Labyrinthine Sequestrum

Abstract

Labyrinthine sequestrum, a rare form of labyrinthitis, is highly distinct from the more commonly encountered labyrinthitis ossificans based on its unique clinical, radiologic, and histologic characteristics. The study included 4 such patients who had undergone clinical and laboratory investigations, computed tomography (CT), and magnetic resonance imaging (MRI) assessments followed by surgical procedures and pathological evaluation. Their major symptoms were otorrhea, otalgia, tinnitus, and profound hearing loss. Imaging studies showed an osteolytic soft mass with calcified debris in the inner ear, and the bony labyrinth was eroded partly or completely by granulation mass, with loss of bony morphology. Further pathological examination was coincident with inflammatory granulation tissue with some calcification or osseous tissue. The disease process is attributed to chronic osteomyelitis due to the presence of osteonecrosis. Prompt CT and MRI examinations and optimal therapeutic management facilitate definitive diagnosis and protect against fatal complications.

Labyrinthine sequestration secondary to auditory implantation: report of two cases and review of the literature

“…Surgical removal of an implanted prosthesis should be considered if the infection does not respond to antibiotic therapy, in order to remove any ongoing nidus for infection and allow resolution of the pathology. However, our second case demonstrates that contrary to previous literature advocating radical surgical approaches in all instances, a conservative approach can be successfully employed when necessitated by the circumstances 7 …”

“…Tympanogenic labyrinthitis is a potential consequence of otitis media. It has also been reported to occur post-operatively in up to 2 per cent of middle-ear procedures performed for indications including otosclerosis, meningitis and cancer surgery (patients undergoing cochlear implantation were excluded from that study) 7 , 9 …”

“…Even in the absence of a prosthesis, Lao et al . warn of fatal encephalopathic complications if vestibular sequestration is not treated surgically 7 …”

“…Several previous reports of patients who developed the pathology did not fall into these categories however. Those cases concerned young adults who were previously healthy, with no predisposing co-morbidities, as in case one and in the case series published by Lao et al 7 …”

ACR Appropriateness Criteria ® Tinnitus

“…Please see the ACR Appropriateness Criteria Ò "Hearing Loss and/or Vertigo" [4] to guide imaging of tinnitus in the setting of asymmetric hearing loss or vertigo, which may be associated with disorders of the middle ear (otitis or cholesteatoma [57]), cochlea (labyrinthitis [58], otosclerosis [59], or intralabyrinthine hemorrhage [52,60]), or central and neural structures (vestibular schwannoma and cerebellopontine angle masses [37,38,40], brain stem or auditory pathway lesions [51,61]).…”