Browsing by keyword "otopathology"

Now showing items 1-3 of 3

    • Histopathology of the Incudomalleolar Joint in Cases of "Indeterminate" Presbycusis
      Roychowdhury, Prithwijit; Castillo-Bustamante, Melissa; Polanik, Marc; Kozin, Elliott D; Remenschneider, Aaron K (2021-02-23)
      Age-related hearing loss (presbycusis) is a prevalent condition attributed primarily to inner ear dysfunction. Little is known about age-related changes in the ossicular joints or their contribution to presbycusis. Herein, we performed a histopathologic analysis of the incudomalleolar joint (IMJ) in specimens from the National Temporal Bone Registry with audiometrically confirmed presbycusis but without histologically observed sensory, neural, strial, or mixed features. Seventeen “indeterminate” presbycusis (IP) ears and 13 young, normal-hearing ears were examined. The age was 73.2 ± 9.5 years for the IP group and 32.1 ± 9.5 for the young group (P < .05). The joint space between the 2 ossicles was 23% wider in the IP group (139 ± 26.2 µm) compared to young ears (113 ± 49.0 µm) (P = .02). We report that IP ears have a wider IMJ than young ears. These findings have implications for understanding the etiology of presbycusis in indeterminate cases.

    • Human Otopathology of Cochlear Implant Drill-out Procedures
      Trakimas, Danielle R.; Ishai, Reuven; Kozin, Elliott D.; Nadol, Joseph B. Jr.; Remenschneider, Aaron K. (2019-05-07)
      OBJECTIVE: Human otopathology following drill-out procedures for cochlear implantation (CI) in cases with labyrinthitis ossificans (LO) has not been previously described. This study uses the high sensitivity of histopathology to (1) evaluate surgical drill-out technique with associated intracochlear findings and (2) quantify spiral ganglion neuron populations in a series of patients with LO who underwent CI. STUDY DESIGN: Retrospective otopathology study. SETTING: Otopathology laboratory. SUBJECTS AND METHODS: Temporal bone (TB) specimens from cases with evidence of preoperative intracochlear fibroossification that required a drill-out procedure for CI electrode array insertion were included. All cases were histopathologically evaluated and 3-dimensional reconstructions of the cochleae were performed to interpret drilling paths and electrode trajectories. RESULTS: Five TB specimens were identified, of which 4 underwent drill-out of the basal turn of the cochlea and 1 underwent a radical cochlear drill-out. In multiple TBs, drilling was imprecise with resultant damage to essential structures. Two TBs showed injury to the modiolus, which was associated with substantially decreased or even absent neuronal populations within these areas. In addition, 2 cases with inadequate drill-out or extensive LO of the basal turn resulted in extracochlear placement of electrode arrays into the vestibule due to persistent obstruction within the basal turn. CONCLUSION: Otopathology highlights the challenges of drill-out procedures in cases of LO. Imprecise drilling paths, due to distortion of normal cochlear anatomy, risk injury to the modiolus and adjacent neurons as well as extracochlear placement of electrode arrays, both of which may contribute to poorer hearing outcomes.

    • Otopathology of Unilateral Cochlear Implantation in Patients With Bilateral Temporal Bone Fracture
      Trakimas, Danielle R.; Knoll, Renata M.; Ishai, Reuven; Lee, Daniel J.; Jung, David H.; Nadol, Joseph B. Jr.; Remenschneider, Aaron K.; Kozin, Elliott D. (2019-01-01)
      OBJECTIVE: Audiometric outcomes following cochlear implantation (CI) in patients with temporal bone fracture (TBF) are variable and the pathophysiology is not well understood. Herein, we describe otopathologic findings in two such cases to provide insight into pathophysiology and outcomes. PATIENTS: Two patients had a history of head trauma resulting in bilateral TBF and sudden, profound, sensorineural hearing loss. INTERVENTION: Both cases underwent unilateral CI following head trauma. MAIN OUTCOME MEASURES: Both TBs from each patient were harvested postmortem and histologically analyzed to determine fracture lines, intralabyrinthine fibroosseous changes, and spiral ganglion neuron (SGN) counts. Clinical histories and audiometric outcomes were also reviewed. RESULTS: In both cases, the implanted TB showed extensive intracochlear ossification, which was greater when fracture involved the cochlea. In contrast, the nonimplanted cochleae were patent with small osseous deposits at the round window membrane. Interaural SGN counts were lower on the implanted side and hearing results were moderate to poor. CONCLUSIONS: Otopathologic analyses of patients with a CI after bilateral TBF are rare. Based on otopathology of two patients with bilateral TBF and subsequent CI, implanted TBs show extensive intracochlear fibroosseous changes greater than the nonimplanted side. Findings have implications for auditory rehabilitation after TBF.