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Research ArticleHead and Neck Imaging

Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review

E. Verheij, L. Elden, T.B. Crowley, F.A. Pameijer, E.H. Zackai, D.M. McDonald-McGinn and H.G.X.M. Thomeer
American Journal of Neuroradiology March 2018, DOI: https://doi.org/10.3174/ajnr.A5588
E. Verheij
aFrom the Department of Otorhinolaryngology–Head and Neck Surgery (E.V., H.G.X.M.T.)
bBrain Center Rudolf Magnus (E.V., H.G.X.M.T.)
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  • ORCID record for E. Verheij
L. Elden
dDepartment of Otorhinolaryngology–Head and Neck Surgery (L.E.)
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T.B. Crowley
eThe 22q and You Center (T.B.C., E.H.Z., D.M.M.-M.)
fDepartment of Human Genetics (T.B.C., E.H.Z., D.M.M.-M.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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F.A. Pameijer
cDepartment of Radiology (F.A.P.), University Medical Center Utrecht, Utrecht, the Netherlands
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E.H. Zackai
eThe 22q and You Center (T.B.C., E.H.Z., D.M.M.-M.)
fDepartment of Human Genetics (T.B.C., E.H.Z., D.M.M.-M.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
gDepartment of Pediatrics (E.H.Z., D.M.M.-M.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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D.M. McDonald-McGinn
eThe 22q and You Center (T.B.C., E.H.Z., D.M.M.-M.)
fDepartment of Human Genetics (T.B.C., E.H.Z., D.M.M.-M.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
gDepartment of Pediatrics (E.H.Z., D.M.M.-M.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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H.G.X.M. Thomeer
aFrom the Department of Otorhinolaryngology–Head and Neck Surgery (E.V., H.G.X.M.T.)
bBrain Center Rudolf Magnus (E.V., H.G.X.M.T.)
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  • Fig 1.
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    Fig 1.

    Radiologic malformations of the middle and inner ear encountered in 52 ears.

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    Fig 2.

    A, Axial CT image of the left mastoid shows a normal stapes superstructure for comparison with B. B, Axial CT image of the right mastoid shows a dense, thick stapes superstructure. The pure tone audiogram of this patient is shown in Fig 5B. The mastoid bones shown in A and B do not belong to the same patient.

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    Fig 3.

    A, Axial CT image of the right mastoid shows an incomplete partition type II of the cochlea. The basal turn (BT) of the cochlea is intact; the apical and middle turn (A/M) seem confluent. B, A pure tone audiogram of the same ear shows normal hearing. The circle indicates an unmasked air-conduction threshold; the bracket, a masked bone-conduction threshold.

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    Fig 4.

    A, Axial CT image of left mastoid bone shows the lateral semicircular canal with a small bony island. B, A pure tone audiogram of the same ear shows a mild conductive hearing loss. The x indicates an unmasked air-conduction threshold; the bracket, a masked bone-conduction threshold.

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    Fig 5.

    A, Axial CT image of the right mastoid bone. The bony island of the lateral semicircular canal is missing, and the canal and vestibule are composed of a single cavity (SC). B, A pure tone audiogram of the same ear shows conductive hearing loss, more pronounced in the low frequencies. The circle indicates an unmasked air-conduction threshold; the bracket, a masked bone-conduction threshold.

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    Fig 6.

    Axial CT image of the right mastoid bone showing a carotid canal dehiscence (C).

Tables

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    Table 1:

    Number of ears with audiometric results per anatomic malformation

    MalformationPTATympanometrya
    No HL (%)HLType
    C (%)SN (%)M (%)PTA Range in dBABCAsAdLV
    Dense malleus2 (100)––––––––––
    Dense stapes superstructure7 (39)6 (33)1 (6)4 (22)21–1003313–2
    IP type II5 (42)3 (25)1 (8)b3 (25)38–100
    LSCC: small bony island7 (41)4 (24)3 (18)b3 (18)b35–100
    LSCC: single cavity6 (40)5 (33)2 (13)2 (13)25–96
    • Note:—HL indicates hearing loss; C, conductive; SN, sensorineural; M, mixed; PTA, pure tone average; A, normal situation; B, flat curve; C, negative peak pressure; As, small pressure peak; Ad, high pressure peak; LV, large volume; IP, incomplete partition.

    • ↵a The number of ears does not amount to the total number of ears with a malformation due to missing data.

    • ↵b Including 1 ear measured with visual reinforcement audiometry and brain stem evoked response audiometry.

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    Table 2:

    Overview of number of ears with middle and/or inner ear abnormalities reported by Loos et al16 and in the present study

    MalformationLoos et al16; No. of Ears (%) (Total, 22 Ears)Present study; No. of Ears (%) (Total, 52 Ears)Total No. of Ears (%) (Total, 74 Ears)
    Malleus, incus, or stapes abnormalitiesa2 (9)3 (6b)5 (7c)
    Dense stapes superstructure10 (45)18 (36b)28 (39c)
    LSCC: single cavity4 (18)15 (29)19 (26)
    Wide vestibule/small bony island in LSCC14 (64)17 (33)31 (42)
    IP type II12 (55)12 (23)24 (32)
    Carotid canal dehiscence2 (9)5 (10b)7 (10c)
    • Note:—IP indicates incomplete partition.

    • ↵a Other than a dense stapes superstructure.

    • ↵b Calculated from a total of 50 ears; bone structures in 2 ears in the present study could not be assessed on MRI.

    • ↵c Calculated from a total of 72 ears; bone structures in 2 ears in the present study could not be assessed on MRI.

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E. Verheij, L. Elden, T.B. Crowley, F.A. Pameijer, E.H. Zackai, D.M. McDonald-McGinn, H.G.X.M. Thomeer
Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5588

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Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review
E. Verheij, L. Elden, T.B. Crowley, F.A. Pameijer, E.H. Zackai, D.M. McDonald-McGinn, H.G.X.M. Thomeer
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5588
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