Über die zeitliche Auflösung von mon- und binauralen Intensitätsdifferenzen (Töne und Weißes Rauschen

Zusammenfassung Es wird über Versuche zur Ermittlung der zeitlichen Auflösung von l-Sprüngen bei un- und vorbelastetem Gehör berichtet. Durch Addition von zwei Impulsen (Rauschen oder Töne) und durch zeitliche Verschiebung der Anfangs- und Endflanken wird ein l-Sprung erzeugt. Die Impulse werden monaural und binaural angeboten. Die Abhängigkeit der t-Werte von der Intensitäts-differenz und der Frequenz wird dargestellt und diskutiert.     

Analysis of most common CFTR mutations in patients affected by nasal polyps

Nasal polyps, a chronic inflammatory disease occurring in the nose and para-nasal sinuses, result from several different causes, including cystic fibrosis (CF). Forty-four patients affected by nasal polyps were admitted to the Department of Otolaryngology, Lublin University School of Medicine, Lublin, Poland, and screened for the most-commonly identified CFTR mutations [F508, G542X, N1303 K, 1717–1 (G to A), W1282X, G551D, R553X and I507] by applying the INNO-LIPA CF2 test strips. None of the patients had symptoms that allowed for the diagnosis of CF, including the negative sweat test. We detected 5 of 44 (11.4%) carriers of the CFTR mutations. All patients positive for this test were heterozygous carriers of F508. In the control group, only 1 of 70 (1.4%) cases showed F508 heterozygosity. The frequency of F508 mutation herein reported was significantly higher than in the control group ( P =0.0312) and in the general Polish population as well ( P =0.0059). Our data suggest that a heterozygous manifestation of the F508 may exist in a selected group of patients affected by nasal polyps, who have no other clinical features of CF.     

A comparison of current expressions of nasal patency

Summary Rhinomanometry is well established as a useful clinical method for objective assessment of nasal patency, although several expressions of nasal patency have been reported and universal standardization has not been achieved. In this communication, nasal resistances were calculated from the equation R = P/V (R; resistance; P; transnasal differential pressure; V; nasal airflow) at P 100 Pa and at peak flow. Time-averaged nasal resistances and integrated nasal patencies were measured in 350 adult patients by Rhinorheograph MPR-1100 and processed by a NI-101 computer program. The values from the equation R = P/V at P 100 Pa were slightly lower than those from the same equation at peak flow or those from the time-averaging method. Correlations between the values of nasal resistance at peak flow and the time averaging method were very close to the line of identity. No significant correlations were demonstrated between integrated nasal patency and the values from the other three expressions. The differences of the results from these expression are discussed.     

Infrared laser stapedotomy

Summary A pulsed holmium: YAG laser ( = 1980 nm) was used to perform 0.4 mm stapedotomy fenestrations in human stapes footplates from freshly dissected cadavers under simulated surgical conditions. The energy was coupled into ( 400 m core diameter nylon fiber. Thermal gradients were then measured following laser applications and tissue responses examined by light microscopy. The results of this study suggest the feasibility of using ( surgical holmium: YAG laser in middle ear surgery.Dedicated to Prof. K. Burian on the occasion of his 70th birthday     

Postjunctional α2-adrenoceptors in blood vessels of human nasal mucosa

Summary Human nasal mucosa has various types of blood vessels and is a good tissue for demonstrating receptors for many vasoactive substances, including -adrenoceptors. In contrast to the large contractile response induced by ₂-agonists, our studies have shown that ₂-agonists produce a small maximal contraction. This ₂-induced response was easily blocked by ₁-antagonists, indicating that it is evoked, at least partially, by the stimulation of ₁-adrenoceptors. Noradrenaline (NA)-induced contractions could not be abolished by either ₁- or ₂-antagonists alone, but were almost completely blocked by the combination of both antagonists. This suggests the presence of postjunctional ₂-adrenoceptors. The low-maximal responsiveness to ₂-agonists and calcium independency of NA-induced contractions were distinct from our former results obtained on canine nasal specimens.     

Relationship between Inner-Ear Fluid Pressure and Semicircular Canal Afferent Nerve Discharge

The present study was designed to determine (1) the transcupular fluid pressure (P) generated across the semicircular canal cupula in response to sinusoidal head rotation, (2) the translabyrinthine dilational pressure (P₀) generated across the membranous labyrinth in response to an increase in endolymph fluid volume (hydrops), (3) afferent nerve discharge patterns generated by these distinct pressure stimuli and, (4) threshold values of P and P₀ required to elicit afferent neural responses. The experimental model was the oyster toadfish, Opsanus tau. Micromechanical indentation of the horizontal canal (HC) duct and utricular vestibule was used to simulate sinusoidal head rotation and fluid volume injection. Single-unit neural spike trains and endolymph pressure within the ampulla, on both sides of the cupula, were recorded simultaneously. P averaged 0.013 Pa per 1°/s of sinusoidal angular head velocity and P₀ averaged 0.2 Pa per 1 nL of endolymph volume injection. The most responsive afferents had a threshold sensitivity to P of 10^-3 Pa and to P₀ of 5 × 10^-2 Pa based on a discharge modulation criterion of 1 impulse/s per cycle for 2 Hz pressure stimuli. Neural sensitivity to P was expected on the basis of transverse cupular and hair bundle deflections. Analysis of mechanics of the end organ, neuronal projections into the crista, and individual neural firing patterns indicates that P₀ sensitivity resulted from pressure-induced distension of the ampulla that led to a nonuniform cupular deformation pattern and hair bundle deflections. This explanation is consistent with predictions of a finite element model of the end organ. Results have implications regarding the role of P in angular motion transduction and the role of P₀ under transient hydropic conditions. Abbreviations: 1 Pa = 1 N/m² = 10 dyn/cm² 102 µm H₂O 0.0075 mm Hg. nL = nanoliter     

Musikalische Pseudohalluzinationen bei Spätertaubten

Summary In 49 subjects with binaural deafness and 51 subjects with hearing impairment at least bordering on deafness, the question was examined whether there are, in addition to the low-structured tinnitus, highly structured acoustic phenomena after hearing loss analogous to the scenic-optical experiences of subjects with late blindness and the phantom-limb sensation of amputees.Mostly every day or often, 31 of the 100 subjects examined have musical experiences in the form of melodies, songs and concerts, which are usually of extreme forcefulness and can be precisely differentiated. Some of them think they can discern individual musical instruments in the total sound of the music. The beginning and end cannot be consciously controlled; constant repetitions are typical, as when a record is played over and over again.The phenomena are best classified as pseudohallucinations, since they are recognized — usually right away, but sometimes only after brief reality control — as inner hearing.Results are reported from anamnestic, audiological and psychological examinations as well as from tests of communication ability (capacity for speech perception by lipreading), which were carried out in all subjects for clarification of the genesis of this phenomenon.     

Null Mutation of α<Subscript>1D</Subscript> Ca<Superscript>2+</Superscript> Channel Gene Results in Deafness but No Vestibular Defect in Mice

Multiple Ca²⁺ channels confer diverse functions to hair cells of the auditory and vestibular organs in the mammalian inner ear. We used gene-targeting technology to generate _1D Ca²⁺ channel-deficient mice to determine the physiological role of these Ca²⁺ channels in hearing and balance. Analyses of auditory-evoked brainstem recordings confirmed that _1D^–/– mice were deaf and revealed that heterozygous (_1D^+/–) mice have increased hearing thresholds. However, hearing deficits in _1D^+/– mice were manifested mainly by the increase in threshold of low-frequency sounds. In contrast to impaired hearing, _1D^–/– mice have balance performances equivalent to their wild-type littermates. Light and electron microscope analyses of the inner ear revealed outer hair cell loss at the apical cochlea, but no apparent abnormality at the basal cochlea and the vestibule. We determined the mechanisms underlying the auditory function defects and the normal vestibular functions by examining the Ba²⁺ currents in cochlear inner and outer hair cells versus utricular hair cells in _1D^+/– mice. Whereas the whole-cell Ba²⁺ currents in inner hair cells consist mainly of the nimodipine-sensitive current (~85%), the utricular hair cells express only ~50% of this channel subtype. Thus, differential expression of _1D channels in the cochlear and utricular hair cells confers the phenotype of the _1D null mutant mice. Because vestibular and cochlear hair cells share common features and null deletion of several genes have yielded both deafness and imbalance in mice, _1D null mutant mice may serve as a model to disentangle vestibular from auditory-specific functions.     

Vascular permeability of the middle ear mucosa in otitis media with effusion

Summary Vascular permeability (VP) of the middle ear mucosa (MEM) in chronic otitis media with effusion (OME) was estimated in both pediatric and adult patients by calculating the middle ear effusion (MEE) to serum concentration ratios of albumin and of four protease inhibitors: 1-antitrypsin (1-AT), 1-antichymotrypsin (1-X), inter--trypsin inhibitor (I--I) and 2-macroglobulin (2-M). The levels of albumin and 1-AT in MEE were higher while those of I--I and 2-M were lower than their serum levels in both adult serous and pediatric mucoid groups. There was a negative correlation between molecular weight and the mean value of the ratio (MEE/serum) of the four inhibitors in both serous (r=–0.989) and mucoid (r=–0.924) groups. Vascular permeability of the MEM seems to be variable in both serous and mucoid groups during middle ear inflammation. Selective leakage of proteins by molecular weight appears to occur in MEM. Our findings further indicate that a high level of the high-molecular-weight inhibitor 2-M in MEE may be a significant index reflecting the remarkably enhanced VP of the MEM.     

Enhanced production of γ-interferon by therapy with parenteral OK-432 and α-interferon in patients with head and neck cancer

Summary Although the drug OK-432 can induce the release of -interferon (IFN-), the serum concentrations of IFN- produced are very low. We studied the effects of combining OK-432 with -interferon (IFN-) on the endogenous production of IFN and the postoperative courses of patients with oral cavity cancers. Forty patients operated on for head and neck cancers were studied. Each patient was given an injection of OK-432 1 week after surgery. Between 10 and 14 days later, a combination of OK-432 and IFN- was given to assess the effects of the concomitant use of IFN- on IFN production. In 18 of the 30 patients given a large dose of IFN- (3 or 5×10⁶ IU/ mg protein), IFN production induced by OK-432 was enhanced. A small dose of IFN- (7×10³ IU) did not enhance the action of OK-432. OK-432 also induced the release of both endogenous IFN- and IFN-, and the production of both types of IFN was enhanced by the concomitant administration of parenteral IFN-. Next, 50 patients operated on for oral cavity cancers were given OK-432 or a combination of OK-432 and IFN- for 4 months, and their postoperative courses were followed for 2–5 years. The clinical courses were better in the combined therapy group than in the group given OK-432 alone.     

Paukenergüsse bei Erwachsenen

Summary Of a large groupe of patients, Seromucotympanon (SMT) of adults was investigated according to sex, anamnesis, medical findings, progress, and therapy. Tympanometric measurements were used for diagnosis and controls. These findings are compared with SMT of children. The ratio of mucous to serous otitis was found to be about: 12 in adults and 3:1 in children.Time and application of conservative or surgical therapy are discussed.     

Quantitative untersuchungen zur hörschwelle,adaptation und lautheitsempfindung am gesunden und hörgeschädigten Menschen mittels der „Objektiven Audiometrie”

Zusammenfassung Die Mittelung zentraler akustischer Reizantworten aus dem EEG des wachen Menschen mit Computern zum. Zwecke der Objektiven Audiometric ergibt bei exakter Methodik eine sehr geringe Streubreite dieser akustischen Reizantworten beim normalhörenden Menschen. Die Fehlermöglichkeiten dieser Methodik werden ausführlich dargestellt. Es wurde der Beweis erbracht, daß signifikante Untersehiede im Cerebro-Audiogramm (CAG) bei Schwerhörigen im Vergleich zur Norm objektiv zu erfassen sind. Durch Aufstellen der Intensitäts-funktionen, wie sie psychoakustisch von Stevens gewonnen wurden, können an Hand der Reizstärken-Erregungs-Kennlinien die Hörschwelle, Adaptation und Lautheitsempfindungen (Hyperakusis, Recruitment usw.) beim hörgeschädigten Menschen objektiv erfaßt und quantitativ beurteilt werden. Die Ergebnisse und Probleme der Objektiven Audiometrie bei Kindern werden dargestellt.

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Summary The average of central acoustic responses of awake human beings according to the EEG for purposes of objective audiometry shows, if accurately, only a very small dispersion-range of these responses in normal hearing persons. Possibilities of error of the computer-methods are represented in detail. Thus it is scientifically proven that significant differences in audiograms of deaf persons, done with the computer, compared with normal hearing people, can be registered objectively. By using the power functions (according to Stevens subjectively) hearing-threshold, adaptation, perception of soundvolume and recruitment in cases of impaired hearing can be verified objectively and then quantitatively judged. The results and the problems of childrens are represented.

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Die CAT-Computer-Anlage verdanken wir der Stiftung Volkswagenwerk.Herrn Prof. Dr. W. D. Keidel in Verehrung zum 50. Geburtstag gewidmet. Teilweise vorgetragen auf der Arbeitstagung der Arbeitsgemeinschaft Deutscher Audiologen, März 1967 in Freiburg i. Br.     

Cyclic nucleotide and prostaglandin F2 alpha contents of otosclerotic auditory ossicles

Summary We found that the cyclic-adenosine-3,5-rnonophosphate (cAMP) contents of Otosclerotic human ossicles were 40–50 times greater than basal levels. Cyclic-guanosine-3,5-monophosphate (cGMP) levels were also found to be greater than in physiological conditions, but lower than in cortical bone. These findings suggest the extensive participation of these nucleotide coenzymes in effector cells during the process of bone resorption. This emphasizes the role of bone-resorbing cells in this process as well as the probable osteoclast progenitor role of vascular endothelial cells and their enhanced activity for differentiation. At the same time, the absence of prostaglandin F_{2 alpha} content in the Otosclerotic bone analyzed appears to exclude cartilage remnants as a source for inducing the changes in remodelling that occur.     

Der Einfluß der Presbyacusis auf das soziale Hörvermögen

Summary Audiological experience indicates, that results of tone and speech audiometric tests show only a loose correlation with the ability in social hearing. That is why the influence of presbyacusis upon social hearing was investigated using a psychological test, the so-called Social Hearing Handicap Index (SHHI).The results indicate the influence of presbyacusis on social hearing. The SHHI gets worse with increasing presbyacusis, though in the oldest patient group some individuals with normal social hearing were found. There was only little influence of the hard of hearing component. The social hearing was mainly effected by the disturbance of the selective ability. This is valid for the social hearing handicap within and between the examined groups. Significant differences between female and male patients could not be revealed.     

Vergleichende klinische und morphologische untersuchungen an rachen- und kehlkopfpapillomen

Zusammenfassung In vergleichenden klinischen, histologischen, histochemischen und elektronenmikroskopischen Untersuchungen an Rachen- und Kehlkopfpapillomen fand sich keine Korrelation zwischen biologischem Verhalten und morphologischer Tumorstruktur. Gegenüber normaler unverhornter Larynx- und Pharynxschleimhaut bestanden nur quantitative Unterschiede. In fünf Papillomen und einem Uvulapolyp wurden elektronenmikroskopisch ovale, 112 × 150 nm große cytoplasmatische Partikel nachgewiesen, die den in Haut und Mundschleimhaut beschriebenen membrane-coating granules entsprechen. Hinweise auf die Virusgenese der Papillome fanden sich nicht.

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Summary Papillomas of the pharynx and larynx have been studied by clinical methods, histochemistry, light and electron microscopy. The structural patterns of the tumors failed to correspond to the clinical behaviour. Only quantitative epithelial differences between the normal non-keratinizing mucous membranes of pharynx and larynx and the papillomas have been established. Electron microscopic studies revealed the presence of cytoplasmic particles measuring 112–150 nm in size which resemble the membrane-coating granules described in normal skin and oral epithelia of various species. Virus particles have not been found.

     

Association of retinal vasculitis (Eales’ disease) and Meniere-like vestibulocochlear symptoms

The objective of this study was to present a previously unknown association of visual loss and Meniere-like vestibuloauditory symptoms in Eales disease (idiopathic retinal vasculitis) and to give a survey of other conditions affecting both the retina and inner ear. A 32-year-old man diagnosed with Eales disease presented with recurrent deteriorations of visual acuity and simultaneous recurrent vestibuloauditory symptoms strongly reminiscent of Menieres disease. Both the recurrent low frequency hearing losses and the losses of visual acuity could be restituted repeatedly by high dose i.v. corticosteroids. A literature review reveals that in a number of other retinopathic diseases associated with Meniere-like symptoms, microvasculopathy is also the pathomechanism. A common pathogenetic cause, e.g., autoimmune-mediated microvasculitis of retinal periphlebitis and vestibulocochlear symptoms, in this case is suggested. The presented case adds new evidence to microvasculopathy being a pathogenetic factor in Menieres disease. In cases of coincidence of vestibulocochlear symptoms and retinal perivasculitis, a therapeutic attempt with high-dose corticosteroids is advisable.     

ERA-Befunde bei „kortikaler Schwerhörigkeit“

Summary Since about the last 2 years the late potential's component N₁ (90–110 ms) as well as the early acoustically evoked potentials, appearing in a latency range of 1–8 ms and consisting of the nerve action potential (Pot. I) and the brain-stem potentials (Pot. II–V), were registered at some hearing impaired patients. This procedure enabled us to diagnose a cortical hearing defect at five patients: a) three children at an age of 2–3 years; they all have a slight cerebral damage, a hearing impairment and no speech-development; b) a 15 year old girl with a hearing impairment which is on the right side more severe than on the left side, as consequence of an encephalitis; and c) a 50 year old man suffering on both sides from a loss of temporal brain's substance and from a total deafness after an insult of both arteriae meningeae mediae.At all these patients the ERA-findings result in an almost normal behaviour of the bioelectrical transfer of the acoustic stimuli in the region of the brain-stem, whereas the late potential's component N₁ showed a pathologic distortion. The ERA-results together with the anamnesis make a cortical hearing disorder probable at these five patients. The audiograms and the ERA-characteristic lines are shown and discussed.

Die beiderseitige temporale Hirnsubstanzminderung wurde durch Pneumo-Encephalographie, Scintigraphie der Cisternen mit 4 mCi 99 m-Tc und durch axiale Computer-Tomographie nachgewiesen.     

Registrierung und Erkennung von Hirnstamm- und Cortex-Reizantworten auf übergehörte Click- bzw. Tonreize

Summary Crosshearing depends on the difference of hearing loss between both ears and the level of sound intensity stimulating. From 12 unilateral deafs we recorded the fast brainstem response P₆ and the slow cortical response N₉₀ to crossheard click and tone stimulation, i.e., first we stimulated the bad ear and recorded the responses with an electrode position adjusted to the bad ear, too. Then, the good ear was masked and we tried to record the responses from the deaf ear again. For control of our results we adjusted the position of the electrodes to the normal ear and recorded responses with and without masking while still stimulating the deaf ear.The slow cortical response N₉₀ could be recorded by adequate intensities in both electrode positions; it vanished when masked. The fast brainstem response P₆ could not be recorded from thedeaf side but from the normal side to which it was crossheard. This implies that masking isnot necessary when recordingfast brainstem responses but always has to be considered when recording slow cortical responses.     

Die Objektivierung akustischer und optischer Vorstellungen im Elektroenzephalogramm

Zusammenfassung In dieser Arbeit werden zwei neue Gleichspannungspotentiale beschrieben, die während akustischen bzw. optischen Vorstellungen auftreten. Das akustische Imaginationspotential (AIP) ist eine am Vertex ableitbare negative Gleichspannungsschwankung, die während der gesamten Dauer einer akustischen Vorstellung anhält. Während einer optischen Vorstellung entsteht eine ähnliche negative Gleichspannungsschwankung nur in der Occipitalregion. Diese Vorstellungspotentiale können infolge einer speziellen Versuchstechnik schon im Roh-EEG erkannt werden. Die Amplitudengröße korreliert mit dem Konzentrationsgrad der Versuchsperson. Bei intensiven Vorstellungen sind Potentiale mit Amplituden bis zu 20 V und einer Dauer von einigen Sekunden registrierbar. Der Vergleich zwischen der Vertex- und der Occipitalableitung erlaubt die Beobachtung des abwechselnden Auftretens von akustischen und optischen Bewußtseinsprozessen. Die Vorstellungspotentiale (AIP und OIP) sind reiz- und reaktionsunabhängig und stellen modalitätsspezifische EEG-Korrelate kognitiver, bewußter Erlebensprozesse (Erinnerung bzw. Vorstellung) dar. Ihre Bedeutung für die objektive Audiometrie wird diskutiert.     

On the influence of the middle ear muscles upon changes in sound transmission

Summary The influence of artificially induced impedance changes on the frequency response of the middle ear has been investigated in three experienced listeners. The tensor-reflex has been simulated by application of positive and negative air-pressure to the outer ear canal. In this test-situation, the thresholdshift (L) obtained is greatest in the surrounding of the first resonance of the middle ear (L = 8 dB at 500 Hz). For bone-conduction, the effect is weaker by about 2 dB than for air-conduction. The change in sound transmission is constant for all SPL's and is mainly due to the impedance change of the middle ear.In contrast the influence of the stapedial reflex is strongly dependent on SPL. In the range between hearing-threshold and 70 dB (HL) the attenuation is only 2 dB below 1 kHz. At higher levels the attenuation may amount to 30 dB. Thus, excitation of the cochlea remains nearly constant. We suppose that the intensitydependent influence of the stapedius reflex on sound transmission is due to a change of the stapes motion. The regulating device works without considerable distortion but with an attack-time of about 100 ms. The phenomenon of conductive recruitment in otosclerosis is probably due to the lack of this regulating effect by the fixed stapes. One function of the stapedial reflex could be the protection of the ear from high amplitudes during phonation and shouting. Furthermore, because frequencies above 1 kHz are also attenuated, a protective function of the stapedial reflex in industrial noise exposure can be assumed.