10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归.方法对10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗.结果迟发性面瘫多发生于术后第4天左右.面神经功能Ⅱ～Ⅲ级,绝大部分病例在3周左右完全恢复,且无任何后遗症.结论慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致;也可能与并发单纯疱疹病毒感染有关.     

17例中耳术后迟发性面瘫的临床特征分析

目的 探讨中耳手术后迟发性面瘫出现的可能病因、处理措施及结果。 方法 收集自2017年1月至2018年12月接受中耳手术病例资料1 124例,回顾性分析迟发性面瘫发生时间、相关因素、治疗经过及恢复情况。 结果 1 124例中耳手术术后出现迟发性面瘫17例,发生率为1.51%;术后3~20 d出现迟发性面瘫,平均(10.00±4.11)d;按照各术式分布如下:鼓室成形术Ⅰ型(8/348, 2.30%),鼓室成形术Ⅱ型(4/247,1.62%),开放式乳突切开+鼓室成形术(5/529,0.95%),各术式之间迟发性面瘫发生率差异无统计学意义;按照面神经骨管情况分布如下:面神经骨管部分缺失348例,术后迟发性面瘫(5/348, 1.44%),面神经管完整776例,术后迟发性面瘫(12/776, 1.55%),面神经骨管是否完整,术后迟发性面瘫发生率差异无统计学意义;1例发生术后术腔感染,细菌培养提示铜绿假单胞菌感染,对症处理感染控制后,行面神经探查、耳大神经切取面神经吻合术,术后1年面神经功能恢复至Ⅲ级;其余16例全部予以激素等保守治疗,治疗后0.5~3个月后功能完全恢复。 结论 中耳术后迟发性面瘫与手术方式、面神经是否裸露等因素无关,保守治疗效果好。     

10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的 :探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归。方法 :对 10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察 ,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗。结果 :迟发性面瘫多发生于术后第 4天左右。面神经功能Ⅱ～Ⅲ级 ,绝大部分病例在 3周左右完全恢复 ,且无任何后遗症。结论 :慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致 ;也可能与并发单纯疱疹病毒感染有关。     

中耳乳突手术面瘫的原因和预防

目的 :探讨中耳乳突手术面瘫和手术后面瘫的原因。方法 :回顾我院 1991～ 1998间年共行中耳乳突手术 5 16例 (5 30耳 )中 ,发生面瘫 18例 (18耳 ) ,占 3.4% ,术中出现面瘫 12例 ,其中有 8例立即行面神经减压术 ;6例为迟发性面瘫 ,行保守治疗。结果 :术中出现面瘫 12例中 ,行面神经减压术 8例 ,面瘫均完全恢复 ,4例未行面神经减压术者 ,其中 3例面瘫 2年部分恢复 ,1例 5年部分恢复 ;术后迟发性面瘫经保守性治疗 6例均完全恢复。结论 :术中出现面瘫 ,要迅速探查 ,常规行面神经减压术 ;术后面瘫可行保守治疗。     

中耳乳突手术面瘫的原因和预防

目的：探讨中耳乳突手术面瘫和手术后面瘫的原因。方法：回顾我院１９９１～１９９８间年共行中耳乳突手术５１６例（５３０耳）,发生面瘫１８例（１８耳）,占３．４％,术中出现面瘫１２例,其中有８例立即行面神经减压术;６例为迟发性面瘫,行保守治疗。结果：术中出现面瘫１２例中,得面神经减压术８例,面瘫均完全恢复,４例未行面神经减压术者,其中３例面竣２年部分恢复,１例５年部分恢复;术后迟发性面瘫经保守性治疗６例     

中耳乳突手术致面神经损伤的原因分析及防治

目的 分析中耳乳突手术至致面神经损伤的原因,提出预防策略.方法 回顾性分析32例因中耳乳突手术发生面瘫的原因及治疗效果.结果32例中迟发性面瘫11例,经抽出术腔填塞物、给予糖皮质激素、抗生素和抗病毒药物治疗后,9例完全恢复,2例未恢复.速发性面瘫21例,经面神经减压、端端吻合等处理,10例恢复正常(I级),5例恢复到II级,2例恢复到III级,4例未恢复.造成面瘫的原因可能为:①术者经验不足、对颞骨解剖不熟悉,特别是出现天盖下垂、面神经解剖异常、乙状窦前移等解剖异常时手术易损伤面神经;②乳突气房发育不良而采用凿小孔方法 寻找鼓窦;③面神经管部分缺损、去除病变方法 不正确而损伤面神经.结论 熟悉面神经颞骨面神经解剖,遵循中耳乳突手术原则,是防止面神经损伤的主要手段.     

开放式鼓室成形术后迟发性面瘫6例

目的探讨开放式鼓室成形术后迟发性面瘫的病因、预防和处理措施。方法分析1991～2005年开放式鼓室成形术后迟发性面瘫6例,面神经功能评估采用House-Brackmann分级法,患者均使用激素、营养神经和扩血管药物及理疗等综合治疗。结果面瘫出现后10d恢复者1例,20d恢复者4例,50d恢复者1例。均无后遗症状。结论开放式鼓室成形术后迟发性面瘫的致瘫原因可能与面神经骨管裂、术中术后各种不良刺激、病毒再活化等因素相关,治疗以保守为主,一般预后较好。     

中耳术后迟发性面瘫相关因素分析

目的 分析中耳手术后迟发性面瘫的可能发病原因和预防方法。方法 回顾性分析1995-2005年来8例中耳乳突术后迟发性面瘫患者的临床资料。结果 术中发现面神经骨管缺损3例，术中鼓索神经受到明显牵拉2例，不明原因3例；7例在术后1月内面瘫完全恢复，1例在术后3月内面瘫完全恢复。结论 迟发性面瘫多发生于术后7～8d，一般为不完全性面瘫，均可完全恢复。其病因可能与牵拉鼓索神经、面神经解剖异常、填塞物过紧、血肿压迫等有关。     

面神经减压治疗周围性面瘫的临床分析

目的总结各种原因所致周围性面瘫行面神经减压术的经验和疗效。方法回顾分析37例周围性面瘫的临床资料、面神经减压的手术方式及疗效。结果 37例中,包括颞骨骨折、中耳乳突手术后、中耳乳突炎、面神经瘤、听神经瘤及中耳癌等不同原因。术后随访3月至4年,其中25例面神经功能恢复至House-BrackmannⅠ、Ⅱ级(68%)。面瘫病程<2月者手术减压效果明显优于>2月者。结论面神经减压术是治疗周围性面瘫的有效手段,对保守治疗恢复不满意、有手术指征的患者,应尽早行面神经减压术。     

鼓室乳突术后迟发性周围性面神经麻痹的临床诊治

目的分析和探讨鼓室-乳突手术后迟发性周围性面神经麻痹的临床特征、诊断和治疗要点。方法回顾性分析从2010年3月~2014年12月接受鼓室-乳突手术术后出现迟发性周围性面神经麻痹的共7例患者的临床诊治过程,包括其病史、专科查体、影像学及听力学检查、手术经过、面神经麻痹发生的时间、治疗用药及随访情况等。结果 664例鼓室-乳突手术的患者中,有7例在术后出现了迟发性周围性面神经麻痹,发生率为1.05%,面神经麻痹的发生时间是术后5~14天,平均11天,面神经功能情况:HBⅣ级4例,Ⅲ级2例,Ⅱ级1例,6例术前颞骨CT检查显示面神经水平段裸露,3例伴有耳周疼痛,3例有面部受冷风刺激史,3例进行了疱疹病毒抗体检测,其中3例阳性;经抗病毒、糖皮质激素、营养神经等治疗,10天后所有患者的面神经麻痹症状明显好转,其中1例恢复正常,1月后5例恢复正常,余1例在2月后也恢复正常。结论迟发性周围性面神经麻痹是鼓室-乳突术后少见的并发症之一,多发生在术后10天左右,其发生的具体病因不明,可能与局部细菌感染或病毒感染、鼓室内填塞物刺激或鼓索神经牵拉肿胀等因素有关。经积极药物治疗,大部分患者的面瘫症状可在10天内得到明显改善,2月后均恢复正常。     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.     

Physiologische Grundlagen einer Hörprothese

Zusammenfassung Im Bemühen, eine Hörprothese zu entwickeln, die ein Sprachverständnis erlaubt, erscheint es zumindest fürs erste am zweckmäßigsten, durch künstliche elektrische Reizung des Hörnerven die natürlichen Verhältnissen so gut als möglich zu imitieren. Der normale Hörnerv enthält etwa 30000 Nervenfasern, die sich qualitativ gleich, quantitativ jedoch unterschiedlich verhalten, wobei über die Eigenschaften der von den ÄHZ kommenden Spiralfasern im Augenblick sichere Aussagen nicht möglich sind (siehe 2.3). Die quantitativen Unterschiede zwischen den einzelnen Hörnervenfasern beziehen sich auf deren Frequenzabstimmung, Frequenzselektivität, Schwellen, Intensitätsfunktionen und — wichtig insbesondere für das Vorhaben einer künstlichen elektrischen Reizung — in Zeitunterschieden in den Aktivitätsmustern, die durch Laufzeitunterschiede auf der Basilarmembran bedingt sind (2.3). Diese Zeitunterschiede in der Aktivität einzelner Fasern liegen im Bereich mehrerer ms (2.3.6; 2.3.7). Die durch Schallreize im normalen Hörnerven ausgelösten Aktionspotentiale haben überdies einen probabilistischen Charakter, d. h. ihr Auftreten ist keineswegs streng determiniert. Es versteht sich von selbst, daß man bei künstlicher, elektrischer Reizung nicht alle verbliebenen Nervenfasern selektiv reizen kann. Somit wird eine Reizelektrode immer eine Gruppe von Nervenfasern erregen müssen. Bei jeder denkbaren elektrischen Reizung wären alle Fasern im Reizbereich einer Elektrode synchron und streng deterministisch aktiviert, was einen außerordentlich ernstzunehmenden Unterschied zu natürlichen Verhältnissen darstellt (3.2).Um die Zahl der zum Sprachverständnis mindestens notwendigen Reizkanäle abzuschätzen, wird man, in Ermangelung anderer experimenteller Daten, von psychoakustischen Untersuchungen an Normalhörenden auszugehen haben. Diese haben gezeigt, daß das Gehör neben einer außerordentlichen Fähigkeit verschiedene Tonhöhen zu unterscheiden, andererseits die Fähigkeit besitzt, bestimmte Frequenzgebiete zu sogenannten Frequenzgruppen zu integrieren. Die in eine solche Frequenzgruppe fallende Schallenergie wird zu einem einheitlichen Höreindruck verarbeitet. Es scheint also sinnvoll, die für einen Prothesenbau notwendige Zusammenfassung von Gruppen von Fasern des Hörnerven in verschiedene Reizkanäle entsprechend diesen Frequenzgruppen vorzunehmen (3.1). Demnach müßte der Sprachbereich in 15 Reizkanäle aufgeteilt werden, was wiederum, wenn man in der Cochlea reizen will, 1,2 mm Abstand von Kanal zu Kanal erlauben würde. Dabei müßte der Reizerfolg sauber auf die einzelnen Kanäle beschränkt bleiben, d.h. eine optimale Kanaltrennung erreicht werden. In Anbetracht der groben Abweichungen der neuronalen Aktivität vom normalen Verhalten, die bei künstlicher, elektrischer Reizung unvermeidlich sind, ist freilich unsicher, ob die angegebene Zahl ausreichen würde. Andererseits ist es in Anbetracht der zu erwartenden Stromverteilung im Sprachbereich kaum vorstellbar, mehr als die angegebene Zahl von Kanälen realisieren zu können.Was die Kodierung der Schallparameter innerhalb eines Elektrodenkanals betrifft, wird vorgeschlagen, die Frequenzkodierung nach dem Ortsprinzip optimal auszunutzen, und im Hinblick auf die Periodizitätsanalyse und die Lautheitskodierung sich soweit als möglich den natürlichen Verhältnissen anzunähern (3.3). Dabei wären Laufzeitunterschiede zwischen den Kanälen und der probabilistische Charakter der neuronalen Entladungen soweit als möglich einzuführen, um die Dominanz eines periodicity pitch zu vermeiden.Eine für Sprachverständnis ausreichende Prothese ist auch nur denkbar, wenn eine Prothese die zur Sprachübertragung notwendige Übertragungskapazität besitzt. Ergebnisse der Kanal-Vocoder-Technik zeigen, daß Sprache noch mit 1500 bit/s befriedigend übertragen werden kann. Eine Abschätzung der möglichen Leistungsfähigkeit einer 15-kanaligen Prothese (3.4), basierend auf der Zahl der möglichen unterscheidbaren Unterschiedsstufen der Hörempfindung, ergibt, daß diese Übertragungskapazität knapp erreicht werden könnte. Allerdings ist damit noch nicht gesagt, daß das Zentralnervensystem die angebotene Information auch im Sinne einer Phonemanalyse auswertet und damit für ein Sprachverständnis maximal ausschöpft. Nur für diesen Fall wäre ein Sprachverständnis zu erwarten.Als Reizort erscheint in erster Linie die Cochlea (5.1) geeignet. Für den Fall einer Degeneration der primären afferenten Fasern des Hörnerven ist aufgrund physiologischer Überlegungen auch der Nucleus cochlearis ventralis (5.5) interessant, allerdings würde so nur der ventrale Anteil der Hörbahn stimuliert. Doch besitzen auch andere Reizorte spezifische Vorteile (5.2–5.4).Theoretische Überlegungen (6.1) und experimentelle Messungen an implantierten Elektrodensätzen (6.3) zeigen, daß die Forderung der Kanaltrennung nur schwer zu erreichen sein wird. Deswegen wird der dynamische Bereich (im Hinblick auf Veränderung des Reizstromes) eines nach den obigen Kriterien konstruierten Reizkanals auf maximal 3 dB zu beschränken sein, so daß Erregungsausbreitung auf weitere Bereiche der Cochlea durch Ansteuerung von mehreren Reizkanälen zu imitieren wäre.Die Chancen, eine Prothese zu verwirklichen, die befriedigendes Sprachverständnis auf der Basis einer quasinatürlichen Reizung des Hörnerven erlaubt, wird von uns in Anbetracht der geschilderten mannigfaltigen Schwierigkeiten als sehr niedrig angesehen. In Anbetracht des großen Nutzens, der andererseits eventuell resultieren könnte, halten wir die Erforschung des Problems jedoch für angebracht.Es wird von uns vorgeschlagen, auch zu untersuchen, ob sich für eine prothetische Versorgung vorverarbeitete Sprache besser eignet (7.). Für Prothesen, die ein Sprachverständnis nicht anstreben, halten wir eine Implantation in die Cochlea für überflüssig. Hier erscheint uns die Implantation von Reizelektroden am runden Fenster (Douek et al., 1977; Fourcin et al., 1978; s. a. 1. und 7.) wegen des geringeren Risikos der überlegenere Weg.Die zitierten eigenen Arbeiten der Autoren wurden mit Unterstützung der DFG durchgeführt (DFG-K1 219).     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Limited Surgery for Cancer of the Larynx and Hypopharynx: Options and Consequences

We reviewed surgical options for laryngeal preservation (limited surgery) in laryngeal and hypopharyngeal cancers and the consequences of the options. Of 44 patients with laryngeal cancer, 11 (25%) received limited surgery and 33 (75%) received total laryngectomy. The survival rates were 91% for the limited surgery group and 73% for the total (radical) surgery group. Of 31 patients with hypopharyngeal cancer, 7 (23%) received limited surgery and 24 (77%) received total laryngopharyngectomy. The survival rates were 53% for the limited surgery group and 40% for the total (radical) surgery group. The survival rates associated with limited surgery were thus better than those for total (radical) surgery for cancers of both the larynx and hypopharynx. This was attributed to the limited surgery group comprising well-selected patients with confined lesions. Organ preservation surgery should be technically simple, reliable in terms of its functional impact and, above all, should not jeopardize the patient's survival. Supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy or cricohyoido-pexy has great potential for laryngeal preservation and will become the major limited surgery modality for treating cancer of the larynx. Limited surgery, however, needs to be performed with great care and is indicated only for very well-selected patients with cancer of the hypopharynx.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Cochlear Function in Ears with Immunomediated Inner Ear Disorder

The aim of the present study was to evaluate the performance of ears with inner ear disorder, responsive to immunosuppressive drugs, in advanced tests designed to assess primary cochlear functions (temporal integration, frequency selectivity, cochlear mechanics). The results of this study suggest that immunomediated inner ear disease results, in the acute clinical stage, in the development of endolymphatic hydrops, which increases the stiffness of the vibrating structures within the inner ear and causes dysfunctions of the outer hair cells. Our patients presented with upsloping or flat sensorineural hearing loss, absence of evoked otoacoustic emissions and distortion-product otoacoustic evoked emissions and abnormal temporal integration, frequency selectivity and cochlear mechanics. Following immunosuppressive treatment, hydrops recovered, hearing subsequently returned to normal, the audiometric curve became flat at low-to-middle frequencies and primary cochlear function tended to normalize. This study seems to support the usefulness of testing primary cochlear functions in order to monitor the clinical course of immunomediated inner ear disorders.