Otopathologic Changes in the Cochlea following Head Injury without Temporal Bone Fracture

Otolaryngol Head Neck Surg. 2018 Sep;159(3):526-534. doi: 10.1177/0194599818769861. Epub 2018 Jun 12.


Objective Hearing loss following temporal bone (TB) fracture may result from direct transection of the middle and inner ear. The pathophysiology of hearing loss due to head injury without TB fracture, however, is not well understood. Few reports describe otopathologic findings. Herein, we investigate the pathologic findings of patients who sustained a head injury without evidence of a TB fracture. Study Design Otopathology study. Setting Otopathology laboratory. Subjects Subjects with a history of head injury without TB fracture. Methods The TBs of patients with head injury were evaluated by light microscopy. Inner ear anatomy was evaluated, including counts of spiral ganglion cells (SGCs), hair cells, pillar cells, atrophy of the stria vascularis, and the presence of endolymphatic hydrops. SGC counts were compared with those of historical age-matched controls. Results All cases (N = 6 TBs) had evidence of inner ear pathology. Of the 6 cases, 2 (33%) had severe loss of hair cells in all 3 turns of the cochlea, and 4 (67%) cases demonstrated moderate to severe loss at the basal turn of the cochlea. Four cases had scattered atrophy of the stria vascularis, and 3 (50%) had cochlear hydrops. The number of total SGCs was decreased, with an average 53% loss (range, 25%-79%) as compared with controls. The SGC count loss was evenly distributed along Rosenthal's canal. Conclusions Patients with a history of head injury without TB fracture demonstrate inner ear pathology. Further studies are necessary to determine if otopathology findings are directly attributable to trauma.

Keywords: conductive hearing loss; hair cells; hearing loss; histopathology; inner ear; sensorineural hearing loss; spiral ganglion cells; temporal bone; traumatic brain injury.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Audiometry / methods
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / diagnosis
  • Brain Injuries, Traumatic / pathology*
  • Case-Control Studies
  • Cochlea / pathology*
  • Endolymphatic Hydrops / pathology*
  • Female
  • Fractures, Bone
  • Hair Cells, Auditory, Inner / pathology
  • Hearing Loss / etiology
  • Hearing Loss / pathology
  • Hearing Loss, Sensorineural / etiology*
  • Hearing Loss, Sensorineural / pathology
  • Humans
  • Male
  • Middle Aged
  • Otolaryngology / methods
  • Prognosis
  • Severity of Illness Index
  • Temporal Bone / pathology*
  • Tomography, X-Ray Computed / methods*