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Electromyographic correlation of tensor tympani and tensor veli palatini muscles in man.

It is the purpose of this study to attempt a correlation of function, by electromyographic means, of the tensor tympani and tensor veli palatini muscles in humans. Despite the small number of patients tested, it is believed that the similarities and characteristics of the two are unmistakably equivalent. A separate theory for the combined tensor function is discussed in distinction to the stapedius mediated acoustic reflex. The concept of a single tensor muscle, with two anatomic divisions, a common nerve supply, and parallel function, is therefore submitted.

Ear, Middle

The tensor tympani, stapedius, and tensor veli palatini muscles--an electromyographic study.

Electromyographic recordings of the activity of the tensor veli palatini, tensor tympani, and stapedius muscles were obtained from several adult human subjects. Muscle responses were recorded under four stimulus conditions, ie, contralateral intense wide-band noise, air jet to the eye, swallow, and electrical stimulation of the tongue. The results indicated that the two tensor muscles responded to the same stimuli in similar patterns. The latter muscle differed from the response of the stapedius.

Acoustic Stimulation

Tensor tympani, a 'tuner' of tensor palati muscle.

The author has proved experimentally (in two dogs) that there is reflex hypertonia of the tensor palati muscle, synchronous with the 'shortening' reaction of the tensor tympani muscle in response to its "static" relaxation during the gradual passive inward displacement of the drum resulting from the negative intratympanic 'dip' due to absorption of air imprisoned within the middle ear. The author coined the term 'tuning' for the reflex hypertonia of tensor palati which is directly proportional to the degree of the slackness of its 'tuner', the muscle-tensor tympani. The degree of opening of the eustachian tube on swallowing depends upon the degree of 'tuning' of the tensor palati. The 'untuned' tensor palati fails to open the eustachian tube during swallowing. Presumably the excitation of tympanic chemoreceptors (glomus body) by the excess of CO2 during hypoxia of the tympanic cleft strengthens the 'shortening' reaction as well as the excitability of the tensor tympani muscle.

Animals

Neonatal myosin in bovine and pig tensor tympani muscle fibres.

In previous studies of middle ear muscles, the classification of fibre types by histochemical methods was particularly difficult in the bovine and porcine tensor tympani muscle, suggesting the presence of immature fibres. We therefore reexamined the tensor tympani from pigs and cattle of various ages immunohistochemically, using a panel of antimyosin antibodies, including one (anti-NE) specific for neonatal and embryonic myosins. Fibres positive to anti-NE were found in tensor tympani in both species in all ages examined; only a few of these fibres reacted exclusively with this antibody; some also contained slow myosin and the majority also contained adult fast (type IIA) myosin. Furthermore, although the remaining fibres included some of the classical types I and IIA, the majority of them showed a mismatch between their histochemical and immunohistochemical profiles. The morphological appearance of the muscle, the widespread presence of neonatal myosin (often together with another myosin in the same fibre) and the persistence of this composition from birth to adulthood, could be explained by an incomplete development of the muscle fibres, resulting in a 'muscle' much better suited to the role of a ligament.

Aging

Histopathology of the tensor tympani muscle in otitis media.

Involvement of the tensor tympani muscle (TTM) and tendon in otitis media have been suggested both clinically and experimentally. Extensive postmortem histopathological studies of the human TTM in cases with known otitis media have not been done. One-hundred-five human temporal bones with and without otitis media were evaluated using light microscopy to determine the pathological changes of the TTM and tendon. Fatty cell infiltration and degenerative changes of the muscle fibers were observed in non-otitis and otitis media groups, but were greater in those cases with otitis media. Inflammatory cell infiltration and fibroblastic reactions occurred more often in chronic and purulent otitis media, and hypercontracted fibers were more frequent in serous and chronic otitis media. This study indicates that the human TTM and tendon are pathologically involved in the inflammatory process of otitis media.

Adolescent

Electromyogram of the tensor tympani muscle in man during swallowing.

Experiments were carried out on 2 patients who underwent an operation for chronic otitis media, whereupon the tensor tympani muscle was visualized. A unipolar platinum electrode was inserted into the muscle belly. EMG recordings were made during swallowing and other motor activity. Distinct, pronounced EMG activity was recorded from both patients every time they swallowed. It was concluded that the tensor tympani muscle participates in the act of swallowing and thereby probably contributes to the ventilation of the middle ear.

Deglutition

Bipolar electric stimulation to elicit and isolated tensor tympani reflex.

A bipolar electrode is described, designed to obtain improved reflex responses from the tensor tympani muscle by electric stimulation of the under surface of the tongue, d.c. generator, 7-9 V d.c. In comparison with the previous unipolar method of stimulation the responses under oscilloscopic analysis appear very constant and of greater size. The latency, in normal subjects, is 117 msec.

Electric Stimulation

Value of the isolated tensor tympani muscle reflex elicited by electric lingual stimulation.

A bilateral reflex contraction of the isolated tensor tympani muscle has been obtained in man by bipolar electric stimulation of the edge of the tongue (DC generator). The avoidance of the elevated and variable body electric resistance and of the variable contact resistance from the hand to the ground plate, represents an appreciable improvement of this method in comparison with the unipolar method described in a earlier paper. A further improvement has also been achieved by applying the electric stimulus to one inferior aspect of the tongue near the floor of the mouth, nearer to the lingual nerve. An analysis has been subsequently conducted in normal subjects and in patients affected by pathologies of the tympano-ossicular system; otosclerosis, tympanosclerosis, unilateral complete suprastapedial facial paralysis, interrumption of the ossicular chain; in cases of interruption of the afferent arc: section of the unilateral lingual nerve; involvement of its central portion: cerebello-pontine angle tumour, brain stem tumour. A chiasma-like central nervous pattern is suggested.

Brain Neoplasms

Morphology of tensor veli palatini, tensor tympani, and dilatator tubae muscles.

The relationships among the paratubal muscles were studied in human fetal and adult Eustachian tubes. That which has, in recent years, been labeled the tensor veli palatini muscle actually consists of two distinct groups of muscle fibers: a medial group, henceforth termed dilatator tubae, and a lateral group, called tensor veli palatini. The latter was found to have no Eustachian tube origin, but was continuous superiorly with the tensor tympani muscle. The dilatator tubae muscle was found to have a tubal attachment. The participation of this muscle system in the normal functioning of the Eustachian tube-middle ear system in man, and the problems inherent in the development of animal models simulating the physiology of the physiology of the human system, are discussed.

Adult

Infiltration of the tensor tympani and stapedius muscles in otitis media. An experimental study in the cat.

A longitudinal sequential study of otitis media was done in an experimental animal (cat) using eustachian tube obstruction. Fifty animals were used. Cellular infiltration of the tensor tympani and stapedius muscles was studied in a continuum from day 1 to 6 months after inducing otitis media. We observed that there is infiltration of the connective tissue of both muscles in otitis media, and that the cellular changes follow the same pattern as that seen in the mucoperiostium and the round window of the middle ear, although to a lesser degree. In this first report of sequential changes in middle ear muscles in otitis media, clinical implications of these findings are discussed.

Animals

[The tensor tympani muscle reflex in nasopharyngeal carcinoma].

The initial stages of carcinoma of the nasopharynx may be manifested by different types of impaired hearing. The Eustachian tube may be obstructed by a tumour or its orifice compressed, sometimes the tumour penetrates into the middle ear. The authors discuss the position which may develop in infiltration of the semicanalis m. tensoris tympani and how functional disorders of this muscle may be manifested. They describe the provoked reflex of this muscle by trimolar acetic asid and investigate tympanometric reactions of this artificially provoked contraction of the m. tensor tympani in patients with carcinoma of the nasopharynx.

Acoustic Impedance Tests

Extratympanic manometry in man. Clinical and experimental investigations of the acoustic stapedius and tensor tympani contractions in normal subjects and in patients.

New ideas and inspirations for future human investigations have emerged from the experience obtained in this study. These investigations ought to be performed for both scientific and clinical reasons. It is the author's opinion that the ETM method is extremely useful and valuable. The author intends to continue the human investigations if proper conditions are available. The ETM equipment can also be further improved for scientific and special clinical investigations. For normal clinical practice a more "simplified" ETM equipment should be developed. Clinical investigations concerning the diagnosis of brain stem disorders and the selection of noise susceptible persons will be two of the primary clinical tasks.

Acoustic Impedance Tests

[Otologic manifestations of the pain dysfunction syndrome of the stomatognathic system].

Phylogenesis, ontogenesis and anatomy explain the close relationship between temporo-mandibular joint and the middle ear and can therefore help understanding otologic symptoms such as: otalgia which often correspond to articular and muscular pain irradiation (coming from sterno-cleido-mastoid, lateral and medial pterygoid, deep layer of the masseter and temporal muscles); acouphens and ear block sensation that could be caused by a spasm extension of the manducatory (i.e. medial pterygoid) to levator and tympani tensors. These three muscles, which originate from the first branchial arch, have a proprioceptive sensitivity and share the same innervation. What is more tensor and levator veli exchange certain muscular fibers. Tensor tympani spasm can be held responsible both for a decrease or abolition of the Klockhoff's reflex, together with a decrease of the stapedian reflex, the latter due to tympani rigidity induced by a spasm of the tensor tympani.

Ear Diseases

Eardrum displacement following stapedius muscle contraction.

Simultaneous monitoring in human subjects on the same ear of eardrum displacement by tympanomanometry, and impedance with the electroacoustic bridge, provided information concerning contraction of the stapedius muscle and its effect on eardrum displacement. Extensive control procedures were employed to elicit only the stapedius reflex; lower intensity auditory stimulation, electrocutaneous stimulation of the homolateral external ear canal, and anesthetization of nerves leading to the tensor tympani. Following these procedures the following results were obtained: (1) Extremely small biphasic and monophasic eardrum movements were seen in the stapedius--only ear to auditory and electrocutaneous stimulation; the form of the response was much less predictable to auditory stimulation. (2) At high sound intensities relatively large inward and biphasic movements of the eardrum occurred in the normal ear, unquestionably due to contraction of the tensor tympani. These results were further validated in a group of stapedectomized ears, without the stapedius but with normal tensor tympani. (3) Biphasic responses did not occur in the tensor tympani--only ear, only monophasic inward responses. (4) Upon air-jet stimulation to the orbit of the eye, these subjects had an accentuated tensor response in that large inward movements of the eardrum occurred as compared with those in normal ears, suggesting that there is an alteration of the tensor response by the presence of the stapedius muscle. Estimates of the actual eardrum displacement were calculated based on a model of the external ear canal and eardrum.

Acoustic Stimulation

The biphasic acoustic reflex: a new perspective.

The anatomic, neurologic, and physiologic characteristics of the middle ear structures have created confusion concerning the nature of the intraaural muscle reflex. After reviewing the relevant literature, we correlated this information with our studies of human temporal bones and computer analyses of the acoustic reflex responses of individuals with normal hearing. Our hypothesis is that although the stapedius is the initiator of the reflex and the primary contributor to ossicular chain fixation, the tensor tympani is responsible for the major observed response. The negative deflection present in normals tested on the impedance bridge is caused by the stapedius, whereas the large positive deflection is the result of the tensor tympani contraction. We postulate that proprioceptive feedback mechanisms located within the stapedius muscle and tendon permit and/or initiate tensor tympani contraction during acoustic stimulation.

Acoustic Stimulation