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Effects of prolonged noise exposure in chinchillas with severed middle ear muscles.

Using the round window-recorded cochlear microphonic as the index of acoustic reflex activity, we noted a decay in the strength of middle ear muscle contraction in the chinchilla following an eight hour exposure to octave band noise (500 Hz. center frequency, 95 dB. sound pressure level). On the basis of this observation it was concluded that the prolonged exposure reduced the effectiveness of the acoustic reflex in protecting the cochlea. This reduction, however, may have been underestimated if the exposure was also sufficient to reduce cochlear output. The present investigation examined this possibility by comparing the effects of a similar exposure in chinchillas with intact (normal) and severed middle ear muscles. Following exposure, the cochlear microphonic magnitude increased slightly in the normal group. Decreases in the cochlear microphonic were observed in the animals with severed muscles even when the overall exposure level was reduced to simulate the effects of middle ear muscle contraction. These findings indicate that although the muscles did afford some degree of protection to the cochlea during the exposure, the protective effects of the acoustic reflex may have been reduced even beyond our original observations.

Animals↗

Cells involved in the middle ear defense system.

Despite the high incidence and prevalence of otitis media, its pathogenesis is not thoroughly understood. In the last decade, many efforts have been made to provide a better understanding, and abundant information has become available. At the same time the field of immunology has advanced at an extremely rapid pace. We have followed the gradual cellular events in the defense reaction of the middle ear, utilizing eustachian tube obstruction to induce otitis. Seventy-five cats were divided in groups and sacrificed at intervals between one day and six months, and their temporal bones were studied. During an initial phase of inflammation, polymorphonuclears appear at three days in connective tissue; at the same time active fibroblasts synthesize tropocollagen and ground substance while epithelial cells secrete mucus and lysozymes. These cells, together with those involved in the mucociliary transport system and a patent functional eustachian tube, constitute the nonspecific system of defense. The transition cells are the macrophages which appear at one week to interact with T and B cells to produce the specific immune response. Plasma cells appear at two weeks to peak at one month with synthesis of immunoglobulins A, G and M. A secretory immune system is observed. At three and six months, lymphocytes are the predominant cells and occasional accumulations of mononuclears are observed. The reaction involves the entire middle ear, including mucoperiosteum, middle ear muscles and round window membrane. We believe that a better understanding of the middle ear defense system will lead in time to a practical clinical assessment of the immunological status during the evolution of each particular process or disease involving the middle ear, and a more rational approach to the treatment and, hopefully, prevention of chronic ear disease.

Animals↗

Sensorineural hearing loss caused by a high jugular bulb.

A 15-year-old female presented with sensorineural hearing loss related to a high jugular bulb. She noticed temporary worsening of her right hearing with mild dizziness when her neck was compressed whereas she noticed no change in her left hearing. An audiogram showed temporary worsening of low tone bone-conduction on such occasions. A large jugular bulb covering the right round window was observed through the perforation. Computed tomography (CT) revealed a large jugular bulb obliterating the round window niche. Deterioration of bone conduction during neck compression was thought to be caused by the protrusion of the jugular bulb into the inner ear via the round window. This case suggested the possibility of sensorineural hearing loss due to the jugular bulb. As in the present case, jugular bulb or vein-related ear disorders should be examined by neck compression.

Adolescent↗

Round-window anatomical considerations in intratympanic drug therapy for inner-ear diseases.

Our aim was to elucidate the importance of anatomical aspects in planning local therapies for inner-ear diseases. The study undertakes the anatomical evaluation, from a surgical-approach perspective, of the relationship between the false and true round-window membranes. As our design, we chose a human temporal bone dissection study, for which we used 20 fresh temporal bones. After an exploratory tympanotomy and atticotomy, we drilled the anterosuperior (promontory) edge of the round-window niche until the true round-window membrane was completely exposed. We registered the presence or absence and the extent of the false round-window membranes on the round-window niche. We found false round-window membranes obstructing the round-window niche partially or completely in five temporal bones (25%). Complete obstruction was present in one temporal bone (5%). We found mucoperiosteal folds obstructing the round-window niche partially or completely in a significant proportion of the ears. These anatomical particularities could account, at least partially, for the great variability of the results of intratympanic therapies for inner-ear diseases.

Humans↗

[Effect of hyaluronan perfusion through the round window on the function and morphology of the inner ear in guinea pigs].

UNLABELLED: In order to study the effect of the hyaluronan (HA) on the inner ear, twenty-six guinea pigs were divided into experimental and control groups, the experimental group were perfused with 2% HA 0.2 ml through the left round window. Auditory and vestibular function were investigated before and 5, 14, 28 days after perfusion. The threshold of action potential (AP) response to filtered clicks (0.25-10 kHz) were elevated at 5 days and were improved (at 1-4 kHz) at 14 days after perfusion (P < 0.05). At 28 days all AP response thresholds had returned to normal (P > 0.05). The nystagmus duration induced by caloric test (ENG) had no obviously change comparing with that of preoperation (P > 0.05). All guinea pigs were sacrificed 28 days after operation. The histology of inner ear were examined by means of membranous labyrinth mapping and temporal bone section after celloidin embedding. The morphology of Corti's and vestibular organs were not significantly damaged after perfusion. IN CONCLUSION: 1) 2%HA caused reversible and temporary changes in auditory function of inner ear; 2) 2%HA lacked ototoxic adverse effects, whereas exerted considerable osmotic effects and a slow dehydration of inner ears.

Action Potentials↗

Intratympanic dexamethasone treatment for control of subjective idiopathic tinnitus: our clinical experience.

In this report, we summarize our clinical experience with intratympanic dexamethasone treatment (IDT) for control of tinnitus. From March 2000 through February 2001, we observed 54 patients (23 women, 31 men; mean age, 49.6 +/- 7.2 years; range, 24-71 years) suffering from subjective idiopathic tinnitus (SIT). After common audiological tests had been performed; all patients underwent specific topodiagnostic tests to verify the cochlear SIT genesis. The 50 subjects with positive results from a furosemide test and negative results from caraverine and carbamazepine tests were selected for the IDT, consisting of transtympanic perfusion of 4 mg dexamethasone to the round window via the middle ear. The treatment was repeated three times daily for 3 consecutive months. Its short-term effects were evaluated 2 weeks after the last perfusion. In 17 of 50 of these patients (34%), the SIT disappeared; 20 of the 50 (40%) reported a significant decrease of the symptom; and the remaining 13 of the 50 (26%) did not experience any improvement. Therefore, we believe that IDT represents an effective drug delivery system for SIT control, as long as the condition arises from inner ear disorders only and treatment occurs within 3 months of symptom onset.

Adult↗

Electrically induced auditory brainstem response as a clinical tool in estimating nerve survival.

Nerve survival estimates in totally deaf ears of cats and humans can be easily obtained by auditory brainstem responses to electrical stimulation at the round window. In humans, electrically induced auditory brainstem responses require considerably more current than concurrently observed perceptual thresholds and "maximum loudnesses," and there is much variability from patient to patient. In cats, in which we also compared efficacy of stimulation sites, preliminary data analysis suggests that the scala tympani is clearly much more efficient than the round window, and the round window better than the promontory in ears with large populations of ganglion cells. In ears with no or nearly no ganglion cells, scala tympani and round window stimulations are about equal.

Animals↗

Histologic variants in otosclerosis.

A study of 164 temporal bones with otosclerosis revealed stapes fixation in 123. Large lesions (4 mm or larger) were characterized by involvement of the cochlear endosteum, increased cellular activity, and bone resorption. Anatomical sites of predilection were: 1. anterior to the oval window, 2. margins of the round window, and 3. apical-medial wall of the cochlea. Two of the five ears with cochlear otosclerosis were from a patient with severe bilateral hearing loss. The size, cellular activity, and location of otosclerotic lesions showed no correlation with the magnitude of sensorineural hearing loss. Subjects over 69 years of age had greater bone-conduction losses than age-matched controls. Nine ears showed occlusion of the round window niche.

Adult↗

Effects of vestibular stimulation on acetylcholine release from rat hippocampus: an in vivo microdialysis study.

1. The effects of electrical stimulation to the round window of the inner ear and caloric vestibular stimulation on the in vivo release of acetylcholine (ACh) from rat hippocampus were investigated, using brain microdialysis coupled with high performance liquid chromatography-electrochemical detection. 2. Hippocampal ACh release was increased to 152% of the basal release by 1-Hz, 200-ms, and 500-microA electrical stimulation to the round window. This effect was dependent on current intensity. 3. Microinjection of 6,7-dinitroquinoxaline-2,3-dione (DNQX) (10 nmol/0.2 microliter), an antagonist of the non-N-methyl-D-aspartate (non-NMDA) type of glutamate receptor, into the medial vestibular nucleus blocked the increase of hippocampal ACh release by electrical stimulation to the round window. In contrast, microinjection of DNQX (10 nmol/0.2 microliter) into the ventral cochlear nucleus did not inhibit the increase of hippocampal ACh release by electrical stimulation to the round window. 4. Electrical stimulation of the round window increased histamine release from the medial septum, which is the origin of the hippocampal cholinergic terminals. However, the depletion of neuronal histamine by alpha-fluoromethylhistidine (100 mg/kg ip) did not suppress the vestibular-evoked release of hippocampal ACh. 5. Although caloric stimulation with water at 37 degrees C did not affect the hippocampal ACh release, the release was increased to 131% of the basal release by caloric stimulation with hot water at 45 degrees C and was also increased to 160% of the basal release by caloric stimulation with ice water, suggesting that the changes in activities of vestibular afferents increased the hippocampal ACh release.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetylcholine↗

Computer-aided three-dimensional reconstruction and measurement of the round window niche.

The goal of this study was to clarify the three-dimensional shape of the round window niche and to measure this structure three-dimensionally using the computer-aided reconstruction method we developed. The equipment used in this study included a personal computer (NEC 98-XA), a high-resolution 14-inch color CRT, a digitizer (Hitachi HDG-1111), and a printer. We studied five normal temporal bones obtained from five individuals with negative otologic histories, who had been 5 months and 14, 15, 18, and 59 years old at death. In each case the round window niche was located posteroinferior to the round window. The round window niches had wide openings to the middle ear cavity that became narrower near the aperture; thus, the round window niche seemed to be shaped like a pouch. The maximal diameter of the round window niche was 2.98 +/- 0.23 mm. The shortest distance between the aperture of the round window niche and the margin of the round window was 0.66 +/- 0.16 mm. The volume of the round window niche, on average, was 4.65 +/- 0.67 mm3. The volume of the round window niche was found to be correlated with the area of the round window.

Adolescent↗

Gas permeability of round window membrane.

The perilymphatic oxygen tension in the scala tympani was measured with a polarographic technique after various gases were insufflated into the middle ear cavity of 7 guinea pigs. Pure oxygen, insufflated into the middle ear cavity, easily permeated the round window membrane and elevated the perilymphatic oxygen tension. Oxygen transport to the inner ear, other than by the inner ear vessels, was confirmed. The inner ear function may partially be maintained by oxygenation through this route.

Animals↗

Blood flow of the round window.

Motion pictures of the blood flow of the round window in guinea pigs were taken. In this part the blood flow of the inner ear could be distinguished from that of the middle ear. Our motion pictures show that the blood flow of the inner ear can be observed through the round window membrane without an operation on the inner ear.

Animals↗

The round window membrane under normal and pathological conditions.

Current research and an overall review of round window membrane studies is presented and the concepts that have evolved from these studies are described. Ultrastructural studies of the round window membrane of rodents, felines, and primates disclosed three basic layers: an outer epithelium lining the middle ear, a middle core of connective tissue, and an inner epithelium bordering the inner ear. Morphological evidence suggests that the membrane participates in: (a) the release of mechanical energy supplied by the ossicular chain to the labyrinthine fluids; (b) an alternative route for sound energy to enter the cochlea; (c) secretion into and absorption from perilymph; and (d) the defense system of the middle and inner ears. Permeability of the round window is considered an accident and not a function of the membrane. The complications of permeability (potential ototoxicity) and its potential usefulness (drug delivery) are discussed.

Animals↗

Middle ear inflammatory mediators and cochlear function.

Sensorineural hearing loss (SNHL) has been documented in patients with otitis media. Despite a number of clinical and pathologic works dealing with this common problem, animal studies searching for possible relationships between the middle ear inflammation and cochlear function remain insufficient. Bacterial inoculation and ototoxins and inflammatory products in the middle ear cavity cause SNHL in rodents. Human serum albumin placed in the middle ear cavity in chinchillas also produces SNHL, owing to the effects of nonspecific inflammation in the middle ear cavity. Most of the middle ear inflammatory mediators enter the inner ear through the round window route, and alteration of the permeability of the round window membrane plays an important role in causing cochlear dysfunction. Although an immunologic response in the middle ear plays an important role in otitis media, the immunologic response in the inner ear as it relates to middle ear inflammatory mediators requires further study.

Animals↗

Fluorescein as an easy, low-cost, indirect, or reverse intraoperative marker to rule out perilymph versus local injection.

Clear fluid found in the dependent portions of the middle ear (round and oval windows) is generally assumed to be perilymph (PL). However, all clear fluid observed at middle ear exploration is not necessarily PL. PL should be distinguished from local injection. An accumulation of the local injection could be confused with perilymph fistula (PLF) diagnosis. There is no standard way of distinguishing perilymph from local injection, as both are clear, watery fluids. Fluorescein, tagged with a mixture of xylocaine and epinephrine (FLOTAX) was used as the local injection in 10 patients undergoing middle ear exploration for possible PLF.FLOTAX was injected into the vascular strip and ear canal skin in routine fashion. Transtympanic endoscopy and special Zeiss custom fluorescein filters were used to document any accumulation of fluid in the dependent portions of the middle ear and confirm whether any fluorescein (from the FLOTAX) was present. The middle ear was checked both before (endoscopically) and after raising the tympanomeatal flap. After the "local" injection, FLOTAX was observed to accumulate in dependent portions of the middle ear before raising the tympanomeatal flap in six of 10 ears. In the other four ears, FLOTAX slowly seeped into the middle ear cleft after the tympanomeatal flap was elevated and manipulated. Fluorescein can be used as an inexpensive, indirect intraoperative marker or "reverse test" for possible PLF. By eliminating a likely and common offender (local injection), any accumulation or reaccumulation of clear fluid that is not fluorescein tagged may more confidently be identified as possibly perilymph. The use of FLOTAX helps eliminate the confusion between the local injection and potential PLF. It does not in any way eliminate the possibility of other transudates from incisions, allergic reactions, or other manipulation of the tympanomeatal flap or middle ear mucosa.

Anesthetics, Local↗

Round window gentamicin absorption: an in vivo human model.

OBJECTIVE/HYPOTHESIS: Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured. STUDY DESIGN: A prospective study. METHODS: Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative). The lateral semicircular canal and vestibule were opened, and by means of a microsyringe, labyrinthine fluid was aspirated. A sample of serum was also drawn. In all patients cerebrospinal fluid was also drawn. The samples were analyzed using a standard chemistry analyzer. RESULTS: Intratympanic gentamicin diffused through the round window membrane and achieved concentrations in the labyrinthine fluid ranging from 0 to 16 mg/L. Intratympanic gentamicin was absorbed into the systemic circulation in 4 of 11 patients with serum levels ranging from 0.3 to 0.4 mg/L. No gentamicin was detected in the cerebrospinal fluid. CONCLUSIONS: Intratympanic gentamicin diffuses rapidly through the round window membrane and achieves significant levels in the inner ear. Thus, this new model can be used to assess round window permeability to clinically relevant medications such as steroids and ototopical antibiotics.

Adult↗