Biomechanics of Third Window Syndrome

Iversen, Marta M.; Rabbitt, Richard D.

doi:10.3389/fneur.2020.00891

Cited by 28 publications

(24 citation statements)

References 98 publications

(135 reference statements)

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“…Thereafter, Merchant and Rosowski theorized that an SSCD acts as a TW between the vestibule and the dura resulting in pseudo-conductive hearing loss through worsened airway thresholds and improved bone conduction (12). The labyrinthine membrane, unprotected by the bony covering at the level of the dehiscence, has therefore a locally higher compliance allowing a deviation of the perilymphatic flow toward the bony defect (10,12,(15)(16)(17)(18). Thus, under some conditions, depending on the location, size, and shape of the dehiscence, the normal acoustic energy transported by the PS could be transmitted to the vestibular compartment of the endolymphatic system (ES).…”

Section: Introduction History Of the Third Window Hypothesismentioning

confidence: 99%

“…As a result, a deformation of the membranous labyrinth will appear in the dehiscent area, modulated by sound characteristics (intensity, frequency). Then, due to a local transfer of vibrations by a resonance phenomenon between the perilymphatic and endolymphatic spaces, a significant deformation of the crista ampullaris can be observed ( 15 , 16 , 18 ). This anarchic vestibular co-stimulation mediated by strong sounds of varying intensities ( 15 , 16 , 18 ), e.g., the Tullio phenomenon, leads to vertigo or/and dizziness.…”

Section: Introductionmentioning

confidence: 99%

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Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

et al. 2022

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Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants.Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities.Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed.Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.

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Section: Introduction History Of the Third Window Hypothesismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

et al. 2022

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“…The effects of an additional third window in the otic capsule on the auditory and the vestibular system have been comprehensively investigated in animal and mathematical models [133][134][135][136][137][138]. The clinical symptoms and electrophysiological findings can be classified into four major categories: Pressure-induced vertigo Variations in intracranial pressure (e. g., sneezing, coughing, straining) or middle ear pressure (e. g., rapid changes in altitude) are directly transmitted to the fluid-filled spaces of the inner ear via the newly created third window (▶Fig.…”

Section: Pathophysiology and Cardinal Symptomsmentioning

confidence: 99%

Section: Episodic Vestibular Syndromesmentioning

confidence: 99%

“…Die Auswirkungen eines zusätzlichen dritten Fensters in der otischen Kapsel auf die Hör-und Gleichgewichtsfunktion wurden in Tier-und mathematischen Modellen eingehend untersucht [133][134][135][136][137][138]. Im Wesentlichen lassen sich die klinischen Symptome und die elektrophysiologischen Befunde vier Gruppen zuordnen: Druckinduzierter Schwindel Schwankungen des intrakraniellen Drucks (z.…”

Section: Pathophysiologie Und Leitsymptomeunclassified

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Seltene Erkrankungen des vestibulären Labyrinths: von Zebras, Chamäleons und Wölfen im Schafspelz

Dlugaiczyk

2021

Laryngorhinootologie

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ZusammenfassungDie Differenzialdiagnose von Erkrankungen des vestibulären Labyrinths stellt eine grosse Herausforderung dar, da sich hinter dem sehr häufigen Leitsymptom «Schwindel» viele verschiedene und v. a. seltene Erkrankungen verbergen können. Der vorliegende Beitrag gibt einen Überblick über die für den HNO-Arzt wichtigen seltenen Erkrankungen des vestibulären Labyrinths ausgehend von ihrer klinischen Präsentation als akutes (AVS), episodisches (EVS) oder chronisches vestibuläres Syndrom (CVS). Der Schwerpunkt liegt dabei auf den EVS, sortiert nach ihrer Dauer und dem Vorhandensein von Triggern (Sekunden, ohne Trigger: Vestibularisparoxysmie, Tumarkin-Krise; Sekunden, lärm- und druckinduziert: Syndrome des «dritten Fensters»; Sekunden bis Minuten, positionsabhängig: seltene Varianten und Differenzialdiagnosen des benignen paroxysmalen Lagerungsschwindels; Stunden bis Tage, spontan: intralabyrinthäre Schwannome, Tumoren des endolymphatischen Sacks, Autoimmunerkrankungen des Innenohres). Des Weiteren werden seltene Differenzialdiagnosen eines AVS (Neuritis vestibularis inf., Otolithenfunktionsstörungen, vaskuläre Ursachen, akute bilaterale Vestibulopathie) und eines CVS (bilaterale Vestibulopathie) erläutert. Dabei werden insbesondere die entscheidenden diagnostischen Massnahmen für die Identifikation der einzelnen Krankheitsbilder und die Warnzeichen für potentiell gefährliche Ursachen (z. B. Labyrinthinfarkt/-blutung) dargelegt. Somit dient dieser Beitrag dem HNO-Arzt in Klinik und Praxis als eine Art «Vademecum» für die zügige Identifikation und zeitnahe Therapie seltener Erkrankungen des Gleichgewichtsorgans.

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