The round window-a critical re-evaluation.
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Ear, Middle↗
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Evaluation of perilymphatic fistulas by middle ear endoscopy.
Transtympanic endoscopy provides a unique opportunity to view the undisturbed contents of the middle ear. Fiberoptic and rigid endoscopes have been used for thorough examination of the middle ear without the need for local anesthetics or surgical trauma. Endoscopy is now routinely used in the evaluation of a perilymphatic fistula and the patient is awake during an intermittent forceful Valsalva maneuver. Oval and round windows in both ears of five cats were studied endoscopically to evaluate surgically created fistulas. Excellent visualization of the defect was obtained in all instances. Endoscopy is a useful office technique for the evaluation of perilymphatic fistula. It reduces the need for surgical exploration and provides a satisfactory examination of the middle ear. Obliteration of the window niche can even be performed through the myringotomy using autologous blood.
Adult↗
[Importance of the membrane of the round window and of the stapes in the experimental determination of the perilymphatic pressure].
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Ear, Inner↗
Experimental labyrinthitis in guinea pigs caused by a hantavirus.
Hantavirus-induced acute viral infection of the inner ear of guinea pigs is reported. Guinea pigs were inoculated directly into the inner ear through the round window, or intraperitoneally with hantavirus (B-1 strain), and the cochlea was examined using an immunohistochemical technique for the localization of viral antigens. Virus-specific antigens were detected prominently in the stria vascularis and to a lesser degree in other inner ear structures of the infected guinea pigs. The morphological changes in the inner ear structures of these guinea pigs were observed. Virus was isolated from the blood of some infected guinea pigs. These data suggest that hantavirus can infect the inner ear of the guinea pig via viremia. The effect of immunosuppression by ciclosporin A or cyclophosphamide is discussed.
Acute Disease↗
When is a conductive hearing loss not a conductive hearing loss? Causes of a mismatch in air-bone threshold measurements or a "pseudoconductive" hearing loss.
The otolaryngologist is sometimes faced with a patient with an apparent conductive hearing loss on audiometric testing who appears to have normal and mobile middle ear structures on ear exploration. Some causes of these "pseudoconductive" hearing losses can be diagnosed without resorting to surgery. This article reviews several possible mechanisms for this condition with diagnostic procedures to distinguish etiologic diseases. Conditions discussed include poor audiometry, functional hearing losses, "third window" causes, obliterated round window, abnormal inner ear connection with the cerebrospinal fluid space, inner ear mechanical conductive hearing loss, and apparent inner ear loss owing to missed middle ear pathology.
Audiometry↗
Round window membrane and perilymph in experimental otitis media with effusion.
To investigate the influence of middle ear effusion (MEE) on perilymph (PL), an experimental otitis media with effusion (OME) was manufactured in chinchillas by injecting the tympanic cavity with immune complexes. The presence of MEE lasted for up to 9 days after the injection of immune complexes. Perilymph was aspirated on the fourth, tenth, and 21st days after the inoculation. The mean concentrations of albumin, immunoglobulin G, histamine, and prostaglandin E2 (PGE2) were significantly greater in PL from ears with induced OME than in that from normal control ears. The 3H-PGE2 placed on the round window membrane of pathologically affected ears passed into PL in significantly greater amounts than in normal control ears. The findings indicate that the immune complexes placed in the middle ear cavity affect the biochemical milieu of PL, and that MEE is a result of immune complexes.
Albumins↗
Instrumental perforation of the round window. Animal experiments using cochleography and ERA.
The round window membrane of the inner ear of the guinea pig was perforated under Ketanest anaesthesia. A very rapid and almost total loss of cochlear microphonics, auditory nerve action potential and brain-stem response developed. Replacement of the perilymph with Ringer's solution and surgical closure of the membrane damage had no effect on auditory nerve action potential or brain-stem response. Further decline in the amplitude of cochlear microphonics was halted, however. When perfusion of the round window membrane was carried out whilst the bulla was full with Ringer's solution, no essential decline was seen in the amplitudes of microphonics and auditory nerve action. Only brain-stem response was reduced--temporarily by 40% of the original amplitudinal level--but this showed subsequent recovery. Preservation of cochlear microphonics and auditory nerve action after perforation in Ringer's solution, i.e. excluding air, indicates that air entering the scala tympani is the cause of the sudden hearing loss after round window perforation. Using a simple physical model, an attempt is made to demonstrate this process. The anatomic connections between the round window, cochlear aqueduct and scala tympani are discussed, as are the different ways in which the round window membrane can be perforated.
Action Potentials↗
Middle-ear mechanics of Type III tympanoplasty (stapes columella): I. Experimental studies.
OBJECTIVE: To investigate the mechanics of Type III tympanoplasty by developing a cadaveric temporal bone model. BACKGROUND: Type III stapes columella tympanoplasty involves the placement of a tympanic membrane graft, usually made of temporalis fascia, directly onto the stapes head. The procedure is usually done in conjunction with a canal wall down mastoidectomy. Postoperative hearing results vary widely, with air-bone gaps of 10 to 60 dB. The structural features responsible for the wide range in hearing results have not been systematically investigated. METHODS: Canal wall down Type III procedures were performed in eight cadaveric temporal bones. Acoustic stimuli were presented in the ear canal, and round window velocity VRW (used as an index of hearing) was measured, while systematically varying stapes mobility, mechanical properties of tympanic membrane graft, and tightness of connection between tympanic membrane graft and stapes. The effect of interposing a thin cartilage disc between the tympanic membrane graft and stapes head was also assessed. RESULTS: When the middle ear was aerated and the stapes was mobile, VRW was 15 to 30 dB lower than in an intact, normal ear. Stapes fixation led to a significant reduction in VRW; reduction was greatest at low frequencies. There was little effect of varying the tightness of connection between the tympanic membrane graft and stapes head. Sound energy was transmitted from the graft to the stapes as long as the graft was in physical contact with the stapes head. Different tympanic membrane graft materials with a range of mechanical properties (stiffness and mass) resulted in little variation in VRW. Interposing a thin cartilage disc between the tympanic membrane graft and stapes improved VRW in the lower frequencies by 5 to 10 dB. The authors hypothesize that the disc acted to increase the effective vibrating area of the graft. CONCLUSIONS: The feasibility of using a cadaveric temporal bone model to study the mechanics of Type III tympanoplasty was demonstrated. A mobile stapes and aerated middle ear were essential for a successful Type III tympanoplasty. There was little effect of varying the mechanical properties of the tympanic membrane graft or changing the tightness of connection between the graft and stapes head. Improved results were achieved by interposing a thin cartilage disc between the graft and stapes head to increase the effective vibrating area of the graft.
Aged↗
Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Ménière's disease.
Recent clinical and laboratory evidence indicates that Meniere's disease is an immune-mediated disease. Dexamethasone perfusion of the inner ear through the round window plus intravenous dexamethasone often will stop the dizzy spells, reduce the fullness and low-frequency tinnitus, and sometimes improve the hearing in patients with Meniere's disease. The dexamethasone must act mostly on the endolymphatic sac and, to a lesser extent, on the stria vascularis and spiral ligament, the known targets of immune response in the inner ear, to reduce the endolymphatic hydrops and restore the fluid dynamics of the endolymph. Despite the good results with streptomycin perfusion, the number of patients with further hearing loss is large, so dexamethasone perfusion with intravenous dexamethasone should be tried first. The initial response to dexamethasone perfusion plus intravenous dexamethasone has been very good, with very little risk of further hearing loss, and it holds great promise for the future.
Administration, Topical↗
[Traumatic perilymphatic fistula of round and oval windows (four cases reported)].
OBJECTIVE: To explore the diagnosis and treatment to traumatic perilymph fistula (PLF) of round and oval window. METHOD: Traumatic PLF was diagnosed by the traumatic history of head, neck and ear, the examinations of auditory and vestibular function, and the exploratory tympanotomy. The PLF of round and oval windows were repaired by fascia graft or tragus perichondrium and gelform. Four cases with traumatic PLF of round and oval window were reported in this paper, which included 2 cases hitten by hand, 1 by brick, 1 insulted by middle ear surgery. Exploratory tympanotomy was performed from one and half to nine months after injury. One case was misdiagnosed as Meniere's disease before confirming PLF. Exploration and repair of PLF underwent in all cases. RESULT: The symptom of vertigo relieved in all cases after surgery, while the hearing recovery was not evident. CONCLUSION: 1. Traumatic PLF is unrare, hence, traumatic PLF should be alerted if patients suffer from vertigo and hearing impairment after head and ear injury. 2. The features with vertigo attacks, fluctuating hearing loss and tinnutis should be distinguished from Meniere's disease. 3. Early exploratory tympanotomy and repair of PLF are effective for relieving vertigo and improving hearing.
Adult↗
Operations on the middle ear and mastoid.
From 1953 to 1957, inclusive, 373 patients were operated on for chronic mastoid disease at the Mayo Clinic. Mainly because of the extensive use of magnifying glasses and microscopes, through these years, closer attention has been given to the preservation or improvement of hearing by meticulous procedures on the structures of the middle ear and the use of skin grafts. It is stressed, however, that it is extremely important to eradicate the underlying disease. Illustrative cases to represent different types of procedures are presented. The author recommends closer attention to the condition of the round window in the future.
Ear, Middle↗
The round window as access route for agents injurious to the inner ear.
The ototoxicity of 50% propylene glycol, 70% isopropyl alcohol, 2% acetic acid, Otic Domeboro solution (Miles Pharmaceuticals, West Haven, CT), 1% Gentian violet (Purepac Pharmaceutical, Elizabeth, NJ), Vosol Otic solution (Wallace Laboratories, Cranbury, NJ), Genoptic Ophthalmic solution (Allergan Pharmaceuticals, Irvine, CA), Cortisporin Otic suspension (Burroughs Wellcome, Greenville, NC), Coly-Mycin S Otic (Parke-Davis, Rochester, MI), and Pyocidin Otic (Berlex Laboratories, Cedar Knolls, NJ) was studied in rats according to their effect on the latencies of the second peak of the auditory brainstem responses (ABR) at different sound pressure levels. The substances were instilled into the round window (RW) niches of rats, and the ABR to 1-kHz and 6-kHz tonebursts were obtained, 30 minutes, two hours, and 1 week after exposure. For all substances except isopropyl alcohol and propylene glycol, which evidently quickly penetrated the RW, approximately two hours of exposure were required before inner ear function was affected. The ototoxic effect of the antibiotic drugs was to some degree reversed with time, whereas the recorded potentials for antiseptics such as 1% Gentian violet, 2% acetic acid, and Otic Domeboro indicate that they caused severe damage to inner ear function. Some increases in latencies were also noted after exposure to propylene glycol and isopropyl alcohol, except when the latter was quickly withdrawn from the RW niche.
Animals↗
Pneumolabyrinth in perilymphatic fistula: report of three cases.
In three patients with perilymphatic fistula, exploratory tympanotomy revealed air bubbles emerging through the ruptured round window membrane. Review of the literature disclosed three case reports in which air was demonstrated in the labyrinth in association with perilymphatic fistula. Experimental evidence that air could enter the labyrinth through a defect of the round window membrane was described in two articles. In our patients, the perilymphatic fistula was produced by implosive force. When a perilymphatic fistula was produced by implosive force, or in the case of a pre-existing perilymphatic fistula, we assume, air may enter the scala tympani through the defect of the round window membrane if the middle ear pressure rises beyond a certain limit. Sudden onset of deafness and reversibility of hearing in perilymphatic fistula could be attributable to the presence of air bubble in the scala tympani--pneumolabyrinth--which might disturb propagation of the traveling wave of the basilar membrane.
Adolescent↗
Intratympanic and Round-Window Drug Therapy: Effect on Cochlear Tinnitus.
Tinnitus is a common symptom for which few existing therapeutic approaches can produce reliable reduction or elimination. Chemical perfusion involves the delivery of medication directly into the inner ear via the round-window membrane. This report discusses the use of dexamethasone or gentamicin in 20 individuals who had inner ear diseases in which disturbing cochlear tinnitus was one of the symptoms. Preliminary results indicate that chemical perfusion is a promising option for the treatment of cochlear tinnitus.
Journal Article↗
Cochlear aqueduct flow resistance is not constant during evoked inner ear pressure change in the guinea pig.
Inner ear fluid pressure was measured during 6.25 mHz square wave middle ear pressure manipulation, with a perforated tympanic membrane. After a negative-going middle ear pressure change the calculated flow resistance of the inner ear pressure release routes (mainly the cochlear aqueduct) was approximately constant, with a value of 12 Pa s/nl (averaged over two ears), when values for the inner ear window compliance are taken from the literature. After a positive-going middle ear pressure change the calculated flow resistance changed with round window position and with the pressure difference across the cochlear aqueduct. It reached an average maximum value of 114 Pa s/nl. The change of flow resistance during inner ear pressure variation can be explained by a permeability change of the cochlear aqueduct, caused by a change of structures filling the aqueduct and its entrance in scala tympani.
Animals↗
Influence of middle ear effusion on perilymph.
To investigate the influence of middle ear effusion (MEE) on perilymph (PL), an experimental otitis media with effusion (OME) was provoked in chinchillas by injecting the tympanic cavity with immune complexes. MEE remained for up to 9 days after the injection of immune complexes. PL was aspirated on the 4th, 10th, and 21st day after the inoculation. The mean concentrations of albumin, IgG, and prostaglandin E2 (PGE2) were significantly greater in PL from OME induced ears than in that form normal control ears. 3H-PGE2 placed on the round window membrane of pathologically affected ears passed into PL in significantly greater amounts than in normal controls. The findings of the present study indicate that MEE affects the biochemical environment of PL. However, this influence was transient and reversible.
Albumins↗
Long-term study after perforation of the round window. Animal experiments using electric response audiometry.
The round-window membrane of the inner ear of the guinea pig was perforated with a platinum wire under ketamine-xylazine anaesthesia. The latency times of waves I and V (Jewett) increased to 0.6 ms at 100 dB click HL stimulus loudness. The interpeak latencies did not change (4.0-4.2 ms). At 60 dB CHL stimulus loudness, no responses were discernible. Closure of the membrane damage by adhesive fibrin tissue had no effect on the auditory nerve potentials or the brain-stem responses. Normal latency times of waves I-V were seen 7 days after perforation. There was no difference between the animals with repaired and unrepaired membrane damage. We observed spontaneous healing of the round-window membrane 7 days after perforation, and a normal organ of Corti.
Acoustic Stimulation↗
Endoscope-guided round window fistula repair.
OBJECTIVE: Endoscope-guided round window membrane repair was performed to evaluate whether the approach is feasible in the treatment of a round window fistula. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care academic center. PATIENT: A 27-year-old man had been scuba diving 6 days previously in the Australian Great Barrier Reefs. He had poor hearing with tinnitus in the left ear and a vertiginous sensation. INTERVENTION: A myringotomy was incised, and a tympanoscope was introduced into the middle ear cavity. With the patient under general anesthesia, the middle ear and the oval and round window areas were examined with a tympanoscope. In endoscopic visualization, a round perforation could be seen in the round window membrane. After detection of the round window perforation, a small piece of temporal fascia was obtained to seal the membrane perforation. RESULTS: One month after the operation, the patient's hearing was significantly better. The myringotomy had healed. CONCLUSION: A transmyringeal endoscopic procedure for round window fistula repair is feasible and combines the best features of minimally invasive surgery and aural endoscopy.
Adult↗