Cervical sympathectomy in Meniere's disease.
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For the congenital syphilitic patient to develop sensorineural deafness is uncommon. For the congenital syphilitic patient to have persistence of treponemes after treatment is rare. To demonstrate viable organisms in the inner ear perilymph of the congenital syphilitic patient, despite treatment with penicillin, has not been recorded to date. This is a case report of such a patient.
It is possible that acute labyrinthine hydrops characteristic of Meniere disorder is related to hyperparasympathetic tone analogous to that observe in rhinorrhea or nasal congestion. This new hypothesis is is supported by anatomical, clinical, and surgical arguments. Anatomically, the ear is supplied by a parasympathetic pathway from the acousticofacial anastomoses of Wrisberg intermediate nerve and the vestibular nerve. These anastomoses are of great importance and appear at a very early stage of embryonal development, much earlier than other parts of the parasympathetic component of the facial nerve. Surgically, vestibular neurectomy via the middle fossa route conserves the anatomy of the inner ear. Together with the vestibular nerve, the acousticofacial anastomoses are removed. This operation results in an improvement of hearing that is far from negligible.
Previous studies by the Adams method demonstrated a strong correlation between hydrolytic enzyme activity of perilymph and progression of bone conduction loss two years preceding stapedectomy. Alpha 1-Antitrypsin was chosen since its activity can be very precisely measured by a radical immunodiffusion technique and since it is one of the enzymes identified in perilymph of patients with active otospongiosis. Samples of 3 mul to 5 mul of perilymph removed during 103 stapedectomies and samples of known alpha 1-trypsin activity were placed on slides coated with alpha 1-antitrypsin serum. The zone of diffusion was stained and measured after 38 hours of incubation. Antitrypsin values were lowest in 24 cases, two with no preoperative bone conduction progression, three with moderate progression of 10 to 15 dB, and 19 with rapid progression of more than 20 dB. They were highest in 36 cases with no progression, and in one case with moderate progression. This study confirms previous reports on the enzymatic activity in otospongiotic disease.
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The dynamics of perilymph flow in the cochlea was studied in guinea pigs. After placement of sodium chloride crystals on the round window membrane, the potassium ion concentration in the scala vestibuli in the basal turn does not change. The potassium ion concentrations in the scala tympani in the basal turn increases rapidly, while the potassium ion concentration in the scala tympani in the third turn increases slowly and to a lesser extent. The cochlear microphonic potential decreases in the basal turn and to a lesser extent in the third turn. After placement of sodium chloride on the fenestra in the scala tympani of the third turn, the chochlear microphonic potential in the basal turn does not change. These data lend support to the theory of longitudinal flow of perilymph in the scala tympani.
Cochlear microcirculation was studied with oxygen-sensitive microelectrodes simultaneously in all three scalas during anoxia, hyperoxia, and hypercapnia. The anoxia caused a sharp decline of Po2 in the scala media (SM), scala vestibuli (SV), and scala tympani (ST). Hyperoxia and hypercapnia resulted in an elevation of Po2 in all three scalas. During anoxia, the SM showed the earliest and largest decline in Po2, with the shortest recovery and reoxygenation time. When Po2 slopes (during anoxia) were compared, the SM to ST and the SM to SV were substantially different and remained different even when the partial pressures of oxygen quantified as oxygen in nanomoles. Our experiments also showed that changes in Po2 within the SM closely correlate with changes of endocochlear potential and BP.
In a previous study, a special rheological model of intra-arterial perfusion was used to examine the existence and effectiveness of vasomotor control of the cochlear vessels in guinea pigs. Catecholamines were injected intra-arterially into this animal model and the changes induced in the cochlear action potentials were examined. In this investigation, we used the same animal model and technique to measure the perilymph Po2 after perfusion of the cochlea with catecholamines. In addition, the effect of drainage of the CSF before infusion was examined. The results indicated that opening the labyrinth allows the escape of CSF through the patent cochlear duct. This may modify the concentration of the substance under study in the perilymph and cause inaccuracies in the data obtained.
Stapes gusher is a rare and usually unexpected complication of stapes surgery. This complication will inevitably be encountered during stapes surgery in all affected males with the X-linked, progressive mixed deafness syndrome. The opportunity of studying eight affected males in a large Dutch family with audiometry, vestibulometry, and polytomography was used to identify specific features. Awareness of these features will assist the otologist in recognizing new cases preoperatively.
Perilymphatic and endolymphatic pressures were consecutively measured by means of a servomechanical nulling pressure system through the round window and basilar membrane one to 2.5 months after obliteration of the left endolymphatic sac and duct in seven guinea pigs. The position of the pipette was monitored by the simultaneous recording of the direct current potential through the micropipette used for the pressure measurement. (1) The perilymphatic and endolymphatic pressures of the control ears were equal. (2) The histological evaluation showed that the ears operated on had a significantly greater endolymphatic space than the control ears. (3) The endolymphatic pressure of the ear operated on was significantly higher (0.78 +/- 0.32 mm Hg) than that of the perilymph. (4) The endolymphatic direct current potential was equal in both ears.
The concentration of salicylate in serum and perilymph was measured in chinchillas after intraperitoneal administration of sodium salicylate. Serum salicylate concentration peaked 2 to 4 hours after a single injection. Clearance was approximately complete after 16 hours. The within-subject variability of serum concentration 4 hours after injection was very low. Subject weight significantly affected serum salicylate concentration, with heavier animals showing higher serum levels. The relationship of perilymph to serum salicylate concentration was approximately linear, with a high correlation between measures.
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