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Recurrent meningitis secondary to perilymph fistula in young children.

All young children treated for meningitis should have post-treatment evoked potential audiometry. If neurosensory hearing loss is identified, the clinician should be alerted to the possibility of a perilymph fistula as the cause of the meningitis. Radiology of the inner ear and possibly exploratory tympanotomy may be necessary to rule out a perilymph fistula. Two young children with meningitis secondary to perilymph fistula are presented to illustrate the problems of diagnosis and management.

Audiometry, Evoked Response↗

Effect of urea on osmolality of perilymph.

Blood osmolality was altered in chinchillas by intravenous administration of urea. Serum osmolality peaked rapidly at 30 minutes after administration and decreased slightly to a plateau for 180 minutes. Perilymph and CSF osmolality lagged substantially behind the increase in serum osmolality and equaled serum osmolality only after one hour. Perilymph osmolality followed changes in the serum up to 60 minutes with a definite time lag. This phenomenon suggests the existence of a selective blood-labyrinth barrier that is permeable to urea and water. However, the time lag due to the barrier may permit the reduction of hydrostatic pressure in the labyrinth. The results of the present study seem to render partial explanation of improved hearing in patients with Meniere's disease who were treated with urea.

Animals↗

Dynamics of the flow of perilymph in the cochlea of the guinea pig.

The dynamics of perilymph flow in the cochlea was studied in guinea pigs. After placement of sodium chloride crystals on the round window membrane, the potassium ion concentration in the scala vestibuli in the basal turn does not change. The potassium ion concentrations in the scala tympani in the basal turn increases rapidly, while the potassium ion concentration in the scala tympani in the third turn increases slowly and to a lesser extent. The cochlear microphonic potential decreases in the basal turn and to a lesser extent in the third turn. After placement of sodium chloride on the fenestra in the scala tympani of the third turn, the chochlear microphonic potential in the basal turn does not change. These data lend support to the theory of longitudinal flow of perilymph in the scala tympani.

Animals↗

Influence of catecholamines on perilymph Po2.

In a previous study, a special rheological model of intra-arterial perfusion was used to examine the existence and effectiveness of vasomotor control of the cochlear vessels in guinea pigs. Catecholamines were injected intra-arterially into this animal model and the changes induced in the cochlear action potentials were examined. In this investigation, we used the same animal model and technique to measure the perilymph Po2 after perfusion of the cochlea with catecholamines. In addition, the effect of drainage of the CSF before infusion was examined. The results indicated that opening the labyrinth allows the escape of CSF through the patent cochlear duct. This may modify the concentration of the substance under study in the perilymph and cause inaccuracies in the data obtained.

Animals↗

Concentration of salicylate in serum and perilymph of the chinchilla.

The concentration of salicylate in serum and perilymph was measured in chinchillas after intraperitoneal administration of sodium salicylate. Serum salicylate concentration peaked 2 to 4 hours after a single injection. Clearance was approximately complete after 16 hours. The within-subject variability of serum concentration 4 hours after injection was very low. Subject weight significantly affected serum salicylate concentration, with heavier animals showing higher serum levels. The relationship of perilymph to serum salicylate concentration was approximately linear, with a high correlation between measures.

Animals↗

Surgical management of perilymph fistulas. A new technique.

A wide range of recurrence rates (21% to 47%) for perilymph fistula repairs have been reported in the otology literature. An improved surgical technique developed at the Portland (Ore) Good Samaritan Hospital and Medical Center Neurotology Department was used to repair perilymph fistulas in 58 patients from October 1986 to October 1988. Our recurrence rate was reduced from 27% in a 1982-1985 study to 8% in our study. At 1 year postoperatively, improvements in disequillibrium, dizziness, and vertigo were comparable with results of older surgical techniques. Functional outcomes were also good: 83% of patients returned to normal activities of daily living, and 71% also returned to school or resumed gainful employment outside the home.

Adolescent↗

Perilymph fistulas. Clinical criteria.

A perilymph fistula may be defined as an abnormal opening between the inner ear and the external surface of the labyrinth capsule, which allows the escape of perilymph and causes specific disorders of hearing, balance, or both. Its diagnosis remains somewhat controversial. This communication presents a defined set of clinical diagnostic criteria, the historic context by which those criteria have been developed, the histopathologic and clinical studies by which they have been challenged or substantiated, and the deficiencies that remain in our understanding of the pathogenic mechanisms that allow for abnormal cochlear or vestibular function.

Fistula↗

Occupational perilymph fistula.

A case of occupational perilymph fistula in an ironworker is described. The patient was lifting and lowering 200 pounds of steel when he developed sudden onset of vertigo. Surgical exploration of the middle ear demonstrated leakage of perilymph fluid from the round window. Grafting of the window led to improvement of symptoms, but the patient was unable to continue work as an ironworker due to difficulty with balance.

Adult↗

Kinetic experiments with radionuclides concerning the perilymph-blood barrier in a guinea pig model.

Since 1950 many animal radiotracer experiments have been performed to study inner ear kinetics. For the most part in these studies, radionuclides were applied systemically, following which a discontinuous probing of inner ear fluids or of inner ear tissues was done. Two techniques have been developed in the Section for Experimental Otorhinolaryngology of the University of Würzburg. These have been adapted to the direct and continuous measurements of inner ear efflux kinetics for several hour periods. For this purpose, only a tiny amount of radiotracer need be applied directly to the inner ear. Experiments were done on the anesthetized guinea pig as an animal model. In the first technique, a collimator-detector system is focused precisely on the cochlea, which had been quickly resealed after application of the radionuclide bolus via two small holes in the basal turn of the cochlea. The second technique makes use of a perilymph cycling system, whereby a small outer volume includes a microcuvette with a so-called artificial round window. By this latter cycling technique, perilymph clearance kinetics of all kinds of radiotracers--with the exception of tritium labelled ones--can be measured. Calculations from clearance kinetics show that quite small particles with particle weights up to 100, such as the chlorine anion and the potassium cation, as well as urea, glycerol, pyruvate, and lactate, exhibit perilymphatic half-lives varying from 45 to 60 min. These half-live data are plausible in regard to cochlear blood flow measured previously via an independent technique developed by Angelborg et al.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Active otosclerosis of the stapes footplate: histological and clinical aspects of its influence on the perilymph (author's transl)].

Pathologic capillaries are usually seen in the center of an otospongious process. Next to obliteration, dilatation and increased permeability a loss of basement membrane structure is evident. Around the capillaries exists a wide network of mesenchymal cells which have a glycogen like mass within the cytoplasm; glycogen can be delivered into the extracellular fluidspace. Free erythrocytes are located around many vessels. Near the margin of the lacunae decalcificated areas are seen; in the center of these areas osteocytes undergo lysis; they show intracytoplasmatic deposits of apatite which we assume to be located within the mitochondria. The collagen structure in the neighbourhood of the osteocytes seems to be damaged. Once the resorptive process has reached the perilymphatic surface of the footplate there comes to an connection between the otospongiotic lacunae and the vestibule. Free erythrocytes, glycogen like drops and lysosomes are delivered into the perilymph. Comparing the histological results with the operative results in patients with floride otosclerosis we conclude that operation should be done as early as possible to prevent damage from the inner ear, caused by the continuous intoxication of the perilymph from the otosclerotic focus.

Bone Resorption↗

The blood-perilymph barrier.

Freeze fracture replicas of the guinea pig inner ear were studied under the electron microscope to define the blood-perilymph barrier morphologically. This barrier is represented basically by the continuous endothelium of the inner ear capillaries. The endothelial cells contain only a few micropinocytotic vesicles in contrast to those of the stria vascularis vessels. The cochlear plexus also exhibits some special differences. Tight junctions of the continuous mesothelial type connect the endothelial cells of the inner ear capillaries. Cell membranes of these cells possess a lower particle density than those of the stria vascularis vessels. In general, the blood-perilymph barrier is morphologically similar to the blood-brain barrier.

Animals↗

Inhibition of myosin light-chain kinase activity in the organ of Corti by 0.3-5 kilodalton substances of the otosclerotic perilymph.

The guinea pig organ of Corti contains myosin light-chain kinase (MLCK) activity. The upper and lower most parts of the cochlea do not show significantly different activities of the enzyme, which is Ca2+ and calmodulin-dependent. Short-term noise exposure does not cause a significant change. 0.3-5 Kilodalton substances of the otosclerotic perilymph, separated by SG-25 column chromatography, inhibit the MLCK activity in in vitro organ of Corti preparations. This inhibitory action of the perilymph substances can also be observed with the purified MLCK of turkey gizzard. The activity of the enzyme can be specifically inhibited by cyclic AMP-dependent protein kinase.

Animals↗

Sources of endolymph and EP. Does the perilymph or Reissner's membrane influence the ionic content of the endolymph and EP?

The source of EP and the production of the endolymph are often considered to be at the stria vascularis. However, the significance of Reissner's membrane in maintaining the ionic composition of the endolymph cannot be ruled out. We perfused the entire perilymphatic space of guinea pigs with paraffin oil to determine the effects on the endolymph and perilymph. After 1 and 2 h the endolymph was removed from the second turn and the ionic concentration of these samples was measured by flamephotometry. The results revealed no significant changes in Na+ and K+ concentration as compared to normal endolymph. EP was measured from the second turn under an equivalent experimental condition. During 1 h of oil perfusion, EP remained fairly constant. From these experiments we surmise that perilymph and Reissner's membrane do not influence the ionic composition of the endolymph and EP during 1 or 2 h of our experiments.

Animals↗

The pharmacokinetics of azlocillin in the perilymph of guinea pigs and otitis media.

The results of studies on the pharmacokinetics of azlocillin in the perilymph of the guinea pig following the intramuscular administration of 200 mg per kg body weight are shown graphically. Similar to mezlocillin and the aminoglycoside antibiotics, this new acylureido penicillin is retained in the inner ear. The results of our studies, together with the data on the in vitro and in vivo activity of azlocillin and gentamicin and the applicable dosage for clinical purposes, indicate that the azlocillin levels in the perilymph are considerably more effective against Pseudomonas aeruginosa and many times more effective against the other microorganisms usually involved in acute otitis media than those of the aminoglycosides.

Animals↗

Potassium circulation in the perilymph of guinea pig cochlea.

To determine whether any differences exist in potassium circulation between the scala vestibuli and scala tympani, we recorded the change in K+ activity in both scalae of the guinea pig cochlea at the basal and third turns, using a double-barrelled, K(+)-sensitive microelectrode after perfusion with artificial perilymph containing 20 mM KCl and 130 mM NaCl. K+ activity increased immediately after the start of perfusion and decreased after its completion. The rates of decrease of K+ activities were approximately 1.0 mEq/l per min in the scala vestibuli of the basal and third turns, also 1.0 mEq/l per min in the scala tympani of the basal turn, and approximately 0.5 mEq/l per min in the scala tympani of the third turn. The rate of decrease of K+ activity in the scala tympani was significantly slower in the third turn than in the basal turn. Blockage of the cochlear aqueduct depressed the rate of decrease of K+ activity in the scala tympani more in the basal turn than in the third turn. These results suggest that there is a difference in potassium circulation between the scala vestibuli and scala tympani, and that the cochlear aqueduct plays an important role in potassium circulation in the perilymph of the scala tympani.

Animals↗

[Cold deformation elements for attaching an implantable hearing aid transducer to ear ossicles or perilymph].

Development and short-term implantation results of the Tübingen implantable hearing aid (TI = Tübingen implant) have been presented. The TI is designed for patients with sensorineural hearing loss due to a malfunction of the cochlear amplifier. This can be identified by the presence of positive recruitment and the absence of TEOAE (transitory evoked otoacoustic emissions). The Tübingen implant functions in two ways: it allows electronic amplification of the auditory signal and electromechanical signal transduction into a micromechanical vibratory stimulus. There are two paths by which vibratory stimulus reaches the cochlea: (1) directly through a perforation in the stapes foot plate into the perilymph or (2) via the ossicular chain. Made of pure titanium, the casing of the helium-tight welded transducer includes the piezoelectric actuator. An implantable manipulator device is designed for transducer positioning and anchoring in the mastoid cavity. Usually, the transducer probe tip is directly coupled to the body of the incus. This functions without a special coupling device by utilization of an Erbium-YAG laser. Special anatomical situations or the loss of incus and/or stapes suprastructure, however, requires coupling of the vibratory signal to other points of the ossicular chain or to the perilymph. A major problem, however, was an intraoperative, irreversible link between the titanium probe tip and coupling elements. To overcome this problem, the coupling elements were made of gold. A crimp technique was developed, allowing the surgeon to induce cold deformation of the gold. The cold deformation technique (crimp) results in an irreversible coupling between the titanium probe tip and the golden coupling element.

Cochlear Implantation↗

Perilymph detection by beta 2-transferrin immunoblotting assay. Application to the diagnosis of perilymphatic fistulae.

beta 2-Transferrin, the asialotransferrin, is found in cerebrospinal fluid (CSF) and inner ear perilymph, but is absent from serum and other body fluids or secretions except the aqueous humor. The detection of this asialo-fraction of the transferrin in ear fluid microsamples with an immunoblotting technique is of great interest when a perilymphatic fistula (PLF) is suspected. beta 2-Transferrin was detected on microsamples collected by syringe or on micro-collagen sponges from 30 patients undergoing ear surgery. The problem is reviewed, the technique and sample preparation are explained and the results discussed. beta 2-Transferrin detection in the ear fluid allows the identification of perilymph, except in the CSF oto- or rhinorrheal context, and is proposed as a promising test to confirm perilymphatic fistula.

Blotting, Western↗

Water permeability of the endolymph-perilymph barrier in the guinea pig cochlea.

The diffusional water permeability of the endolymph-perilymph barrier was determined in guinea pigs by perfusing the perilymphatic space with tritiated water and measuring the uptake of tritiated water into the endolymph. Assuming that the volume flow across the endolymph-perilymph barrier is negligible for short periods of perfusion, the water permeability of the barrier is approximately 130 times greater than its permeability to K+ in normal guinea pigs.

Animals↗