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Pediatric Sensorineural Hearing Loss, Part 2: Syndromic and Acquired Causes

B.Y. Huang, C. Zdanski and M. Castillo
American Journal of Neuroradiology March 2012, 33 (3) 399-406; DOI: https://doi.org/10.3174/ajnr.A2499
B.Y. Huang
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C. Zdanski
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M. Castillo
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    Fig 1.

    BOR syndrome. A, Axial CT image through the level of the cochlear aperture demonstrates a hypoplastic cochlea without a definable modiolus or apical turn. B, An image slightly superior to A demonstrates a medially displaced canal for the labyrinthine segment of the facial nerve (arrow) and an enlarged vestibular aqueduct. This patient also has a left middle ear cholesteatoma causing ossicular erosion. Only the head of the malleus remains (arrowhead in A). C, CT image through the right epitympanum in the same patient demonstrates a foreshortened dysplastic incus with an enlarged body that essentially articulates directly with the stapes.

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    Fig 2.

    CHARGE syndrome. A, Axial CISS image through the left temporal bone demonstrates a small vestibule (white arrow) and absence of the lateral SCC. The cochlea is also hypoplastic (arrowhead). B, Axial fast spin-echo T2WI through the brain and orbits demonstrates a left-sided coloboma (black arrow).

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    Fig 3.

    Waardenburg syndrome. Axial CISS image through the right temporal bone demonstrates absence of the posterior SCC (arrow) but a normal lateral SCC (arrowhead). This is a characteristic finding of Waardenburg and Alagille syndromes.

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    Fig 4.

    X-linked hearing loss with stapes gusher. A, Axial CT image through the mid-IAC on the left demonstrates a bulbous IAC, widening of the cochlear aperture, and cochlear hypoplasia with modiolar deficiency. The vestibule is also dilated. B, Axial CT image slightly superior to A demonstrates widening of the bony canal for the labyrinthine segment of the facial nerve (arrow).

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    Fig 5.

    Labyrinthine fibrosis. A, Axial CISS image through the left IAC demonstrates loss of normal high-fluid signal intensity in the left cochlea (arrow). B, On the corresponding axial CT image through the left temporal bone, the turns of the cochlea are not ossified; however, subtle thickening of the modiolus may reflect very early cochlear ossification.

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    Fig 6.

    Two cases of labyrinthitis ossificans. A, Axial left temporal bone image demonstrates increased attenuation in the basal turn of the cochlea (small arrows) in a patient with early labyrinthitis ossificans. B, Axial right temporal bone image in a patient who has undergone a previous tympanomastoidectomy demonstrates complete ossification of the cochlea and lateral and posterior SCCs, consistent with advanced labyrinthitis ossificans. Portions of the vestibule (large arrow) remain unossified. Note the normal-sized IAC, which helps to distinguish this from labyrinthine aplasia.

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    Fig 7.

    Autoimmune labyrinthitis. Axial gadolinium-enhanced T1WI through the right inner ear demonstrates enhancement of the cochlea (arrow), vestibule (arrowhead), and SCCs. Acute infectious labyrinthitis would have an identical appearance.

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    Fig 8.

    Transverse temporal bone fracture resulting in a perilymph fistula. A, Axial left temporal bone CT image through the level of the superior SCC demonstrates a transversely oriented fracture (arrow), which involves the posterior limb of the superior SCC. B, Axial CT image just inferior to A demonstrates pneumolabyrinth in the vestibule and cochlea. In addition, there is gas in the vestibular aqueduct, which happens to be enlarged in this patient.

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    Fig 9.

    Hemolabyrinth. Coronal unenhanced T1WI through the cochleae demonstrates increased signal intensity in the right cochlea (arrow), consistent with hemorrhage following trauma.

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    Fig 10.

    NF-2 axial gadolinium-enhanced T1WI through the level of the IACs demonstrates enhancing vestibular schwannomas in both IACs (arrows) and trigeminal schwannomas in both Meckel caves (arrowheads).

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    Fig 11.

    Pilocytic astrocytoma causing left-sided hearing loss. Axial T2WI demonstrates an exophytic hyperintense mass arising from the region of the left inferior cerebellar peduncle (arrow).

Tables

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    Table 1:

    Selected hereditary syndromes commonly associated with SNHL

    Inner Ear Malformations on ImagingInner Ear Malformations Not Common on Imaging
    Alagille syndromeAlport syndrome
    Branchio-oto-renal syndromeBiotinidase deficiency
    CHARGE syndromeJervell and Lange-Nielsen syndrome
    Klippel-Feil syndromeNorrie syndrome
    Pendred syndromeStickler syndrome
    Waardenburg syndromeUsher syndrome
    X-linked hearing loss with stapes gusher
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    Table 2:

    Updated diagnostic criteria for CHARGE syndrome9

    Major and Minor Signs of CHARGE Syndromea
    Major (the 3 Cs)
        Coloboma
        Choanal atresia
        Hypoplastic semicircular Canals
    Minor
        Rhombencephalic dysfunction
        Hypothalamohypophyseal dysfunction
        Abnormal middle or external ear
        Malformation of mediastinal organs (heart, esophagus)
        Mental retardation
    • ↵a Typical CHARGE = 3 major signs OR 2 major signs +2 minor signs; partial/incomplete CHARGE = 2 major signs +1 minor sign; and atypical CHARGE = 2 major signs +0 minor signs OR 1 major sign +3 minor signs.

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American Journal of Neuroradiology: 33 (3)
American Journal of Neuroradiology
Vol. 33, Issue 3
1 Mar 2012
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Cite this article
B.Y. Huang, C. Zdanski, M. Castillo
Pediatric Sensorineural Hearing Loss, Part 2: Syndromic and Acquired Causes
American Journal of Neuroradiology Mar 2012, 33 (3) 399-406; DOI: 10.3174/ajnr.A2499

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Pediatric Sensorineural Hearing Loss, Part 2: Syndromic and Acquired Causes
B.Y. Huang, C. Zdanski, M. Castillo
American Journal of Neuroradiology Mar 2012, 33 (3) 399-406; DOI: 10.3174/ajnr.A2499
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Cited By...

  • Oval window perilymph fistula in child with recurrent meningitis and unilateral hearing loss
  • A Case Series of X-Linked Deafness-2 with Sensorineural Hearing Loss, Stapes Fixation, and Perilymphatic Gusher: MR Imaging and Clinical Features of Hypothalamic Malformations
  • The Unwound Cochlea: A Specific Imaging Marker of Branchio-Oto-Renal Syndrome
  • Spectrum of Third Window Abnormalities: Semicircular Canal Dehiscence and Beyond
  • Spectrum of Temporal Bone Abnormalities in Patients with Waardenburg Syndrome and SOX10 Mutations
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