title: Inner ear anomalies and conductive hearing loss in children with Apert syndrome: an overlooked otologic aspect.
abstract: OBJECTIVE
  To identify the occurrence of inner ear structural anomalies and conductive hearing loss (CHL) in children with Apert syndrome.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Pediatric tertiary referral center.
  
  
  METHODS
  Twenty pediatric patients with Apert syndrome were found; all patients (38/40 ears) had inner ear anomalies.
  
  
  METHODS
  Computerized tomography of the head/temporal bone, pure-tone (including air and bone conduction) audiometry, and tympanometry.
  
  
  METHODS
  Imaging demonstrating inner ear anomalies, including malformations of the cochlea, dilated vestibule, and/or semicircular canal; audiologic findings of air-bone gap(s).
  
  
  RESULTS
  Hearing loss was found in 90% of the patients with Apert syndrome, and 80% of them had CHL. Air-bone gaps were found at all frequencies, with larger gaps at low frequencies. Fifty percent (20/40) of the ears had better than 0 dB hearing level bone conduction thresholds at 250 and/or 500 Hz. Normal middle ear pressure and mobility were found in all ears with intact eardrum. Inner ear anomalies were found in all patients, and 90% of them had bilateral involvement. Most frequently observed inner ear anomalies were dilated vestibule, malformed lateral semicircular canal, and cochlear dysplasia.
  
  
  CONCLUSIONS
  Children with Apert syndrome may present with significant CHL that cannot be explained by minor middle ear pathologies alone. This conductive loss may be, at least partially, attributed to the inner ear anomalies; however, these structural anomalies are usually not recognized in these patients. Failure to close air-bone gap after surgical intervention may raise the suspicion of inner ear anomalies, and computed tomographic scan of the temporal bone can provide definitive proof.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, Massachusetts 02115, USA. guangwei.zhou@childrens.harvard.edu
authors.forename: Guangwei
authors.initials: G
authors.lastname: Zhou
authors.forename: Lynn Thomas
authors.initials: LT
authors.lastname: Schwartz
authors.forename: Quinton
authors.initials: Q
authors.lastname: Gopen
mesh_terms: D000158:Acoustic Impedance Tests; D000168:Acrocephalosyndactylia / Q000150:complications* / Q000473:pathology*; D000293:Adolescent; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D007758:Ear, Inner / Q000473:pathology*; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013701:Temporal Bone / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult