Jose N Fayad1, Fred H Linthicum. 1. House Clinic and House Ear Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California 90057, USA.
Abstract
HYPOTHESIS: Growing nerve fibers from the stumps of amputated sensory nerves can form traumatic neuromas within inner or middle ear postsurgical fibrosis and may produce symptoms commensurate with the normal function of the nerve involved, that is, balance or pain. BACKGROUND: Microscopic traumatic neuromas have been identified in postoperative middle and inner ear fibrosis in the temporal bones of patients complaining of intractable pain or imbalance. METHODS: Postsurgical temporal bones having inner or middle ear traumatic neuromas were reviewed. Of 20 bones with inner ear fibrosis after a variety of neurotologic surgeries, 12 were found to have traumatic neuromas, most from the utricular nerve or lateral canal. Five ears in 4 patients with middle ear fibrosis after chronic ear surgery had traumatic neuromas arising from Jacobson nerve. An additional 58 bones from chronic ear surgery patients with no neuromas served as a control group. Neurofilament immunohistochemistry labeling substantiated the presence of nerve fibers. Clinical symptoms noted from the clinical records were compared between those with and without traumatic neuromas. RESULTS: Of the 12 patients (75%), 9 with inner ear traumatic neuromas clinically reported constant disequilibrium postsurgery lasting for years. None (0%) without neuromas reported new symptoms postoperatively (p <or= 0.001). All 5 ears with middle ear traumatic neuromas experienced otalgia postsurgery, whereas none of the other 58 patients with no neuroma reported this problem. CONCLUSION: Postoperative intractable disequilibrium or pain may occur as a result of the formation of traumatic neuromas in scar tissue in the inner or middle ears.
HYPOTHESIS: Growing nerve fibers from the stumps of amputated sensory nerves can form traumatic neuromas within inner or middle ear postsurgical fibrosis and may produce symptoms commensurate with the normal function of the nerve involved, that is, balance or pain. BACKGROUND: Microscopic traumatic neuromas have been identified in postoperative middle and inner ear fibrosis in the temporal bones of patients complaining of intractable pain or imbalance. METHODS: Postsurgical temporal bones having inner or middle ear traumatic neuromas were reviewed. Of 20 bones with inner ear fibrosis after a variety of neurotologic surgeries, 12 were found to have traumatic neuromas, most from the utricular nerve or lateral canal. Five ears in 4 patients with middle ear fibrosis after chronic ear surgery had traumatic neuromas arising from Jacobson nerve. An additional 58 bones from chronic ear surgery patients with no neuromas served as a control group. Neurofilament immunohistochemistry labeling substantiated the presence of nerve fibers. Clinical symptoms noted from the clinical records were compared between those with and without traumatic neuromas. RESULTS: Of the 12 patients (75%), 9 with inner ear traumatic neuromas clinically reported constant disequilibrium postsurgery lasting for years. None (0%) without neuromas reported new symptoms postoperatively (p <or= 0.001). All 5 ears with middle ear traumatic neuromas experienced otalgia postsurgery, whereas none of the other 58 patients with no neuroma reported this problem. CONCLUSION: Postoperative intractable disequilibrium or pain may occur as a result of the formation of traumatic neuromas in scar tissue in the inner or middle ears.