Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Center for Clinical Investigation, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Am J Otolaryngol. 2019 Jul-Aug;40(4):473-477. doi: 10.1016/j.amjoto.2019.03.008. Epub 2019 Mar 29.
Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.
A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.
Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).
Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.
前庭导水管扩大（EVA）是小儿感音神经性或混合性听力损失患者最常见的先天性畸形之一。前庭导水管（VA）形态与听力损失之间的性别关系尚未得到很好的描述。本研究以性别为主要预测因素，评估 VA 形态和频率特异性听力阈值。
采用回顾性、纵向和重复测量研究。在学术性三级护理中心，有听力损失且有内听道 CT 扫描记录的 47 名患者符合 EVA 标准，并在确认测量前庭导水管中点和镫骨宽度后符合入选标准。听力学测量包括纯音平均听力和频率特异性阈值。
在 47 名患者（23 名女性和 24 名男性）中，79 只耳朵受到 EVA 的影响；诊断时的中位年龄为 6.60 岁。比较性别之间的形态测量值后，发现女性患者的平均镫骨宽度更大（3.25 毫米对男性的 2.70 毫米，p=0.006），平均 VA 中点宽度更大（2.80 毫米对男性的 1.90 毫米，p=0.004）。调整形态后，男性患者的纯音平均听力阈值比女性患者高 17.6 分贝（95%可信区间，3.8 至 31.3 分贝）。
尽管女性似乎有更大的前庭导水管扩大，但这种差异并不延伸到听力损失。因此，我们的结果表明，EVA 诊断标准可能需要重新评估。进一步探索性别之间的形态和听力学差异可能有助于为临床医生和患者提供信息。
