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PubMedDate not supplied

Diving injuries to the inner ear.

Most of the previous literature concerning otologic problems in compressed gas environments has emphasized middle ear barotrauma. With recent increases in commercial, military, and sport diving to deeper depths, inner ear disturbances during these exposures have been noted more frequently. Studies of inner ear physiology and pathology during diving indicate that the causes and treatment of these problems differ depending upon the phase and type of diving. Humans exposed to simulated depths of up to 305 meters without barotrauma or decompression sickness develop transient, conductive hearing losses with no audiometric evidence of cochlear dysfunction. Transient vertigo and nystagmus during diving have been noted with caloric stimulation, resulting from the unequal entry of cold water into the external auditory canals, and with asymmetric middle ear pressure equilibration during ascent and descent (alternobaric vertigo). Equilibrium disturbances noted with nitrogen narcosis, oxygen toxicity, hypercarbia, or hypoxia appear primarily related to the effects of these conditions upon the central nervous system and not to specific vestibular end-organ dysfunction. Compression of humans in helium-oxygen at depths greater than 152.4 meters results in transient symptoms of tremor, dizziness, and nausea plus decrements in postural equilibrium and psychomotor performance, the high pressure nervous syndrome. Vestibular function studies during these conditions indicate that these problems are due to central dysfunction and not to vestibular end-organ dysfunction. Persistent inner ear injuries have been noted during several phases of diving: 1) Such injuries during compression (inner ear barotrauma) have been related to round window ruptures occurring with straining, or a Valsalva's maneuver during inadequate middle ear pressure equilibration. Divers who develop cochlear and/or vestibular symptoms during shallow diving in which decompression sickness is unlikely or during compression in deeper diving, should be placed on bed rest with head elevation and avoidance of maneuvers which result in increased cerebrospinal fluid and intralabyrinthine pressure. With no improvement in symptoms after 48 hours, exploratory tympanotomy and repair of a possible labyrinthine window fistula should be considered. Recompression therapy is contraindicated in these cases...

Action Potentials↗

PubMed2002

Temporal bone histopathology related to cochlear implantation in congenital malformation of the bony cochlea.

HYPOTHESIS: Histopathologic findings in temporal bones with congenital malformations of the bony cochlea may provide insight into cochlear implantation planning, surgical approach, and complications. BACKGROUND: Patients with congenitally malformed cochleae account for an increasing percentage of candidates for cochlear implantation. Few studies on the relationship between histopathologic findings of temporal bones with malformation of the bony cochlea and cochlear implantation have been reported. METHODS: We studied 21 temporal bones from 12 cases with congenital malformations of the bony cochlea. Ages ranged from stillborn to 50 years. Length of the cochleae and dimensions of facial recesses were measured with light microscopy. Other malformations associated with a shortened cochlea were determined, emphasizing how they affect cochlear implantation. RESULTS: The average length of the malformed cochlear duct was 22.84 +/- 0.69 mm. Average dimensions of facial recesses were not significantly different between malformed cochleae and the controls. Other malformations included enlarged cochlear aqueduct (43%), abnormal facial nerve course (57%), enlarged vestibular aqueduct (52%), aplasia of the middle ear (19%), malformed ossicles (67%), abnormal oval window (57%), and abnormal round window (29%). CONCLUSION: A shortened cochlear duct may cause an incomplete insertion of the implant electrode. Because dimensions of the facial recesses are similar to normal cases, a facial recess surgical approach is recommended. An enlarged cochlear aqueduct may cause perilymphatic oozing or gushing on fenestration of the cochlea. An anomalous course of the facial nerve is a common finding. Tympanic malformations such as round and oval window deformities and small middle ear cleft should be noted preoperatively to better guide surgery.

Adolescent↗

PubMed1988

[Topography of the round window and its significance for the surgical therapy of perilymph fistulas].

The clinical findings concerning the diagnosis of a rupture of the round window membrane vary widely. Therefore, microtopography of the round window was studied using 45 serially sectioned human temporal bones of the Wittmaack Collection, ENT Clinic, University of Hamburg. Our morphometrical data show a great variety in respect of the dimension of the round window membrane and the angle between the window membrane and the tympanic membrane. The extension and the microtopography of the promontory are as variable as the mucosal folds in the round window niche. It can be concluded that a direct view of the round window membrane is possible only in rare cases. Surgical manipulations to improve the view of the round window should be avoided because of the danger of an iatrogenic lesion of the inner ear.

Adolescent↗

PubMed1999

[Round window membrane defect in divers].

BACKGROUND: The rupture of the round window membrane is a special form of traumatic inner ear deafness. Because of the changing pressure levels, divers are at risk of developing such a membrane rupture, especially if tube function is disturbed. As the popularity of diving as a sport increases, ENT specialists have to deal with diving related problems increasingly frequently. PATIENTS AND METHODS: Seven cases of divers are presented in whom a tympanotomy was performed following the diagnosis of a rupture of the round window membrane. The symptoms and intraoperative findings are discussed and the otologic and diving literature is reviewed. Following a case report, the pathophysiology, clinical symptoms and differential diagnosis of round window ruptures are discussed controversially. Possible therapeutical consequences are described. RESULTS: None of our patients exhibited the classical triad of deafness, tinnitus, and vertigo as described in the diving literature. The leading symptom in our patients was the loss of hearing; only two patients had vertigo. Tinnitus was found in half of the patients. Intraoperative a rupture of the round window membrane was presumed in five divers. CONCLUSIONS: If disturbance of inner ear function does occur concurrently with diving, a rupture of the round window membrane must be considered. An otologic examination must be performed in any diver with a loss of hearing and/or signs of a barotrauma of the middle ear. After differential diagnosis to exclude other possibilities, a tympanotomy to cover the round window membrane should be performed if symptoms persist more than 24 hours.

Adult↗

PubMed1998

Hearing results of intratympanic steroid treatment of endolymphatic hydrops.

OBJECTIVES/HYPOTHESIS: This study evaluated the effectiveness of a single application of steroids to the open middle ear in improving short-term hearing in patients with Meniere's disease and cochlear hydrops. STUDY DESIGN: Retrospective study in which each patient's pretreatment hearing served as the control compared with posttreatment hearing. METHODS: Patients were treated with a single application of dexamethasone, 8 mg, in hyaluronan. Following tympanotomy and lysis of round window adhesions, steroids were placed in the round window niche with absorbable gelatin sponge and the remainder of the middle ear was then filled with the steroid solution. Systemic steroids were not administered. Audiograms were performed within 1 month before surgery and at least 1 month after surgery. RESULTS: Between September 1996 and July 1997, 21 ears in 19 patients underwent intratympanic steroid treatment. The criterion for hearing change was a 10-dB or greater change in pure-tone average (PTA), or a 15% change in speech discrimination score (SDS). Of the 15 ears meeting inclusion criteria for this study, five (33%) demonstrated hearing improvement and three (20%) demonstrated hearing deterioration. Maximum improvement was a 38-dB improvement in PTA and a 32% improvement in SDS. CONCLUSION: A single application of intratympanic dexamethasone/hyaluronan solution directly to the round window did not produce dramatic short-term hearing improvement in patients with endolymphatic hydrops. Although the theoretical basis for intratympanic steroid treatment of endolymphatic hydrops is appealing, we urge close evaluation of the results of specific protocols of intratympanic steroid administration before widespread utilization of this treatment. The choice of steroid, route of administration, frequency of application, and need for simultaneous systemic administration require standardization to adequately assess the efficacy of this treatment.

Adjuvants, Immunologic↗

PubMedDate not supplied

Inner ear pathology and otitis media. A review.

Insidious inner ear complications of otitis media have been and are being studied in our laboratory. The purpose of this paper is to review these studies, coordinate, capsulize and highlight the results with emphasis on the transport role of the round window membrane.

Animals↗

PubMed1983

Anesthesia and surgical trauma: their influence on the guinea pig compound action potential.

A chronic implant consisting of a fine thermocouple placed on the round window permitted measurement of temperature and of the compound action potential (CAP) of the cochlear nerve in guinea pigs. Thresholds and latencies of the CAP, in response to tone bursts (2-40 kHz), were measured when the animal was awake and unrestrained, and again after several hours of anesthesia. The CAP remained unchanged with a variety of common anesthetics when precise control of round window temperature was maintained. However, when anesthesia was accompanied by several hours of slight cochlear cooling, thresholds were elevated for CAPs evoked by frequencies above 24 kHz and latencies were increased for CAPs evoked by all frequencies tested. The effects of surgery on CAP threshold and latency were also examined. Guinea pigs were tested while still anesthetized at the conclusion of the implantation procedure, and then again several days later while awake. Thresholds and latencies were unchanged. In two anesthetized guinea pigs already implanted with thermocouples, ventral and post-auricular surgery to expose the middle ear had no effect on the CAP, when low-speed drilling was used to open the auditory bulla. However, when small portions of the bulla were broken away with forceps, the CAP in response to high-frequency tone bursts immediately showed elevated thresholds. This alteration of the CAP was clearly different from that produced by lowered temperature, since the latencies at threshold were significantly decreased.

Action Potentials↗

PubMed2005

Intratympanic steroid perfusion for refractory sudden sensorineural hearing loss.

OBJECTIVE: Patients with sudden sensorineural hearing loss (SSHL) can benefit from systemic steroid therapy. Unfortunately, some patients are not candidates for steroid therapy due to concern over possible complications. Furthermore, not all patients will benefit from steroid administration. This study evaluates the potential benefits and safety of treating patients with SSHL refractory to oral steroids with intratympanic steroid therapy. METHODS: A retrospective case review was performed on all patients who presented with sudden sensorineural hearing loss refractory to oral steroid therapy during the past year. Seventeen patients were identified. All patients underwent intratympanic steroid administration, via MicroWick placement and/or round window catheter placement. RESULTS: Nine patients with sudden sensorineural hearing loss showed an improvement with intratympanic steroid therapy, consisting of MicroWick placement with dexamethasone drop (Decadron) administration for 1-2 weeks and/or round window catheter placement with steroid perfusion. Only one of the patients presenting with hearing loss present for greater than 8 weeks benefited from intratympanic therapy. Complications were few and included tympanic membrane perforation, chronic otitis media, dysequilibrium, and dysguesia. CONCLUSIONS: Intratympanic steroid therapy can be beneficial in treating patients with sudden sensorineural hearing loss refractory to oral steroid use. EBM RATING: C.

Administration, Oral↗

PubMed1988

Development of pressure monitoring and controlling system for quantitative analysis of experimentally induced perilymph fistula.

The cause of perilymph fistula, a subgroup of sudden deafness, has not been clearly understood. To study its etiology quantitatively, the inner ear pressure monitoring system with a computer controlled pressurizing device and three types of low-pressure monitoring sensors was constructed and utilized in ex vivo experiments using white guinea pigs. Hypothesizing that cerebrospinal pressure increases cause rupture of the round window membrane, direct and indirect pressurization to cerebrospinal region and simultaneous measurement of inner ear and cerebrospinal pressures were carried out. Ruptures of the round window membranes were seen in the experiments with direct saline infusion into the cochlea when the increment of inner ear pressure exceeded 500 mmH2O. There was no sign of rupture when squeezing abdomen was employed as an indirect pressurization, although cerebrospinal pressure increased.

Animals↗

PubMed2006

Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window.

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60-80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.

Acoustic Stimulation↗

PubMed1997

Round window membrane. Structure function and permeability: a review.

The ultrastructure of the round window membrane of humans, monkeys, felines, and rodents discloses three basic layers: an outer epithelium, a middle core of connective tissue, and an inner epithelium. Interspecies variations are mainly in terms of thickness, being thinnest in rodents and thicker in humans. Morphologic evidence suggests that the layers of the round window participate in absorption and secretion of substances to and from the inner ear, and that the entire membrane could play a role in the defense system of the ear. Different substances, including antibiotics, local anesthetics, and tracers such as cationic ferritin, horseradish peroxidase, and 1 mu latex microspheres, are placed in the middle ear side traverse the membrane. Cationic ferritin and 1 micron microspheres placed in perilymph become incorporated by the inner epithelial cells of the membrane. Permeability is selective; factors include size, concentration, liposolubility, electrical charge, and thickness of the membrane. Passage of substances through the round window membrane is by different pathways, the nature of which is seemingly decided at the outer epithelium of the round window membrane.

Aged↗

PubMed1997

Analysis of middle ear mechanics and application to diseased and reconstructed ears.

OBJECTIVE: To review current concepts of the mechanical processes of the human middle ear, and to apply them to practical issues in clinical otology and tympanoplasty surgery. BACKGROUND: The wide range of conductive hearing losses associated with middle ear pathology and reconstruction cannot be adequately explained by simple models of middle ear function. METHODS: Variables used to describe the system are sound pressure, volume velocity, and acoustic impedance. The relationship between specific middle ear structures and these variables is described such that inferences can be drawn regarding sound conduction in the normal, diseased, and reconstructed middle ear. RESULTS AND CONCLUSIONS: Sound can be transmitted from the car canal to the cochlea via two mechanisms: the tympano-ossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. In the normal ear, middle ear pressure gain (which is the result of ossicular coupling) is frequency-dependent and less than generally believed. The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapescochlear input impedance are altered. Hearing after type IV and V tympanoplasty is determined solely by acoustic coupling. The difference in magnitude between the oval- and round-window pressures is more important than the difference in phase in determining cochlear input. In tympanoplasty types I, II, and III, adequate middle-ear and round-window aeration is necessary and the tympanic membrane-ossicular configuration may be less crucial.

Acoustics↗

PubMedDate not supplied

Effect of topical application of nitroglycerin on cochlear blood flow.

PURPOSE: To investigate whether topical application of the vasodilator nitroglycerin would increase cochlear blood flow without adversely affecting inner ear function. MATERIALS AND METHODS: The effect of topical application of nitroglycerin to the round window membrane on cochlear blood flow was measured in 33 guinea pigs with a laser Doppler flowmeter. Endocochlear potential, as an indicator of inner ear function, was recorded by a glass microelectrode inserted through the round window membrane in a second series of 27 guinea pigs. Blood pressure was also monitored in both experiments. RESULTS: Low doses (0.0001 to 1 microgram) of nitroglycerin induced an increase in cochlear blood flow with no change in blood pressure. The cochlear blood flow was maximally increased by approximately 50%. A high dose (50 micrograms) of nitroglycerin induced a significant decrease in blood pressure but did not significantly affect endocochlear potential. CONCLUSIONS: Topical application of nitroglycerin may be useful in increasing cochlear blood flow in various inner ear diseases.

Animals↗

PubMedDate not supplied

Interleukin 8 can affect inner ear function.

The chemokine interleukin 8 (IL-8) was instilled into the round window niche of rats through a small perforation in the tympanic membrane in order to study its effect on inner ear function by electrophysiological and morphological techniques. The frequency-specific auditory brainstem response (ABR) was recorded at the frequencies 4, 8, 10, 12, 16 and 20 kHz just before and 1, 2, 5 and 14 days after instilling IL-8 to ascertain the hearing level during each interval. Morphological examination by light microscopy was performed during the same interval following the instillation of IL-8. On day 1, the rise in ABR threshold was within 5 dB SPL (non-significant elevation). However, a significant threshold elevation (above 5 dB SPL) occurred in high-frequency areas (16 and 20 kHz) on day 2, and in middle frequency areas (10 and 12 kHz) on day 5 with sensorineural hearing loss type intensity-latency curves. By day 14, the elevated thresholds had returned to pre-instillation levels. In the lowest areas (4 and 8 kHz), no significant threshold elevation was detected at any time during the observation period. By light microscopy, on day 1, clusters of inflammatory cells (predominantly neutrophils) were observed just outside the round window membrane (RWM), while only a few neutrophils were detected in the cochlea. These cells were still present outside the RWM on day 2. The neutrophils had disappeared by day 5 and only macrophages were present on the middle ear side of the RWM. However, throughout the observation period, the organ of Corti and stria vascularis appeared to be intact. These results suggest that IL-8 in the middle ear cavity is able to influence inner ear function.

Animals↗

PubMed1998

Round window administration of gentamicin: a new method for the study of ototoxicity of cochlear hair cells.

Damage to inner ear sensory hair cells after systemic administration of ototoxic drugs has been documented in humans and animals. Birds have the ability to regenerate new hair cells to replace those damaged by drugs or noise. Unfortunately, the systemic administration of gentamicin damages both ears in a variable fashion with potentially confounding systemic drug effects. We developed a method of direct application of gentamicin to one cochlea of hatchling chickens, allowing the other ear to serve as a within-animal control. We tested variables including the vehicle for application, location of application, dosage, and duration of gentamicin exposure. After 5 or 28 days survival, the percent length damage to the cochlea and regeneration of hair cells was evaluated using scanning electron microscopy. Controls consisted of the opposite unexposed cochlea and additional animals which received saline instead of gentamicin. Excellent damage was achieved using gentamicin-soaked Gelfoam pledgets applied to the round window membrane. The percent length damage could be varied from 15 to 100% by changing the dosage of gentamicin, with exposures as short as 30 min. No damage was observed in control animals. Regeneration of hair cells was observed in both the base and apex by 28 days survival.

Animals↗

PubMed1990

[Transmission of changes in the external ear atmospheric pressure to the perilymph].

Using guinea pig, pressures in the external ear canal, in the middle ear and in the perilymph were registered simultaneously, while pressure was applied to the external ear canal using an impedance audiometer. In the first experiment, applied pressure was changed in the range from 200 mmH2O to -200 mmH2O with and without the opening of the otic bulla. The change in the perilymphatic pressure with the opening was smaller than that without the opening. The result indicates that the external ear pressure is transmitted to the perilymph not only via the ossicular chain but also via the middle ear cavity without the opening, while it is exclusively transmitted via the ossicular chain with the opening. Pressure transmission to the perilymph was significantly impaired either by disrupting the ossicular chain or by closing the round window niche, especially by the latter. Thus the middle ear cavity itself plays an important role in pressure transmission from the external ear canal to the perilymph mainly via the round window. In the second experiment, applied pressure to the external ear canal was changed in the range from 1000 mmH2O to -1000 mmH2O after the Eustachian tube being closed. Between 400 mmH2O and -200 mmH2O, the middle ear and perilymphatic pressures paralleled well with the applied pressure. Beyond these levels, the middle ear pressure increased or decreased in response to the applied pressure but the perilymphatic pressure reversed against the middle ear pressure. Communication between perilymph and cerebrospinal fluid via the cochlear aqueduct is thought to be a major factor causing this reversal which, in turn, aggravates pressure gradient between the middle ear and the perilymph.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Multidirectional tomography in otospongiosis.

Eight clinical situations are best examined by polytomography, namely, ossicular chain disruption, malleus fixation, assessing the extent of footplate fixation, delineating cochlear otospongiosis, postoperative studies of unsuccessful cases, developing an anatomic map preoperatively with particular reference to the intratympanic course of the facial nerve, ruling in or out the rare closure of the round window by otospongiosis, and differentiation of the congenital footplate fixation from true otospongiosis. We discuss each of these situations briefly.

Cochlea↗

PubMedDate not supplied

Use of the pinna reflex as a test of hearing in mutant mice.

Although it is a gross measure, the pinna reflex test is easily administered and is, therefore, incorporated as a general screening tool in mutagenesis programs. Our recent application of this approach indicated that mutant mice lacking one of the small Maf proteins, in this case MafG, failed to exhibit a pinna reflex. In contrast, littermate controls, with the same mixed 129/CD1 background, and including both wild type and heterozygous mutant animals, passed the test. Because previous studies indicate that mafG is expressed in both cochlear and vestibular parts of the mouse inner ear, the source of this 'presumed deafness' was further assessed by making round window recordings to determine compound action potential thresholds. Auditory brainstem responses were also acquired to assess function along portions of the central auditory pathway. In all cases, responses in homozygous mutants (-/-) were comparable to those obtained from littermate controls, either wild type (+/+) or heterozygous mutants (+/-). Gross anatomy of the organ of Corti was also found to be similar in all three groups of mice. Hence, the lack of a pinna reflex must relate to nonauditory causes.

Acoustic Stimulation↗