内耳膜迷路积水的基础研究和临床诊治

我们对内耳膜迷路积水的认识一般来源于梅尼埃病。1938年Hallpike和Cairns发现梅尼埃病的病理学改变为内耳膜迷路积水，又称内淋巴积水。其实，膜迷路积水是许多耳科疾病内耳损伤后相同的病理改变，梅尼埃病只是其中一种，称为有症状特发性膜迷路积水。内耳膜迷路积水的基础研究，尤其是动物模型的建立，成为为研究眩晕机制且最终根治眩晕的关键。掌握不同种类膜迷路积水疾病的临床特点，有助于眩晕的诊断、鉴别诊断和临床治疗。     

耳蜗组织连续切片显微结构的三维重建研究

目的:探讨生物组织连续切片显微结构的三维重建使用方法.方法:应用火棉胶切片技术获得耳蜗组织连续切片,显微镜下放大40倍后对耳蜗组织摄像.使用Adobe photoshop 6.0图像处理软件和Amira3.0三维重建软件对内耳结构进行图像拼接、对位和三维重建.结果:三维重建立体真实再现了耳蜗组织的解剖结构,重建效果表明该研究显微结构的数据输入、图像拼接、内定位技术和三维重建方法是可行的.结论:采用内定位技术,借助重建软件,可以在个人计算机上实现生物组织连续切片显微结构的立体重建,是一种实用的重建方法.     

二次固定法在内耳耳蜗切片标本制作中的应用

内耳耳蜗的结构非常特殊,由两套管道套叠而成：外层骨蜗管（bony cochlear duct）和内层膜蜗管（membranous cochlear duct）[1-2]。特殊的结构导致了标本制作时膜蜗管内组织极易自溶、取材耗时久、不易及时固定等难题。许多研究者采用了各自不同方法制作内耳切片标本,比较经典的有耳蜗开窗固定法[3]、颈动脉灌注法[4]、石蜡包埋切片法[5-8]、OCT包埋冷冻／恒冷切片法[9-10]、非脱钙冷冻切片法[11-12]、石蜡火棉胶双重包埋切片法[3,13]、火棉胶包埋切片法等[14],但这些方法不是未能取得满意的效果,就是制作过程复杂、周期长,难以批量制作切片标本。本研究采用心脏灌注在第一时间对豚鼠内耳组织进行初步迅速固定,再在耳蜗顶尖部及底部钻孔后二次充分固定,保留内耳膜蜗管的完整结构,以期找出一种理想的内耳切片标本制作方法。     

豚鼠与鸡内耳膜迷路蛋白电泳图像分析

豚鼠与鸡内耳膜迷路蛋白电泳图像分析胡宁姜泗长顾瑞胡吟燕本文旨在通过对不同种属的内耳膜迷路蛋白（ＭＰＬ）的电泳分布特点的分析，为以异种ＭＬＰ为抗原检测人血清抗内耳抗体提供依据。一、材料与方法ＭＬＰ的提取：取听力正常的杂色豚鼠４只和１日龄雏鸡２０只的双侧...     

耳科学

20050513颞骨立体解剖图谱的研制和应用/戴朴…//解放军医学杂志.2004,29(5).392～395目的:综合颞骨连续切片、计算机三维重建技术和体视学研制颞骨系列立体解剖图谱。方法:制作50套带参照点的颞骨连续切片,应用计算机三维重建技术恢复颞骨内系列结构的三维形态,配合体视镜制作系列颞骨结构立体图谱。结果:共进行针对骨迷路、膜迷路、听骨链、耳内肌、面神经、圆窗龛和膜、后壶腹神经、内淋巴囊、前庭水管、耳蜗导水管、前庭蜗神经的三维重建48例次,选取最佳的有代表性的图片制成系列颞骨立体解剖图谱,系统显示了上述结构的细微形态和结构间…     

利尿剂对膜迷路积水的作用

在豚鼠作内淋巴管和囊堵塞手术后,作者观察了利尿剂对这种膜迷路积水的作用。77只豚鼠分为三组:组1于闭塞术后第1天服醋唑磺胺(159～434mg/kg),每日1次,服1月;组2于术后第1天服氯噻酮(72～182mg/kg),每两天服1次,服一个月;组3不服任何药物做对照。各实验组分别观察7天、8天、9天、1个月和4个月。内耳用火棉胶包埋连续切片,耳蜗中阶容积用计算机求积仪从连续切片中求出,测定正常中阶和积水中阶的面积。在日服159～434mg/kg醋唑磺胺30天的动物中,膜迷路积水达不到未服药动物程度,但在服药一个月后停药3个月的动物则与不服药组无差     

1.5T MRI经静脉钆造影在内耳膜迷路积水诊断中的临床应用[论著]

目的　探讨1.5T MRI经静脉3D-Flair内耳钆造影在内耳膜迷路积水诊断中的临床应用价值。方法　收集2018年5月至2020年11月鄂尔多斯市东胜区人民医院耳鼻咽喉科门诊就诊的17例（17耳）梅尼埃病和16例（16耳）前庭性偏头痛患者。其中梅尼埃病组（实验组）男11例（11耳）,女6例（6耳）,年龄28~69岁,中位年龄56岁,病程1~17年;前庭性偏头痛组（对照组）16例（16耳）, 男3例（3耳）,女13例（13耳）,年龄31~67岁,中位年龄48.5岁,病程6个月~3年。两组病例均先行1.5T MRI内耳水成像和3D-Flair序列扫描（层厚1 mm）,第1次扫描后即行静脉注射钆剂,剂量为0.4 ml/kg,通过肘静脉以3.0 ml/min的速度注射入体内,注射钆剂后4.5 h行第2次3D-Flair序列扫描。由2名有经验的核磁室医师依据内耳膜迷路MRI评分法观察比较内耳半规管、前庭、耳蜗各 转水成像及钆造影前后3D-Flair图像,并进行评分判断是否存在内耳膜迷路积水。结果　33例患者均获得满意的MRI图像,其中17例梅尼埃病患者中16例患耳提示膜迷路积水,积水显示率为94.11%;16例前庭性偏头痛患者中1例症状耳提示膜迷路积水,积水显示率为6.25%。实验组和对照组比较,实验组积水率高于对照组,两者比较差异有统计学意义（χ2=25.48,P <0.05）。结论  1.5T MRI经静脉双倍剂量内耳3D-Flair钆造影在内耳膜迷路积水诊断中具有一定的临床应用价值。     

颞骨矢状位组织切片与CT图像对照研究

目的制作颞骨矢状位数字化火棉胶薄层断层数据集,CT片与HE染色照片进行对照观察,为临床影像学诊断及手术入路设计提供参考。方法用2例尸头标本进行螺旋CT扫描后制作侧颅底区标本,火棉胶包埋后,用大型轮式切片机沿矢状位切片,厚度100μm,每切一片均采用SonyF-717数码照相机(500万像素)摄影并保存在计算机。选取代表性层面的切片进行HE染色。将断层数码照片与HE染色照片和CT片进行对照观察,对代表性层面结构特点进行描述,包括鼓窦入口层面、面神经锥曲层面、前庭窗层面、蜗窗层面、内耳道底层面。结果获取颞骨完整矢状位数字化薄层断层数据集2套。火棉胶断层照片与CT图像有良好的对应关系,连续观察可以对结构毗邻关系深入理解。火棉胶组织学断层切片为影像学断层片结构的识别提供重要参考。矢状位可以较好显示面神经垂直段行程以及面神经锥曲段与水平半规管之间的关系,对锤砧关节、前庭导水管、颈静脉窝、颈内动脉、内耳道内神经等的显示有优势。结论矢状位组织切片与CT对照研究有助于颢骨三维立体结构和中耳乳突手术入路的理解,HE染色照片可以帮助火棉胶断层图像结构的准确识别,二者结合可以指导CT读片,为影像诊断和手术定位提供有价值的参考。     

内耳体素模型三维可视化

内耳结构精细而复杂,位于颞骨岩部骨质内,又称为迷路,由半规管、前庭、耳蜗三部分组成。迷路内充满淋巴液,临床MRI检查可以获取清晰影像,但不能或仅能部分显示膜迷路结构[1]。内耳三维可视化和空间方向测量对于临床和研究都非常重要,其三维显示方式主要为表面绘制技术和体绘制技术。表面绘制仅提取内耳表面进行表面形态显示,需要分割内耳结构并三维重建。体绘制以体素为基本单元,直接由体数据生成三维物体的凸显,通过调节颜色和透明度,半透明视野可观察内部结构[2]。为更好显示内耳解剖,基于图像处理技术,对其进行分割一直是研究热点和难点。目前内耳分割技术还没有取得非常大的进展,主要是手工分割或半自动分割,非常耗时,缺乏有效的自动分割方法。常用内耳自动分割算法包括阈值分割技术、区域增长技术、聚类分割技术、图谱法分割技术、形变模型分割技术和分水岭算法等[3～5]。因内耳周围结构复杂,体素成像常因周围骨骼阻挡影响观察,且很难通过调节阈值屏蔽周围结构。但通过体裁剪技术,可以剔除内耳周围组织结构,甚至可以根据表面模型进行裁剪成为体素模型[4]。内耳体素模型包括体素数据完整信息,因而通过体绘制成像更为清晰可靠,且因为仅保留内耳数据,大大减少了计算机运算量。     

鼻科学

20031234墓于CT圈像的异部解剖结构三维,建/董硕…//首都医科大学学报一2003,24(2).一1 15一117 为了给可视化虚拟人体模型的建立探索一246种精确的重建方法和显示手段,同时也为医疗工作者提供一种更为细致、完全和快捷的观察方案,利用3D Slicer软件实现鼻部解剖结构的三维可视化。分别对单层切片进行感兴趣区的轮廓提取,将处理后的体数据导人3D Slicer,选择阔值进行进一步的图像分割,产生感兴趣区的标志图(l aber maps),并根据标志图重建出组织的三维表面模型;还可以显示不同结构之间的毗邻关系与空间定位。结果表明,基于CT图像和用3D …     

BPPV Viewer: A downloadable 3D BPPV model for study of otolith disease

ObjectiveTo develop a downloadable three-dimensional (3D) study tool of the membranous labyrinth in order to facilitate the study of benign paroxysmal positional vertigo (BPPV).BackgroundThe diagnosis and treatment of BPPV depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principles of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth.MethodsA previously reported 3D model of a human labyrinth was transposed to a 3D development software to allow the creation of markers along the semicircular ducts and utricle. These markers represent otoliths at different positions during movement of the model within the 3D environment. User-friendly tools were created to navigate the model, to allow clear documentation and communication of studied problems, and to study the model across relevant planes. The final model can be downloaded and is available for general useat https://bppvviewer.com/download/.ResultsThe model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct, the planes of the cristae, and the position of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations in various draw styles.ConclusionThis simple model could offer insights that lead to more accurate diagnosis and treatment of BPPV. It may also be useful as a tool to teach BPPV.     

The creation of geometric three-dimensional models of the inner ear based on micro computer tomography data

The modeling of the mechanical process of hearing requires an accurate geometrical model of the inner ear (cochlea). The purpose of this study was the creation of a 3-D model of the fluid chambers of Guinea pig cochlea, which could serve as a basis for further mechanical modeling. Micro computer tomography used in this study is a noninvasive method to visualize bony structures. The visualization of the membranous labyrinth was achieved by additional staining of the specimen with OsO(4). The resulting stack of images has been transformed into a cylindrical coordinate system. To suppress noise on tomography images, a nonlinear smoothing method, anisotropic diffusion, were applied. A new approach has been proposed to estimate algorithm parameters automatically. Then, a segmentation using active contours (snakes) was performed. In this study, a new energy linking the contours on adjacent slices has been added to the standard approach. This compensates the inconsistencies between adjacent contours. The images segmented in this way were used as a basis for a 3-D reconstruction of the hearing organ.     

Magnetic resonance imaging virtual endoscopy of the labyrinth

OBJECTIVE: To explore the feasibility of applying virtual endoscopic (VE) techniques to examine the normal anatomy of the labyrinth using magnetic resonance imaging (MRI) data. STUDY DESIGN: Feasibility study using data from a normal subject. MATERIALS AND METHODS: MRI data was acquired in a single normal subject using a three-dimensional (3D) CISS (Constructive Interference in the Steady State) sequence. Perspective volume rendering (PVR) techniques were used to produce virtual endoscopic visualization of the fluid filled structures of the inner ear. RESULTS: The reconstructive algorithms enabled generation of a "fly-through" simulation of the labyrinth. The cochlea, the oval window, the vestibule, the common crus, and the semicircular canals were successfully visualized. CONCLUSIONS: Virtual endoscopic techniques were successfully applied to MRI data enabling a 3D virtual display of the internal anatomy of the normal labyrinth.     

Inner ear morphology of experimental perilymphatic fistula.

The inner ear pathology of experimental perilymphatic fistula (EPLF) is described. EPLF was produced by injecting artificial perilymph into the subarachnoid space, or by suctioning 4 microL of perilymph through one of the round window membranes of the guinea pig. The animals were either killed immediately, or were kept alive for 3 weeks to 3 months. The conventional celloidin embedding method was employed for morphologic study. Vestibular function of the animals was tested by observing spontaneous nystagmus and positional nystagmus after the experiment. The caloric test was also performed. Various pathologic changes of the membranous labyrinth were observed. In the cochlea these included rupture or collapse of Reissner's membrane, bulging of Reissner's membrane, loss of hair cells, and compression of the organ of Corti. Pathology of the otolithic organs and semicircular canals mainly consisted of collapse of the membranous labyrinth. Clinical symptoms in patients with perilymphatic fistula (PLF) are explained, based on our experimental findings. Electronystagmography (ENG) of EPLF animals showed either no caloric response or, with a longer duration, caloric irregularity. Prolonged unsteadiness in patients may be due to "floating" labyrinth.     

Three-dimensional reconstruction and measurement of the human membranous semicircular canal

The planar relationship of the human semicircular canals was determined by Blanks et al. at a series of points measured from the dissected bony labyrinth of the human skull. The relationship of membranous canal planes have not, however, been measured from the human temporal bone. We reconstructed 3 semicircular canals by computer-aided 3-dimensional analysis and measured the angles formed between pairs of 3 osseous and membranous canal planes of temporal bones. Five temporal bones in adults were used for this study. Results indicated angles formed between pairs of ipsi-lateral canal planes of both the bony and membranous labyrinth. Angles formed between the horizontal-anterior, anterior-posterior, and posterior-horizontal canal planes of the bony labyrinth were 89.64 +/- 1.82 (mean +/- SD), 90.95 +/- 1.25, and 94.02 +/- 3.77 degrees. The same angles measured from the membranous labyrinth were 90.12 +/- 2.64, 90.18 +/- 2.75, and 91.48 +/- 6.32 degrees. Differences between the angles formed between bony and membranous canal planes were 2.11, 6.05, and 3.26 degrees in the anterior, horizontal, and posterior canal. Pairs of membranous canal planes were nearly perpendicular without exception, but pairs of osseous canal planes had a larger deviation from 90 degrees. This suggested that membranous canals could successfully be constructed in adequate alignment for canal function in the large perilymphatic space within osseous semicircular canals.     

自身免疫性内耳病动物模型的抗内耳特异性抗体谱系分析

目的 为明确哪几种膜迷路蛋白成分参与了实验性自身免疫性内耳病（ａｕｔｏｍｍｕｎｅｉｎｎｅｒ－ｅａｒ ｄｉｓｅａｓｅ，ＡＩＥＤ）的形成。方法 以同种内耳组织抗原免疫豚鼠，建立自身免疫性内耳病动物模型。用免疫转印迹技术（Ｗｅｓｔ－ｅｒｎ ｂｌｏｔ）检测动物血液中抗膜迷路蛋白抗体。结果 豚鼠膜迷路蛋白成分复杂，ＳＤＳ－ＡＰＧＥ电泳至少可分出５种，但免疫后大多数动物（１５／２０）体内仅产生了抗６８ｋＤ和１     

PCR技术对大鼠内耳膜迷路线粒体DNA的检测

目的：建立灵敏、可靠的大鼠内耳膜迷路线粒体ＤＮＡ提取和检测方法。方法：结合ＰＣＲ技术扩增ｍｔＤＮＡ编码ＮＤ１－１６ＳｒＲＮＡ基因的６０１ｂｐ片段，检测大听泡内耳膜迷路线粒体ＤＮＡ方法，并对两种ｍｔＤＮＡ获取方法进行比较。结果：采用Ｓｅｉｄｍａｎ的方法，将１只大鼠的以侧听泡内耳膜迷路作为一个样品，检测１０个样品均成功扩增出编码ＮＤ１－１６ＳｒＲＮＡ基因的６０１ｂｐ片段；而采用ＥｄｒｉｓｍｔＤＮＡ提取     

A new approach to visualizing the membranous structures of the inner ear - high resolution X-ray micro-tomography

CONCLUSION: Through the application of high resolution X-ray micro-tomography and a method of contrast enhancement based on en bloc staining in osmium tetroxide (OsO4), we report an approach that facilitates accurate three-dimensional (3D) reconstruction to reveal the fine structure of the inner ear. OBJECTIVES: To overcome the problems of artefacts, including tissue distortion and loss of 3D context that are inherent in existing methods that rely on manual dissection and/or histological sectioning. MATERIALS AND METHODS: A staining protocol was developed that involved the en bloc application of the OsO4 solution (2% w/v) for an extended period of time. The samples were then scanned using an X-ray micro-tomography platform and subsequent 3D visualizations were constructed. RESULTS: The digital nature of the data allowed a complete 3D contextual visualization to be constructed whereby the individual sensory structures could be seen in relation to other inner ear structures. This included a detailed anatomy of the membranous labyrinth and nerve supply including the spatial configuration of the utricular and saccular maculae. This is a new way of undertaking temporal bone histology.     

Computer-aided three-dimensional reconstruction of the osseous and membranous labyrinths

Summary In order to obtain an adequate knowledge of the stereoscopic anatomy of the temporal bone, it is very useful to make three-dimensional reconstructions of the bone. By using the histological sections of a human temporal bone processed for routine evaluation, we have undertaken computer-aided reconstruction of the osseous and the membranous labyrinths, as well as the inner ear sensory organs. Reconstructions were done either separately or simultaneously. Owing to the semitransparent display function of the computer system, it was possible to observe the reconstructed membranous labyrinth through the simultaneously reconstructed osseous labyrinth, and the sensory organs through the membranous labyrinth. The results were satisfactory for understanding the spatial relationships among these structures. We also attempted computer-aided measurements of the reconstructed sensory organs and calculated the length of the organ of Corti and the angle between the saccular and the utricular maculae.     

Cisplatin: evaluation of its ototoxic potential

The ototoxic potential of cisplatin was analyzed in an organ culture model exposing the hair cells and other inner ear structures to cisplatin doses from 0.1 to 10 micrograms/ml. Selective hair cell degeneration was obvious at concentrations of 0.1 microgram/ml. Incubation with 1 microgram/ml caused morphologic damage in the supporting cells in both the cochlear and vestibular parts of the labyrinth. Exposure to 10 micrograms/ml during five days caused a total collapse of the membranous labyrinth. The morphologic degeneration pattern at the ultrastructural level is nonspecific, except that nuclear chromatin was either swollen and disintegrated or considerably condensed. Based on inner ear concentrations equivalent to aminoglycoside antibiotics in the range of 0.1 to 10 micrograms/ml, cisplatin is, in the in vitro model used in this study, the most ototoxic drug known. However, because of its single dose administration and long intervals between administration, clinical ototoxicity is less pronounced than that from aminoglycoside antibiotics.