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Cytomegalovirus labyrinthitis in an infant: morphological, virological, and immunofluorescent studies.

The inner ears obtained from an infant who died of severe congenital cytomegalovirus infection were examined using virological and morphological methods. The techniques of microdissection and surface preparations, immunofluorescent microscopy, and transmission and scanning electron microscopy were employed. Cytomegalovirus was isolated from the perilymph. Injury to the cochlea was minor and was confined to the first half of the basal turn. There were signs of a severe labyrinthitis of the vestibular endolymphatic system. Vestibular organs, especially the saccule and utricle, showed severe damage, with collapse of the saccular membranous wall. Inclusion-bearing cells containing cytomegalovirus antigen, as shown by immunofluorescent staining, and cytomegalovirus virions, as observed by electron microscopy, were found on the endolymphatic surface of the membranous walls, mainly in the saccule and utricle. In the utricle, the infected cells appeared to be concentrated in the regions where the so-called dark cells were located. These dark cells are similar to the proximal tubule cells in the kidney, another common target for cytomegalovirus infection.

Antigens, Viral↗

In vitro models of viral-induced congenital deafness.

Cytomegalovirus (CMV) infects 1 to 2 percent of liveborn infants in the United States and causes varying degrees of perceptive hearing loss. There are eight reported pathologic studies of temporal bones in CMV-infected neonates. Viral replication occurs in nonsensory endolabyrinthine epithelium, but viral antigen is also found in the organ of Corti and spiral ganglion neurons, and CMV has been cultured from perilymph. Further clinicopathologic correlation is frustrated, since the inner ear cannot be biopsied during life, and the number of temporal bones available for study is limited, owing to the decrease in the number of autopsies being performed. Inoculation of CMV into newborn mice, and extracorporeal preparations of mouse and guinea pig fetal inner ears, either in organ culture or as grafts on chick chorioallantoic membranes, yields viral perilabyrinthitis. The different ultrastructural appearances of CMV replicating in epithelial and mesenchymal cells show that animal CMV replicates in mesenchymal cells and human CMV replicates in epithelial cells of the inner ear. These different ultrastructural patterns indicate that the chromophobe (transitional) cells of the stria vascularis of the guinea pig are of mesenchymal origin.

Animals↗

Labyrinthine ossification secondary to childhood bacterial meningitis: implications for cochlear implant surgery.

Of 20 children who underwent cochlear implantation for profound sensorineural hearing loss secondary to bacterial meningitis, 14 had round-window and cochlear ossification at surgery. Preoperative polytomography demonstrated ossification in 11 of these. The incidence of ossification was highest after meningitis secondary to pneumococcal pneumonia. In only one of four children with severe ossification of the labyrinth was implant surgery unsuccessful. Preliminary results indicate that mild labyrinthine ossification is not a contraindication to cochlear implantation.

Bacterial Infections↗

Vestibular dysfunction presenting as syncope.

A case of chronic vestibulitis presented as episodes of recurrent drop attacks that had been interpreted as recurrent syncopal episodes. The importance of distinguishing between syncope and drop attacks-a difficult task-is emphasized. This case stresses the need to include benign vestibulitis in the differential diagnosis of syncope and drop attacks.

Diagnosis, Differential↗

Panoramic zonography in ear radiography.

Thirty ears in 15 patients were examined by plain film radiography and by panoramic zonography with two tracks: A cylindrical concave image layer with 26 mm. radius and a paired sagittal image layer, at 51 mm. distance from midline. The films were interpreted according to the visibility of 23 different anatomic details. On panoramic films the visualization was better in 14 details, equal in 6 and worse in 3 compared to the plain films. The result suggests that panoramic techniques can replace conventional radiography of the ear.

Adult↗