Vascular Loops and Neuro-Otologic Symptoms: Is There Any Correlation?

Amaya Roldán-Fidalgo, Antonio Rodríguez-Valiente, Francisco Martín González, Mayte Pinilla, Almudena Trinidad, Beatriz Brea Álvarez

Department of Otorhinolaryngology and Neuroradiology, Puerta de Hierro University Hospital, Madrid, Spain.

DOI: 10.4236/ijohns.2013.26051                

Abstract

Objective: To determine the relationship between vascular loops in the internal auditory canal and otologic symptoms. Methods: We performed a retrospective study, with a systematic review of the literature and analyzed the magnetic resonances imaging (MRI) of 91 patients attended in the ENT department since April to June 2013, in order to correlate radiological findings with otologic symptoms. Results: Vascular loops were seen in the internal auditory canal of patients without clinical symptoms; however an association was found between the presence of vascular compression of the eighth nerve displayed on MRI and the presence of sensorineural hearing loss and tinnitus. No association was found between vertigo and vascular loops. Conclusion: The presence of vascular loops in the internal auditory canal may be an incidental finding in MRIs of patients without clinical symptoms. However, in patients with tinnitus or sensorineural hearing loss that is unexplained by other clinical pathologies, these may be correlated with the existence of vascular loops which compress the eighth cranial nerve or contact the bone wall of the internal auditory canal. Further studies involving a larger number of patients are required to accurately evaluate the association between these symptoms and vascular loops.

Keywords

Vascular Loop; Arterial Loop; Internal Auditory Canal; Tinnitus; Deafness; Vertigo

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	N. K. Chadha and G. M. Weiner, “Vascular Loops Causing Otological Symptoms,” Clinical Otolaryngology and Allied Sciences, Vol. 33, No. 5, 2008, pp. 5-11. http://dx.doi.org/10.1111/j.1749-4486.2007.01597.x
[2]	C. Reisser and H. F. Schuknecht, “The Anterior Inferior Cerebellar Artery in the Internal Auditory Canal,” Laryngoscope, Vol. 101, No. 7, 1991, pp. 761-766. http://dx.doi.org/10.1288/00005537-199107000-00012
[3]	J. Kanzaki and E. Koyoma, “Vascular Loops in the Internal Auditory Canal as Possible Cause of Meniere’s Disease,” Auris Nasus Larynx, Vol. 13, No. 2, 1986, pp. S105-S111.
[4]	J. Kanzaki and K. Ogawa, “Internal Auditory Canal Vascular Loops and Sensorineural Hearing Loss,” Acta OtoLaryngologica, Vol. 447, 1988, pp. 88-93. http://dx.doi.org/10.3109/00016488809102862
[5]	L. M. Odkvist, K. A. Thuomas and M. Niklasson, “Macrovascular Causes Underlying Otoneurological Disturbances,” Acta Oto-Laryngologica, Vol. 115, No. 2, 1995, pp. 145-148. http://dx.doi.org/10.3109/00016489509139278
[6]	N. Galvez-Jimenez, M. R. Hanson and M. Desai, “Unusual Causes of Hemifacial Spasm,” Seminars in Neurology, Vol. 21, No. 1, 2001, pp. 75-83. http://dx.doi.org/10.1055/s-2001-13122
[7]	J. Magnan, F. Caces, P. Locatelli and A. Chays, “Hemifacial Spasm: Endoscopic Vascular Decompression,” Otolaryngology-Head and Neck Surgery, Vol. 117, No. 4, 1997, pp. 308-314.
[8]	J. A. Herzog, S. Bailey and J. Meyer, “Vascular Loops of the Internal Auditory Canal: A Diagnostic Dilemma,” American Journal of Otolaryngology, Vol. 18, No. 1, 1997, pp. 26-31.
[9]	R. R. Tash, E. L. Kier and D. Chyatte, “Hemifacial Spasm Caused by a Tortuous Vertebral Artery: MR Demonstration,” Journal of Computer Assisted Tomography, Vol. 12, No. 3, 1988, pp. 492-494. http://dx.doi.org/10.1097/00004728-198805010-00027
[10]	P. J. Jannetta, “Neurovascular Compression in Cranial Nerve and Systemic Disease,” Annals of Surgery, Vol. 192, No. 4, 1980, pp. 518-525. http://dx.doi.org/10.1097/00000658-198010000-00010
[11]	J. De Carpentier, N. Lynch, A. Fisher, et al., “MR Imaged Neurovascular Relationships at the Cerebellopontine Angle,” Clinical Otolaryngology, Vol. 21, No. 4, 1996, pp. 312-316. http://dx.doi.org/10.1111/j.1365-2273.1996.tb01077.x
[12]	J. Kanzaki and K. Ogawa, “Internal Auditory Canal Vascular Loops and Sensorineural Hearing Loss,” Acta OtoLaryngologica, Vol. 105, No. 447, 1988, pp. 88-93. http://dx.doi.org/10.3109/00016488809102862
[13]	A. Sirikci, Y. Bayazit, E. Ozer, et al., “Magnetic Resonance Imaging Based Classification of Anatomic Relationship between the Cochleovestibular Nerve and Anterior Inferior Cerebellar Artery in Patients with Non-Specific Neuro-Otologic Symptoms,” Surgical and Radiologic Anatomy, Vol. 27, No. 6, 2005, pp. 531-535. http://dx.doi.org/10.1007/s00276-005-0015-6
[14]	E. L. Applebaum and G. Valvasorri, “Internal Auditory Canal Vascular Loops: Audiometric and Vestibular System Findings,” American Journal of Otolaryngology, 1985, pp. 110-113.
[15]	R. M. Irving and S. Chavda, “Re: Vascular Loops Causing Otological Symptoms: A Systematic Review and Meta-Analysis,” Clinical Otolaryngology, Vol. 33, No. 5, 5, 2008, pp. 498; Author Reply 499.
[16]	E. L. Applebaum and G. E. Valvassori, “Auditory and Vestibular System Findings in Patients with Vascular Loops in the Internal Auditory Canal,” Annals of Otology, Rhinology and Laryngology, Vol. 112, 1984, pp. 63-70.
[17]	L. Jane, M. D. Weissman, E. Barry, et al., “Imaging of Tinnitus: A Review,” Radiology, Vol. 216, No. 2, 2000, pp. 342-349.
[18]	D. De Ridder, L. De Ridder, V. Nowe, et al., “Pulsatile Tinnitus and the Intrameatal Vascular Loop: Why Do We Not Hear Our Carotids?” Neurosurgery, Vol. 57, No. 6, 2005, pp. 1213-1217. http://dx.doi.org/10.1227/01.NEU.0000186035.73828.34
[19]	B. F. McCabe and L. A. Harker, “Vascular Loop as a Cause of Vertigo,” Annals of Otology, Rhinology and Laryngology, Vol. 92, No. 6, 1983, pp. 542-543.
[20]	A. Sismanis, “Pulsatile Tinnitus: A 15-Year Experience,” American Journal of Otolaryngology, Vol. 19, 1998, pp. 472-477.
[21]	E. L. Applebaum and G. E. Valvassori, “Auditory and Vestibular System Findings in Patients with Vascular Loops in the Internal Auditory Canal,” Annals of Otology, Rhinology and Laryngology, Vol. 112, 1984, pp. 63-70.
[22]	A. L. McDermott, S. N. Dutt, R. M. Irving, et al., “Anterior Inferior Cerebellar Artery Syndrome: Fact or Fiction,” Clinical Otolaryngology, Vol. 28, No. 2, 2003, pp. 75-80. http://dx.doi.org/10.1046/j.1365-2273.2003.00662.x
[23]	V. Nowe, D. De Ridder, P. H. Van de Heyning, et al., “Does the Location of a Vascular Loop in the Cerebellopontine Angle Explain Pulsatile and Non-Pulsatile Tinnitus?” European Radiology, Vol. 14, 2004, pp. 2282-2289. http://dx.doi.org/10.1007/s00330-004-2450-x
[24]	P. J. Jannetta, “Neurovascular Cross-Compression in Patients with Hyperactive Dysfunction Symptoms of the Eighth Cranial Nerve,” Surgical Forum, Vol. 26, 1975, pp. 467-468.
[25]	G. B. Brookes, “Vascular-Decompression Surgery for Severe Tinnitus,” American Journal of Otolaryngology, Vol. 17, No. 4, 1996, pp. 569-576.
[26]	T. Okamura, Y. Kurokawa, N. Ikeda, et al., “Microvascular Decompression for Cochlear Symptoms,” Journal of Neurosurgery, Vol. 93, No. 3, 2000, pp. 421-426. http://dx.doi.org/10.3171/jns.2000.93.3.0421