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Original Investigation |

Histopathologic Evaluation of Vascular Findings in the Cochlea in Patients With Presbycusis

Natsuko Kurata, MD1; Patricia A. Schachern, BS1; Michael M. Paparella, MD1,2; Sebahattin Cureoglu, MD1
[+] Author Affiliations
1Department of Otolaryngology, University of Minnesota, Minneapolis
2Paparella Ear Head and Neck Institute, Minneapolis, Minnesota
JAMA Otolaryngol Head Neck Surg. 2016;142(2):173-178. doi:10.1001/jamaoto.2015.3163.
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Importance  Age-related changes in cochlear vessel wall thickness in human temporal bones have not been described previously.

Objectives  To compare thickness of the spiral modiolar artery and strial capillaries and to investigate strial atrophy and vessel loss in temporal bones with and without presbycusis.

Design, Setting, and Participants  This retrospective case-control study examined the autopsy reports of 1024 patients in the temporal bone collection at the University of Minnesota. Inclusion criteria consisted of being 60 years or older with sensorineural hearing loss and progression of hearing loss with age (presbycusis group). Age-matched controls had no record of hearing loss. All patients underwent pure-tone audiometry. Exclusion criteria included a history of otologic disease, ototoxic drug use, head or acoustic trauma, or systemic disease. Data were collected from October 1, 2013, to October 1, 2014.

Main Outcomes and Measures  Vessel wall thickness in the modiolar artery and strial vessels, the strial area, and number of strial vessels were measured under light microscopy.

Results  Among the 1024 autopsy reports examined, 11 patients (19 temporal bones) with presbycusis (7 men and 4 women; age range, 67-88 years; mean [SD] age, 78 [7] years]) and 15 controls (24 temporal bones) (7 men and 8 women; age range, 67-94 years; mean [SD] age, 79 [8] years) met the inclusion criteria. Compared with the control group, the presbycusis group had significantly increased mean (SD) thickness of vessel walls in the modiolar arteries (6.73 [2.39] vs 5.55 [0.86] μm; P = .02) and the strial capillaries in the lower basal (1.57 [0.21] vs 1.39 [0.15] μm; P = .005), upper basal (1.62 [0.28] vs 1.40 [0.13] μm; P < .001), lower middle (1.68 [0.22] vs 1.39 [0.20] μm; P < .001), upper middle (1.74 [0.39] vs 1.40 [0.19] μm; P = .01), and apical (1.70 [0.36] vs 1.47 [0.21] μm; P = .04) turns of the cochlea. Compared with the control group, the presbycusis group had significant loss of strial area in the lower basal (6614 [1559] vs 8790 [1893] μm2; P = .002), upper basal (6387 [2211] vs 9105 [2700] μm2; P < .001), lower middle (5140 [1471] vs 7269 [2181] μm2; P = .003), upper middle, (5583 [1742] vs 7206 [2258] μm2; P = .02), and apical (4286 [1604] vs 6535 [2454] μm2; P < .001) turns of the cochlea; in the vessel area in the lower basal turn (74.65 [127.74] vs 124.92 [89.04] μm2; P = .01); and in the number of vessels in the lower basal (1.00 [0.78] vs 1.94 [0.93]; P = .008) and lower middle (1.00 [0.78] vs 1.94 [0.93]; P = .04) turns of the cochlea.

Conclusions and Relevance  The histopathologic findings of increased thickness of the vascular walls of the modiolar arteries and stria vascularis, increased strial atrophy, and decreased number of strial vessels may have led to decreased cochlear microcirculation. Deficiency in the circulation and perfusion of the cochlea may be a factor in presbycusis.

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Figure 1.
Vessel in the Midmodiolus of the Right Cochlea

A, Light microscopy demonstrates increased spiral modiolar artery wall thickness (arrowhead) in a case patient with presbycusis in his 80s (hematoxylin-eosin; original magnification, ×400). B, The graph demonstrates significantly increased thickness of the spiral modiolar artery walls compared with the control group. Box indicates 25th to 75th percentiles; horizontal line, median; and error bars, 10th and 90th percentiles.

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Figure 2.
Mean Vessel Wall Thickness of the Stria Vascularis in Each Turn of the Cochlea

Mean thickness of the vessel walls of the stria vascularis in the presbycusis group were increased significantly compared with those of the control group. Box indicates 25th to 75th percentiles; horizontal line, median; and error bars, 10th and 90th percentiles.

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Figure 3.
Stria Vascularis Area of a Control and a Case Patient With Presbycusis

Light microscopy shows the left upper basal turn and upper middle turn of a woman in her 60s (control) and a man in his 70s with presbycusis. The stria vascularis (arrowheads) of the case patient with presbycusis was severely atrophic and had fewer hair cells compared with the stria vascularis of the control (hematoxylin-eosin; original magnification, ×100).

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Figure 4.
Analysis of the Strial Area in Presbycusis

Atrophy in the area of the stria vascularis in each turn of the cochlea in the presbycusis group was significantly higher than that of the control group. Box indicates 25th to 75th percentiles; horizontal line, median; and error bars, 10th and 90th percentiles.

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Figure 5.
Comparison of Stria Vascularis in Both Groups

A, We found a significant loss of vessel area in the stria vascularis in the presbycusis group compared with the control group in the lower basal turn of the cochlea. No significant difference in vessel area was found in the other turns. B, The number of vessels in the stria vascularis in the presbycusis group was significantly less than that of control group in the lower basal and lower middle turns of the cochlea. No significant difference in number of vessels was found in the other turns. Box indicates 25th to 75th percentiles; horizontal line, median; and error bars, 10th and 90th percentiles.

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