The Narrowed Internal Auditory Canal: A Distinct Etiology of Pediatric Vestibular Paroxysmia

Abstract

Vestibular paroxysmia (VP) is a disorder encountered in the pediatric population that etiology has been attributed to neurovascular cross-compression syndrome (NVCC). The purpose of this study was to report a new probable pathological condition, the narrowed internal auditory canal (IAC), which appears to be involved in the development of a clinical picture of VP in the pediatric population. A retrospective descriptive comparative study was conducted to compare clinical, electrophysiological, radiological, and therapeutic outcomes in both etiologies. Overall, 16 pediatric patients suffering from VP were included and divided into two groups: patients with narrowed internal auditory (Group 1) were compared to those with NVCC syndrome (Group 2). Patients in both groups were similar in terms of auditory complaints, as well as hearing, vestibular, and electrophysiological status. A narrowed IAC was encountered in the adolescent age category and females, especially those with rapid growth. The diagnosis requires a careful analysis of the shape and diameters of the IAC. Radiologic measurements in the axial plane do not seem to be sufficient to confirm the diagnosis, and, therefore, an analysis of diameters in the coronal plane is required. Treatment with sodium-channel blockers drugs showed promising results not only by relieving vertigo but also by normalizing the electrophysiological findings. In conclusion, a narrowed IAC can be considered in patients suffering from VP.

The “Near”-Narrowed Internal Auditory Canal Syndrome in Adults: Clinical Aspects, Audio-Vestibular Findings, and Radiological Criteria for Diagnosis

“…For this purpose, we retrospectively sought out all cases presenting with these clinical features and carefully examined their MRI and high-resolution computed tomography (HRCT) images with morphometric analysis of the IAC since in some of these cases, as in some of these cases, this structure appeared narrowed. Similar symptoms and radiological signs have already been observed and reported in a pediatric series in which the initial presumptive diagnosis was either Benign Paroxysmal Vertigo of Childhood or VP by NVCC of the CVN [20]. Therefore, the aim of the present study is two-fold: (1) to discuss this apparently distinct form of CVN impairment in relation to a narrowed IAC, different from other pathological entities in the adult population, and (2) to propose radiological criteria for its diagnosis.…”

“…Similarly, in a recent study, our team previously reported that NNIAC could generate VP-evocative symptoms in a cohort of 16 children who were initially suspected of benign paroxysmal vertigo in childhood [20]. In half the cases, NVCC was diagnosed.…”

Facts of Vertigo in Adolescents: Controversies and Challenges – A Narrative Review

“…The prevalence of this type of vertigo is unregistered but its presentation is usually seen in late adolescence [36]. Clinical manifestations are described as frequent vertiginous spells that last seconds to minutes, occur at rest and with certain head positions, and respond to treatment with low-dose sodium channel-blocking [36][37][38][39][40][41]. The challenge with of vertigo is the similarity with the benign paroxysmal positional vertigo.…”

“…Herein, it is necessary to perform maneuvers with Frenzel goggles as well in difficult cases of vestibular testing such as videonystagmography and video-head impulse test [36]. When magnetic resonance is useful while performing the diagnosis, this is done concomitantly with a supplementary HRCT of temporal bones with an analysis of the shape, diameter, and opening width of the IAC in both axial and coronal planes [36][37][38][39][40][41].…”

Recent Advances in the Diagnosis and Treatment of Vestibular Disorders

“…In the first, Gill-Lussier et al carried out a scoping review of proprioceptive cervicogenic dizziness [ 6 ], showing how heterogeneous this concept is regarding etiology, differential diagnosis, measurement, and treatment, also providing a good characterization for further studies. In the second, Idriss et al have shown the intriguing place of the narrow internal auditory canal in pediatric vestibular paroxysmia [ 7 ]; both are unusual conditions in the studied population, and the authors direct some remarks to the methodology of imaging to obtain an adequate result.…”