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High-resolution 3-D T2-weighted imaging in the diagnosis of labyrinthitis ossificans: emphasis on subtle cochlear
Timothy N Booth1, Peter Roland, Joe W Kutz
1Department of Radiology, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA, tim.booth@childrens.com.
Background:
Meningitis is the most common cause of acquired sensorineural hearing loss (SNHL) in children. Labyrinthitis ossificans develops in a significant number of patients with meningitis-related SNHL. Reduced T2 signal on MRI within the membranous labyrinth is often noted in the fibrous and ossifying stages of labyrinthitis ossificans.
Objective:
The purpose of this study is to demonstrate the distribution and extent of involvement of the cochlea in children being evaluated for labyrinthitis ossificans; using high-resolution 3-D T2-weighted imaging, and to evaluate for subtle involvement of the scala tympani within the basal turn of the cochlea.
Materials And Methods:
A retrospective review from 2002 to 2012 was performed using a cochlear implant database and PACS search function. Twenty-four patients were found to have MR findings consistent with labyrinthitis ossificans, 13 previously reported. Axial 3-D T2-weighted sequences were obtained in all patients. The presence of abnormal decreased T2 signal within the scala tympani and vestibuli of the cochlea was noted and graded according to the extent. The electronic medical record was reviewed for audiometry and risk factors as well as correlative operative findings.
Results:
The average age at imaging was 4.2 years. M:F ratio = 5:1. Eighty-eight percent (21/24) of patients had bilateral SNHL. The most common risk factor for labyrinthitis ossificans was meningitis (19/24 or 79%). Eighteen (75%) patients had a history of bacterial meningitis. The mean age for the onset of labyrinthitis was 1.2 years with an average of 2.2-year interval to imaging. Nineteen patients (79%) underwent placement of a cochlear implant. Cochlear obstruction was documented in 83% (40/48) of the ears. Lower grade (1) cochlear obstruction was present in 14 ears and limited to the scala tympani. Statistical analysis was performed correlating MRI imaging and surgical findings.
Conclusion:
Subtle, isolated involvement of the scala tympani within the proximal basal turn is a common finding in labyrinthitis ossificans and history typical for meningitis is not uniformly present. The extent of cochlear obstruction is important and has surgical implications.
Insights
Meningitis can cause sensorineural hearing loss in children, leading to labyrinthitis ossificans. High-resolution MRI reveals subtle cochlear involvement, particularly in the scala tympani, impacting surgical decisions for cochlear implants.
Area of Science:
- Pediatric Radiology
- Neuroscience
- Otolaryngology
Background:
- Meningitis is a leading cause of acquired sensorineural hearing loss (SNHL) in children.
- Labyrinthitis ossificans frequently develops following meningitis-related SNHL.
- Reduced T2 signal on MRI indicates labyrinthitis ossificans stages.
Purpose of the Study:
- To map cochlear involvement in pediatric labyrinthitis ossificans using 3D T2-weighted MRI.
- To assess subtle scala tympani involvement in the basal turn.
- To correlate imaging findings with clinical data.
Main Methods:
- Retrospective review of 24 pediatric patients (2002-2012) with labyrinthitis ossificans.
- High-resolution 3D T2-weighted axial MRI sequences analyzed for cochlear signal changes.
- Correlation with audiometry, risk factors, and surgical findings from medical records.
Main Results:
- Meningitis was the primary risk factor (79%) for labyrinthitis ossificans.
- Bilateral SNHL was present in 88% of patients.
- Cochlear obstruction occurred in 83% of ears, with subtle scala tympani involvement noted.
Conclusions:
- Subtle, isolated scala tympani involvement in the basal turn is common in labyrinthitis ossificans.
- Meningitis history is not always present.
- The extent of cochlear obstruction has significant surgical implications for cochlear implantation.
