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[Malformation of the internal ear and recurrent meningitis: radio-surgical correlations].

Authors report one case of bilateral inner ear malformation in a 3 years-old child with congenital sensorineural hearing loss, recurrent meningitis and cerebro-spinal fluid leakage. This anomaly is a pseudo-Mondini's malformation with a meningocele through the oval window and a fistula of C.S.F. of the round window. A close radiological and surgical correlation support some physiopathological hypothesis about fistula between sub arachnoid space and middle ear. Authors discuss the place of high resolution computed tomography in case of congenital sensorineural learning loss.

Child, Preschool↗

A case of salivary gland choristoma of the middle ear.

The authors present a case of tympanic cavity salivary gland adenochoristoma in association with an abnormal course of the facial nerve, absence of the oval and round windows, absence of the stapes, hypoplasia of the long process of the incus, and the existence of a subtympanic bony lamina.

Choristoma↗

Experimental basis for lidocaine therapy in cochlear disorders.

In order to further our basic understanding of the effects of lidocaine hydrochloride in the inner ear, cochlear potentials and blood flow (CBF) were assessed after intravenous (i.v.), anterior inferior cerebellar artery (AICA), and local round window (RW) lidocaine administrations in guinea pigs and rats. Lidocaine RW applications produced a dose dependent decrease in compound action potentials (CAP) and cochlear microphonics (CM). The sensitivity changes were more pronounced at high frequencies. These findings suggest that lidocaine has specific pharmacological action in the inner ear other than simple anesthesia of the auditory nerve. The basal turn endocochlear potentials (EP) were not altered by topical lidocaine, implicating altered organ of Corti function following local application of lidocaine. RW applications of lidocaine had no effect on CBF or systemic blood pressure (BP). I.v. infusions caused substantial reductions in BP. In the case of systemic infusions the percent changes in CBF were equal to and accountable by the BP changes. The microinfusions (50 mg/ml, 100 nl/min) through AICA produced a 30%, long lasting increase in CBF. However, neither systemic lidocaine nor AICA infusions had an effect on CAP or CM. These findings indicate that systemically given lidocaine may not cross the blood-cochlear barrier and that the cochlear electrophysiological effects due to lidocaine when given locally are partly mediated by direct influence on cochlear hair cell function; they also suggest that lidocaine-induced interference with active ion transport in the lateral wall or an influence on CBF are not contributing factors.

Action Potentials↗

[Sudden hearing loss in inner ear trauma].

Quite often a sudden surdity can appear after baro or mechanical traumas, it happens because of rupture of the round window membrane which leads to the formation of the perilymphatic fistula. The article deals with the syndrome of the round window membrane rupture. The authors describe two successful cases of treatment of patients with vestibular disorders caused by posttraumatic perilymphatic fistula. Practical recommendations are given for providing a tertiary medical care in emergency situations.

Adult↗

Some pitfalls in the evaluation of auditory function after surgical procedures.

Because clinical bone conduction is composed of at least three different mechanisms, two of which are air conduction, uncritical use of the air-bone gap in connection with surgical procedures may give rise to erroneous conclusions. Genuine bone conduction may be influenced by ear pathology and by surgery due to alterations in the mechanical impedance at the site of application of the bone vibrator and at the round and oval windows. The supplementary use of impedance audiometry and advanced speech audiometry is recommended.

Acoustic Impedance Tests↗

Inner ear injury caused by air intrusion to the scala vestibuli of the cochlea.

In a previous communication, we demonstrated that the introduction of air into the scala tympani of the cochlea causes a decrease of cochlear potentials; however, the change in endocochlear dc potential (EP) was mild and the decreased cochlear microphonics (CM) and compound action potentials (CAP) were, at least partially, reversible. In contrast, we have now found that air perfusion (3-60 microliters/min) in the scala vestibuli decreased cochlear potentials more drastically than that in the scala tympani. The change in the EP after air perfusion in the scala vestibuli was characterized by a decrease of the negative EP in response to anoxia. The CM drastically decreased upon the initiation of air perfusion and no recovery was observed after refilling of the perilymph. Histological examination showed collapse of Reissner's membrane in 12 out of 17 cochleas examined. The extent and frequency of the collapse increased with an increase in the amount of air perfused in the scala vestibuli. As the minimal amount of air needed to cause inner ear damage by air perfusion in the scala vestibuli is as small as 3 microliters, it is possible that the prognosis is worse in cases with fistula of the oval window compared to that of the round window area, if the pneumolabyrinth is involved in the pathophysiology of perilymphatic fistula. It is also indicated that air inflation of the middle ear is dangerous in cases with fistula in the oval window.

Air↗

The Berlin cochlear implant--surgical concept.

The extent of channel interactions using monopolar extrascalar stimulation probably limits the number of independently acting electrodes of a cochlear implant to three. Comparison of psychoacoustic and histopathological findings led to the conclusion that stimulation of the neurons in the upper basal and the second coil is of greatest benefit to the patient. By using a middle fossa approach, access to the upper basal coil and the second coil is possible without destruction of middle ear structures. The danger of infection is probably reduced. Using an additional external round-window electrode, a device providing three different stimulating electrodes can be applied.

Cochlea↗

[Cochlear morphological changes over time after the introduction of bacterial endotoxin into the middle ear].

Guinea pigs weighing 350 g each were used in this experiment. A small piece of Gelform containing 0.04 mg of E. coli derived endotoxin was set on the round window 24 hours after intraperitoneal injection of 0.02 mg endotoxin. Morphological changes in the cochlea were observed at 24 hours (previous report), 48 hours, 72 hours and 7 days after the introduction of the endotoxin into the middle ear. As the results of the morphological changes of cochlea at 24 hours after the introduction of the endotoxin were reported in previous paper we present only an outline of these. Inflammatory cell infiltration and bleeding were observed in both endolymphatic and perilymphatic spaces. Inflammatory cells also infiltrated the stria vascularis, spiral ligament, spiral prominence and organ of Corti. Almost all of the inflammatory cells were neutrophils. Blood sludge was observed in all of the strial capillaries of the upper three turns. The hair cells were intact in every turn except for having small vacuoles. Intermediate cells and marginal cells of the stria vascularis were shrunken. At 48 hours after the introduction of the endotoxin into the middle ear, the changes in the stria vascularis were almost the same as at 24 hours. However the infiltrated inflammatory cells changed from neutrophils to macrophages. Macrophages had phagocytosed many neutrophils. The hair cells had many large vacuoles. At 72 hours, the enlargement of the intercellular space in the stria vascularis disappeared and damage to the hair cells decreased although many macrophages were still observed. At 7 days, the cochlea was morphologically normal.

Animals↗

[Late sequelae following laterobasal fractures, therapeutic and forensic viewpoints].

Report on two cases of temporal bone fracture with unilateral profound deafness and vestibular dysfunction. The other ear was apparently not involved. After 4, respectively 18 years, a sudden hearing loss occurred in the second ear, fluctuating and associated with acute vestibular symptoms. On operation we found in the first case a perilymph fistula in the round window, in the second case a gaping fracture in the promontory. A retrospective study of 527 cases of "sudden hearing loss" revealed 11 more cases with similar histories that must be regarded as sequelae of the head trauma. The latency between trauma and onset of hearing loss in the second ear ranged from 4 to 33 years. Discussion of the pathomechanism of the trauma, therapeutic and medico-legal issues.

Adult↗

Spectrum of middle and inner ear abnormalities in infants with congenital heart defects.

OBJECTIVE: To evaluate temporal bone histopathology in infants with congenital heart defects (CHD). STUDY DESIGN AND SETTING: A retrospective review of our temporal bone collection was conducted to identify temporal bones acquired from infants with CHD. Subjects were divided into nonsyndromic and syndromic CHD groups. The presence of temporal bone abnormalities and the incidence of abnormalities that may result in hearing impairment were determined. RESULTS: Thirty-eight temporal bones obtained from 16 infants with nonsyndromic CHD and 4 with syndromic CHD were evaluated. Nonsyndromic CHD cases had abnormalities such as a mesenchymal remnant, malformed stapes, persistent stapedial artery, shallow round window, dehiscent facial nerve canal, short cochlea, strial basophilic deposits, deformity of the spiral ligament, bulging Reissner's membrane, hypoplastic lateral semicircular canal, and cupular deposits. Syndromic CHD cases had abnormalities including narrow round window niche, facial canal dehiscence, strial basophilic deposits and cysts, and outer hair cell loss. Middle and inner ear abnormalities that may impair hearing were observed in 6 subjects with nonsyndromic CHD and in 1 subject with syndromic CHD. CONCLUSIONS: A wide variety of temporal bone defects were documented in infants with CHD. Congenital middle and inner ear abnormalities should be anticipated in the hearing assessment and otologic surgery of infants with CHD.

Abnormalities, Multiple↗

Surgical techniques for cochlear implantation of the malformed inner ear.

OBJECTIVE: The objective was to describe surgical techniques helpful in implanting children with inner ear malformations. STUDY DESIGN: This was a retrospective chart review and description of surgical techniques in the setting of a tertiary referral center. PATIENTS: The study population was composed of 10 children with inner ear deformities who received 22-channel implants. RESULTS: The primary surgical challenges encountered in these procedures include complete electrode insertion, cerebrospinal fluid gusher, identification of cochleostomy site in the absence of the round window and aberrant facial nerve, and fixation and stabilization of the electrode. CONCLUSIONS: The techniques described allow safe and effective insertion of multichannel electrodes in patients with inner ear malformations.

Child↗

The permeability of SPION over an artificial three-layer membrane is enhanced by external magnetic field.

BACKGROUND: Sensorineural hearing loss, a subset of all clinical hearing loss, may be correctable through the use of gene therapy. We are testing a delivery system of therapeutics through a 3 cell-layer round window membrane model (RWM model) that may provide an entry of drugs or genes to the inner ear. We designed an in vitro RWM model similar to the RWM (will be referred to throughout the paper as RWM model) to determine the feasibility of using superparamagnetic iron oxide (Fe3O4) nanoparticles (SPION) for targeted delivery of therapeutics to the inner ear. The RWM model is a 3 cell-layer model with epithelial cells cultured on both sides of a small intestinal submucosal (SIS) matrix and fibroblasts seeded in between. Dextran encapsulated nanoparticle clusters 130 nm in diameter were pulled through the RWM model using permanent magnets with flux density 0.410 Tesla at the pole face. The SIS membranes were harvested at day 7 and then fixed in 4% paraformaldehyde. Transmission electron microscopy and fluorescence spectrophotometry were used to verify transepithelial transport of the SPION across the cell-culture model. Histological sections were examined for evidence of SPION toxicity, as well to generate a timeline of the position of the SPION at different times. SPION also were added to cells in culture to assess in vitro toxicity. RESULTS: Transepithelial electrical resistance measurements confirmed epithelial confluence, as SPION crossed a membrane consisting of three co-cultured layers of cells, under the influence of a magnetic field. Micrographs showed SPION distributed throughout the membrane model, in between cell layers, and sometimes on the surface of cells. TEM verified that the SPION were pulled through the membrane into the culture well below. Fluorescence spectrophotometry quantified the number of SPION that went through the SIS membrane. SPION showed no toxicity to cells in culture. CONCLUSION: A three-cell layer model of the human round window membrane has been constructed. SPION have been magnetically transported through this model, allowing quantitative evaluation of prospective targeted drug or gene delivery through the RWM. Putative in vivo carrier superparamagnetic nanoparticles may be evaluated using this model.

Journal Article↗

Tolerability of N-chlorotaurine in the guinea pig middle ear: a pilot study using an improved application system.

The tissue tolerance of N-chlorotaurine (NCT), a mild endogenous antimicrobial oxidant, has been investigated by application to the guinea pig middle ear. The animals were implanted with a novel cannula system that allows chronic external drug delivery to the round window niche. In the first part of the study, 3 animals each received 100 microL of 0.1% NCT (5.5 mmol/L) and 1% NCT, respectively, in aqueous solution twice daily for 8 days. In the second part, NCT was dissolved in phosphate-buffered saline solution to 300 milliosmolar (isotonic), and 27 microL was injected in 3 additional animals twice daily for 7 days. The guinea pigs injected with 100 microL of NCT developed immediate dizziness and nystagmus and did not thrive. Other reactions included mucosal thickening in the middle ear, rupture of the tympanic membrane, and blood and gelatinous material in the cochlea accompanied by hair cell loss and a 10- to 90-dB elevation of the hearing threshold as determined by auditory brain stem responses. The effects seemed to be dose-dependent, but the rate of variability was high across animals. In contrast, the guinea pigs treated with 27 microL of isotonic NCT showed no signs of discomfort, no or only moderate thickening of the middle ear mucosa, no shift of the hearing threshold, and no hair cell loss. Positive control animals injected with 10% neomycin sulfate developed extensive hair cell loss. Provided that the membranes of the inner ear are intact and that low single-dose volumes are used to avoid increased middle ear pressure, isotonic NCT seems to be well tolerated in the tympanic cavity. The new drug delivery system proved to be advantageous for ototoxicity studies.

Animals↗

Quinine-induced hearing loss in the guinea pig is not affected by the Ca2+ channel antagonist verapamil.

It is well documented that quinine induces reversible hearing loss and tinnitus. The purpose in this study was to induce a quinine hearing loss and to investigate if verapamil, a Ca2+ channel antagonist of L-type might affect the response. Pigmented guinea pigs (n = 24) were anaesthetized by atropine. Hypnorm and midazolam but permitting spontaneous respiration. An electrode of platinum was placed on the round window and short (10 msec) tone pulses at 8 kHz were presented to the external ear. A typical deflection of the N1-wave was determined as the hearing threshold. Quinine hydrochloride 40 mg/kg and verapamil 1 mg/kg were given intravenously. Quinine induced a significant and reversible hearing loss (mean 16 dB). This hearing loss was not at all affected by verapamil given before or after quinine. Verapamil often caused acute cardiac arrest and particularly the combination verapamil followed by quinine-induced death to the animal. We conclude that verapamil and quinine had no in vivo interaction with regard to the hearing ability.

Animals↗

The use of a temporary extracochlear electrode in preoperative testing of permanent implant candidates.

This paper describes hearing and speech perception in 9 post-lingually deaf adults fitted with a temporary single electrode, surgically positioned close to the round window niche. After baseline testing, unaided and aided binaurally with the high-power Phonic Ear PE 845, each subject was admitted to hospital for a period of 7 days. During each test session, stimuli were presented directly to the electrode lead by means of an isolation unit. Current thresholds, upper tolerable limits and gap detection were measured for various acoustical waveforms and stimulus frequencies. A laryngograph was used to test the discrimination of prelinguistic and suprasegmental speech features. The results indicated that the prosthesis could provide acoustic sensations of loudness, pitch and duration that changed with stimulus waveform, level of current and frequency, and a gap threshold less than 50 msec. Lipreading appeared to be a necessary adjunct for consonant discrimination.

Adult↗

Meniere's disease: the incidence of hydrops in the contralateral asymptomatic ear.

OBJECTIVE: This study analyzes the incidence of endolymphatic hydrops in the asymptomatic contralateral ear of patients with classic Meniere's disease. STUDY DESIGN: A retrospective study of 3000 subjects who underwent electrocochleography (ECOG) from 1988 to 1998. METHODS: The presence of endolymphatic hydrops was determined by use of ECOG recordings, which were made through a transtympanic recording needle situated in the round window niche. Analysis was made of the 1-kHz toneburst summation potential (SP), and comparison was made between asymptomatic contralateral "Meniere's ears" (n = 144) and asymptomatic normal "control ears" (n = 114). RESULTS: Results demonstrated that more than 10% of the contralateral asymptomatic Meniere's ears have an ECOG recording that is highly suggestive of the presence of endolymphatic hydrops. In contrast, less than 2% of the control population demonstrate abnormal ECOG recordings. Furthermore, 15% of the population of contralateral Meniere's ears lie above the 95th percentile of the control population for 1-kHz tone-burst (100 dB) SP negativity. CONCLUSIONS: This study suggests that a high percentage of patients who have what appears to be unilateral Meniere's disease have evidence of endolymphatic hydrops in the contralateral asymptomatic ear. This finding has important clinical relevance for the management of patients in whom destructive surgery is planned and further highlights the importance of electrocochleography in the diagnosis and management of this disease process.

Audiometry, Evoked Response↗