颞骨冠状切片和高分辨率CT定位圆窗区的邻近结构

背景:作者前期实验曾探讨了圆窗区及周围结构在横断面上的配布特点,虽有资料对颞骨中耳及邻近解剖结构的冠状位影像学特点进行了描述,但由于无统一的冠状扫描基线,导致相关研究结果存在差异。目的:对比分析成人头部标本颞骨冠状切片和高分辨率CT冠状扫描图像上圆窗区及其周围结构的差异。方法:15例(30侧)成人头部标本,以与眦耳线相垂直的直线为基线,获得间隔为1.00mm,厚度为1.00mm的CT冠状扫描图像,扫描后的头部标本按原定位截取以耳颞区为中心的组织块,并制成厚为1.00mm的连续冠状薄层切片。标本切片与CT图像对照,对颞骨内听小骨、骨性半规管、前庭、耳蜗、圆窗、圆窗龛、蒲氏间隙以及面神经颞骨内段等结构进行观察。结果与结论:圆窗龛的内外径、深度分别为(1.36±0.26)和(1.55±0.26)mm,面神经迷路段至弓状隆起的距离为(4.19±0.52)mm,面神经水平段距鼓室盖、距耳蜗、距锤骨头、距盾板、距砧骨短脚间的距离分别为(5.27±0.92),(1.36±0.28),(3.19±0.85),(5.30±0.58)和(2.86±0.54)mm。提示耳颞区火棉胶冠状薄层断面标本能良好显示圆窗区及其周围结构的解剖位置和毗邻关系,可直接与高分辨率CT冠状`扫描图像进行对照分析,其结果对耳科疾病的影像诊断及手术治疗有参考价值。     

蜗窗(圆窗)外口的解剖及其临床意义

取成人颞骨100侧,暴露鼓室的内侧壁,用YSX系列轻型手术显微镜(×6),在进行前庭窗区域解剖学观测的基础上,进行观察圆窗的位置及其外口的形态;用改制的计算尺,对圆窗外口的前后径及上下径进行了测量;并用改制的游标卡尺测量圆窗至邻近结构的距离。以统计学方法处理测量结果。一、圆窗的位置:圆窗位于前庭窗的下方,鼓岬的后下方。该窗开口多呈斜位,口朝后下方。100侧标本中有24侧圆窗居于中鼓室,占24%;8侧圆窗居于下鼓室,占8%;68侧圆窗居于中鼓室与下鼓室交界处,占68%。本文100侧标本未见圆窗先天性缺失者。陈兆和在50具死婴(100耳)观察中,见22耳圆窗位于中鼓室,72耳的圆窗居于中下鼓室交界处,6耳圆窗居于下鼓室。本文按此观察统计方法,所得结果亦与其在死婴中所观察的结果基本一致,     

颞骨局部腐蚀原位显示内耳铸型法

内耳铸型方法的研究已有较详细的论述在腐蚀方法上也有一些改进。考虑到临床内耳手术途径的改进和创新,与颞骨有关的定位标志和邻近结构有密切的关系,为此,我们改用局部腐蚀法制作内耳原位铸型标本,目的是更完整地保留颞骨外形和准确地显示内耳在颞骨内的自然位置。标本制作过程中,颞骨的准备和过氯乙烯灌注法按我们过去的方法处理,仅在腐蚀处理上加以改进,介绍如下。     

大鼠内淋巴囊的解剖学与组织学观察

目的 研究大鼠内淋巴囊的解剖学与组织学特征。方法 选用健康成年SD大鼠，处死后取双侧颞骨，先观察颞骨内侧面的解剖结构、内淋巴囊的位置及毗邻关系，然后将标本固定、脱钙、石蜡包埋切片，HE染色，观察内淋巴囊的形态和组织结构；再用抗大鼠IgG、CD3单克隆抗体，应用免疫组织化学技术，观察免疫活性细胞在内淋巴囊组织的定位分布。结果 大鼠内淋巴囊的上皮类型以单层立方上皮和扁平上皮为主；内淋巴囊上皮层、上皮下及囊周组织有淋巴细胞，CD3、IgG免疫反应阳性淋巴细胞主要存在于内淋巴囊的上皮层。结论 大鼠内淋巴囊具有与人和豚鼠内淋巴囊基本相似的形态结构；组织中存在CD3、IgG免疫活性细胞，提示其在内耳免疫应答过程中可能发挥重要作用。     

与镫骨手术和球囊穿刺术有关的内耳应用解剖

本文采用颞骨组织学方法,光镜观测85侧正常颞骨标本。测量了镫骨底板至前庭各点:圆窗膜与球囊间的距离及其解剖关系,为内耳手术如镫骨手术,球囊穿刺术等提供解剖学依据。     

显示中耳和内耳细微结构的标准化标本制作方法

目的 探索显示中耳和内耳细微结构直视标本的标准化制作方法。 方法 使用人颞骨材料,在颅内和颅底面画出标准锯路的标志线,选择细齿窄条钢弓锯,沿标志线锯开颞骨显示中耳结构。再用手握式玉石磨钻分别研磨显示内耳结构。最后完成对鼓膜、听小骨、面神经、鼓索神经和颈内动脉等结构的仿真复原,并用合页连结锯开的两半颞骨。 结果 在锯开的颞骨内可清晰显示中耳鼓室的6个壁,以及锥状隆起、咽鼓管、前庭窗和蜗窗等细微结构。磨制后的内耳可见3个打开的骨半规管和耳蜗的剖面。复原后的听骨链、面神经、鼓索神经、颈内动脉和鼓膜等结构,均以三维方式显示原有结构的特征和位置关系。由合页连结的颞骨标本,既可打开观察内部结构,也可合拢显示整体形态。 结论 采用锯开和研磨技术制作耳标本可以取得满意的结果,标准化的锯路标志和标准的定位研磨是成功制作的关键。     

耳横断高分辨率CT中表盘定位的应用

目的:探讨耳颞区高分辩率体层摄影术(HRCT)横断扫描图像上表盘定位的可行性,为耳颞区病变的影像诊断和手术治疗提供一种新的定位方法。方法:30例无耳部病变的成人以眦耳线(CML)为基线,用GE Hispeed NX/i Sys#CT扫描,获得间隔为1·00mm,厚度为1·00mm的CT图像,在扫描图像上套用表盘,逐一对颞骨内各主要结构进行定位。结果:利用表盘法对外半规管上部、外半规管、锤砧关节、鼓岬和圆窗龛等5个横断层面内的面神经、中耳及内耳的各重要结构进行了定位。结论:耳颞区HRCT扫描图像用表盘法定位,其方法简单实用,在耳科的教学与科研、耳科病变的诊断与治疗等方面均具有广泛的应用前景。     

人内耳膜迷路整体标本的制作法

在解剖学技术资料中,涉及内耳骨迷路制作方法的较多,而内耳膜迷路的则较少,作者解剖人内耳120余例,总结出一套简便的人内耳膜迷路整体标本的制作方法。过程介绍如下:一、取材与准备取死亡不久(七个月以上)的胎儿颞骨,粗略暴露骨性耳蜗,在蜗尖打一小孔,打开圆窗、卵圆窗,用滴管向蜗尖孔、蜗底两窗分别     

一种综合显示的前庭蜗器标本制作法

前庭蜗器又称耳,按部位可分为外耳、中耳、内耳三部分,是感受听觉和位觉刺激的感受器.耳的形态结构复杂,特别是内耳的结构,它主要埋于颞骨岩部很小的一个范围内,同时颞骨岩部的骨质致密、坚硬且形态不规则,所以制作内耳骨迷路标本是解剖学技术中难度最大的[1].     

内耳圆窗膜解剖

圆窗膜是间隔于中耳和内耳之间的重要屏障，其结构及正常的功能对保证内耳正常生理功能具有重要意义。准确测量圆窗膜的面积和形态有助于对其进行深入的病理生理学研究，进而计算圆窗膜在病理状态下对各种物质的转运速率，测试内耳各腔隙离子浓度变化等，为阐明中耳和内耳疾病的相互影响，中耳腔内毒素和药物等影响内耳功能的机理，及更好的开展内耳显微手术，电子耳蜗手术等治疗奠定基础。     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

Modeling of Sound Transmission from Ear Canal to Cochlea

A 3-D finite element (FE) model of the human ear consisting of the external ear canal, middle ear, and cochlea is reported in this paper. The acoustic-structure-fluid coupled FE analysis was conducted on the model which included the air in the ear canal and middle ear cavity, the fluid in the cochlea, and the middle ear and cochlea structures (i.e., bones and soft tissues). The middle ear transfer function such as the movements of tympanic membrane, stapes footplate, and round window, the sound pressure gain across the middle ear, and the cochlear input impedance in response to sound stimulus applied in the ear canal were derived and compared with the published experimental measurements in human temporal bones. The frequency sensitivity of the basilar membrane motion and intracochlear pressure induced by sound pressure in the ear canal was predicted along the length of the basilar membrane from the basal turn to the apex. The satisfactory agreements between the model and experimental data in the literature indicate that the middle ear function was well simulated by the model and the simplified cochlea was able to correlate sound stimulus in the ear canal with vibration of the basilar membrane and pressure variation of the cochlear fluid. This study is the first step toward the development of a comprehensive FE model of the entire human ear for acoustic-mechanical analysis.     

干细胞移植豚鼠耳蜗形态结构及听力的变化

背景：既往研究证明耳蜗微造孔注射病毒或非病毒载体行基因治疗对耳蜗结构及听功能的影响轻微。 目的：观察骨髓间充质干细胞通过耳蜗微造孔术移植到正常豚鼠内耳后对耳蜗结构及听功能的影响。 方法：正常豚鼠分3组,空白对照组未予任何干预;单纯耳蜗微造孔术组单纯行耳蜗微造孔术,不注射任何成分;骨髓间充质干细胞组鼓阶微造孔后注射经DAPI荧光标记的骨髓间充质干细胞。 结果与结论：单纯耳蜗微造孔术组、骨髓间充质干细胞组经耳蜗微造孔术后7 d的听性脑干诱发电位阈值均较空白对照组提高,术后28 d恢复至正常水平;耳蜗石蜡切片苏木精-伊红染色显示实验动物耳蜗内结构无明显异常改变。骨髓间充质干细胞组耳蜗切片可见荧光信号多分布于耳蜗底周的外淋巴腔(鼓阶和前庭阶),无堆积堵塞管腔情况。结果表明经鼓阶开窗行骨髓间充质干细胞移植对耳蜗形态结构和听力的影响是轻微的,干细胞移植后能在耳蜗内迁移并存活。     

Experimental viral infections of the inner ear. I. Acute infections of the newborn hamster labyrinth.

Acute viral infections of the inner ear were produced in neonatal hamsters. Viruses were inoculated percutaneously through the temporal cartilage into the endolymphatic and perilymphatic spaces of the labyrinth or were inoculated intracerebrally to reach the perilymphatic spaces via the cochlear aqueduct. Selective vulnerability of inner ear structures was demonstrated using a variety of viruses. Influenza virus infected only the mesenchymal cells of the perilymphatic channels of the cochlea; mumps virus infected principally endolymphatic structures; herpes simplex virus infected primarily the sensory cells of the labyrinth; and rubeola and vaccinia viruses infected both perilymphatic and endolymphatic cells.     

MR内耳水成像技术在人工耳蜗植入术中的应用价值

目的 探讨MR内耳水成像技术在人工耳蜗植入术中的应用价值。方法 回顾性分析2015年4月—2016年3月在黑龙江省医院和哈尔滨医科大学附属第四医院行人工耳蜗植入术的128例患者的影像资料,其中男68例、女60例,年龄4～48岁,右耳植入101例、左耳植入27例。患者术前、术后均行头颅内听道螺旋CT及MR内耳水成像检查,并比较两种检测方法对患者内耳、中耳畸形及病变的检出率。结果 MR内耳水成像内听道总体异常检出率90.63%(116/128),CT检出率为76.56%(98/128),二者比较差异有统计学意义(χ²=9.228,P＜0.05)。在前庭导水管异常、耳蜗畸形、内听道狭窄、耳蜗纤维化等疾病,MR诊断的灵敏度、特异度、准确度、阳性预测值和阴性预测值均高于CT,但差异均无统计学意义(P值均>0.05)。结论 在人工耳蜗植入术前、术后进行MR内耳水成像技术检查,可有效了解患者内听道解剖学信息,对治疗方案的选择具有指导性意义,值得临床进一步推广应用。     

The olivocochlear efferent bundle and susceptibility of the inner ear to acoustic injury

1. The role of the efferent olivocochlear bundle (OCB) in protecting the inner ear from acoustic injury was studied in the anesthetized cat. Middle-ear muscles (MEM) were cut to eliminate possible effects of this feedback system on the auditory periphery. In each of a series of animals, the OCB was unilaterally transected. The animal was then exposed binaurally to an intense pure tone, and the resultant damage to the two sides compared by measuring threshold shifts in the compound action potential from each ear. Data from each animal provide one control measurement (threshold shift with an intact OCB) and one experimental measurement (threshold shift without a functional OCB). 2. Two experimental series were analyzed. In one the OCB was electrically stimulated, providing maximal firing rates in the efferents projecting to the control ear. In another series the OCB was not electrically stimulated: thus any OCB activity to the control ear was only that evoked by the acoustic stimulation itself. 3. In neither experimental series was there evidence that activity in the OCB provides protection from acoustic injury. These results are in disagreement with conclusions drawn from experiments with acoustic overstimulation of guinea pigs. 4. Interpretations for the discrepancy between the present study and those on guinea pigs include interspecies differences and the possible contribution of the MEM reflex or cochlear blood-flow changes to previously observed effects.     

Loud sound-induced changes in cochlear mechanics

To investigate the inner ear response to intense sound and the mechanisms behind temporary threshold shifts, anesthetized guinea pigs were exposed to tones at 100-112 dB SPL. Basilar membrane vibration was measured using laser velocimetry, and the cochlear microphonic potential, compound action potential of the auditory nerve, and local electric AC potentials in the organ of Corti were used as additional indicators of cochlear function. After exposure to a 12-kHz intense tone, basilar membrane vibrations in response to probe tones at the characteristic frequency of the recording location (17 kHz) were transiently reduced. This reduction recovered over the course of 50 ms in most cases. Organ of Corti AC potentials were also reduced and recovered with a time course similar to the basilar membrane. When using a probe tone at either 1 or 4 kHz, organ of Corti AC potentials were unaffected by loud sound, indicating that transducer channels remained intact. In most experiments, both the basilar membrane and the cochlear microphonic response to the 12-kHz overstimulation was constant throughout the duration of the intense stimulus, despite a large loss of cochlear sensitivity. It is concluded that the reduction of basilar membrane velocity that followed loud sound was caused by changes in cochlear amplification and that the cochlear response to intense stimulation is determined by the passive mechanical properties of the inner ear structures.     

Acoustic-structural coupled finite element analysis for sound transmission in human ear--pressure distributions

A three-dimensional (3D) finite element (FE) model of human ear with accurate structural geometry of the external ear canal, tympanic membrane (TM), ossicles, middle ear suspensory ligaments, and middle ear cavity has been recently reported by our group. In present study, this 3D FE model was modified to include acoustic-structural interfaces for coupled analysis from the ear canal through the TM to middle ear cavity. Pressure distributions in the canal and middle ear cavity at different frequencies were computed under input sound pressure applied at different locations in the canal. The spectral distributions of middle ear pressure at the oval window, round window, and medial site of the umbo were calculated and the results demonstrated that there was no significant difference of pressures between those locations at frequency below 3.5 kHz. Finally, the influence of TM perforation on pressure distributions in the canal and middle ear cavity was investigated for perforations in the inferior-posterior and inferior sites of the TM in the FE model and human temporal bones. The results show that variation of middle ear pressure is related to the perforation type and location, and is sensitive to frequency.