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Biophysical basis for inner ear decompression sickness.

Isolated inner ear decompression sickness (DCS) is recognized in deep diving involving breathing of helium-oxygen mixtures, particularly when breathing gas is switched to a nitrogen-rich mixture during decompression. The biophysical basis for this selective vulnerability of the inner ear to DCS has not been established. A compartmental model of inert gas kinetics in the human inner ear was constructed from anatomical and physiological parameters described in the literature and used to simulate inert gas tensions in the inner ear during deep dives and breathing-gas substitutions that have been reported to cause inner ear DCS. The model predicts considerable supersaturation, and therefore possible bubble formation, during the initial phase of a conventional decompression. Counterdiffusion of helium and nitrogen from the perilymph may produce supersaturation in the membranous labyrinth and endolymph after switching to a nitrogen-rich breathing mixture even without decompression. Conventional decompression algorithms may result in inadequate decompression for the inner ear for deep dives. Breathing-gas switches should be scheduled deep or shallow to avoid the period of maximum supersaturation resulting from decompression.

Adult↗

BMP pathways are involved in otic capsule formation and epithelial-mesenchymal signaling in the developing chicken inner ear.

The vertebrate inner ear consists of a complex labyrinth of epithelial cells that is surrounded by a bony capsule. The molecular mechanisms coordinating the development of the membranous and bony labyrinths are largely unknown. Previously, using avian retrovirus encoding Noggin (RCAS-Noggin) or beads soaked with Noggin protein, we have shown that bone morphogenetic proteins (BMPs) are important for the development of the otic epithelium in the chicken inner ear. Here, using two additional recombinant avian retroviruses, dominant negative and constitutively active forms of BMP receptors IB (BMPRIB), we show that BMPs, possibly acting through BMPRIB, are important for otic capsule formation. We also show that Bmp2 is strongly expressed in the prospective semicircular canals starting from the canal outpouch stage, suggesting that BMP2 plays an important role in canal formation. In addition, by correlating expression patterns of Bmps, their receptors, and localization of phosphorylated R-Smad (phospho R-Smad) immunoreactivity, an indicator of BMP activation, we show that BMPs emanating from the otic epithelium influence chondrogenesis of the otic capsule including the cartilage surrounding the semicircular canals.

Animals↗

Laboratory diagnosis of immune inner ear disease.

Immune inner ear disease is a relatively new and distinct clinical entity that produces unexplained, rapidly progressive, bilateral sensorineural hearing loss. The diagnosis is based on clinical manifestations, positive immune laboratory testing, and beneficial response to a trial of corticosteroids. Immune laboratory tests are used to confirm a presumptive clinical diagnosis. The two tests most commonly used are the lymphocyte transformation test and Western blot immune assay. The rationale behind these tests is presented, and the role they play in laboratory diagnosis of immune inner ear disease is discussed.

Antibodies↗

Presence of mRNA for vasoactive intestinal polypeptide (VIP) and its receptor in the rat inner ear.

Although mechanisms regulating inner ear fluid have not been yet elucidated, control of blood flow has been thought to be of great importance. Vasoactive intestinal polypeptide (VIP) was the first neuropeptide demonstrated in cerebrovascular nerves. To study the possible role of VIP in regulation of inner ear fluid, we investigated the presence of mRNA for VIP and VIP receptor in the rat inner ear using a reverse transcription-polymerase chain reaction (RT-PCR) method. A single band of the size expected for VIP and its receptor was detected in mRNA from the rat inner ear by using primers specific for VIP and the receptor. The nucleotide sequences of the subcloned RT-PCR products were identical to those of rat VIP and the rat lung VIP receptor. These results indicate that both VIP and VIP receptor are expressed in the inner ear of the rat and suggest that VIP may be implicated in regulation of fluid in the inner ear.

Animals↗

Blood-labyrinth barrier and fluid dynamics of the inner ear.

Under normal conditions, the inner ear possesses remarkably stable homeostatic mechanisms for the maintenance of functional integrity of the inner ear fluid. The inner ear fluid maintains its homeostasis by a variety of regulatory mechanisms such as an ion transport system, a blood-labyrinth barrier, and a constant blood supply. Highly regulated transport of ions into and out of the inner ear provides for the maintenance of inner ear fluid composition necessary for auditory transduction. Any disturbance in one of these mechanisms can disrupt homeostasis expressed by ionic, osmotic, or metabolic imbalance between the compartments. Free radicals, stress hormones, noise exposure, and aminoglycoside antibiotics may induce short- and long-term effects on cellular function of the auditory or vestibular system (or both) and serve as a triggering mechanism for abrupt functional disturbances of inner ear fluid ion homeostasis. In this article, we present a comprehensive review of the mechanisms underlying inner ear fluid homeostasis necessary for normal auditory function and factors that can disrupt homeostasis and lead to functional disturbances, namely sensorineural hearing loss, tinnitus, and vertigo.

Blood↗

Effects of middle ear pressure on the inner ear.

It was demonstrated in experiments on normal subjects that moderate ambient pressure changes, creating overpressure in the middle ear, may induce a vestibular reaction. In other experiments on subjects suffering from acute attacks of Meniere's disease, relief of symptoms was achieved by means of ambient pressure changes of the same magnitude.

Ear, Inner↗

[Relations between pure-tone threshold and discrimination of monosyllables in inner ear high-frequency hearing disorders].

To prove earlier studies with similar subjects (Lehnhardt 1973, 1977) we examined the report of 613 patients (1046 ears) with inner ear high frequency hearing disorders in order to find a correlation between the pure tone threshold and discrimination for monosyllables. The present data again confirm a close correlation between the pure tone hearing loss above 40 dB (HL) at the frequencies 3,000, 2,000 and 1,000 Hz and the percentage discrimination for monosyllables at 65 dB speech intensity level. Furthermore, in progressive high tone deafness with residual hearing in the low frequency range alone, correlations can be shown between the hearing loss above 40 dB in the frequencies 500 and 250 Hz on one hand and the discrimination for monosyllables at intensity levels of 80 and 95 dB on the other hand. These correlations have been converted into a table to enable a recognition of these connections without further calculation. They should be taken into consideration in routine audiometry and in legal cases especially. Greater differences in results indicate errors in testing or calibration; in individual cases they may be a hint of an uncommon origin of the hearing disease.

Adult↗

In vitro cultivation of the fetal guinea pig inner ear.

Fetal guinea pig inner ears, gestational age from 21 to 54 days, were cultivated in vitro and then observed with light and electron microscopes. Early 21-day gestation otocysts developed cartilaginous capsules from differentiating mesenchyme and discrete neurosensory structures from endolabyrinthine epithelium. Coiling of the cochlea occurred. Older, differentiated inner ears showed progressive increase in size and development of the labyrinth. The 26-day gestation cochlea, maintained for 12 days in vitro, doubled in size with development comparable to the 37-day gestation in vivo control. The large size of the guinea pig inner ear resulted in varying degrees of necrosis. However, the well-defined growth and development of the guinea pig fetal inner ear in vitro indicates the efficacy of the technique and suggests that similar success would be forthcoming with other animals used in audiologic research, such as chinchilla and hamster.

Age Factors↗

Effects of fluorodeoxyuridine on the developing inner ear of the rat.

The inner ear in rats develops from the surface ectoderm on day 8 of a 22-day gestational period. Labeled thymidine incorporation studies have indicated that in the developing inner ear most of the cells undergo terminal mitosis between gestational days 13 and 15. During this period the developing inner ear would be particularly vulnerable to environmental hazards. To test this hypothesis, pregnant rats were given a single intraperitoneal injection of 5-fluoro-2'-deoxyuridine (FUdR), an antimitotic substance, on gestational days 12 to 16. The rats also received one injection of 3H-thymidine 1 h prior to the removal of the fetuses. The animals were killed after various time intervals following the treatment, and the otocysts or inner ears were prepared for morphologic observations and biochemical assays. The cells in the inner ear of rats exposed to FUdR exhibited pyknotic nuclei and chromatolytic degeneration, and they eventually died. By 4 h after the administration of FUdR, pyknotic nuclei were seen in the antiluminal zone of the otic epithelium, and there was a substantial decrease in the number of the otic cells. This decline in cell number was seen until 24 h after treatment. However, the inner ears from the fetuses exposed to FUdR during gestational days 12--15 showed complete recovery from the toxic effects of the drug when examined on day 21 of gestation. The phenomenon of programmed cell death observed in the developing inner ear of the rat indicates that more cells are produced during the earlier stages of development than are required for the definitive adult structures. This phenomenon may represent an important protective feature. The redundant production of cells perhaps allows the developing otocysts to respond to an environmental stress by subtotal destruction of cells from the pool of undifferentiated cells, resulting in relatively fewer congenital anomalies of the inner ear.

Animals↗

Distribution of labeled chloroquine in the inner ear.

Autoradiography of the inner ear was performed at varying intervals following intravenous injection of either chloroquine tagged with carbon 14 (14C), or an iodine 125 (125l)-labeled analogue of chloroquine, in rats. In pigmented rats a strong accumulation and retention was noted in the melanin-bearing tissues. In the inner ear there was a very high concentration in the melanin-containing tissues, eg, the stria vascularis and the planum semilunatum. A strong retention was found in these structures 13 days after injection. Accumulation was not observed in the endolymph nor in the perilymph. No accumulation was found in the inner ear of an albino rat. The ototoxic effects of chloroquine may be caused by an accumulation of the drug in the melanin-containing structures in the inner ear, leading to pathological changes in these tissues and secondary lesions in the receptor cells.

Animals↗

Spiral modiolar vein: its importance in inner ear inflammation.

The inner ear responds immunologically to foreign proteins and pathogens introduced into the cochlea. The route of entry of the cells participating in the inner ear inflammatory process is the spiral modiolar vein with its collecting venules. Since this vein is located adjacent to the scala tympani, the end result of cellular infiltration is fibro-osseous obliteration of this scala preferentially. This observation has implications for the placement of cochlear implant electrodes of patients with labyrinthitis as the cause of hearing loss.

Adult↗

Expression of intercellular adhesion molecule-1 in immune response of inner ear.

To understand the role of intercellular adhesion molecule-1 (ICAM-1) in immune response of the inner ear, inner ear immune response was induced in rats by inoculation of keyhole limpet hemocyanine (KLH) into the scala tympani of the animals who had been systemically sensitized. The expression of ICAM-1 in the inner ear was immunohistochemically examined. ICAM-1 was found in the epithelium of the spiral modiolar vein (SMV) with its collecting venules (CVs) as early as 6 h after challenge. Expression of ICAM-1 was observed on the epithelium of the endolymphatic sac (ES) and perisaccular region at 12 h. The intensity of ICAM-1 staining reached its peak within 24-48 h in these sites of the inner ear. By day 28, most specimens were devoid of appreciable staining for ICAM-1. Our study demonstrates that adhesion molecules play an important role in extravasation of inflammatory cells from the systemic circulation in the process of inner ear immune response. It also shows that cytokines that control expression of adhesion molecules may be released by cells outside ES, besides those cells in the ES.

Animals↗

[Acute inner ear deafness].

Sudden inner ear hearing loss initially might suggest a psychogenic disorder of hearing, particularly when it is bilateral and simultaneous. The differential diagnosis includes disseminated encephalitis, syphilitic labyrinthitis and Cogan's syndrome. The history and cause of acute bilateral deafness in meningitis are easy to recognise. Furthermore, unilateral acute inner ear deafness should not be regarded as idiopathic without further consideration. A acoustic neuroma is a possible cause even of a low-tone hearing loss. More controversial is rupture of the round window membrane as a cause of sudden deafness. The deafness after epidemic parotitis obviously leads to a total unilateral hearing loss in every case. Even labyrinthine apoplexy with loss of hearing and vestibular function can be caused by a tumour of the cerebellopontine angle. Idiopathic sudden deafness should be defined as an acute sensory hearing loss whose anatomical basis in an acute vascular endolymphatic hydrops of unknown cause. The sudden deafness affects only one ear; tinnitus and brief vertigo can be accompanying symptoms. A sudden hearing disorder due to other causes should be distinguished from idiopathic lesions.

Audiometry, Evoked Response↗

Proinflammatory cytokine expression in the endolymphatic sac during inner ear inflammation.

The inner ear is capable of rapidly mounting an immune response that can ultimately lead to cochlear degeneration and permanent hearing loss. The role of the endolymphatic sac in this immune process is not clear. In order to investigate the cytokine expression of cells within the endolymphatic sac, a secondary inner ear immune response to keyhole limpet hemocyanin (KLH) was created in mice. The animals were sacrificed 3-48 h and 7 days following initiation of the immune response. The cochleas and endolymphatic sacs were assayed by immunocytochemistry for IL-1beta, TNFalpha, and IL-6. Three hours after KLH challenge of the scala tympani, the perisaccular tissue of the endolymphatic sac contained more inflammatory cells than the scala tympani or endolymphatic sac lumen. Only a few of these cells, however, expressed the proinflammatory cytokines IL-1beta and TNFalpha between 3 and 12 h after KLH injection. On the other hand, TNFalpha, which plays an important role in the cochlear secondary immune response, was expressed in cells in the endolymphatic sac lumen. The maximum percentage of cells expressing TNFalpha was seen later than in the scala tympani. Animals treated with systemic injection of the TNF blocker, etanercept, showed a reduction in the number of cells in the endolymphatic sac lumen. It is concluded that the cells in the endolymphatic sac lumen contribute to the amplification of the adaptive immune response by expressing TNFalpha, while the infiltration of cells into the perisaccular connective tissue is part of the nonspecific, innate, cochlear immune response.

Animals↗

[New animal experiments on aerobic and anareobic inner ear metabolism].

The inner-ear function is bound up with a permanent oxygen supply. The evidence of it are the patterns of the LDH subunits in inner-ear of eight species. The inner-ear energy turnover of glycolysis post-mortem was demonstrated at those species possessing glycogen storages. The MP2 are alterated by perfusion of glucose or iodoacetic acid. During oxygen respiration the MP are not decreased by iodoacetic acid.

Animals↗

Dan is required for normal morphogenesis and patterning in the developing chick inner ear.

During vertebrate inner ear development, compartmentalization of the auditory and vestibular apparatuses along two axes depends on the patterning of transcription factors expressed in a region-specific manner. Although most of the patterning is regulated by extrinsic signals, it is not known how Nkx5.1 and Msx1 are patterned. We focus on Dan, the founding member of the Cerberus/Dan gene family that encodes BMP antagonists, and describe its function in morphogenesis and patterning. First, we confirmed that Dan is expressed in the dorso-medial region of the otic vesicle that corresponds to the presumptive endolymphatic duct and sac (ed/es). Second, we used siRNA knockdown to demonstrate that depletion of Dan induced both a severe reduction in the size of the ed/es and moderate deformities of the semicircular canals and cochlear duct. Depletion of Dan also caused suppression of Nkx5.1 in the dorso-lateral region, suppression of Msx1 in the dorso-medial region, and ectopic induction of Nkx5.1 and Msx1 in the ventro-medial region. Most of these phenotypes also appeared following misexpression of the constitutively active form of BMP receptor type Ib. Thus, Dan is required for the normal morphogenesis of the inner ear and, by inhibiting BMP signaling, for the patterning of the transcription factors Nkx5.1 and Msx1.

Animals↗

A syndrome with mixed deafness, Mozart ear, middle and inner ear dysplasias.

A 10-year-old boy presenting a disorder of multiple malformations with an otologic component consisting of mixed deafness, Mozart ear, thin stapes, small oval window and agenesis of the semicircular canals, was studied. A comparative analysis of similar malformation-entities has permitted the delineation of a previously undescribed syndrome.

Abnormalities, Multiple↗