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Labyrinthitis secondary to experimental otitis media.

PURPOSE: Analysis of labyrinthitis in a model of otitis media. MATERIALS AND METHODS: Morphologic study in 20 Wistar rats in which otitis media was induced by transbullar inoculation of Pseudomonas aeruginosa with obstruction of the eustachian tube. RESULTS: Seventy percent of rats showed vestibular signs. Histologic changes ranged from nonaffected labyrinths to suppurative labyrinthitis. CONCLUSIONS: Dissemination of infection probably occurs through round window membrane. A thinner round window membrane typical of rodents would be the reason for a more severe clinical and morphologic picture in rats when compared to human beings.

Animals↗

Induction of labyrinthitis ossificans after pneumococcal meningitis: an animal model.

Newly formed disorganized bone fills the open spaces within the otic capsule in various pathologic conditions, resulting in labyrinthitis ossificans. The pathologic mechanisms of this disease remain poorly understood. To better study the sequence of events and contributing mechanisms involved in labyrinthitis ossificans, an animal model was developed. Three groups of Mongolian gerbils received either an intralabyrinthine injection of normal saline solution (group 1) or Streptococcus pneumoniae polysaccharide capsule antigens (groups 2 and 3). The temporal bones were harvested after 3 months and serially sectioned. None of the eight control animals (group 1), which received intralabyrinthine injections of normal saline solution had any histologic changes in their temporal bones. Nine of the surviving 19 animals in groups 2 and 3 had fibrosis or evidence of early ossification. A fourth group of Mongolian gerbils received two intrathecal injections of live S. pneumoniae organisms. The temporal bones were harvested after 3 months and serially sectioned. Fourteen of the surviving 15 animals had fibrosis or ossification or both. This animal model will provide a method for study of the mechanisms of labyrinthitis ossificans.

Animals↗

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and viral labyrinthitis: evidence of otolith-canal interaction.

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss alone) and viral labyrinthitis (cochleovestibular loss). MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was evaluated by conventional caloric and impulsive testing. A simplified model of vestibular function was used to analyze the vestibulo-ocular response to rotational stimulation. RESULTS: The results showed a significant difference in h-VOR characteristics between the two pathologies. Patients with vestibular neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR asymmetry between the two rotational directions. In contrast, patients with viral labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in rotation toward the affected ear. CONCLUSION: These findings support the hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral inner ear lesion is not due to canal dysfunction alone, but involves complex adaptive changes in the central VOR that may implicate the otolith system. Based on histopathologic and clinical differences in the two pathologies reported in the literature, we postulate that this otolith-canal interaction is mainly linked to the loss of saccular function.

Adolescent↗

"Floating" labyrinth. Pathophysiology and treatment of perilymph fistula.

Collapse of the membranous labyrinth of the pars superior is a morphological change observed in 50% of animals with experimentally produced perilymph fistula, although the extent and degree of the collapse may vary greatly. The moderately collapsed membranous labyrinth may drift with CSF and/or perilymph pressure changes and this may stimulate sensory cells of the utricle and/or semicircular canals if the sensory cells are intact and the collapsed wall is in contact with the otolithic membrane and/or cupula. This condition is termed "floating" labyrinth. Caloric irregularity is often observed in electronystagmograms recorded from animals with experimental perilymph fistula. This is also observed in patients with perilymph fistula. Partial destruction of the vestibular organs using argon laser was performed in a patient with perilymph fistula who was incapacitated because of persistent positional vertigo after closure of the oval window fistula. Irradiation of the argon laser beam was directed to the macula utriculi, utriculoampullary nerve and singular nerve. The hearing of the patient was maintained, and vertigo disappeared after laser labyrinthectomy.

Audiometry, Pure-Tone↗

Experimental autoimmune labyrinthitis induced by cell-mediated immune reaction.

This study was designed to establish an experimental cell-mediated autoimmune labyrinthitis model in C57BL/6 mice, which could exhibit high reproducibility and be adopted for precise immunological analysis. Inner ear antigen (IEA) was prepared from bovine membranous labyrinth. Following pretreatment with cyclophosphamide (CP) and primary sensitization with IEA/FCA, many inflammatory cells infiltrated transiently into the perilymphatic and endolymphatic regions of the cochlea, vestibule and the endolymphatic sac, but not into the kidney, lung, brain or liver. This reaction occurred from day 7 and peaked on day 12 in all animals, and then rapidly reduced. This reaction occurred in all experimental mice during day 10 to day 12. The control mice showed no cellular reaction in the inner ear. These results suggest that the inner ear may possess cross-species organ-specific antigen and that a cell-mediated immune reaction may play an important role in the induction of autoimmune labyrinthitis.

Animals↗

3D MRI of the in vivo vestibulo-cochlea labyrinth during Gd-DTPA-BMA uptake.

The morphology, time-course and volume of the in vivo uptake of the T1 contrast agent gadolinium (Gd) in the perilymphatic vestibulo-cochlea labyrinth, including the utricle, saccule, semicircular canals and scalae of the guinea pig inner ear were analyzed as Fourier transform signal intensity enhancement levels by 3D MRI at 4.7 T. The uptake of Gd as a function of time in the perilymphatic space of the vestibular labyrinth was shown by ANOVA and PLSD post hoc tests to be significantly less (p < 0.05) than that of the scala tympani of the cochlea 10, 30, 60 and 90 min after i.v. injection. Experimentally induced fistulae resulted in MRI detected morphological and quantitative alterations in Gd concentration in the perilymphatic labyrinthine space. The findings demonstrate that Gd-enhanced 3D MRI of the perilymphatic space may be used to examine the morphology, kinetics and intravenous substance delivery in the in vivo mammalian vestibulo-cochlea labyrinth.

Analysis of Variance↗

Effects of depletion of complement in the development of labyrinthitis ossificans.

HYPOTHESIS: Labyrinthitis ossificans results in part from the intense inflammatory response to Streptococcus pneumoniae cell wall components. Depletion of complement in Mongolian gerbils following induction of meningitis will reduce the degree of inflammation and subsequent cochlear fibrosis. STUDY DESIGN: Random prospective study. Histological evaluations were performed with the researcher blinded to the experimental group METHODS: S. pneumoniae meningitis was induced in 10 control and 18 experimental Mongolian gerbils with an intrathecal injection of the bacteria. Both groups of animals received treatment with penicillin. The experimental group was also treated with cobra venom factor to deplete complement in the animals. Three months after the induction of meningitis, the animals' temporal bones were harvested for histological evaluation. RESULTS: The decomplemented animals developed significantly less intracochlear fibrosis (P < .01). The mortality rate for the experimental group was 11% compared with 40% in the control group (P = .14). CONCLUSIONS: Reduction of the intense inflammatory response to the S. pneumoniae cell wall components in suppurative labyrinthitis secondary to bacterial meningitis reduced the degree of labyrinthitis ossificans.

Animals↗

Passive transfer of experimental autoimmune labyrinthitis.

The aim of the present study was to establish an animal model of autoimmune labyrinthitis using heterologous inner ear antigen (IEAg) and to elucidate whether the experimentally induced labyrinthitis could be passively transferred. Cochlear and vestibular membranous labyrinthine tissues from bovine temporal bones were used as IEAg. Donor mice were inoculated intracutaneously at multiple sites with an emulsion consisting of equal parts of IEAg and complete Freund's adjuvant. After 10 days, mononuclear cells were collected from lymph nodes, spleen and blood of the donor mice and injected intravenously into naive recipient mice. Cellular infiltration was observed in the perilymphatic space of the cochlea of all donor and recipient mice. Endolymphatic hydrops was also observed in 63% of donor and 42% of recipient mice. These findings suggest that the experimentally induced labyrinthitis observed in this animal model was probably due to an autoimmune reaction to the IEAg and was passively transferred by a cell-mediated immune reaction.

Animals↗

Ben H. Senturia lecture. Leaking labyrinth lesions, deafness, tinnitus and dizziness.

The remarkable integrity of the finely balanced membranous labyrinth is occasionally disrupted, resulting in fistulae of various types in a number of locations. Such leaking labyrinth lesions can be congenital origin, due to various types of malformations. They may be caused by destructive diseases such as syphilis, by many variants of acute and chronic otomastoiditis, and sequelae of otosclerosis surgery, and finally, as results of a variety of traumatic disruptions of labyrinthine integrity. Deafness dizziness, and tinnitus are frequent symptoms and sequelae may include meningitis and other intracranial complications. The clinical consideration of leaking labyrinth lesions must always be considered in otologic diagnoses.

Deafness↗

Fistulae in the membranous labyrinth.

Fistulization at various parts of the membranous labyrinth has been currently in use as one of the treatments for the symptoms of Meniere's disease. The present report concerns our experience with membranous fistulae in experimental animal ears with and without manifestation of endolymphatic hydrops. The materials presented are mostly new; however, our previous data are also incorporated in order to bring this issue into better perspective. The first part describes the nonproduction aspect of endolymphatic hydrops in the rat, chinchilla, and squirrel monkey after obliteration of the endolymphatic duct in relation to the occurrence of spontaneous fistulae. The second part describes surgical fistulization of the vestibular membranous labyrinth and cochlear duct in order to prevent or control development of endolymphatic hydrops in the guinea pig, the species in which hydrops can be produced consistently. These results are tabulated and analyzed in terms of the pathological consequences that can be expected in performing fistulization of the membranous labyrinths in animals as well as in humans.

Animals↗

Cochlear implantation in children: labyrinthitis following pneumococcal otitis media in unimplanted and implanted cat cochleas.

Pneumococcal otitis media is frequent in young children and could lead to labyrinthitis post-implantation. To assess the risk, and methods of minimizing it by a graft to the round window around the electrode entry point, we have used a cat animal model of pneumococcal otitis media. Twenty-one kittens were used in the study. Thirty-two cochleas were implanted when the kittens were 2 months of age. Fourteen cochleas were implanted without using a graft (12 were available for study); 9 had a fascial graft, and 9 a Gelfoam graft (7 were available for study). The implanted kittens had their bullae inoculated with Streptococcus pneumoniae 2 months after implantation and were sacrificed 1 week later. There were also 9 unimplanted control ears which were inoculated when the animals were 4 months of age. Labyrinthitis occurred in 44% of unimplanted control, 50% of implanted ungrafted, and 6% of implanted grafted (fascia and Gelfoam) cochleas. There was no statistically significant difference between the unimplanted control and the implanted cochleas (p < 0.05). There was, however, a difference between the implanted-ungrafted and implanted grafted cochleas, but not between the use of fascia and Gelfoam to graft the round window entry point. As a result, the data indicates that cochlear implantation does not increase the risk of labyrinthitis following pneumococcal otitis media, but it is desirable to use fascia as a graft to the round window around the electrode entry point.

Animals↗

Demonstration of intermediate filament proteins in the guinea pig vestibular labyrinth by a new, high-resolution cryotechnique.

In order to establish the more precise localization of IFPs in the vestibular labyrinth we have developed an immunohistochemical method using semithin cryosections from guinea pig inner ear. The vestibular end organs were fixed by intralabyrinthine perfusion with formaldehyde and glutaraldehyde. Microdissection was performed, followed by decalcification in EDTA. After specimen embedding in gelatin, semithin cryosections (1 micron) were prepared. Prior to the immunohistochemical staining, a new antigen-unmasking treatment was performed. Monoclonal antibodies for cytokeratins (Cks), vimentin, neurofilament protein (NF), and glial fibrillary acidic protein (GFAP) were used and visualized with an indirect ABC method. In the guinea pig vestibular labyrinth, Cks8, 18 and 19 were present. Vimentin and NF were stained positively, GFAP negatively. These results are in accordance with our previous results in the human vestibular labyrinth except for Ck7. The high-resolution cryotechnique in combination with a new antigen-unmasking method may yield more, and more detailed information about the localization of IFPs in the vestibular region.

Animals↗

[Early cellular immune response in experimental labyrinthitis: immunohistochemical study].

Labyrinthitis ossificans is a recently recognized entity with the extending cochlear implant surgery. Up to date there are not so many studies of the cellular response leading the organization of the inflammatory reaction within the cochlea. Immunemediated labyrinthitis is a valid experimental model that allow the knowledge of the cellular infiltration mechanisms within the cochlea. The inner ear communicates with systemic immunity via the circulation by the passage of cells through the spiral modiolar vein (SMV) and its collecting venules in the scala tympani. Inflammatory reaction within the cochlea lead to the formation of fibrotic tissue and bone (osteoneogenesis) inside it and injuring the neurosensory organs of hearing and balance. To test which cells are proliferating early in an inflammatory response, an animal model of Keyhole limpet haemocyanin (KLH) induced labyrinthitis was utilized, showing a granulomatous lesions not previously reported in this experimental model.

Animals↗

Computed tomography findings of labyrinthitis ossificans secondary to meningitis: a case report.

A 26-year-old man was admitted to our hospital with chronic left ear drainage. He had a history of meningitis when he was a child. Computed tomography (CT) of the temporal bone showed complete obliteration of the otic labyrinth by sclerotic tissue. Based on CT findings, the patient was diagnosed as labyrinthitis ossificans. Computed tomography is an appropriate method of examination for the identification of labyrinthitis ossificans and is of particular importance for the evaluation of patients before cochlear implantation.

Adult↗

Contrast enhancement of the labyrinth on MR scans in patients with sudden hearing loss and vertigo: evidence of labyrinthine disease.

The sudden onset of hearing loss and vertigo presents a difficult diagnostic problem. We describe the finding of labyrinthine enhancement on MR images in five patients with sudden unilateral hearing loss or vertigo or both and correlate the MR findings with audiologic and electronystagmographic studies. All patients were studied with T2-weighted axial images through the whole brain, contrast-enhanced 3-mm axial T1-weighted images through the temporal bone, and enhanced T1-weighted sagittal images through the whole brain. Cochlear enhancement, on the side of hearing loss only, was found in all five patients. The presence of associated vestibular enhancement correlates with objective measures of vestibular function on the electronystagmogram. In two patients, the resolution of symptoms 4-6 months later correlated with resolution of the enhancement on gadopentetate dimeglumine-enhanced MR images. Two patients had luetic labyrinthitis. No labyrinthine enhancement was seen in a series of 30 control subjects studied with gadopentetate dimeglumine-enhanced MR using the same protocol. Labyrinthine enhancement in patients with auditory and vestibular symptoms is a new finding and is indicative of labyrinthine disease. While abnormalities on electronystagmograms and audiograms are nonspecific and indicate only a sensorineural problem, gadopentetate dimeglumine-enhanced MR may separate patients with retrocochlear lesions, such as acoustic neuromas, from those in whom the abnormal process is in the labyrinth or is intraaxial. This group of patients underscores the importance of identifying and commenting on the structures of the membranous labyrinth when evaluating MR studies of the internal auditory canal and the cerebellopontine angle in individuals with hearing loss.

Adult↗

[Total sequestration of the labyrinth].

At present total sequestration of the labyrinth in the case of purulent epitympanitis and cholesteatoma is a rare pathology. This paper describes data from the literature and two observations by the present authors. They offer an efficient method for arresting labyrinthectomy-induced liquorrhea by means of a flap of the lip mucous membrane. They maintain that computer tomography combined with traditional tomography is an informative method for diagnosing labyrinth destruction. They assert that continuous destruction of the labyrinth during prolonged pyorrhea and progressive development of cholesteatoma can be stimulated by functional changes of the body, e.g. pregnancy. They also suggest that the vestibular apparatus has high compensatory potentials under the conditions of a complete destruction of the vestibule and semicircular canals as a result of extended inflammation of the middle and internal ear.

Cholesteatoma↗

Sinusoidal galvanic stimulation of the labyrinths and postural responses.

We studied the effect of sinusoidal stimulation of the labyrinths on postural reflexes in man, using a 0.3 Hz current of alternating polarity and +/- 1 mA intensity for stimulation. The test subjects were tested binaurally by the bipolar method (BB), with two electrodes on the mastoid processes, and binaurally by the monopolar method (BM), with electrodes localized bilaterally on the mastoid process and the hand. Stabilographic postural parameters were measured in 22 subjects in five experimental situations. Each situation lasted 60 s. Body sway, detected by astabilometer, was recorded on a Philips FM tape-recorder and then analysed off-line on a PDP-11/34 computer. On BB stimulation of the labyrinths, the variance of body sway in the left-right (LR) direction increased more than in the anteroposterior (AP) direction. In BM stimulation, only the variance of LR sway increased. Other posturographic parameters displayed a similar effect. From the aspect of body sway frequency, BB stimulation produced a peak in the course of the power spectral density of the lateral stabilogram at 0.3 Hz. In this experimental situation, a habituation effect was manifested, depending on the subject. It can be stated that binaural bipolar (BB) stimulation of the labyrinths selectively influences lateral body sway, while the increase in AP body sway in this situation is merely a concomitant phenomenon.

Adult↗

Tonic inhibitory influences of locus coeruleus on the response gain of limb extensors to sinusoidal labyrinth and neck stimulations.

Previous experiments had shown that in decerebrate cats activation of limb extensor motoneurons during side-down roll tilt of the animal or side-up neck rotation depends on both an increased discharge of excitatory vestibulospinal (VS) neurons and a reduced discharge of inhibitory reticulospinal (RS) neurons of the medulla, thus leading to disinhibition of limb extensor motoneurons. The present experiments were performed to find out whether the locus coeruleus (LC) complex keeps under its tonic inhibitory control the medullary inhibitory RS neurons and, if so, whether this structure intervenes in the gain regulation of the vestibular and neck reflexes acting on the limb extensor musculature. In precollicular decerebrate cats with good postural rigidity of the four limbs, the amplitude of modulation and thus the response gain of the first harmonic component of multiunit EMG responses of limb extensors to sinusoidal stimulation of labyrinth and neck receptors (at 0.15 Hz, +/- 10 degrees) were quite small in forelimb muscles (triceps brachii) and almost negligible or absent in hindlimb muscles (triceps surae). Electrolytic lesion limited to the LC complex decreased the tonic contraction of limb extensors, but greatly increased in the forelimbs (and brought to the light in the hindlimbs) the response modulation of extensor muscles to the same parameters of labyrinth or neck stimulation. Correspondingly, the response gain increased, but no change in the phase angle of the responses was observed. Both changes in posture, as well as in response gain of the limb extensors to labyrinth and neck stimulation, fully developed some time after the LC lesion. This increase in response gain of the vestibular and neck reflexes acting on the limb extensor muscles did not depend on the decrease in postural activity following the LC lesion, since it was still obtained when an increased static stretch of the extensor muscle following passive flexion of the limb compensated for the reduced EMG activity. Moreover, the slope of the regression line relating the gain of the multiunit EMG response of the triceps brachii to animal tilt with the base frequency greatly increased following lesioning of the LC, thus indicating that for the same background discharge of the muscle the amplitude of modulation, and thus the response gain, increased significantly. The effects described above involved mainly, but not exclusively, the limbs ipsilateral to the side of the lesion.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗