Enlarged vestibular aqueduct in pediatric sensorineural hearing loss

Karuna Dewan, Franz J Wippold 2nd, Judith E C Lieu, Karuna Dewan, Franz J Wippold 2nd, Judith E C Lieu

Abstract

Objective: Comparison of the Cincinnati criteria (midpoint >0.9 mm or operculum >1.9 mm) to the Valvassori criterion (midpoint > or =1.5 mm) for enlarged vestibular aqueduct (EVA) in pediatric cochlear implant patients.

Study design: Cohort study.

Subjects: One hundred thirty pediatric cochlear implant recipients.

Methods: We reviewed temporal bone CT scans to measure the vestibular aqueduct midpoint and opercular width.

Results: The Cincinnati criteria identified 44 percent of patients with EVA versus 16 percent with the Valvassori criterion (P < 0.01). Of those with EVA, 45 percent were unilateral and 55 percent were bilateral using Cincinnati criteria; 64 percent were unilateral and 36 percent bilateral using Valvassori criterion (P < 0.01). The Cincinnati criteria diagnosed 70 ears with EVA classified as normal using the Valvassori criterion (P < 0.01); 59 lacked another medical explanation for their hearing loss.

Conclusion: The Cincinnati criteria identified a large percentage of pediatric cochlear implant patients with EVA who might otherwise have no known etiology for their deafness.

Figures

Figure 1
Figure 1
Temporal bone CT scans of normal and enlarged vestibular aqueducts by both the Valvassori and Cincinnati criteria. A. Normal right vestibular aqueduct. B. Enlarged left vestibular aqueduct. *1: Mastoid Air Cells. *2: Internal Auditory Canal. *3: Limb of the posterior semicircular canal. *4: Horizontal semicircular canal. OP: operculum width, perpendicular to the PL. MP: midpoint width, bisects the PL. PL: line from the posterior wall of the vestibular aqueduct, perpendicular to the ray measuring operculum width.
Figure 1
Figure 1
Temporal bone CT scans of normal and enlarged vestibular aqueducts by both the Valvassori and Cincinnati criteria. A. Normal right vestibular aqueduct. B. Enlarged left vestibular aqueduct. *1: Mastoid Air Cells. *2: Internal Auditory Canal. *3: Limb of the posterior semicircular canal. *4: Horizontal semicircular canal. OP: operculum width, perpendicular to the PL. MP: midpoint width, bisects the PL. PL: line from the posterior wall of the vestibular aqueduct, perpendicular to the ray measuring operculum width.
Figure 2
Figure 2
Temporal bone CT scan of a patient with bilaterally enlarged vestibular aqueducts (marked by arrows) as defined by the Cincinnati criteria but normal by the Valvassori criterion. A. The right vestibular aqueduct measures 1.3 mm at the midpoint and 1.5 mm at the operculum. B. The left vestibular aqueduct measures 1.1 mm at the midpoint and 1.0 mm at the operculum.
Figure 2
Figure 2
Temporal bone CT scan of a patient with bilaterally enlarged vestibular aqueducts (marked by arrows) as defined by the Cincinnati criteria but normal by the Valvassori criterion. A. The right vestibular aqueduct measures 1.3 mm at the midpoint and 1.5 mm at the operculum. B. The left vestibular aqueduct measures 1.1 mm at the midpoint and 1.0 mm at the operculum.
Figure 3
Figure 3
Correlation of the midpoint and the operculum measurements of 242 ears without regard to right or left ear.
Figure 4
Figure 4
Scatter plot of midpoint measurement compared with age of subject.
Figure 5
Figure 5
Scatter plot of opercular measurement (mm) in comparison to age of subject.

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