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Perilymph sampling from the cochlear apex: a reliable method to obtain higher purity perilymph samples from scala tympani.

Measurements of drug levels in the fluids of the inner ear are required to establish kinetic parameters and to determine the influence of specific local delivery protocols. For most substances, this requires cochlear fluids samples to be obtained for analysis. When auditory function is of primary interest, the drug level in the perilymph of scala tympani (ST) is most relevant, since drug in this scala has ready access to the auditory sensory cells. In many prior studies, ST perilymph samples have been obtained from the basal turn, either by aspiration through the round window membrane (RWM) or through an opening in the bony wall. A number of studies have demonstrated that such samples are likely to be contaminated with cerebrospinal fluid (CSF). CSF enters the basal turn of ST through the cochlear aqueduct when the bony capsule is perforated or when fluid is aspirated. The degree of sample contamination has, however, not been widely appreciated. Recent studies have shown that perilymph samples taken through the round window membrane are highly contaminated with CSF, with samples greater than 2microL in volume containing more CSF than perilymph. In spite of this knowledge, many groups continue to sample from the base of the cochlea, as it is a well-established method. We have developed an alternative, technically simple method to increase the proportion of ST perilymph in a fluid sample. The sample is taken from the apex of the cochlea, a site that is distant from the cochlear aqueduct. A previous problem with sampling through a perforation in the bone was that the native perilymph rapidly leaked out driven by CSF pressure and was lost to the middle ear space. We therefore developed a procedure to collect all the fluid that emerged from the perforated apex after perforation. We evaluated the method using a marker ion trimethylphenylammonium (TMPA). TMPA was applied to the perilymph of guinea pigs either by RW irrigation or by microinjection into the apical turn. The TMPA concentration of the fluid sample was compared with that measured in perilymph prior to taking the sample using a TMPA-selective microelectrode sealed into ST. Data were interpreted with a finite element model of the cochlear fluids that was used to simulate each aspect of the experiment. The correction of sample concentration back to the perilymph concentration prior to sampling can be performed based on the known ST volume (4.7microL in the guinea pig) and the sample volume. A more precise correction requires some knowledge of the profile of drug distribution along the cochlear prior to sampling. This method of sampling from the apex is technically simple and provides a larger sample volume with a greater proportion of perilymph compared to sampling through the RW.

Animals↗

Effect of pentobarbital anesthesia on amikacin concentrations in plasma and perilymph and evaluation of multiple sampling in perilymph of guinea pigs.

The purpose of this study was to determine whether a multiple-sampling procedure could be used in guinea pigs to study the kinetics of amikacin in perilymph. Amikacin was infused intravenously for 6 h into conscious anesthetized guinea pigs, and the concentrations of the drug in plasma and perilymph were measured. From each anesthetized guinea pig, five to six perilymph samples were collected from one ear, and one sample was collected from the other ear at 6 h. The concentrations of amikacin in perilymph were dose proportional and increased slowly during the 6-h infusion. However, after 6 h of intravenous infusion, the concentrations of amikacin in perilymph of the multiply sampled ears were significantly higher than those of the singly sampled ears, indicating that the multiple-sampling procedure should not be used as is to study the kinetics of amikacin in perilymph. Amikacin concentrations in perilymph were linearly related to amikacin concentrations in plasma in pentobarbital-anesthetized animals, as had previously been observed for conscious guinea pigs. However, the slope of the regression line was only 0.09 for anesthetized animals compared with 0.24 for conscious animals. Drug concentrations in plasma were found to be threefold higher in anesthetized animals, whereas drug levels in perilymph were the same in both groups at similar dosing rates. These results indicate that the amikacin concentration in perilymph is not solely dependent upon its concentration in plasma and that other factor(s) can affect the entry of amikacin into the inner ear.

Amikacin↗

[Effects of acoustic overstimulation and perilymph perfusion--with Joro spider toxin on the concentrations of amino acids in the perilymph].

Glutamate (Glu) is considered one of the most probable neurotransmitter candidates in primary afferent nerves of the cochlea. In the present study, the amino acid profile in the perilymph was determined in order to investigate the effects of acoustic overstimulation and perilymph perfusion with Joro Spider Toxin (JSTX), a specific antagonist of the quisqualate sensitive Glu receptor, on the stimulus-induced release of Glu. In the first series of experiments (control group; n = 10), samples of the scala tympani perilymph (PST) were collected from albino guinea pigs at 60 and 75 min after initiating cochlear perfusion with an artificial perilymph. In the second series of experiments (acoustic overstimulation group; n = 7), the PST samples were collected before (at 60 min after the initiation of perilymph perfusion) and after (at 75 min after the initiation of perilymph perfusion) exposure to a pure tone (2000 Hz, 110 dBSPL for 15 min). In the third series of experiments (JSTX group; n = 8), the PST samples were collected as described above under condition of cochlear perfusion with an artificial perilymph containing of 3.54 x 10(-8) M and 3.54 x 10(-6) M of JSTX. The concentrations of Glu, aspartate, glycine, alanine and leucine were measured by high-performance liquid chromatography (HPLC) using phenylisothiocyanate derivatization. There was no significant effect of acoustic overstimulation or perilymph perfusion with JSTX on the levels of amino acids.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗

Protein profile of human perilymph: in search of markers for the diagnosis of perilymph fistula and other inner ear disease.

Recent developments in high-resolution two-dimensional polyacrylamide gel electrophoresis, combined with amino acid sequencing and computer-assisted image analysis, have allowed separation of approximately 100 proteins and identification and quantitation of some 30 proteins in human perilymph. The majority of proteins were found to be present in perilymph at levels in basic agreement with the total protein gradient between perilymph and plasma (1:35). However, several striking differences were observed: (1) beta 2-transferrin, known to be absent from normal plasma but present in cerebrospinal fluid, was detected in perilymph at a concentration roughly equal to that in cerebrospinal fluid; and (2) two high-density lipoprotein-associated apolipoproteins--apo D (formerly PLS:33) and apo J or NA1 and NA2 (formerly PSL:29/30), the latter showing identity with SP40/40, or cytolysis inhibitor--were found to be present at concentrations 1 to 2 orders of magnitude higher when examined in terms of total protein and to be comparable with or higher than plasma levels when examined in terms of absolute concentrations. The functional significance of the extremely high levels of the two apolipoproteins is not known at this time. An attempt was made to use beta 2-transferrin, as well as apo D and apo J (NA1/NA2), as markers for the diagnosis of perilymph fistula, one of the most controversial and challenging problems for the otologist today. It was determined that the technique is indeed applicable when relatively pure fistula samples are analyzed. Limitations and potential improvements of the technique are discussed. In addition, the potential usefulness of two-dimensional polyacrylamide gel electrophoresis in other pathologic conditions of the inner ear is discussed briefly.

Apolipoproteins↗

Protein distribution in the human perilymph. A comparative study between perilymph (post mortem), CSF and blood serum.

The large differences in the protein content of perilymph and serum as well as the perilymph volume limit of 10-15 microliter cause serious problems when collecting samples of uncontaminated perilymph in order to analyse its protein composition. In 8 out of 24 extremely carefully taken samples of perilymph removed during autopsy, we were able, by keeping to certain selection criteria, to carry out electrophoretic analyses which were suitable for reproduction and comparison. Comparison of human perilymph, CSF and serum, using SDS-Page and Western blotting, gave the expected agreement which had been suggested by tests on guinea pigs. However, a closer examination of individual proteins pointed to some relatively large differences in quantity and quality.

Animals↗

[Perilymph fistula: diagnosis by detection of perilymph in the middle ear by beta-2 transferrin immunofixation].

beta 2-transferrin is a specific protein found in the cerebrospinal fluid and in the perilymph. Detecting beta 2-transferrin in the middle ear is of great interest when a fistula of the perilymph is suspected. This protein can be detected on microsamples with an immunofixation technique. We searched for beta 2-transferrin in pure perilymph, cerebrospinal fluid and serum in 8 patients operated by translabyrinthine approach for acoustic tumor removal. Search for beta 2-transferrin was performed in liquid from the inner ear in 3 labyrinthectomies. Samples were taken on collagen sponges or with micro syringes. beta 2-transferrin was detected in the perilymph of patients operated for neurinoma and in 2 of the 3 labyrinthectomies. This protein was found in only one of the patients for which the diagnosis of perilymphatic fistula had been retained. Detection of beta 2-transferrin in the middle ear can be proposed as a specific diagnostic test for perilymphatic fistula when the clinical situation does not suggest a fistula involving cerebrospinal fluid.

Adolescent↗

Facilitated transfer of glucose from blood into perilymph in the rat cochlea.

The transport of glucose into cochlear endolymph, perilymph of scala vestibuli and perilymph of scala tympani, and cerebrospinal fluid (CSF) was studied after intravenous administration of tracers of D-glucose, L-glucose, and 3-O-methyl-D-glucose in anesthetized rats. The data showed that D-glucose concentrations in perilymph of scala vestibuli, perilymph of scala tympani, and CSF were approximately 50%, and in endolymph less than 10%, that in plasma; D-glucose concentration in perilymph of scala vestibuli, perilymph of scala tympani, and CSF increased as a linear function of that in plasma; D-glucose entry into perilymph of scala vestibuli, perilymph of scala tympani, and CSF was more rapid than that of L-glucose; after infusion of 3-O-methyl-D-glucose, but not after that of mannitol, both the D-glucose concentration ratio of perilymph over plasma and D-glucose transfer into perilymph were lowered. These results indicate that D-glucose enters into perilymph of scala vestibuli by a facilitated transport, possibly located at the blood-perilymph barrier.

3-O-Methylglucose↗

Herpes simplex virus antibodies in the perilymph of patients with Menière disease.

OBJECTIVE: To evaluate the presence of IgG antibodies directed to herpes simplex virus (HSV) in the perilymph of patients with Menière disease. DESIGN: Antibodies to HSV, Epstein-Barr virus, cytomegalovirus, and measles virus were analyzed in serum and perilymph samples by enzyme-linked immunosorbent assay. Total IgG and albumin in serum and perilymph samples were measured by nephelometer analysis. The relation of specific antivirus IgG in the perilymph vs the serum was expressed as an index. PATIENTS: Perilymph and serum samples from 7 patients with long-standing, disabling Menière disease were collected during therapeutic vestibulotomy. Perilymph and serum samples from 7 patients with otosclerosis and 2 recipients of cochlear implants were used as controls. RESULTS: Compared with the corresponding serum sample, the perilymph from the patients with Menière disease disclosed a higher level of specific anti-HSV IgG. An elevated level of specific anti-measles virus IgG in the perilymph was detected in patients with otosclerosis. Patients of all groups showed no variation of specific anti-Epstein Barr virus IgG and anti-cytomegalovirus IgG in the serum or in the perilymph. CONCLUSIONS: Our results show the presence of HSV IgG in the perilymph of patients with Menière disease and support the hypothesis that HSV may play an important role in the etiopathogenesis of Menière disease.

Antibodies, Viral↗

Contamination of perilymph sampled from the basal cochlear turn with cerebrospinal fluid.

Our understanding of the perilymph kinetics of drugs depends largely on data obtained by the analysis of perilymph samples. Although a number of studies have demonstrated qualitatively that perilymph samples may be contaminated by cerebrospinal fluid (CSF), and some investigations adopt specific methods to minimize CSF contamination of their samples, many other studies fail to consider the influence of this potential artifact on their measurements. In the present study we have attempted to quantify the degree of CSF contamination of perilymph samples taken from the basal turn of the guinea pig cochlea using the ionic marker trimethylphenylammonium (TMPA). TMPA solution was irrigated across the round window membrane while a TMPA-selective electrode sealed into the perilymphatic space continuously monitored perilymph TMPA concentration. After a period of TMPA loading, a perilymph sample was aspirated and its TMPA content determined. Differences between the sample concentration and the measured TMPA time course during perilymph loading and sampling were analyzed using a finite element computer model for simulation of solute movements in the inner ear fluids. The experimental results were consistent with the aspirated fluid sample from the cochlea being replaced by CSF drawn into the perilymphatic space through the cochlear aqueduct. The dependence of perilymph sample purity on the location of sampling and on the volume withdrawn was quantified. These relationships are of value in the design and interpretation of experiments that utilize perilymph sampling.

Animals↗

[Methylprednisolone pharmacokinetics in perilymph and plasma of guinea pig after topical administration and intracardial injection].

OBJECTIVE: To determine pharmacokinetics profiles of methylprednisolone (MTH) in perilymph and plasma of guinea pig after topical and systemic administration. METHOD: A granule gelfoam soaked with MTH (40 mg/ml) was placed in the niche of round window of guinea pig; otocyst was infused with MTH (40 mg/ml); 4 mg/kg of MTH was injected intracardially. Samples of blood and perilymph of the scala tympani were obtained 1-6 h after administration of two routes, respectively. High-performance liquid chromatography was used to assay MTH in the samples. RESULT: After intracardial injection of MTH, concentrations of drug in plasma were obviously higher than those of in perilymph in every hour while drug in perilymph could not be obtained in 4-6 h, and the results were significantly different. After niche was placed with granule gelfoam with drug or otocyst was infused with MTH,drug could not be obtained in plasma, concentrations of drug in perilymph were obviously higher than those of in plasma after intracardial injection,and the highest concentrations in perilymph were manifested in 1 h 20 min. The concentrations of drug in perilymph after otocyst was infused with MTH were higher than those of after niche was placed with granule gelfoam soaked with MTH in every hour, and there were significant differences in between except those in 4 and 6 h. The half-life time of MTH in perilymph after otocyst was infused was 1.51 h, and the one after niche was placed with granule gelfoam soaked with MTH was 1.55 h. CONCLUSION: MTH could penetrate effectively through membrane of round window into the cochlear fluid and reach a much higher concentration following topical administration as compared with systemic application. The concentrations of drug in perilymph after otocyst was infused with MTH were higher.

Administration, Topical↗

Effects of glycerol on sodium and potassium concentrations in guinea pig perilymph.

Serum, cerebrospinal fluid (CSF), scala vestibuli perilymph, and scala tympani perilymph were collected from 85 normal guinea pigs both before and after i.v. administration of glycerol (1 ml/kg), and the sodium and potassium concentrations were assessed using a microflame photometer. Marked increases in sodium concentrations were observed in scala tympani perilymph and CSF, while there was a slight decrease in the serum and there was no significant change in scala vestibuli perilymph. These increases in sodium concentrations are considered to occur in the dehydration process in the body fluids mentioned above. On the other hand, increase in the potassium concentrations was found only in scala vestibuli perilymph and thus cannot be explained by simple dehydration process. This potassium elevation in scala vestibuli perilymph should be understood by further experiment on endolymph. It became evident that scala vestibuli perilymph differs from scala tympani perilymph and CSF in the dynamics of electrolytes after glycerol administration. In this regard, the nature of the scala vestibuli as fluid space should be studied in future. The above findings obtained in the present study may imply the significance in elucidating the glycerol effect on hearing of endolymphatic hydrops case.

Animals↗

Rapid protein test for perilymph fistula.

The existence of a perilymph fistula may be difficult to prove preoperatively or at surgery, except in obvious cases in which perilymph can be seen coming out of the inner ear around the stapes footplate or round window niche. Some surgeons doubt the common occurrence of spontaneous perilymph fistula. Most surgeons believe that a perilymph fistula is rare and is produced by some type of trauma and pressure change to the inner ear fluids. Analysis of fluid collected from the oval window area and round window niche may be a great help in confirming or disproving the diagnosis of perilymph fistula. After a myringotomy or tympanotomy, fluid collected in micropipets from the oval window or round window area is analyzed for protein concentration, using rapid protein indicator paper. The original technique was developed in the 1960's to analyze the inner ear fluid as a diagnostic procedure (i.e., diagnostic labyrinthotomy) in acoustic neuroma suspects. Normal perilymph has a protein content of approximately 200 mg %, which turns the indicator paper light green, whereas serum or transudate has a protein content of approximately 7000 mg %, which turns the indicator paper dark green. The protein concentration is determined by comparing the color of the indicator paper with the color developed by known protein standards. A middle ear tap may help avoid negative middle ear exploration for perilymph fistula and helps document the presence or absence of perilymph after the exploration.

Cochlear Diseases↗

[Protein concentration in the guinea-pig perilymph].

The protein concentration of the guinea pig perilymph was investigated systematically using a micro-modification of the method of Lowry et al. Perilymph of scala vestibuli and of scala tympani was obtained from living animals and immediately post mortem by various methods. In living animals it is especially difficult to obtain samples without blood contamination. Another problem in the obtaining of perilymph from living animals is the contamination of tympanic perilymph samples with cerebrospinal fluid. This contamination diminishes the protein concentration of perilymph to a high degree. When the subarachnoid space is opened suboccipitally before perilymph extraction, there is no significant difference between protein content in tympanic and vestibular perilymph. The mean protein concentration in both cochlea scales is about 150 mg/100 ml. When samples are extracted post mortem from animals perfused intra-arterially, mean values of protein are in the same range. Without perfusion of animals, the mean value of tympanic samples extracted post mortem is significantly higher. Causes of artefacts in perilymph investigations are discussed.

Animals↗

Antigenicity and protein content of perilymph in acoustic neuroma patients.

11 acoustic neuroma patients, exhibiting cell-mediated immunity in vitro against acoustic neuroma extract, were tested for cell-mediated immunity in vitro against perilymph samples from other acoustic neuroma patients. 14 of 21 perilymph samples were antigenic. None of three healthy persons reacted against antigenic perilymph samples. The perilymph antigenicity was reproducible and negatively correlated to the perilymph sample volume. Differences in sample volume could not be ascribed to admixture of endolymph, cerebrospinal fluid, plasma or blood. The perilymph protein concentration varied from 31 to 54 g/l. Gel electrophoresis of perilymph proteins revealed less staining in the alpha-region compared to plasma proteins and a distinct band in the pre-gamma region absent in plasma. Tau-transferrin was not detected in any of 13 samples. The findings support that the cell-mediated immune response against acoustic neuroma extract may be mediated through release of antigen(s) to the perilymph.

Adolescent↗

Fluorescein kinetics in perilymph and blood: a fluorophotometric study.

A modified slit lamp fluorophotometer was used to determine fluorescein concentration changes in the perilymph, cerebrospinal fluid and blood of chinchillas after intravenous injection of 0.2 ml of fluorescein sodium. This new technique provides a means of determining quantitative changes of fluorescein concentration in the perilymph without the need to withdraw fluid samples through the round window membrane of cochlear wall. Fluorescein was observed to enter the perilymph between 1 and 2 minutes after injection, and it reached its peak concentration in the mean time of 23 minutes. The mean peak concentration was 4.20 X 10-6 g/ml. Both increasing and decreasing fluorescein concentration changes in the perilymph followed an exponential time course. Although the observations of cerebrospinal fluid fluorescence were thought to represent a composite of the fluorescence of the cerebrospinal fluid itself and the underlying brain stem blood vessels, the peak fluorescence did not exceed that observed in the perilymph. These observations support the view that most of the perilymph is produced in the cochlea by ultrafiltration from the cochlear blood vessels. The slit lamp fluorophotometer appears to be a satisfactory means of recording fluorescein concentration changes in the perilymph without disturbing the cochlear physiology by penetrating the labyrinth to obtain fluid samples.

Animals↗

Dexamethasone pharmacokinetics in Guinea pig inner ear perilymph.

AIM: To study the dexamethasone pharmacokinetics in the inner ear perilymph of guinea pigs using high-pressure liquid chromatography. METHODS: Sixty-five guinea pigs were divided into three groups. In the first group, the drug application protocol used an intra-abdominal dose of 0.5% dexamethasone 4 mg x kg(-1). In the second group, an intratympanic application dose of 0.5% dexamethasone 150 microl was used. The third group was the control group. The concentrations of dexamethasone in inner ear perilymph were determined by high-pressure liquid chromatography. RESULTS: The perilymph concentration-time curves of dexamethasone conformed to a one-compartment open model after an intra-abdominal application. The Cmax was 0.927 +/- 0.008 mg x l(-1), the Tmax 1.47 +/- 0.04 h, the T(1/2K) 2.92 +/- 0.056 h, the AUC 5.533 +/- 0.05 mg x h x l(-1), the T(1/2Ka) 0.47 +/- 0.024 h. After an intratympanic application, the perilymph concentration-time curves of dexamethasone also conformed to a one-compartment open model. The Cmax was 0.201 +/- 0.006 mg x l(-1), the Tmax 0.117 +/- 0.06 h, the AUC 0.868 +/- 0.004 mg x h x l(-1), the T(1/2K) 2.918 +/- 0.089 h, the T(1/2Ka) 0.161 +/- 0.009 h. Compared to the intra-abdominal application, the intratympanic application resulted in similar levels of inner ear perilymph drug concentrations in 30 min. CONCLUSION: Dexamethasone can penetrate the blood-labyrinthine barrier after intra-abdominal application. Dexamethasone can enter into perilymph after intratympanic application. Under the condition of the study, the intratympanic application resulted in a similar level of inner ear perilymph drug concentrations compared to the intra-abdominal application in 30 min.

Animals↗