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Mechanical leverage in the middle ear of the American bullfrog, Rana catesbeiana.

Textbooks lump the middle ears of 'submammalian Tetrapoda' as being 'one-ossicle ears'. Conventionally the anuran middle ear is depicted with a shaft-like skeletal unit connecting the tympanic membrane to the inner ear. This shaft comprises mediad a long bony columella and laterad a short cartilaginous extracolumella. But dissection of Rana catesbeiana ears showed: the extracolumella, as long as the columella, is proximally expanded in the vertical plane, forming dorsal and ventral heads. The medio-dorsal head is movably jointed to the columella, between these two there is an obtuse angle ventrad; the extracolumellar medio-ventral head is anchored by a ligament to the middle-ear cavity ceiling. When the tympanic membrane moves outwards, pulling the extracolumella, the medio-dorsal head of the extracolumella must be forced inwards, rotating on the ventral anchorage, pushing the columella towards the inner ear. The ossicular chain thus includes a mechanical lever, possessing the magnitude of the ratio length:width of the extracolumella; this is additional to the lever known from the columellar footplate, which rotates on its firm ventral attachment. These levers are confirmed physiologically, by the difference between the inner-ear sensitivity (shown by isopotential audiograms of microphonic potentials) when stimulated by a vibrator first at the tympanic membrane, then at the proximal stump of the amputated columella. Perusal of the primary literature showed that this morphology is widespread among anuran ears.

Acoustic Stimulation↗

[Mondini dysplasia without functional impairment in the framework of a CHARGE association].

UNLABELLED: A male child with fully developed CHARGE association was referred to our hospital several times because of choanal atresia and suspected hearing loss in his first two years of life. As far as they are a main symptom malformations of the ear appear frequently in CHARGE association. This report describes that an obvious anatomic dysplasia of the inner ear can have normal function, which is shown by objective measurement. METHODS AND RESULTS: Computed tomography of the petrous bone showed bilateral Mondini malformation of the cochlea combined with bulky deformation of middle ear ossicles. By the age of one year brainstem evoked response audiometry (BERA) was performed. The result demonstrated a hearing loss of 60 dB on the right ear, but no measurable hearing loss on the left ear. CONCLUSION: This case report proves that a Mondini-type malformation of the cochlea does not need to be combined with hearing loss.

Abnormalities, Multiple↗

Pinna anomalies associated with congenital conductive hearing loss.

This paper compares the normal pinna with the abnormal congenitally malformed pinna. Then the abnormal pinna is related to case histories where a hearing loss was found due to a congenital malformation of the middle ear ossicles. Careful examination of the pinna, therefore, may be a simple diagnostic sign of an underlying potentially surgically correctable hearing loss. An abnormal pinna is more often associated with a middle ear anomaly than with any other congenital malformation including a urinary tract anomaly.

Child↗

Traumatic lesions of the middle ear: aetiology and results of treatment.

A retrospective investigation of the aetiology and results of treatment for traumatic, conductive hearing loss was performed in 122 patients treated from 1979 to 1983. The mean age at the time of the trauma was 25 years. The average treatment delay was 7 years. The patients were grouped according to the nature of the injury. The group with head injury (40 patients) was characterized by a frequent combination of young men and traffic accidents. Among direct trauma (16 patients) lesions to the tympanic membrane and/or the middle ear were caused by ear syringing or by the introduction of swabs or other instruments into the auditory canal. In the group exposed to indirect trauma (57 patients) the dominant single cause of the trauma in the present material consisted of a blow to the ear and was most often seen among young women. A subgroup exposed to blasts contained more young men. The dominant operative findings were rupture of the tympanic membrane, luxation of the incus, partial bone necrosis and fracture of the auditory ossicles. Ear surgery consisted of closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Normal hearing was restored in 78%, and hearing improved in another 10%. The hearing remained unchanged or deteriorated in 9% of the patients, a group often characterized by a long treatment delay and/or the development of chronic otitis.

Adolescent↗

Malformation of stapes in VACTERLS association: a histopathologic study and three-dimensional reconstruction.

OBJECTIVE: To investigate the temporal bone with a malformed stapes in VACTERLS association. STUDY DESIGN: The study design was a case report, histopathology of the temporal bone, and three-dimensional reconstruction of the ossicles and cochlea. SETTING: The study was carried out in the Temporal Bone Bank at Charles University, Hradec Králové, on a case from Temporal Bone Foundation, Boston. PATIENT: A 1540-g, 41-cm female neonate with VACTERLS association, histopathology of the temporal bone, and three-dimensional reconstruction of the middle ear ossicles and cochlea. RESULTS: The posterior part of the footplate was missing, and the posterior crura of the stapes was not connected to the footplate but found freely suspended in the sinus tympani. CONCLUSION: Computer-assisted three-dimensional reconstruction was performed from histologic sections of the temporal bone removed from a case of VACTERLS association. The reconstruction included structures such as the bony labyrinth and the middle ear ossicles. The abnormality observed in the reconstruction included the mislocation of the stapes and a shortened footplate.

Abnormalities, Multiple↗

Bone-conducted sound: physiological and clinical aspects.

OBJECTIVE: The fact that vibration of the skull causes a hearing sensation has been known since the 19th century. This mode of hearing was termed hearing by bone conduction. Although there has been more than a century of research on hearing by bone conduction, its physiology is not completely understood. Lately, new insights into the physiology of hearing by bone conduction have been reported. Knowledge of the physiology, clinical aspects, and limitations of bone conduction sound is important for clinicians dealing with hearing loss and is the purpose of this review. DATA SOURCES: The data were compiled from the published literature in the areas of clinical bone conduction hearing, bone conduction hearing aids, basic research on bone conduction physiology, and recent research on bone conduction hearing from our laboratory. CONCLUSION: Five factors contributing to bone conduction hearing have been identified: 1) sound radiated into the external ear canal, 2) middle ear ossicle inertia, 3) inertia of the cochlear fluids, 4) compression of the cochlear walls, and 5) pressure transmission from the cerebrospinal fluid. Of these five, inertia of the cochlear fluid seems most important. Bone conduction sound is believed to reflect the true cochlear function; however, certain conditions such as middle ear diseases can affect bone conduction sensitivity, but less than for air conduction. The bone conduction route can also be used for hearing aids; since the bone conduction route is less efficient than the air conduction route, bone conduction hearing aids are primarily used for hearing losses where air conduction hearing aids are contraindicated.

Basilar Membrane↗

[High resolution computerized tomography of middle ear abnormalities].

BACKGROUND: The aim of this study was to analyze malformed petrous bones with computed tomography and to develop a radiologic score which can help to judge the indication for operative reconstructions. METHODS: One hundred forty-two petrous bones in 71 patients with unilateral or bilateral microtia, atresia of the external auditory canal, and malformations of the middle ear were evaluated with high-resolution CT. RESULTS: In 97% of patients with severe auricular dysplasia, there was dysplasia of the middle ear ossicles; in 70% the stapes was malformed. In 32% the oval window was occluded, and in 7% the round window. In 75%, the canal of the facial nerve was displaced, and 16% also showed abnormalities of the labyrinth. A close correlation between the malformation of the auricle and of the middle ear was not found. CONCLUSIONS: High-resolution CT is necessary for the evaluation of malformed middle ears. Based on the abnormalities described, we propose a radiologic score for the assessment of malformed petrous bones. This consists of the following criteria: external auditory meatus, pneumatization of the mastoid and of the tympanic space, size of the tympanic space, facial nerve, vessels, malleus and incus, stapes, oval and round window. The graded points of each structure are added up to the score, which might range between 0 and 28. This score can help to judge the indication for reconstruction of the middle ear. In bilateral malformation we suggest a middle ear reconstruction of the better hearing ear if the score is greater than or equal to 15, and in unilateral malformation if it is at least 20. In patients with lower scores, we only suggest hearing aids.

Adolescent↗

Effect of zinc ion on cadmium-induced auditory changes.

Cadmium, which has adverse effects on many physiological systems, is an important environmental pollutant. Our previous experimental study showed that cadmium also has a dose-dependent deleterious effect on the auditory system in rats. Because zinc reverses cadmium cytotoxicity in many systems, we investigated the possible preventive effect of a zinc-enriched diet given isochronally on cadmium-induced hearing loss in rats. Fifty-four male rats were divided into three equal groups. Control rats were fed normal rat food and tap water, whereas the cadmium group was subjected to 15 ppm cadmium-containing water as CdCl2. The third group received 15 ppm CdCl2 and food enriched with 200 ppm zinc as ZnSO4 for 30 d. On d 30, eight animals from each group were used for the measurement of kidney functions. In the remaining animals, hearing functions were measured by auditory brainstem response and distortion product otoacoustic emission. Blood cadmium increased from 1.87+/-1.69 to 6.08+/-2.62 microg/dL and elevated cadmium contents of ear ossicles and kidney cortex were associated with a decreased glomerular filtration rate in rats subjected to high cadmium. A zinc-enriched diet obviously reduced cadmium accumulation in the kidney and prevented the nephrotoxicity. Our data indicated that cadmium-induced ototoxicity seems to be partially zinc preventable and zinc addition to diet without altering cadmium content in ear ossicles may help to prevent cadmium-induced hearing loss.

Animals↗

Teratological studies on craniofacial malformations.

Craniofacial malformations cause great human suffering. The purpose of the experimental studies was to investigate teratogenically induced craniofacial malformations in the rat, and to study if vitamin B6 could prevent the teratogenically induced malformations in the rat. The aim of the clinical investigation was to compare mandibulofacial dysostosis (MFD) with hemifacial microsomia (HFM) and thalidomide-induced malformations restricted to the first and second branchial arches. In the experimental studies we used two different teratogenic agents, etretinate and BAPN (beta-aminoproprionitrile). Vitamin B6 was administered one day prior to and simultaneously with the teratogenic agent. The induced malformations were observed by direct microscopy, histology, differential staining, microdissection and enzyme histochemistry. Knowledge of isoenzymic differentiation was obtained by isoelectric focusing and polyacrylamide gel electrophoresis. The clinical features of 29 patients with MFD, 26 with HFM and seven with thalidomide-induced malformations were investigated. The patients underwent clinical investigations, radiography, tomography, computed tomography, surgical exploration and audiograms. The etretinate-induced syndrome in the rat shows similarities to first and second branchial arch syndromes in man. Defective formation of Meckel's cartilage and the cartilaginous skull base, the zygoma and the middle ear ossicles were prominent features of the observed malformations. The induced malformations were accompanied by increased staining for alkaline phosphatase (APase) in the skull and skull base cartilages and Meckel's cartilage. BAPN induced cleft palate in 95% of the cases and the teratogenically induced cleft palate was accompanied by a pathological differentiation pattern that could be traced by determination of isoenzymes in the palatal shelves as well as in amniotic fluid. Vitamin B6 could prevent the teratogenic malformations induced by etretinate and BAPN in the rat. Comparing MFD, HFM and thalidomide-induced malformations, all syndromes included patients with external, middle and inner ear malformations. Cranial nerve palsy/paresis was only seen in HFM and thalidomide-induced malformations. A relationship between disturbed neural crest cell migration and defects of the first and second branchial arches seems possible.

Alkaline Phosphatase↗

Etretinate-induced malformation of the first two branchial arches: differential staining and microdissection study of embryonic cartilage.

Malformations of the cranial base, temporal bone and middle ear were induced in the offspring of Sprague-Dawley rats by a single intraperitoneal injection of 10-30 mg/kg etretinate (Tigasone) at days 8.5-10.5 of gestation. By differential staining of the embryonic craniofacial cartilage and bone, and microdissection of the otomandibular complex, the induced malformations were studied specifically. Defective formations of Meckel's cartilage and the cartilaginous skull base were found to be prominent features of the malformation. The malformation included defective middle-ear ossicles; especially the malleus and incus were fused with a shorter than normal long process and manubrium. In conjunction with the distal part of Meckel's cartilage, mandibular micrognathia was observed. All of the malformed tissues are derivatives of the first and second branchial arches. The teratogenically induced defects in the rat embryos show some similarities to the clinical syndromes of the first and second branchial arches in man.

Abnormalities, Multiple↗

Effects of cadmium on the hearing system.

The functional resemblance between kidney proximal tubular and inner ear epithelial cells which has often been pointed out in the literature led us to hypothesize that nephrotoxic agents that cause renal tubular injury might also impair the function of inner ear cells. As one of the most toxic environmental nephrotoxic agents is cadmium, we aimed to study its effects on hearing experimentally in rats. In this study, increased blood and renal cortical cadmium levels were associated with high cadmium accumulation in ear ossicles and labyrinth in rats exposed to cadmium. The changes in auditory brainstem response (ABR) and otoacoustic emission in 2-month-old male rats exposed to drinking water containing 5 and 15 ppm CdCl2 for 30 days showed that cadmium-induced nephrotoxicity was associated with signs of defective hearing at a concentration of 15 ppm CdCl2 but that 5 ppm CdCl2 caused hearing loss without affecting kidney function. The mean latency of ABR wave 1, which indicates the function of the cochlea, was 1.335 +/- 0.31 ms in the control group and 1.641 +/- 0.052 and 1.74 +/- 0.88 ms in the rats subjected to 5 and 15 ppm CdCl2, respectively (p < 0.001). In the cadmium-treated groups short interpeak wave I-III latencies (p < 0.01) indicated cochlear dysfunction and this was also supported by the distortion product otoacoustic emission results (p < 0.001). Non-significant changes in wave III and V latencies were accepted as evidence of unaltered function of the other parts of the auditory system. These results suggest that hair cells are more sensitive to cadmium than kidney tubule cells and that the cochlear component of hearing is more vulnerable to cadmium toxicity than other parts of the auditory system.

Animals↗