI: 10.1016/s0079-6123(07)66039-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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De Ridder D, Ryu H, Møller AR, Nowé V, Van de Heyning P, Verlooy J. Functional Anatomy of the Human Cochlear Nerve and Its Role in Microvascular Decompressions for Tinnitus. Neurosurgery 2004; 54:381-8; discussion 388-90. [PMID: 14744285 DOI: 10.1227/01.neu.0000103420.53487.79] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 10/03/2003] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The functional anatomy (i.e., tonotopy) of the human cochlear nerve is unknown. A better understanding of the tonotopy of the central nervous system segment of the cochlear nerve and of the pathophysiology of tinnitus might help to ameliorate the disappointing results obtained with microvascular decompressions in patients with tinnitus.
METHODS
We assume that vascular compression of the cochlear nerve can induce a frequency-specific form of hearing loss and that when the nerve is successfully decompressed, this hearing loss can recuperate. Thirty-one patients underwent a microvascular decompression of the vestibulocochlear nerve for vertigo or tinnitus. Preoperative audiograms were subtracted from postoperative audiograms, regardless of the surgical result with regard to the tinnitus and vertigo, because the hearing improvement could be the only sign of the vascular compression. The frequency of maximal improvement was then correlated to the site of vascular compression. A tonotopy of the cochlear nerve was thus obtained.
RESULTS
A total of 18 correlations can be made between the site of compression and postoperative maximal hearing improvement frequency when 5-dB hearing improvement is used as threshold, 13 when 10-dB improvement is used as threshold. A clear distribution can be seen, with clustering of low frequencies at the posterior and inferior side of the cochlear nerve, close to the brainstem, and close to the root exit zone of the facial nerve. High frequencies are distributed closer to the internal acoustic meatus and more superiorly along the posterior aspect of the cochlear nerve.
CONCLUSION
The tonotopic organization of the cisternal segment of the cochlear nerve has an oblique rotatory structure as a result of the rotatory course of the cochlear nerve in the posterior fossa. Knowledge of this tonotopic organization of the auditory nerve in its cisternal course might benefit surgeons who perform microvascular decompression operations for the vestibulocochlear compression syndrome, especially in the treatment of unilateral severe tinnitus.
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Affiliation(s)
- Dirk De Ridder
- Department of Neurosurgery and Otorhinolaryngology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium.
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Van HT, Deguine O, Esteve-Fraysse MJ, Bonafe A, Fraysse B. Relationship between cochleovestibular disorders in hemifacial spasm and neurovascular compression. Laryngoscope 1999; 109:741-7. [PMID: 10334224 DOI: 10.1097/00005537-199905000-00012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the evolution of cochleovestibular symptoms before, during, and after microvascular decompression (MVD) of the facial nerve in hemifacial spasm. STUDY DESIGN Prospective study in patients with hemifacial spasm. Among our 13 patients who underwent MVD of the facial nerve from 1995 to 1997, 6 had associated cochleovestibular disorders confirmed by neurotologic tests. RESULTS In four of these patients, a concomitant compression of the eighth and facial nerves was found at surgery. Preoperative magnetic resonance angiography studies had shown three cases of this double neurovascular compression. Intraoperative auditory brainstem response monitoring showed that interposition of Teflon between vessel and facial nerve was highly critical to the auditory function. Auditory brainstem response monitoring was used to guide the surgeon during this critical phase. Surgery improved at least one cochleovestibular symptom in each patient. CONCLUSIONS The authors propose two pathophysiologic hypotheses. First, the concomitant facial and cochleo-vestibular symptoms may be due to a hyperactivity of both the facial and vestibular nuclei. According to theories about cryptogenic hemifacial spasm, the origin of this hyperactivity could be an ectopic excitation focus. However, the two nerves may have different sites of ectopic excitation. According to the second hypothesis, a pulsatile compression of the facial nerve may be transmitted to the eighth nerve. This could take place even if only the facial nerve is in contact with a vascular loop.
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Affiliation(s)
- H T Van
- Department of Ear, Nose, and Throat Medicine, Purpan Hospital, Toulouse, France
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Makins AE, Nikolopoulos TP, Ludman C, O'Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms? Laryngoscope 1998; 108:1739-42. [PMID: 9818836 DOI: 10.1097/00005537-199811000-00027] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess whether contact of a vascular loop formed by the anterior inferior cerebellar artery (AICA) with the eighth cranial nerve correlated with unilateral auditory symptoms so as to produce a "vascular compression syndrome." STUDY DESIGN Prospective evaluation of patients with unilateral auditory symptoms using magnetic resonance imaging (MRI) scans to identify contact of a vascular loop with the eighth cranial nerve. METHODS One hundred twelve patients with idiopathic unilateral auditory symptoms (42 women and 70 men, mean age of 51 years) were evaluated with MRI. Location of the vascular loop and contact with the eighth cranial nerve were assessed in each case. The asymptomatic contralateral ears of the patients were used as controls. A power analysis had determined the size of the sample to be studied. RESULTS The arterial loop was found to be in contact with the eighth cranial nerve in 28 (25%) of the 112 symptomatic ears and in 24 (21.4%) of the asymptomatic (control) ears. The statistical analysis revealed that the difference was not statistically significant. CONCLUSION The results suggest that radiologic demonstration of contact between a vascular loop formed by the AICA and the eighth cranial nerve on MRI scans should be considered a normal anatomic finding and should not, on its own, be used to support the diagnosis of a "vascular compression syndrome."
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Affiliation(s)
- A E Makins
- Department of Academic Radiology, University Hospital, Queen's Medical Centre NHS Trust, Nottingham, United Kingdom
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Goycoolea MV, Ruah CB, Lavinsky L, Morales-Garcia C. Overall View and Rationale for Surgical Alternatives for Incapacitating Peripheral Vertigo. Otolaryngol Clin North Am 1994. [DOI: 10.1016/s0030-6665(20)30687-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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