Endolymphatic hypertension and hydrops in Meniere's disease. Current perspectives.
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The effects of angular accelerations in one or two spatial planes over the pressure exerted on the cupule of the semicircular canals, was studied using hydraulic models of the canals. The models were accelerated using a torsion pendulum and the resulting flow was monitored. The relative position of the model modifies the direction and magnitude of the flow in each canal and in the equivalent of the utricle where the canals join each other. When simultaneous accelerations in two spatial planes were used, a coriolic effect was observed, which could be significant to explain some vestibular symptoms that occur under similar conditions. From the information obtained with the models, the excitation-inhibition patterns in each of the six semicircular canals can be predicted for accelerations in any given spatial plane or combination of planes.
This paper summarizes the own electronmicroscopic studies on the inner ear fine structure (guinea pig) with the peroxidase tracer technique and mainly with the freeze-etch-technique. New findings are presented concerning the blood-perilymph-barrier, perilymph-endolymph-barrier as well as cell membrane differentiations of the stria vacularis cells and the sensory epithelia. The physiological and pathophysiological meaning is discussed in detail.
Eighteen patients with delayed endolymphatic hydrops are presented. This distinctive entity typically affects young adults and is characterized by episodic vertigo of Ménière's type occurring years after a sudden hearing loss. Measles or mumps were thought to have caused the hearing loss in eight patients. In the entire group of 18 patients the delay between identification of hearing loss and vertigo averaged 22.6 years. The diagnosis is aided by electronystagmography and labyrinthotomy in selected cases. Medical treatment may be effective and surgical treatment is curative.
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Following perilymphatic perfusion and injection into the cisterna cerebello-medullaris, respectively, the distribution pattern of horseradish peroxidase in the cochlea of the guinea pig was studied light and electron microscopically. The findings prove effective tight junctions (zonulae occludentes) between the cells of the epithelial lining of the endolymphatic compartment. At the level of the reticular membrane the tight junctions are far more extended than elsewhere at the cochlear duct epithelium. From the findings a fairly rapid exchange is suggestive between the lymphatic space of the organ of Corti and the tympanic scale. Various types of cells of the cochlear duct actively take up considerable amounts of peroxidase. However, endocytosis of peroxidase by hair cells and particularly by the outer ones is rather scanty. Passive permeation of the tracer through the membran of undamaged hair cells was disproven.
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The majority of individuals with Ménière's Disease can be successfully managed by medical means; however, there are some patients who become refractory to this form of therapy. It is this group of patients who are candidates for some type of surgical procedure. This paper reviews 109 patients who underwent 112 endolymphatic subarachnoid shunt procedures for the control of their Ménière's Disease. Medical therapy, indications for surgery, surgical technique, results, and complications are covered in detail.
The administration of a dehydrating agent like glycerol may improve the audiometric thresholds and decrease the summating potential in the electrocochleographic recordings of some Méière's diseases. There are many discussions concerning the endolymphatic sac's rôle in this cases. To clarify this subject we have reviewed the labyrinth's liquids physiopathology, the structural observations in cases of Ménière's diseases, the animals models date. We conclude that the presence of an endolymphatic sac is not necessary for obtaining a positive glycerol test. The clinical meaning of this test is discussed.
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Extirpation of the endolymphatic anlage of the ear vesicle or that part of the ear placode which develops into the endolymphatic anlage in chick embryos, resulted in the absence of the endolymphatic system. In specimens of which the endolymphatic anlage was removed on the fourth day, healing of the wound was completed soon after the fifth day of incubation. Most of these experimental animals developed endolymphatic hydrops at a later stage. However, where healing was delayed after the fifth day, the open wound acted as an escape route for the endolymph (thus preventing further closure) which at that stage (or soon after) reached an appreciable volume.
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