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Three-Dimensional Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Investigation of Inner Ear Disturbances in Cases of Middle Ear Cholesteatoma With Labyrinthine Fistula

Sone, Michihiko*; Mizuno, Terukazu*; Sugiura, Makoto*; Naganawa, Shinji; Nakashima, Tsutomu*

doi: 10.1097/MAO.0b013e3181587d95
Middle Ear and Mastoid Disease

Objective: To investigate the cause of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula.

Setting: University hospital.

Study Design: Prospective case study.

Patients: Eight patients who were scheduled to undergo surgery for middle ear cholesteatoma with labyrinthine fistula were included in this study.

Intervention: Imaging analysis was performed using a 3-dimensional fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging sequence.

Main Outcome Measures: Three-dimensional FLAIR findings were compared with clinical symptoms associated with inner ear disturbance and surgical observations of the fistula.

Results: Three-dimensional FLAIR in 6 patients revealed areas of high signal intensity in the inner ears on the affected sides and areas with increased signal after the administration of gadolinium, especially in cases accompanied by acute sensorineural hearing loss. These images were considered to be indicative of breakdown of the blood-labyrinth barrier due to middle ear cholesteatoma. This finding was also present in a patient with no clinical symptoms of inner ear disturbances.

Conclusion: Three-dimensional FLAIR images of the inner ear are valuable in evaluating labyrinthine fistula in patients with cholesteatoma. Future studies are needed to better understand the role of 3-dimensional FLAIR in predicting the severity of inner ear disturbance.

Departments of *Otorhinolaryngology and †Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

Address correspondence and reprint requests to Michihiko Sone, M.D., Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; E-mail:

© 2007 Otology & Neurotology, Inc.