[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to use magnetic resonance imaging (MRI) to investigate the early myelination patterns of the central auditory pathway and then compare the data with past histological research. We observe the MRI signal intensity of the central auditory pathway and clarify the time course difference between MRI and previous histological research studies.
A total of 192 infants ranging in age from -4 to 224 corrected postnatal weeks were included in the study. Images were obtained using a 1.5 T MR unit. We chose three sites (medial geniculate body, auditory radiation, and splenium of the corpus callosum) of the central auditory pathway for analysis. Three cross sections were obtained perpendicular to the long axis of the brain and used to analyze the signal changes of the T1- and T2-weighted MRI by employing a region-of-interest (ROI) methodology that was corrected for postnatal age.
At 10 corrected postnatal weeks, the medial geniculate body showed myelinated intensity changes on T2-weighted images. Auditory radiation showed myelinated intensity changes at 19 corrected postnatal weeks on the T1-weighted images and at 24 corrected postnatal weeks on the T2-weighted images. The splenium of the corpus callosum showed myelinated intensity changes at 16 corrected postnatal weeks on T1-weighted images and at 24 corrected postnatal weeks on T2-weighted images.
As compared to the histological literature, the MRI documented signal intensity changes caused by myelination occurred approximately 3 weeks later for the medial geniculate body, 7-24 weeks later for the auditory radiation and 7-15 weeks later for the splenium of the corpus callosum. Since myelination is a process that occurs gradually, substantial changes of the myelin sheath makeup, a loss of water and the addition of lipids are more required in order to be detectable by MRI than myelin staining of histological study.
No preview · Article · Nov 2008 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: To investigate the myelination progression course in language-correlated regions of children with normal brain development by quantitative magnetic resonance imaging (MRI) analysis compared with histological studies.
The subjects were 241 neurologically intact neonates, infants and young children (128 boys and 113 girls) who underwent MRI between 2001 and 2007 at the University of Tokyo Hospital, ranging in age from 0 to 429 weeks corrected by postnatal age. To compare their data with adult values, 25 adolescents and adults (14 men and 11 women, aged from 14 to 83 years) were examined as controls. Axial T2-weighted images were obtained using spin-echo sequences at 1.5 T. Subjects with a history of prematurity, birth asphyxia, low Apgar score, seizures, active systemic disease, congenital anomaly, delayed development, infarcts, hemorrhages, brain lesions, or central nervous system malformation were excluded from the analysis. Seven regions of interest in language-correlated areas, namely Broca's area, Wernicke's area, the arcuate fasciculus, and the angular gyrus, as well as their right hemisphere homologous regions, and the auditory cortex, the motor cortex, and the visual cortex were examined. Signal intensity obtained by a region-of-interest methodology progresses from hyper- to hypointensity during myelination. We chose the inferior cerebellar peduncle as the internal standard of maturation.
Myelination in all these seven language-correlated regions examined in this study shared the same curve pattern: no myelination was observed at birth, it reached maturation at about 1.5 years of age, and it continued to progress slowly thereafter into adult life. On the basis of scatter plot results, we put these areas into three groups: Group A, which included the motor cortex, the auditory cortex, and the visual cortex, myelinated faster than Group B, which included Broca's area, Wernicke's area, and the angular gyrus before 1.5 years old; Group C, consisting of the arcuate fasciculus, has similar degree of myelination as Group B before 1.5 years but then myelinated more slowly after 3 years of age. No gender or left-right differences between homologous regions were found.
In this study, we determined the sequence of myelination of language-correlated regions in infants and children by quantitative MRI assessment. The higher cortical areas matured later than the primary cortical areas, and the arcuate fasciculus matured last. The observation that myelination reaches maturity after 18 months suggests that myelination may be a reason for the acceleration in vocabulary acquisition observed in children from that age. The slow pace of myelination also suggested the possibility of language development's continuation into early adult life. Myelination assessed by MRI was at least 1 month behind that assessed by histological staining. No gender or left-right hemisphere differences in myelination were noted.
No preview · Article · Nov 2008 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: This study showed that delayed auditory pathway myelination is common in Pelizaeus-Merzbacher disease (PMD), but this delay does not necessarily indicate poor hearing function.
PMD is a rare recessively inherited X-linked leukodystrophy characterized by defective central nervous system myelination owing to a mutation in the proteolipid protein gene (PLP). The aims of this study were to evaluate the hearing function and auditory brain response (ABR) findings of patients with PMD and relate these findings to MRI-assessed myelination in the central auditory pathway.
We retrospectively studied eight male pediatric patients with PMD. Serial auditory examinations included audiometry, behavior audiometry, distortion product otoacoustic emission (DPOAE), and ABR. MRI-assessed myelination in the auditory pathway was evaluated in the PMD patients and in 23 normal young children as a control group.
Audiometry showed normal to moderate hearing impairment and the hearing threshold improved with age and became almost normal over time. DPOAEs positivity and only ABR wave I or waves I and II were found in all the patients. MRI showed delayed myelination in all the patients and the auditory pathway was myelinated up to the inferior colliculus in four cases and up to the medial geniculate body in four cases. Serial MRIs showed no progression in myelination. No clear relation was found between hearing threshold and MRI-assessed myelination in the auditory pathway.
No preview · Article · Jun 2008 · Acta Oto-Laryngologica
[Show abstract][Hide abstract] ABSTRACT: While infants under the age of 1 year exhibited a high rate of abnormal intensities in the middle ear and mastoid cavities, older infants showed no abnormal intensities in these regions. From the signal intensity on T1- and T2-weighted MRI, the abnormal intensities in the middle ear cavity were considered to represent liquid effusion. Taken together with the findings of temporal bone CT, the abnormal intensities in the mastoid cavity were considered to represent bone marrow.
Histopathological studies of the temporal bone and tympanometry investigations have reported the presence of mesenchyme and liquid effusion in the middle ear cavity of infants. However, very few CT or MRI middle ear cavity findings of newborns and infants have been published, and none have included the mastoid cavity. We therefore performed an MRI study of the middle ear and mastoid cavities of infants under 2 years old (83 cases, 88 imaging series).
MRI (1.5 T) was originally performed on suspicion of brain disorders in infants aged under 2 years. All MRI slices were studied and classified on the basis of the distribution of abnormal intensities in the middle ear and mastoid cavities.
All the abnormal imaging appeared in infants under 1 year old, in particular, 74.24% (n=49) of abnormal imaging appeared in the first 20 weeks after birth.
No preview · Article · Sep 2007 · Acta Oto-Laryngologica
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to investigate the early myelination patterns of brainstem auditory nuclei and pathway on magnetic resonance imaging compared with past histological research. We aimed to identify the time course difference in myelination of the brainstem auditory nuclei and pathway between magnetic resonance imaging and histological research results.
Subjects were 192 infants ranging in age from -4 to 224 corrected postnatal weeks. Images were obtained using a 1.5 T magnetic resonance unit. In four sites (cochlear nucleus, superior olivary nucleus, lateral lemniscus, inferior colliculus) of the brainstem auditory nuclei and pathway on four cross-sections obtained perpendicular to the long axis of the brainstem, signal changes of T1- and T2-weighted magnetic resonance images were analyzed using a region-of-interest methodology according to corrected postnatal age.
The cochlear nucleus and superior olivary nucleus showed myelinated intensity change from -3 to 13 corrected postnatal weeks on T2-weighted images. The lateral lemniscus showed myelinated intensity change from -3 to 8 corrected postnatal weeks on T1-weighted images and from -1 to 13 corrected postnatal weeks on T2-weighted images. The inferior colliculus showed myelinated intensity change from -2 to 39 corrected postnatal weeks on T2-weighted images.
Magnetic resonance imaging revealed the signal intensity change by myelination 11-18 weeks later than those reported in the histological literature. This time lag suggests that apart from histological research, the necessity for the milestones of auditory pathway maturation using MRI is suggested to evaluate the development of brainstem auditory pathway using MRI. This result suggests that myelination does not take place suddenly but happens gradually, so definite myelination, namely the complete change of myelin sheath ingredients, loss of water, and gain of lipids, is needed to be detected by magnetic resonance imaging.
No preview · Article · Aug 2007 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: We aimed to quantitatively determine whether middle ear inflammation associated with unilateral chronic otitis media (COM), cholesteatoma, or otosclerosis affects gustatory function.
University Hospital, Department of Otolaryngology.
Forty-two patients had unilateral COM (22 men, 20 women; mean age, 54.2 yr), 57 had unilateral cholesteatoma (35 men, 22 women; mean age, 42.1 yr), and 19 had unilateral otosclerosis (10 men, 9 women; mean age, 49.3 yr).
Patients underwent taste testing using electrogustometry (EGM) and sensation thresholds were compared in the affected and unaffected ears among groups and between affected and unaffected ears in each group.
Patients with COM and cholesteatoma exhibited an increase in taste threshold in the affected ears compared to the unaffected ears (p < 0.05), whereas otosclerosis patients did not. The extent of the increase of the sensation thresholds in the affected ears was very similar between patients with COM and those with cholesteatoma (p = 0.548).
Our EGM study showed that cholesteatoma and chronic middle ear inflammation affected gustatory function to a similar degree.
No preview · Article · Feb 2007 · Otology & Neurotology
[Show abstract][Hide abstract] ABSTRACT: Mobius syndrome is characterized by congenital bilateral facial palsy and abducens nerve paralysis, but reports of radiological and electrophysiological findings are scarce. A 4-year-old boy presented with mask-like facies noted at birth after a 34-week pregnancy. Examination revealed bilateral facial and abducens nerve paralysis with no other neurological abnormalities. Computed tomography revealed bilateral absence of facial nerve canal in the middle ear. Brain magnetic resonance imaging indicated a narrow than expected nerve in the internal auditory canal (IAC). Evoked electromyography and blink reflex testing to evaluate facial nerve function yielded no responses bilaterally. Facial palsy thus appears to be caused by facial nerve dysplasia or aplasia.
No preview · Article · Dec 2005 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: We report a 67-year-old woman with small cell carcinoma of the hypopharynx, a very rare entity with few reports. Our treatment consisted of carboplatin (CBDCA) and etoposide (VP-16) in the same way as small cell carcinoma of the lung is treated. This achieved a complete response. Our case suggests that chemotherapy with carboplatin and etoposide is effective for small cell carcinoma of the hypopharynx.
No preview · Article · Oct 2005 · Auris Nasus Larynx
[Show abstract][Hide abstract] ABSTRACT: The location of lesions causing hearing loss in patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia has remained unclear. We performed behavioral audiometry, distortion product otoacoustic emission (DPOAE) and auditory brainstem evoked response (ABR) in six patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia in order to determine the lesion location causing their hearing impairment. In all cases, behavioral audiometry revealed a threshold elevation of 50-75 dB and ABR were no response. DPOAE were totally absent in five patients and normal in one patient. Our study suggests that lesions causing hearing loss potentially include the organ of Corti especially at the outer hair cells and the cochlear nerve.
No preview · Article · Oct 2005 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Changes in the inner ear due to increased intracranial pressure have not yet been clearly defined. We present a postmortem temporal bone study of child with hydrocephalus. The temporal bone was from a 2-year-old female with IVth ventricle ependymoblastoma. In the basal turn of the cochlea, degeneration of the organ of Corti and the nerve ganglion was observed. In the top and middle turn, structures were intact. The utricle and saccule were well preserved. We propose that changes in the inner ear due to increased intracranial pressure begin in the base of the cochlea, and extend to the apex in decreasing degree.
No preview · Article · Jun 2004 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: We report a patient with antithyroid drug-induced progressive bilateral sensorineural hearing loss associated with myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA). While antithyroid drugs have been linked to MPO-ANCA-associated small-vessel vasculitis, sensorineural hearing loss rarely was noted. A 36-year-old man treated for hyperthyroidism with propylthiouracil (PTU) developed progressive bilateral sensorineural hearing loss accompanied by fever and arthritis. MPO-ANCA were demonstrated in serum. Distortion product otoacoustic emissions test results suggested dysfunction of outer hair cells of the organ of Corti. Inner ear blood flow impairment from ANCA-associated small-vessel vasculitis presumably caused cochlear dysfunction. PTU withdrawal and high-dose methylprednisolone administration greatly improved hearing on both sides.