Conclusion-Middle and inner ear interactions in otitis media can lead to cochlear pathology. More severe pathological changes observed in the basal turn of the cochlea are consistent with prevalence of sensorineural hearing loss at higher frequencies in patients with otitis media.Methods-Of 614 temporal bones with otitis media, 47 with chronic and 35 with purulent otitis media were selected following strict exclusion of subjects with a history of acoustic trauma, head trauma, ototoxic drugs, and other diseases affecting the cochlear labyrinth. Temporal bones with labyrinthine inflammatory changes were further evaluated for loss of hair cells and other histopathologic changes compared to age-matched controls.Results-In all, 19% of temporal bones with chronic and 9% with purulent otitis media showed labyrinthine inflammatory changes. In chronic otitis media, inflammatory changes were: 56% localized purulent, 22% localized serous, 11% generalized seropurulent, and 11% generalized serous. Inflammatory changes in temporal bones with purulent otitis media included 67% localized purulent and 33% were generalized seropurulent. Pathological findings included: serofibrinous precipitates and inflammatory cells in scala tympani of basal turn and cochlear aqueduct, significant loss of outer and inner hair cells, and significant decrease in area of stria vascularis in the basal turn of the cochlea, as compared to controls.
Labyrinthine ossificans is defined as pathologic new bone formation within the otic capsule in response to an inflammatory and/or destructive process. Although the cause is multifactorial in most cases, most extensive disease is seen in postmeningitic cases, with the scala tympani of the basal turn being the most common region of cochlear ossification (1). Causes of ossification include trauma, malignant infiltration, otosclerosis, allergy, and infections reaching the inner ear via hematogenous, meningitic, or tympanic routes (2).Ossification in the inner ear is a well-documented sequela of suppurative labyrinthitis. Paparella and Sugiura (3) outlined the histopathologic stages associated with purulent labyrinthitis and the process leading to ossification in the labyrinth of laboratory animals and humans. They divided the evolution of ossification consequent to purulent labyrinthitis into 3 stages: acute, fibrous, and stage of ossification. The acute stage is characterized by purulent effusion that fills the perilymphatic spaces but spares the endolymphatic space, followed by formation of serofibrinous precipitates. The second or fibrous stage is marked by fibroblastic proliferation within the perilymphatic space. This stage begins approximately 2 weeks after the onset of infection and is accompanied by angiogenesis. The third or stage of ossification shows new bone formation, which is first seen in the basal turn of the cochlea as early as 2 months after onset of infection.Although inner ear ossification is primarily a histopathologic diagnosis, its detection by use of complex motion tomography and computed tomographic scan is clinically relevant in patients who are candidates for cochlear implants (2).We are presenting a case with labyrinthitis ossificans with extensive ossification throughout the cochlea. The patient had a history of acoustic neuroma resection, which was complicated by meningitis in the postoperative period. The cause of ossification may be meningitis, surgical trauma, or a combination of both factors, wherein the surgical trauma provided direct access for the meningeal infection to reach the inner ear. CASE REPORTTemporal bones were obtained from a 72-year-old man who died of unknown cause. This patient had undergone resection of an acoustic neuroma on the right side via a translabyrinthine approach at the age of 63 years. His postoperative course was complicated with meningitis, which resolved with treatment. He had progressive hearing loss in his left ear and received cochlear implantation on the left side at the age of 70 years. Details of the audiologic evaluation are not available. The patient died 2 years after implantation.Address correspondence and reprint requests to Michael M. Paparella, M.D.,
Background: Sarcoidosis is a granulomatous disease of unknown aetiology. Over 90% patients of sarcoidosis present with pulmonary findings. Other organs such as lymph nodes, skin, and joints may be involved. Isolated granulomatous disease confined to the spleen is rare.
Our findings suggest a possible causative relationship between cupular and free-floating deposits in the semicircular canals and the symptom of positional vertigo in patients with Ménière's disease.
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