Vestibular and cochlear nerve enhancement on MRI and its correlation with vestibulocochlear functional deficits in patients with Ramsay Hunt syndrome |
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| Authors: | Mika Takahashi Go Sato Naoki Toda Takahiro Azuma Katsuhiko Nakamura Hidetaka Iwasaki Hitomi Miyoshi Kazunori Matsuda Yoshiaki Kitamura Koji Abe Shoichiro Takao Masafumi Harada Noriaki Takeda |
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| Affiliation: | 1. Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima 770-8503, Japan;2. Department of Diagnostic Radiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8503, Japan;3. Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8503, Japan;1. Department of Otolaryngology, Sleep Center, Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;2. Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;3. Chang Gung University College of Medicine, Kaohsiung, Taiwan;4. Department of Business Administration and Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan;5. Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA;6. Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA;1. Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan;2. Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan;1. Jichi Ika University Saitama Medical Center, Department of Otolaryngology, 1-847 Amanuma, Saitama 330-8503, Japan;2. Tokyo-Kita Medical Center, Department of Otolaryngology, Tokyo, Japan;1. Department of Medical Technology, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie 516-8512, Japan;2. Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan;3. Department of Radiation Oncology, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie 516-8512, Japan;4. Department of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8131, Japan;5. Proton Therapy Center, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui 910-8526, Japan;6. Department of Oral Maxillofacial Surgery, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Niigata, Niigata 951-8151, Japan;7. Department of Oral Health, Faculty of Health and Medical Sciences, Meikai University, 1 Meikai, Urayasu, Chiba 279-8550, Japan |
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| Abstract: | ObjectiveThe correlation between enhancement of the vestibulocochlear nerves on gadolinium-enhanced magnetic resonance imaging (MRI) and vestibulocochlear functional deficits was examined in patients with Ramsay Hunt syndrome (RHS).MethodsNineteen patients with RHS who showed herpes zoster oticus, peripheral facial palsy, and vertigo were enrolled. Canal paresis (CP) in the caloric test, abnormal response to ocular and cervical vestibular myogenic potentials (oVEMP and cVEMP), and refractory sensorineural hearing loss were evaluated. MRI images perpendicular to the internal auditory canal were reconstructed to identify the superior (SVN) and inferior vestibular nerves (IVN) and the cochlear nerve (CV). The signal intensity increase (SIinc) of the four-nerve enhancement was calculated as an index.ResultsAmong RHS patients, 79%, 53%, 17% and 26% showed CP in the caloric test, abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, respectively. SIinc rates of the SVN were significantly increased in RHS patients with CP in the caloric test, and with abnormal responses to oVEMP and cVEMP. SIinc rates of the SVN tended to increase in RHS patients with refractory sensorineural hearing loss (p = 0.052). SIinc rates of the IVN were significantly increased in RHS patients with abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, but not in those with CP in the caloric test. SIinc rates of the CN were significantly increased in RHS patients with CP in the caloric test, abnormal response to oVEMP and refractory sensorineural hearing loss, but not in those with abnormal response to cVEMP.ConclusionIn patients with RHS, the origin of vertigo may be superior vestibular neuritis, which is affected by reactive varicella-zoster virus from the geniculate ganglion of the facial nerve through the faciovestibular anastomosis. The results also suggested that in some RHS patients, inferior vestibular neuritis contributes to the development of vertigo and that the origin of refractory sensorineural hearing loss is cochlear neuritis. |
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