Evaluation of the radiological criteria to diagnose large vestibular aqueduct syndrome

Objective: The main objective of the current work is to increase the sensitivity of the radiological diagnosis of the large vestibular aqueduct syndrome (LVAS). The specific aims were to compare between the two famous criteria to diagnose large vestibular aqueduct (LVA), (i.e., Valvassori and Cincinnati), to correlate between vestibular aqueduct (VA) measurements in the axial view and those in 45 degrees oblique reformate in children with LVAS, and to define radiological criteria to diagnose LVA in the 45 degrees oblique reformate. Methods: The study group included 61 children with LVAS according to Cincinnati criteria (greater than 0.9 mm at the midpoint or greater than 1.9 mm at the operculum in the axial view). All participants were subjected to full Audiological evaluation and CT scanning in axial plane. The axial data were then transferred to workstation for post-processing with 3D reformatting software (Baxara 3D) in order to obtain the 45 degrees oblique reformates. VA measurements were done at 4 points: midpoint and operculum in both the axial plane and the 45 degrees oblique reformate. Results: Only 81% of ears of children with LVAS (99 ears) fit Valvassori criterion (i.e., larger than 1.5 mm at midpoint), while 19% (23 ears) of them were missed. There were statistically significant correlations among the diameters of the VA in the axial view (both in the midpoint and operculum) and their counterparts in the 45 degrees oblique reformate. Values equal to or greater than 1.2 mm in the midpoint and 1.3 mm in the operculum are proposed to be the criteria to diagnose LVA in the 45 degrees oblique reformate. Finally, no significant correlations were found between the degree of hearing loss and VA diameters at the axial or 45 degrees oblique reformate. Conclusion: Cincinnati criteria are more sensitive than Valvassori criterin in the diagnosis of LVAS. We recommend the application of Cincinnati criteria instead of Valvassori criteria in order not miss cases with LVAS. Measurement of VA in the 45 degrees oblique reformate is a reliable method to diagnose LVA. Criteria to diagnose LVA in the 45 degrees oblique reformate were proposed. (C) 2016 Elsevier Ireland Ltd. All rights reserved.