Uchiyama Mio, Monsanto Rafael da Costa, Sancak Irem Gul, Park Grace Sinae, Schachern Patricia, Kobayashi Hitome, Paparella Michael M, Cureoglu Sebahattin
Department of Otolaryngology Head & Neck Surgery, University of Minnesota.
Department of Otolaryngology, School of Medicine, Showa University, Tokyo, Japan.
Otol Neurotol. 2021 Sep 1;42(8):e1152-e1159. doi: 10.1097/MAO.0000000000003192.
HYPOTHESIS/BACKGROUND: We hypothesize that following head trauma there is a difference in temporal bone (TB) pathology in cases with and without skull fracture. Although conductive, sensorineural, mixed hearing loss, and TB pathology following head trauma have been reported, to our knowledge, there are no studies that have compared the pathology of the TB in cases with and without skull fracture.
We analyzed 34 TBs from donors who had a history of head trauma (20 with skull fracture and 14 without fracture), and 25 age-matched controls without clinical or histological evidence of otologic disorders. We documented the presence and location of TB fracture, ossicular injury, and cochlear hemorrhage and evaluated the loss of spiral ganglion cells and sensory hair cells, damage to the stria vascularis, and the presence of endolymphatic hydrops.
We found a significant loss of outer hair cells in the upper basal, lower, and upper middle turns of the cochlea (p = 0.009, =0.019, =0.040, respectively), a significant loss of spiral ganglion cells (p = 0.023), and cochlear hemorrhage predominantly in the basal turns secondary to head trauma. Interestingly, these findings were significantly observed in TBs from donors with a history of head trauma without skull fracture.
The greatest damage was to the cochlear basal turn. Our findings suggest that head trauma may result in tonotopic high frequency sensorineural hearing loss. TBs from donors with skull fracture have less pathologic changes than those without.
假设/背景：我们假设头部外伤后，有颅骨骨折和无颅骨骨折的病例在颞骨（TB）病理学方面存在差异。尽管已有报道称头部外伤后会出现传导性、感音神经性、混合性听力损失以及颞骨病理学改变，但据我们所知，尚无研究比较有颅骨骨折和无颅骨骨折病例的颞骨病理学情况。
我们分析了34例有头部外伤史的供体的颞骨（20例有颅骨骨折，14例无骨折），以及25例年龄匹配、无耳科疾病临床或组织学证据的对照。我们记录了颞骨骨折、听骨链损伤和耳蜗出血的存在及位置，并评估了螺旋神经节细胞和感觉毛细胞的损失、血管纹的损伤以及内淋巴积水的情况。
我们发现耳蜗上基底转、下转和上中转的外毛细胞有显著损失（分别为p = 0.009、= 0.019、= 0.040），螺旋神经节细胞有显著损失（p = 0.023），且头部外伤继发的耳蜗出血主要位于基底转。有趣的是，在有头部外伤史但无颅骨骨折的供体的颞骨中显著观察到了这些发现。
最大的损伤发生在耳蜗基底转。我们的研究结果表明，头部外伤可能导致音调定位性高频感音神经性听力损失。有颅骨骨折的供体的颞骨病理变化比无颅骨骨折的供体少。
