Biomedical subjects
E H Huizing
Publications and source records attributed to E H Huizing.
Pathological findings in the human auditory system following long-standing gentamicin ototoxicity.
The clinical, audiovestibular and histopathological findings in a patient who suffered from a long-standing gentamicin-induced deafness are reported. In both temporal bones, the organ of Corti was completely absent, with only a few nerve fibres remaining in the apical part of the cochlea. Regenerative ingrowth of nerve fibers into the area of the degenerative organ of Corti was present apically in both ears. The stria vascularis exhibited considerable degeneration in all turns and loss of microvasculature was found in the basilar membrane. The spiral ganglion cells, the cochlear nerve and the central auditory pathways and nuclei appeared to be unaffected.
Electrocochleographic study of experimentally induced endolymphatic hydrops.
An endolymphatic hydrops was induced in the left ear of each of 32 guinea pigs by obliteration of the endolymphatic sac. Both the hydropic ear and the control ear were examined by electrocochleography 1, 2, 4 or 8 months after obliteration of the sac using electrodes on the apex and near the round window. One month after obliteration, the threshold of the compound action potential (AP) and the increase of the AP amplitude with sound pressure level (SPL) were the same as the results recorded from the control ears despite the presence of a histologically confirmed hydrops. In the 2-month group, small AP threshold differences (10-20 dB) were recorded, increasing up to 10-40 dB in the 4- and 8-month groups. In the latter animals we also found a more rapid increase of the AP amplitude with SPL, a finding suggestive of recruitment. In the 1-month group we recorded an enhanced negative SP for 2- and 4 kHz stimuli when the electrode was placed near the apex. The same was recorded for 4-kHz stimuli in the 2-month group. In the 4- and 8-month groups there was a tendency towards a decrease in the negative SP. The SP-AP ratio recorded from the apical position showed the same pattern as the SP amplitude, an increase after 1 month and a tendency to decrease in the following months. Near the round window there was no significant effect of hydrops on the SP amplitude or on the SP-AP ratio. A deviation in the AP-SP wave form was recorded in 69% (22/32) of the guinea pigs.(ABSTRACT TRUNCATED AT 250 WORDS)
Histopathological study of experimentally induced endolymphatic hydrops with emphasis on Reissner's membrane.
We investigated the histopathological changes of the guinea pig cochlea in experimentally induced endolymphatic hydrops 1, 2, 4 and 8 months after obliteration of the endolymphatic sac. In this paper special attention is given to the morphological changes created in Reissner's membrane. Reissner's membrane showed various foldings, bony wall connections, local thickenings, duplications, mesothelial defects, ruptures and atrophy. The incidence of these changes increased with survival time. The stria vascularis and hair cells showed degeneration starting apically and proceeding towards the cochlear base. The possible implications of these findings are discussed.
The use of the underpressure chamber in the treatment of patients with Menière's disease.
Thirty-four Menière patients (43 ears) were treated in an underpressure chamber. Békésy audiometry and impedance audiometry were performed immediately before and after the exposure to underpressure. A hearing gain of more than 10 dB. was found in 19 per cent of the ears (8/43). In five ears this improvement lasted for a few days. Only one patient (2 per cent) reported a relief of tinnitus. In 9 out of the 30 patients (30 per cent) with recent vertiginous attacks a positive subjective effect on the vertigo was obtained.
Effects of endolymphatic sac obliteration on the cochlear duct glycocalyx.
The ultrastructural effects of surgical obliteration of the endolymphatic duct and sac on the cochlear duct glycocalyx were investigated using osmium tetroxide-potassium rutheniumcyanide postfixation. After 2 and 3 months a less prominent glycocalyx contrast staining was observed, together with disappearance of interconnecting material between the stereocilia of the inner and outer hair cells. Possible factors involved in this phenomenon are discussed.
Advances in oto-immunology: new trends in functional pathology of the temporal bone.
By using monoclonal and polyclonal antibodies against cell-membrane receptors and cytoskeletal proteins, the cellular and tissue composition of any organ can be far better determined. This is illustrated in the tympanic membrane, middle ear mucosa, and cholesteatoma. Immunotechnology applied to the temporal bone is shown with an animal-ototoxicity model. Antibodies to keratin and vimentin (i.e., to proteins of the fibrillar components that make up the cytoskeleton) stain specific tissue compartments. Langerhans' cell and T-lymphocyte subsets predominate in a cholesteatoma. The normal human tympanic membrane is devoid of these cells. Gentamicin can be traced with a polyvalent anti-gentamicin antiserum in serial sections of the cochlea and kidney. The drug accumulates in the outer hair cells and proximal tubular cells, respectively. A new technique of CT-scanning, microslicing, plastic embedding, and semithin sectioning of undecalcified human temporal bone is described. Perspectives in applying immunotechnology to this method of human temporal bone processing are discussed.
Human cochlear pathology in aminoglycoside ototoxicity--a review.
The pathological findings due to aminoglycoside ototoxicity in man, as reported in the literature, is reviewed. 21 cases (40 ears) have been studied after serial sectioning, 8 cases (12 ears) have been investigated by the microdissection and surface preparation technique. The combination of both methods provides maximal information. OHCs are primarily affected, followed by IHC loss. Degeneration starts at the basal coil and proceeds towards the apex. The stria vascularis becomes involved in all turns. It is not clear whether stria degeneration is primary or secondary. Supporting cells, nerve fibres and ganglion cells degenerate secondary to hair cell loss. In some cases ingrowth of myelinated nerve fibres in areas with complete destruction of the organ of Corti has been observed. Ototoxic lesions can be asymmetric. Attention is drawn to the audiometric Z-curve in moderate lesions.
Use of a diuretic (Dyazide) in the treatment of Menière's disease. A double-blind cross-over placebo-controlled study.
In 33 Menière patients (42 ears) the therapeutic effects of Dyazide (50 mg triamterene and 25 mg hydrochlorothiazide) were investigated in a cross-over placebo-controlled study. The hearing was measured by tone and speech audiometry whereas tinnitus and vertigo were recorded using fixed scales. In this study, Dyazide was found to have no significant effect on hearing or tinnitus. However, the vestibular complaints decreased significantly during the Dyazide treatment. Ears with a positive glycerol or furosemide test and ears with a fluctuating hearing loss did not show significant differences in hearing thresholds between the two periods in the trial. Of the 33 patients 17 had a distinct preference for Dyazide whereas 3 patients chose the placebo. The remaining 13 patients had no preference.
Computed tomography of the petrous bone in otosclerosis and Menière's disease.
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Transplantation terminology in nasal surgery.
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[Nose destruction following septum abscess: surgical prevention].
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Progress in temporal bone histopathology. I. Semithin 3-5 micron sectioning of undecalcified human temporal bone after plastic embedding.
Prior to embedding a human temporal bone in methylmethacrylate the plane of sectioning is determined through CT-scanning. A new technique of micro-slicing, plastic embedding and semithin sectioning of undecalcified human temporal bone is described.
Progress in temporal bone histopathology. II. Immuno-technology applied to the temporal bone.
By using monoclonal antibodies against cell-membrane receptors the cellular composition of an aural cholesteatoma can be determined. Langerhans' cells and T-lymphocytes predominate in the cholesteatoma matrix. The normal human tympanic membrane is devoid of these cells. Immuno-technology applied to the inner ear is illustrated by tracing gentamicin in the cochlea with a polyvalent anti-gentamicin antiserum in serial sections. In an animal model gentamicin is detectable through this method. From 3 days on, after daily i.p. injection of 100 mg gentamicin/kg body weight, the drug accumulates in the outer hair cells.
Follow-up study in a family with dominant progressive hereditary sensorineural hearing impairment. I. Analysis of hearing deterioration.
An autosomal-dominant progressive hereditary sensorineural hearing loss with onset in the high frequencies was studied in a Dutch family with 105 affected individuals. The hearing loss was analyzed by a curve-fitting procedure. A hyperbolic tangent was fitted into the audiogram. Five characteristics were distinguished: the high-frequency plateau, the low-frequency plateau, the slope, the low cut-off frequency and the high cut-off frequency. Six phases are recognizable in the development of the hearing loss, which is characterized by a two-step progression, first in the high and then in the low frequencies. Great differences in the rate of the deterioration were observed. The age of onset is between 5 and 15 years.
Follow-up study in a family with dominant progressive hereditary sensorineural hearing impairment. II. Clinical aspects.
An autosomal-dominant progressive sensorineural hearing loss in six generations of a large family with 105 affected members was studied. The pattern of inheritance is autosomal dominant with an almost complete penetrance. The age of onset is between 5 and 15 years. Individuals with a normal audiogram at the age of 15 and over will not develop the disorder. Different generations show an identical pattern of progression. Because the age of onset is the same, anticipation is excluded. The hearing loss is symmetrical. Over 40 years, low-frequency losses are greater in females than in males. Epistasis possibly plays a role since affected individuals in branch II of this family have a more severe expression than those in the other two affected branches. No abnormal excretion of organic acids in the urine could be established.
Immunobiology of Langerhans' cells migrating into aural cholesteatomas.
Immunohistochemical and submicroscopic analyses of human cholesteatoma matrices reveal the presence of Langerhans' cells and T lymphocytes. Through cell-to-cell interaction, Langerhans' cells probably play a key role in skin-related disorders, including cholesteatomas. They originate from a mobile cell population of monocyte origin and migrate into and out of the body's lining. Their custodial function is always carried out in close relation with T lymphocytes. Various monoclonal antibodies directed against Langerhans' cell and T lymphocyte membrane receptors reveal the presence of these cell populations in cholesteatoma matrices but not in the tympanic membrane. Langerhans' cell and T cell traffic through cholesteatomas are discussed in relation to the pathogenesis, natural course, and recurrence rate of cholesteatomas. Through immunopathologic evaluation the clinical aggressiveness of a cholesteatoma will probably become predictable. Medical manipulation of Langerhans' cell and T cell functions- as an adjuvant to surgery - may have consequences for the future handling of cholesteatomas.
[Feasibility of high resolution CT in the demonstration of the vestibular aqueduct (Ménière) and otospongiosis of the labyrinth].
Ever since the introduction of temporal bone imaging by means of high-resolution CT, it appears that the combination of high spatial resolution, high density resolution and the freedom of patient positioning for scanning of optimal otological planes may play a unique role in the diagnosis and follow-up of a number of otological disorders. Two examples are described here. The first is the possibility of determining whether the vestibular aqueduct in idiopathic Ménière's disease is obliterated or not, and if so, whether it is a bony or a fibrous obliteration. Although the results are preliminary, there are indications that all three cathegories occur and that the efficacy of drainage of the endolymphatic sac can be evaluated prior to surgery. The second example is the possibility of outlining and quantifying the bone mineral loss in cases of labyrinthine otospongiosis. Preliminary studies have outlined that there is a relationship between the degree of decalcification and the severity of sensorineural hearing loss. These examples show high-resolution, thin-section multiplanar CT to have great potential in the diagnosis and treatment of otological disorders. This will become evident as the techniques that were used here are worked out in more detail and become more widely known.