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PubMed1983

Immunology of the inner ear: response of the inner ear to antigen challenge.

The relationship of the inner ear to host immunity and the immunoresponsiveness of the inner ear to antigen challenge were investigated. A radioimmunoassay was used to quantitate antibody titers to keyhole-limpet hemocyanin generated in the serum, perilymph, and CSF of guinea pigs following systemic or inner ear immunizations. The results of these experiments demonstrate (1) the blood-labyrinth barrier is analogous to the blood-brain barrier with respect to immunoglobulin equilibrium, (2) the inner ear is capable of responding to antigen challenge, and (3) the inner ear is an effective route for systemic immunization.

Animals↗

PubMed2001

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion.

We present the results of the insertion of self-made polyethylene T-tubes for a period of 15-24 months for the treatment of chronic middle-ear effusion. We compare the outcome of our patients to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time. In a retrospective review of 603 T-tubes inserted in 306 children up to the age of 12 years, charts were reviewed for age, sex, surgical procedure performed, duration of ventilation and complications. In all cases the indication for surgery was chronic middle-ear effusion. The tubes were electively removed by the authors after 15-24 months of ventilation. Spontaneous extrusion was considered a complication. The mean period of ventilation was 20 months. Post-operative otorrhoea was experienced in 6.6 per cent of ears; 4.8 per cent of tubes extruded spontaneously, whereas 3.15 per cent had to be removed earlier than originally planned; 4.9 per cent of ears were re-ventilated at a later date, and 1.49 per cent of ears developed a persistent perforation. We demonstrate that the outcome of patients treated with our self-manufactured tubes for a period of 15-24 months is, in many respects, better or at least comparable to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time, and that the many complications associated with the conventional T-tube can be reduced. We suggest that our favourable outcome may be due to the duration of ventilation, which was controlled to be shorter than the conventional long-term T-tubes and longer than that of grommets.

Child↗

PubMed1998

Ear preference: association with other functional asymmetries of the ears.

The bases for the preferential use of one ear are not clear. We investigated ear preference, asymmetry on a dichotic listening test and acuity dominance (laterality of hearing loss) in a sample of 51 patients with mild high frequency hardness of hearing. There was a higher correlation between measured ear preference and the measured acuity dominance than between ear preference and dichotic listening, suggesting a certain peripheral (cochlear) base for the ear preference.

Auditory Perception↗

PubMed1987

Hyaluronan in the middle ear of the rat. The normal distribution of hyaluronan and the clearance of exogenously administered hyaluronan from the middle ear.

The content of hyaluronan (HA), a common connective tissue component, was determined in well defined areas of the rat middle ear. The HA concentration in the pars flaccida of the tympanic membrane was considerably greater than in the pars tensa and areas on the medial wall of the middle ear cavity. The fate of exogenous HA introduced into the middle ear was also studied in rats. Tritium-labelled HA disappeared through the Eustachian tube (ET) and was followed by analysis of the nasopharyngeal secretion. The radioactivity in the secretion reached a peak at 3 h and decreased to almost zero within 12 h, indicating that most of the HA was removed. By autoradiography and direct analysis of the HA concentration and molecular weight distribution the fate of HA after obstruction of the ET was followed. Radioactive HA was confined to the middle ear and no uptake into surrounding tissues could be traced by autoradiography 4 days after application. The amount of HA that could be recovered from the middle ear was constant for up to 6 days. Analysis of the molecular weight distribution of the deposited HA indicated only slow degradation during these 6 days.

Animals↗

PubMed1988

The mechanics of the middle-ear at static air pressures: the role of the ossicular joints, the function of the middle-ear muscles and the behaviour of stapedial prostheses.

In an experimental study, the mechanical behaviour of the ossicle-chain during changes of the static air pressure was analyzed microscopically and with a radiographic magnification technique in temporal bone preparations. Several preliminary experiments served to pinpoint methodological problems, like exsiccation-artifacts, storage procedures, preparation defects, missing air-cushion effect with the opened middle-ear cavity, absent labyrinthine pressure, relation of the optical axis to middle-ear structures and statistical reproducibility of the measured values. Variations of the static air pressure in the external ear canal ranging from 0 to +/- 400 mmH2O induce an inward-outward movement of the malleus. In the regular middle-ear, the direction of this movement is changed within the ossicular chain into a predominantly upward-downward direction of the lenticular process, due to a gliding function of the incudo-malleal (IM) joint. This results in a gliding movement of the surfaces of the incudostapedial joint (IS). In this way, the stapes and the inner-ear are decoupled from the excessive displacements of the drum membrane and malleus. This change in the mode of motion explains many former results of ossicle vibration, aroused by unphysiologically high sound pressures, like v. Békésy's description of the tilting footplate. This mode of motion, however, changes completely if the gliding function of the IM-joint is cancelled by experimental ankylosis. In that case, the predominant direction of movement at the incus and stapes is inward and outward, too. This mode of motion has been the generally accepted concept of the ossicle-chain mechanics up to now. This isodirectional motion also occurs with progressive exsiccation of the temporal bone preparations, explicable with drying and shrinking of the capsular ligament of the IM-joint. It is conceivable, therefore, that our concepts of the mechanics of the ossicle-chain were partly based on experiments with insufficiently moistened temporal bone preparations, as the methodological problem of the exsiccation became known only during recent decades. In further experiments with static air pressure, the mechanics of the reconstructed ossicle-chain, i.e. tympanoplasty and stapedial prostheses, were studied. In the columella-like chain reconstruction, the displacement of the stapes equals the values measured with the ankylosed IM-joint. This displacement is limited by the strength of the annular ligament, whose function, however, is eliminated in the case of stapedial prostheses. Now the displacement is limited by the friction of the piston at the perforation in the footplate.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMedDate not supplied

Monitoring middle ear pressure by tympanometry. A study of middle ear pressure variation through seven hours.

The aim of this investigation was to monitor fluctuations in middle ear pressure, to study tympanometric signs of Eustachian tube functioning and to assess the validity of the tympanometric readings. In 20 patients with a low initial middle ear pressure (-150 daPa or lower) and 5 normals, impedance tympanometry was performed every 3 min through 7 h. Median pressure for the patients was -150 daPa (range 100 to -400 daPa) and for the normals 0 daPa (range 50 to -50 daPa). A remarkable pressure increase was seen after changing the body position to the supine. The patients were arranged into three groups according to the lowest middle ear pressure registered. Median pressures for the groups were running at a rather constant level. However, the individual pressure fluctuations in many patients were so great that a single tympanometric reading has to be considered unreliable when selecting patients for insertion of ventilation tubes. Thirteen patients never equalized their negative middle ear pressure, indicating that their Eustachian tube did not open during the test period. In spite of this the pressure did not decrease to lower values, indicating that maintaining a relative constant middle ear pressure is independent of opening of the Eustachian tube.

Acoustic Impedance Tests↗

PubMed1997

Histomorphometric study of the normal middle ear mucosa. Preliminary results supporting the gas-exchange function in the postero-superior part of the middle ear cleft.

This study concerns the distance between the centre of gravity of blood vessels and the basement membrane of the middle ear cleft mucosa. The measurements were performed perpendicular to the long axis of the cross-section of the vessels, and revealed a significant difference between two regions of the middle ear cleft. At the level of the postero-superior part (epitympanum, aditus ad antrum, mastoid antrum and highest part of the mastoid air cells system), the distance between the blood vessels and the basement membrane of the mucosa was statistically shorter than in the antero-inferior part of the middle ear cleft. This indicates a privileged function of gaseous exchange of the postero-superior part of the middle ear cleft and may divide the middle ear cleft into different functional parts.

Aged↗

PubMed1990

PO2 levels in middle ear effusions and middle ear mucosa.

We measured PO2 values in mucoid and serous middle ear effusions (M-MEE, S-MEE) and in the middle ear mucosa of patients with otitis media with effusion (OME) and compared these values with those obtained from patients with middle ear barotrauma (MEBT). The mean and S.D. values of PO2 in M-MEE, S-MEE and MEBT effusions were 28.9 +/- 11.3, 31.5 +/- 9.5 and 37.0 +/- 15.4 mmHg, respectively; the mean and S.D. values in mucosa were 27.1 +/- 11.9, 27.0 +/- 13.2 and 32.5 +/- 1.0 mmHg, respectively. In health, PO2 values in middle ear mucosa are regulated by its blood supply, oxygen solubility in blood and the blood-to-cavity partial pressure gradient of the gas. When the Eustachian tube (ET) function is severely impaired, PO2 values in the middle ear air cavity depend on the mucosal condition, though some studies have shown a lack of relationship between ET function and PO2 values. Our results show that PO2 values in MEBT are consistently higher than in OME, suggesting that the attributable factor could be a better ET function in MEBT.

Barotrauma↗

PubMed1993

Hydrostatic pressure in the inner ear fluid compartments and its effects on inner ear function.

The present study summarizes the experimental findings obtained on the pressure in the inner ear fluids and on the effects of pressure changes on cochlear function in the guinea pig. Two types of pressures have to be distinguished in the inner ear fluid compartments: (i) hydrostatic fluid pressure and (ii) superimposed hydrodynamic high frequency (> 100 Hz) sound pressure oscillations. Hydrostatic pressure in the inner ear fluids in guinea pigs is in the order of 200 Pa (2 cm H2O) and shows slow (< 5 Hz) respiratory and pulsatory oscillations as well as considerable physiological variations in the range of -100 to +700 Pa. In normal ears, hydrostatic pressure in the perilymph equals pressure in the endolymph, and pressure changes applied to one compartment are immediately transmitted to the other one. A high compliance of Reissner's membrane seems to be the cause of this endolymphatic-perilymphatic pressure equalization. In experimental endolymphatic hydrops, a unique animal model for Meniere's disease, endolymphatic pressure is higher (100 Pa and above) than perilymphatic pressure. These pressure gradients occur only in late stages of hydrops, probably when Reissner's membrane has lost its high compliance after long standing distension. Positive endolymphatic-perilymphatic pressure gradients are secondary to and not the primary cause of hydrops formation. Changes of hydrostatic pressure do not affect auditory function as long as they stay in the physiological range. This includes the sudden loss of positive inner ear pressure that occurs in perilymph fistulas. The rationale for surgical repair of perilymph fistulas in patients in order to restore the hearing function thus becomes questionable. Other aspects of surgical repair, however, as e.g. prevention of labyrinthitis due to permanently open fistula, could not be investigated in this model, because in guinea pigs even large fistulas heal spontaneously within a few days. In experimental endolymphatic hydrops, deterioration of auditory thresholds was partially correlated to the presence of positive endolymphatic-perilymphatic pressure gradients. A change in pressure, however, occurred later than the first deterioration in auditory function. Therefore positive endo-perilymphatic pressure gradients may contribute to, but are not the only cause of hearing impairment.

Animals↗

PubMed1996

Type II collagen-induced autoimmune ear disease in mice: a preliminary report on an epitope of the type II collagen molecule that induced inner ear lesions.

To identify the epitope on the type II collagen molecule that induced autoimmune ear disease, electrophysiological and histological studies were carried out in DBA/1J mice immunized with native chick type II collagen (Clln) and cyanogen bromide (CNBr) peptide 1I (CB-I1 peptide) that was cleaved from chicken type II collagen with CNBr digestion. Four months after immunization, three of six Clln-immunized mice and five of six CB-I1 peptide-immunized mice developed moderate hearing loss. No control animals showed hearing loss. The pattern of hearing loss was characteristic of progressive deafness. Furthermore, the immunized mice showed temporal lesions involving atrophy of the Corti organ and degeneration of the spiral ganglion, in proportion to the level of the hearing loss. Because similar inner ear lesions were induced by immunization with Clln and CB-I1 peptide, CB-I1 peptide contains at least one epitope that induces autoimmune inner ear disease in collagen II-induced disease on the chick type II collagen molecule involved in pathogenesis of autoimmune ear disease. CB-I1 peptides were concluded to contain the epitope that induces autoimmune inner ear disease in collagen IIn-induced disease.

Animals↗

PubMed1992

Surgery of the 'only hearing ear' with chronic ear disease.

The management of chronic ear disease affecting the only hearing ear is a controversial subject. The relative scarcity of literature on the subject prompted us to prepare a questionnaire which was sent to European and American otologists and to review 19 cases operated at the ENT Clinic of the University of Parma, Italy, and 16 cases operated at The Baptist Memorial Hospital, Memphis, U.S.A. Surgery of cholesteatoma involving the only hearing ear is advised by all the interviewed otologists without exception, even in the presence of a labyrinthine fistula. The cases from the University of Parma were managed as follows: a classic modified radical mastoidectomy was performed in 10 cases, a staged intact canal wall tympanoplasty was done in four cases, an open tympanoplasty in three and a radical mastoidectomy in the remaining two cases. The cases from The Baptist Memorial Hospital were managed with an intact canal wall tympanoplasty (ICWT) in nine and with an open procedure in seven cases. All the otologists interviewed agreed that surgery of the only hearing ear requires particular attention and experience, and should be performed with extreme care by a very experienced surgeon.

Attitude of Health Personnel↗

PubMedDate not supplied

Inflammatory cells in chronic middle ear disease. Value of lymphocyte subset determination in ear surgery.

Lymphoid cell subsets were studied in biopsy specimens of uninfected and infected ear canal epidermis, tympanic membrane, cholesteatoma epithelium, and middle ear and antrum granulation tissue. All specimens showing uninfected squamous epithelium, including those of cholesteatoma membrane, contained only a few lymphoid cells. Biopsies of infected squamous epithelium showed enhanced Ts/c activity in the subepithelial layer. Granulation tissue showed normal Th/i activity. B-cells and NK cells appeared in small numbers. Lymphoid cell subset analysis is indicated in ears reconstructed with allograft material to detect signs of rejection. It is of little value in cases of chronic inflammatory middle ear disease which have not previously been operated upon.

Cholesteatoma↗

PubMed2002

Cochlear function in ears with immunomediated inner ear disorder.

The aim of the present study was to evaluate the performance of ears with inner ear disorder, responsive to immunosuppressive drugs, in advanced tests designed to assess primary cochlear functions (temporal integration, frequency selectivity, cochlear mechanics). The results of this study suggest that immunomediated inner ear disease results, in the acute clinical stage, in the development of endolymphatic hydrops, which increases the stiffness of the vibrating structures within the inner ear and causes dysfunctions of the outer hair cells. Our patients presented with upsloping or flat sensorineural hearing loss, absence of evoked otoacoustic emissions and distortion-product otoacoustic evoked emissions and abnormal temporal integration, frequency selectivity and cochlear mechanics. Following immunosuppressive treatment, hydrops recovered, hearing subsequently returned to normal, the audiometric curve became flat at low-to-middle frequencies and primary cochlear function tended to normalize. This study seems to support the usefulness of testing primary cochlear functions in order to monitor the clinical course of immunomediated inner ear disorders.

Acoustic Impedance Tests↗

PubMed1991

Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear.

Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading. Brainstem and middle-latency evoked potentials were similar with electrical stimulation of both ears and resembled those evoked by acoustic stimuli in subjects with normal hearing. Cortical electric and magnetic responses differed for right- and left-sided electrical stimulation suggesting that stimulation of the congenitally-deaf ear elicited an abnormal activation of the auditory cortex. These results suggest that only cortical responses were affected by the different histories of deafness of the ears.

Cochlear Implants↗

PubMed2002

Inner ear pressure changes following square wave intracranial or ear canal pressure manipulation in the same guinea pig.

Inner ear pressure was measured in scala tympani with a micropipette during square wave pressure manipulation of the intracranial compartment and, subsequently, of the external ear canal (EEC) in the same guinea pig. As expected, the combination of the cochlear aqueduct and the inner ear behaves as a low-pass filtering system for intracranial pressure manipulation and as a complementary high-pass system for ear canal pressure manipulation. Time constants for pressure equalization were in the order of seconds and depended on the direction of flow through the cochlear aqueduct. Pressure equalization curves could not be fitted to a single exponential function; more complicated functions were needed for good fits, showing that the pressure equalization process is nonlinear. This means that the flow resistance of the cochlear aqueduct and/or the compliance of the cochlear windows is not constant, which is in accordance with a flow-direction dependent resistance of the cochlear aqueduct. An explanation for this can be found in the special structure of the periotic duct inside the aqueduct.

Animals↗

PubMed1998

Kinetics of gentamicin uptake in the inner ear of Chinchilla langier after middle-ear administration in a sustained-release vehicle.

The search for a safe, effective treatment for the vertigo associated with Meniere's disease has long been an important topic in otolaryngology. In recent years many groups have begun using intratympanic gentamicin to treat this vertigo. Although reported cure rates are as high as 90%, many questions remain regarding this type of treatment. Current limitations are the necessity for repeated treatments and a lack of clear dosing guidelines. In addition, the gentamicin must be delivered in a manner that allows maximal vestibulotoxic effect without injury to hearing. Until investigators can control the exact amount of medicine that is placed in the ear and have an understanding of the kinetics of gentamicin absorption, adequate dosing guidelines will be difficult to establish, and therapy will continue to rely on empiric data. We describe the use of a fibrin-based sustained-release vehicle, impregnated with gentamicin, injected into the middle ear of chinchillas. This allows for a prolonged effect without repeated dosing. Using this model, we studied the absorption kinetics of gentamicin at time points ranging from 8 hours to 1 week after injection. We used our findings to create a kinetics curve of gentamicin absorption. We discuss the shape and characteristics of this kinetics curve and examine the effects of the fibrin-based sustained-release vehicle and gentamicin on the middle ear. We noted no absorption in the contralateral (untreated ear) or blood. Through better understanding of the actions of gentamicin in this animal model, we hope to facilitate safer use of intratympanic medicines in our patient population and initiate programs for the use of this sustained-release vehicle in human beings.

Animals↗

PubMed2006

Applied comparative physiology of the avian middle ear: the effect of static pressure changes in columellar ears.

We investigated the motion of the single ossicle found in the middle ears of four different species of birds. In the avian middle ear, the off centre attachment of the extracolumella to the tympanic membrane and the flexion of the joint between the extracolumella and columella results in rocking of the footplate rather than direct excursion in and out of the vestibule. We postulate that this is a protective mechanism to avoid excessive displacement of the footplate into the vestibule during changes in middle-ear pressure and that it is analogous to the ossicular 'decoupling' observed in the human middle ear in the same circumstances.

Animals↗

PubMed1999

The effects of venting on in-the-ear, in-the-canal, and completely-in-the-canal hearing aid shell frequency responses: real-ear measures.

The acoustic effects of 1-, 2-, and 3-mm vents were investigated with in-the-ear, in-the-canal, and completely-in-the-canal hearing aid shells. Real-ear sound pressure level measures were obtained from unvented and vented shells with 12 adults. In general, with increasing vent size, a statistically significant (p < .05) increase in the amount of low-frequency reduction, an upward shift in vent cutoff frequencies, and an upward shift in vent-associated resonances occurred for all hearing aid shell styles. There was no significant change in the slope of the low-frequency reduction across all hearing aid shell styles (p > .05), albeit the frequency response curves were shifted upward in frequency with increasing vent diameters. Only with the in-the-ear and completely-in-the-canal hearing aid shells were statistically significant (p < .05) differences found with the magnitude of vent-associated resonance as a function of vent diameter, and these differences were not consistent across the different styles. These findings suggest that venting may be used effectively to tune low-frequency responses in custom in-the-ear hearing instruments.

Adult↗