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The flow of endolymph in the semicircular canals.
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Dissociation of maximum concentration of kanamycin in plasma and perilymph from ototoxic effect.
Kanamycin was administered in total daily doses of 0 (vehicle), 100, 200 or 300 mg/kg to different groups of guinea pigs for two weeks. These total daily doses were administered according to three different dosing schedules, either as a single injection given once a day, divided into two equal doses and given twice a day, or divided into four equal doses and administered four times a day. It was found that the magnitude of the ototoxicity resulting from kanamycin administration was related to the total daily dose alone and not the dosing schedule. This lack of relationship between the dosing schedule and the magnitude of the ototoxicity due to kanamycin is the reverse of that reported for the nephrotoxicity resulting from gentamicin, tobramycin and netilmicin.
Otitis media and congenital perilymphatic fistula as a cause of sensorineural hearing loss in children.
In all infants and children who have progressive, fluctuating or sudden sensorineural hearing loss, the possibility of a congenital perilymphatic fistula should be considered. Factors determined to be highly suggestive of the presence of a congenital perilymphatic fistula as the cause of sensorineural hearing loss or vertigo, or both, include the following: mixed conductive and sensorineural hearing loss; antecedent sudden physical exertion or barotrauma; congenital deformities of the external ear and head; and abnormal findings on computed tomograms of the temporal bone, especially Mondini-like ear dysplasias. In a series of 37 children who had a congenital perilymphatic fistula treated at the Children's Hospital of Pittsburgh, 28 (76%) had had documented otitis media in the past or a history of middle ear disease. This finding should alert the clinician to the possibility of the presence of a congenital perilymphatic fistula when sensorineural hearing loss develops or progresses during an episode of otitis media. Perilymphatic fistula is caused by either congenital ossicular deformities or abnormalities of the labyrinthine windows or coexistence of both conditions. The likelihood of there being no further deterioration in hearing after surgical repair of a perilymphatic fistula is high. Every infant and child with unexplained hearing loss or disequilibrium or both deserves an attempt to uncover the cause at the earliest possible age.
Limitations of single point pharmacodynamic analysis.
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The surgical treatment of vertigo.
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Shunt surgery in Meniere's disease.
This is a clinical study of the results of endolymphatic sac shunt surgery for Meniere's disease in 28 patients. Postoperative audiometric results and clinical evaluation of vertigo and tinnitus were analyzed to determine the effectiveness of this form of treatment. Although this is a small study and the time interval since operation is of only moderate duration (6 to 46 months), the results are encouraging: 79% of the patients showed improvement or stabilization of hearing as well as control of vertigo.
Perilymph fistula.
Perilymph fistula occurs when endolymph and perilymph mix, or when perilymph leaks into the middle ear space. Sensorineural hearing loss and/or vertigo may result. This paper reviews the pertinent anatomy and physiology of the inner ear, clinical presentations, diagnosis, treatment, and prognosis as a guide for the clinician.
Perilymph fistula: the Iowa experience to date.
This is a follow-up report to the Seltzer-McCabe paper, which appeared in Laryngoscope (1986; 96:37-49). The reader is referred to that article for details of operations, patient selection, and baseline data. This is merely an update.
Perilymph fistulas in children: experience of the Otologic Medical Group.
We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS)
Congenital perilymphatic fistula: an overlooked diagnosis?
Congenital perilymphatic fistula (CPLF) often is the sole cause of sensorineural hearing loss in children that is both progressive and subtle and, therefore, can elude detection by physicians. A 3-year prospective study of 244 children with sensorineural hearing loss of unknown etiology demonstrated that at least 6% (15/244) had CPLF. Close audiologic monitoring and radiologic imaging of the temporal bone of children with sensorineural hearing loss are recommended to detect CPLF.
Perilymphatic fistula in pediatric patients with a preexisting sensorineural loss.
A specific group of 28 children (38 ears) with a preexisting sensorineural hearing loss (SNHL) was studied to determine if a perilymphatic fistula (PLF) was the cause of a progression in their hearing loss. A PLF was identified surgically in six of these ears, but there was no evidence of any defect found in 32 ears. The symptoms shared by the cases in which a fistula was found included a traumatic event (including exertion), CT scan evidence of inner ear defects, hearing threshold decreases of 25 to 30 dB, and vertigo or postural instability.
Aquaporins and Meniere's disease.
PURPOSE OF REVIEW: Review of the role of aquaporins in inner ear homeostasis and potential role in the pathogenesis of Meniere's disease. RECENT FINDINGS: Recent findings include the immunolocalization of aquaporins in the inner ear of mouse, rat, and human to cell types that are likely to undergo high ionic perturbances (e.g. potassium flux) and to putative areas of endolymph resorption or cycling. SUMMARY: The expression of aquaporins and related proteins in the human cochlea and vestibular periphery resembles the distribution found in animal models, suggesting a critical role of aquaporins in inner ear water homeostasis and their potential role in the pathogenesis of Meniere's disease.
Observations on the electrochemistry of the cochlear endolymph of the rat: a quantitative study of its electrical potential and ionic composition as determined by means of flame spectrophotometry.
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Dynamics of labyrinthine pattern formation in magnetic fluids.
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Perilymph fistulae.
A small series of 14 post-stapedectomy fistulae illustrates the varied aetiology. The long-term competence of the oval window seal may be ensured by making a small hole in the footplate. Contraction of ageing fibrous tissue contributes to late stapedectomy failures. Long-term follow-up is important, for any deterioration in hearing after stapedectomy may result from a perilymph leak.
Effect of diatrizoate meglumine (Hypaque) on the perilymphatic oxygen tension.
The effect of diatrizoate meglumine (Hypaque) upon the perilymphatic oxygenation has been investigated using the polarographic method in cats submitted to various conditions such as normoxia, apnea, hypercapnia and chronically reduced vascularization. The minimal changes of the perilymphatic PO2 recorded after the injection of Hypaque permit to conclude that this drug has no practical effect upon the oxygenation of the perilymph.
Labyrinthine window rupture with round window predominance: a long-term review of 32 cases.
A retrospective series is presented of 32 cases of spontaneous labyrinthine window rupture proven at tympanotomy. There was no prior history of stapedectomy or other middle ear surgery. Seventy-eight per cent of cases involved the round window, in contrast to previous series on the subject. The pattern of hearing loss and vestibular symptoms varied widely and followed different antecedent factors, the commonest of which was head injury (46.9%). Including cases misdiagnosed initially, 92.9% of patients with vestibular symptoms experienced improvement following surgery, but only 20.7% of patients had improved hearing; these figures changed with long-term follow-up, which has been rarely reported previously. Seven patients, the majority oval window ruptures, required re-exploration, mainly for vertigo, and prolonged follow-up is required.