Antibodies to inner ear antigens in Meniere's disease

Meniere's disease (MD) is an idiopathic inner ear disorder characterized by fluctuating hearing loss, episodic vertigo and tinnitus. Its aetiology is unknown, although there is growing evidence that autoimmunity may be involved in its development. Using the Western blot immunoassay, we examined the reactivity to bovine inner ear antigens of sera from a series of MD patients who had previously been extensively studied for the presence of antibodies to collagens and membrane proteins. Reactivity to inner ear antigens of molecular weight 44 and 53 kD was found in 11/25 (44%) and 10/25 (40%) of the patients, respectively; both antigens were absent in the sera of healthy donors. It is still unclear whether the antibodies to 44 and 53 kD proteins play a role in the pathogenesis of MD or if they instead represent the result of inflammation and tissue destruction. Even if the latter is true, they may contribute to the perpetuation of the disease or play a role as a cofactor in association with other mechanisms.     

High resolution imaging of the mouse inner ear by microtomography: a new tool in inner ear research

A newly developed desktop microtomograph was used to evaluate whether it is suitable for visualizing the three-dimensional (3D) morphology of the mouse inner ear (at a micrometer level) and whether it is applicable as a fast screening tool to detect hereditary abnormalities in this organ. To this end, the epistatic circler, a mutant mouse showing abnormal circling behaviour, was used as a model. The inner ears were dissected out, formaldehyde-fixed, and scanned at maximal resolution along the longitudinal axis. After segmentation, stacks of tomographic images were used for 3D reconstruction of the bony labyrinth. Finally, the obtained data were correlated with subsequent conventional histological examination. The spatial resolution (8 microm) achieved by this instrument, was found to be far superior to that obtained by conventional computer tomography (CT) and magnetic resonance (MR)-imaging equipment. The technique provides detailed tomographic images of the bony labyrinths and enables an adequate 3D reconstruction of the inner ear structures in this small mammal. In addition, it allows a screening for pathologic specimens prior to the more time- and labour-consuming histological techniques, which are still essential to gather information at a (sub)cellular level. This imaging technique can be regarded as a valuable tool in future research on hereditary inner ear abnormalities.     

The Meniere attack: An ischemia/reperfusion disorder of inner ear sensory tissues

We believe Meniere attacks arise as a chance association of endolymphatic hydrops and vascular risk factors for intracerebral ischemia. Hydrops acts as a variable Starling resistor upon the inner ear vasculature that is capable of inducing ischemic attacks only in people with reduced perfusion pressure in the ear. The unique characteristics of the attacks (loss of vestibular response and hearing acutely followed by a return to apparent normalcy over hours) are explained by the differential sensitivity of the inner ear tissues to transient ischemia, with the sensory tissues (dendrites, hair cells) vulnerable to hours-long ischemia/reperfusion injury, and the stria vulnerable to ischemia due to its high metabolic rate. Permanent hearing loss and vestibular damage after many attacks would result when small areas of irreversible sensory cell damage accumulate and become confluent.     

The Meniere attack: An ischemia/reperfusion disorder of inner ear sensory tissues

We believe Meniere attacks arise as a chance association of endolymphatic hydrops and vascular risk factors for intracerebral ischemia. Hydrops acts as a variable Starling resistor upon the inner ear vasculature that is capable of inducing ischemic attacks only in people with reduced perfusion pressure in the ear. The unique characteristics of the attacks (loss of vestibular response and hearing acutely followed by a return to apparent normalcy over hours) are explained by the differential sensitivity of the inner ear tissues to transient ischemia, with the sensory tissues (dendrites, hair cells) vulnerable to hours-long ischemia/reperfusion injury, and the stria vulnerable to ischemia due to its high metabolic rate. Permanent hearing loss and vestibular damage after many attacks would result when small areas of irreversible sensory cell damage accumulate and become confluent.This theory is supported by the strong correlation of hydrops with Meniere attacks, the finding that autoregulation of cochlear blood flow is impaired in the hydropic ear, and studies demonstrating that symptoms and signs in people and in animal models vary with conditions that alter perfusion pressure in the inner ear. Induction of Meniere attacks in animal models requires both hydrops and a mechanism that reduces perfusion pressure, such as epinephrine injection or head dependency. There is a strong clinical association between Meniere attacks and disorders that increase the risk for cerebrovascular ischemia, such as migraine. The excitable tissues in the sensory structures have long been known to be more vulnerable to ischemia than the remaining aural tissues, and are now known to be vulnerable to excitotoxicity induced by ischemia/reperfusion. This correlates well with autopsy evidence of damage to dendrites and hair cells and with strial atrophy in late Meniere disease cases.If this hypothesis is confirmed, treatment of vascular risk factors may allow control of symptoms and result in a decreased need for ablative procedures in this disorder. If attacks are controlled, the previously inevitable progression to severe hearing loss may be preventable in some cases.     

Embryogenesis of the mammalian inner ear

Summary The development of the tectorial membrane in the basal coil of the cochlea has started already in the 15th gestational day inner ear and has reached a considerable thickness and maturation at birth. The development of the tectorial membrane occurs synchronously in in vivo labyrinths and the in vitro material cultured to an age corresponding to birth. At least during this part of the development the formation of the tectorial membrane is independent of the specific composition of endolymph. In the in vivo material a secretory maximum was reached on the 18th gestational day, whereafter the secretory activity was low, especially after birth. In the in vitro specimens, however, a rather constant secretion of material occurred also post partum, which indicates a lack of control mechanisms during in vitro conditions. A complete maturation of the tectorial membrane did not occur in vitro. When passing the point of time corresponding to birth, in the in vitro inner ear explants the gross structure of the tectorial membrane is only slightly changed. In vivo a mature configuration of the tectorial membrane is observed on the 14th DAB (day after birth).Supported by grants from Karolinska Institutet, the Ragnar & Torsten Söderberg Foundation and the Swedish Medical Research Council (12X-720)     

Successful early treatment in a case of Cogan's syndrome

We report a 53-year-old male with Cogan's syndrome. He was admitted to our hospital because of a fever of 2-weeks duration, blurred vision for 10 days, hypoacusis, and numbness of the left hand for 3 days. In addition to uveitis, hypoacusis, and aseptic meningitis, multiple mononeuropathy was diagnosed based on a nerve conduction study. Furthermore, positron emission tomography/computed tomography (PET/CT) revealed diffuse aortitis. Accordingly, the patient was diagnosed with Cogan's syndrome. After starting steroid-pulse therapy followed by 1 mg oral prednisolone/kg/day, the uveitis and hypoacusis improved immediately, while the peripheral neuropathy persisted until effectively treated with intravenous gamma globulin therapy. Prompt steroid therapy for Cogan's syndrome based on a diagnosis made using PET/CT prevented progression of the hypoacusis.     

Oxidative imbalance in the aging inner ear

The mammalian inner ear loses its sensory cells with advancing age, accompanied by a functional decrease in balance and hearing. This study investigates oxidant stress in the cochlea of aging male CBA/J mice. Glutathione-conjugated proteins, markers of H2O2-mediated oxidation, began to increase at 12 months of age; 4-hydroxynonenal and 3-nitrotyrosine, products of hydroxyl radical and peroxynitrite action, respectively, were elevated by 18 months. Immunoreactivity to these markers was stronger in the supporting cells (Deiters and pillar cells) than the sensory cells and appeared later (23 months) in spiral ganglion cells and in the stria vascularis and spiral ligament. Conversely, antioxidant proteins (AIF) and enzymes (SOD2) decreased by 18 months in the organ of Corti (including the sensory cells) and spiral ganglion cells but not in the stria vascularis. These results suggest the presence of different reactive oxygen species and differential time courses of oxidative changes in individual tissues of the aging cochlea. An imbalance of redox status may be a component of age-related hearing loss.     

Development of the zebrafish inner ear.

Abstract Recent years have seen a renaissance of investigation into the mechanisms of inner ear development. Genetic analysis of zebrafish has contributed significantly to this endeavour, with several dramatic advances reported over the past year or two. Here, we review the major findings from recent work in zebrafish. Several cellular and molecular mechanisms have been elucidated, including the signaling pathways controlling induction of the otic placode, morphogenesis and patterning of the otic vesicle, and elaboration of functional attributes of inner ear.     

Cell replacement therapy in the inner ear

The mammalian inner ear is vulnerable to genetic disorders and aging, as well as to injuries caused by overstimulation, ototoxic drugs, and viral infections. Due to the poor regeneration of the sensory epithelium and the spiral ganglion neurons in the adult mammalian inner ear, cell replacement therapy strategies have been proposed to compensate for degeneration and loss of sensory and neuronal cells. Transplantation of stem cells and embryonic neurons into the inner ear has revealed that exogenous cells can survive, migrate, differentiate, and extend neuritic projections in the auditory system of adult mammals. These results suggest that cell replacement therapy could provide an effective future treatment alternative for hearing loss and other inner ear disorders.     

Angiogenesis: possible analogies between the eye and the inner ear

Angiogenesis is a phenomenon concerning both physiological conditions linked to development and pathological conditions; in the latter it is aimed at providing an enhancement in blood supply to tumours, on one hand, and to restore the circulation in peripheral arterial and ischemic diseases, on the other hand, thus resulting in a controversial effect depending on the circumstances. When occurring in the eye, angiogenesis clearly proved to represent a threaten, whereas an univocal interpretation of the action of angiogenesis on the inner ear homeostasis is still lacking despite the morphologic and functional analogies between eye and labyrinth. These analogies can raise same doubt on the supposed role of angiogenesis in terms of preserving the function of a threatened inner ear: even this organ could be further damaged by microvascular disorders and/or mechanical changes able to jeopardize its architecture and consequently its function. If a parallelism between ear and eye is extendable to this aspect, this could open new perspectives in the treatment of certain affections of the inner ear by borrowing therapeutic strategies that have given appreciable and consolidate responses in the treatment of degenerative retinopathy.     

Structure of the chicken's inner ear: SEM and TEM study

The inner ears of 35 adult chickens were studied by TEM, SEM and light microscopy. Two well differentiated hair cell/nerve ending units were present: tall hair cells with small vesiculated nerve endings were located on the attached part of the basilar membrane; short hair cells with large vesiculated nerve endings were located on the free basilar membrane except for the distal tip. In this respect the chicken ear is similar to that of the pigeon. The chickens examined did have some unique features. Sensory cells of lenticular and hemispheric shape were also present at the proximal end. Bundles of long dense tubules were seen frequently within the sensory cell cytoplasm. Kinocilia were absent from the hair bundles of many of the sensory cells. The internal structure of the kinocilia which were present was atypical and consisted of a variable number of doublets. Eight peripheral plus one central doublet were found most frequently.