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Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans

Objective Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO....

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Published in:Otolaryngology-head and neck surgery 2021-01, Vol.164 (1), p.175-181
Main Authors: Trakimas, Danielle R., Knoll, Renata M., Castillo-Bustamante, Melissa, Kozin, Elliott D., Remenschneider, Aaron K.
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container_title Otolaryngology-head and neck surgery
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creator Trakimas, Danielle R.
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description Objective Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). Study Design Retrospective review. Setting Academic institution. Methods Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. Results Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. Level of Evidence Retrospective review.
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LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). Study Design Retrospective review. Setting Academic institution. Methods Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. Results Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. Level of Evidence Retrospective review.</description><identifier>ISSN: 0194-5998</identifier><identifier>EISSN: 1097-6817</identifier><identifier>DOI: 10.1177/0194599820934748</identifier><identifier>PMID: 32600100</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Child ; Cochlea - microbiology ; Cochlear Implantation ; Female ; Humans ; Labyrinthitis - etiology ; Labyrinthitis - microbiology ; Labyrinthitis - surgery ; labyrinthitis ossificans ; Male ; meningitis ; Meningitis, Bacterial - complications ; Meningitis, Bacterial - microbiology ; Ossification, Heterotopic ; otopathology ; Retrospective Studies ; Scala Tympani - microbiology ; Spiral Ganglion - microbiology ; Temporal Bone - microbiology</subject><ispartof>Otolaryngology-head and neck surgery, 2021-01, Vol.164 (1), p.175-181</ispartof><rights>American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020</rights><rights>2021 American Association of Otolaryngology‐Head and Neck Surgery Foundation (AAO‐HNSF)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3862-693ae41cc627208a46ba07729a209d99c0f5e2832ef41ad3c4874fe73438da3c3</citedby><cites>FETCH-LOGICAL-c3862-693ae41cc627208a46ba07729a209d99c0f5e2832ef41ad3c4874fe73438da3c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32600100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trakimas, Danielle R.</creatorcontrib><creatorcontrib>Knoll, Renata M.</creatorcontrib><creatorcontrib>Castillo-Bustamante, Melissa</creatorcontrib><creatorcontrib>Kozin, Elliott D.</creatorcontrib><creatorcontrib>Remenschneider, Aaron K.</creatorcontrib><title>Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans</title><title>Otolaryngology-head and neck surgery</title><addtitle>Otolaryngol Head Neck Surg</addtitle><description>Objective Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). Study Design Retrospective review. Setting Academic institution. Methods Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. Results Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. 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All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. Level of Evidence Retrospective review.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>32600100</pmid><doi>10.1177/0194599820934748</doi><tpages>7</tpages></addata></record>
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subjects Adolescent
Adult
Child
Cochlea - microbiology
Cochlear Implantation
Female
Humans
Labyrinthitis - etiology
Labyrinthitis - microbiology
Labyrinthitis - surgery
labyrinthitis ossificans
Male
meningitis
Meningitis, Bacterial - complications
Meningitis, Bacterial - microbiology
Ossification, Heterotopic
otopathology
Retrospective Studies
Scala Tympani - microbiology
Spiral Ganglion - microbiology
Temporal Bone - microbiology
title Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans
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