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The association between empty sella and increased intracranial pressure: A potential mechanism of sudden sensorineural hearing loss due to rupture of the inner ear window membrane

otorhinolaryngology
radiology-and-medical-imaging

Abstract

Background. Empty sella is an important imaging marker of elevated intracranial pressure (EICP). Increased cerebrospinal fluid pressure can spread to the labyrinth through structures such as the cochlear aqueduct, leading to rupture of the inner ear window membrane, formation of perilymphatic fistula (PLF), and subsequent hearing loss. This study aimed to investigate the correlation between empty sella and sudden sensorineural hearing loss (SSNHL). Methods . This study adopted a case-control study design. A total of 367 patients with SSNHL who underwent cranial magnetic resonance imaging (MRI) were enrolled as the observation group. Meanwhile, 365 patients who underwent cranial MRI due to chief complaints of headache or dizziness were selected as the control group. The gender, age, presence of empty sella in both groups, as well as the prevalence of chronic diseases (hypertension/diabetes mellitus) in the observation group, were statistically analyzed, and the clinical indicators were compared between the two groups. Endoscopic ear exploration and inner ear window membrane repair were performed on 6 patients with SSNHL complicated with empty sella who had poor responses to conservative treatment. Results . In the observation group, 126 cases were diagnosed with empty sella, accounting for 33.0%; while in the control group, 74 cases were diagnosed with empty sella, accounting for 19.4%, with a statistically significant difference between the two groups (χ²=15.23, P<0.001). Of the 6 patients who underwent surgery, 5 experienced varying degrees of clinical symptom improvement, while 1 showed no symptom improvement. Conclusions . There is a correlation between empty sella and SSNHL. As a potential diagnostic marker for inner ear window membrane rupture, empty sella provides a novel direction for the precise treatment of SSNHL. For SSNHL patients suspected of having PLF, early endoscopic ear exploration and inner ear window repair can significantly improve the prognosis.
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