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Endolymphatic hydrops in perilymphatic fistula.

Cochlear hydrops was produced either by injecting artificial perilymph into the subarachnoid space or by sucking perilymph through the round window membrane. The animals were either vitally fixed immediately or kept alive for 1 to 3 months before fixation. Conventional celloidin embedding method was used for serial sectioning. Animals with cochlear hydrops were selected from among 56 guinea pigs; 13 animals were used for the present observation. The cochleas of these animals showed slight to moderate hydrops, while the vestibule and semicircular canals demonstrated either a normal or collapsed endolymphatic space. The pars superior does not develop hydrops. Changes in the saccular wall were not pronounced. One animal developed marked cochlear hydrops with atrophy of both Corti's organ and stria vascularis. The vestibule and semicircular canals showed marked collapse. The ductus reuniens and the saccule were completely obstructed. Marked cochlear hydrops was produced by blocking the longitudinal flow of endolymph. It is assumed that there may be cochlear hydrops in clinical cases of perilymphatic fistula, with various pathologies of the endolymphatic space of the vestibule and semicircular canals.

Animals↗

Induction of experimental endolymphatic hydrops by immunologic techniques.

Immunologic techniques have been used by many investigators to produce experimental endolymphatic hydrops models. These techniques, however, have achieved little success in producing models simulating the idiopathic endolymphatic hydrops of Meniere's disease, in which no inflammatory changes occur in the perilymphatic spaces. In this study, the antigen horseradish peroxidase (HRP) was injected into the endolymphatic sacs of ninety guinea pigs that had been systematically sensitized to this antigen. Endolymphatic hydrops was induced in sixty-seven of the subjects, sixty-four of which showed no inflammatory changes in the perilymphatic spaces. The endolymphatic sacs of the affected guinea pigs were packed with soft granulation tissue induced by immunologic mechanisms; it is felt that the hydrops was caused by disturbances in endolymph absorption resulting from these tissue formations. Our results suggest that the introduction of antigens into the endolymphatic sac may prove useful in producing endolymphatic hydrops with characteristics similar to those occurring in Meniere's disease.

Animals↗

Perilymph fistula: an important cause of deafness and dizziness in children.

This study underscores the importance of considering a perilymph fistula, an abnormal communication between the inner and middle ear, in any child with a progressive sensorineural hearing loss. A concomitant complaint of intermittent dizziness or observed spells of imbalance (56%) is another indication of the disease. Six of 16 patients (37.5%) with proven fistulas were less than 2 years of age at the onset of symptoms. Unless the fistula is identified and repaired by grafting, the ear may become totally deaf. This would be disastrous in the presence of bilateral fistulas, which occur commonly in children (56% of patients had symptoms of bilateral disease). Our experience in recognizing and treating fistulas and thereby saving and restoring hearing is described.

Adolescent↗

[Mathematic model of the cupuloendolymphatic system for various densities of cupula and endolymph].

This paper presents a mathematical model of time-course variations of the cupulo-endolymphatic system which can be described by the Steinhauzen phenomenological equation for the case of a unidimensional toroid, assuming that the densities of the cupula and endolymph are identical. If the densities are different, the time-course variations of the cupuloendolymphatic system may aggravate and manifest at the powered stages of space flight.

Acceleration↗

Large perilymph fistulas.

Perilymph fistulas may manifest themselves either by otologic symptoms, as in cases of small fistulas, or primarily through neurologic symptoms, as with large fistulas. A case history is presented of a 3-year-old girl with recurrent bouts of meningitis who was found to have a large perilymph fistula. She had a right undeveloped cochlea and labyrinth, as well as multiple defects of the medial wall of her middle ear. The only way of preventing the recurrent bouts of bacterial meningitis in cases of large perilymph fistulas is surgical repair. Our conclusion is that, considering the problems involved in cases of large congenital perilymph fistulas, a simple closure of the fistula is not sufficient and the method of choice is obliteration of a deeper structure--such as the vestibule itself.

Child, Preschool↗

[Critical remarks on the interpretation of the thermal reaction of the labyrinth to weightlessness and evidence for the validity of the extended Bárány theory].

The literature on the biophysics of the vestibular apparatus in weightlessness is reviewed. The results of caloric in the prone position are compared to those in the supine position. The rate of convection and expansion of the endolymph are evaluated. Bárány's theory continues to be valid, because the rate of convection forms a greater proportion of the effective total stimulus than expansion.

Caloric Tests↗

[Perilymph fistulas--symptoms and indications for tympanoscopy].

In the last two years thirteen cases of perilymph fistula were treated by tympanoscopy and covering with connective tissue. Recovery of hearing was not observed in 4 totally deaf ears, but improvement was recorded in each of 9 cases with impaired hearing. Vertigo disappeared in 10 of 11 cases without any correlation with the degree of hearing loss. We perform tympanoscopy in suspected perilymph fistula, because prognosis is uncertain, spontaneous recovery with remaining defects may induce ménièriform syndrome, and pathway of infection should be closed. The diagnosis of a perilymph fistula must be solidified in cases of sudden deafness with vertigo, sudden hearing loss changing to the worse during medical treatment, sudden hearing loss without recovery during medical treatment, sudden hearing loss and subsequent onset of vertigo.

Adult↗