Unpredictable Hearing Loss after Intratympanic Gentamicin Treatment for Vertigo. A New Theory

A new hypothesis is advanced suggesting that unpredictable cases of profound hearing loss after intratympanic gentamicin treatment (IGT) may be caused by decreased patency of the communication routes between the inner ear and the cerebrospinal fluid, primarily of the cochlear aqueduct. A tympanic displacement analyzer, which can indirectly analyze inner ear and intracranial pressure changes and can also evaluate the efficiency of communication between these two compartments, was used. Two cases are presented: in the first, a patient who became deaf after IGT showed signs of decreased patency of the communication routes with the tympanic membrane displacement (TMD) test; in the second, a patient without hearing damage after IGT had efficient communication evaluated by the TMD test. These preliminary findings are in accordance with the proposed pathophysiology. If future clinical studies confirm the present theory and findings, it may prove possible to predict and prevent deafness after IGT and possibly also after systemic aminoglycoside treatment.     

Tympanometry and Fistula Test

The ‘fistula test’ is performed when an abnormal opening between the vestibule and the middle ear cavity is suspected. The fistula is usually seen after stapedectomy, but may also occur after trauma to a normal ear when the round window membrane may rupture. Tympanometry with an electronystagmographic (ENG) tracing may show a positive result after stapedectomy in the absence of a fistula, and there may conversely be a normal ENG tracing after tympanometry when there is in fact a perilymph fistula. The authors explain the reasons for this paradoxical response. In no way does it detract from the value of the test, which only needs to be interpreted correctly.     

A Case of Intractable Suspected Perilymph Fistula with Severe Depression

A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient''s finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment.     

Scanning electron microscopic studies of the capillaries crossing the scala tympani

Summary Scanning electron microscopic examinations were carried out on the perilymphatic space bordering the round window in guinea pigs. A number of small vessels were found crossing free through the lumen of the scala tympani in this area. The larger number (5–10) of these capillaries are suspended between the bony cochlear wall and the terminal net of fibrocytes which covers the cochlear opening of the cochlear aqueduct and spreads onto the basal third of the round window membrane. Other capillaries (3–5) cross the lumen of the scala tympani from the outer cochlear wall to the modiolus. All of these capillaries have a thin endothelium and a very thin pericytic covering. These findings suggest that the capillaries crossing the perilymphatic space may give rise to a different chemical composition of the perilymph bordering the round window in comparison with the more upper parts of the scala tympani.Support for this work was provided by the Deutsche Forschungsgemeinschaft (PL 79/3). Computerization of the literature was sponsored by Breuninger Stiftung GmbH, Stuttgart     

Adenosine 5′-triphosphate (ATP) concentrations in the endolymph and perilymph of the guinea-pig cochlea

The concentration of adenosine 5′-triphosphate (ATP) in endolymph (EL), perilymph (PL) and cerebrospinal fluid (CSF), collected from anesthetized guinea pigs was determined using the luciferase-luciferin reaction. The cochlea was exposed by a ventrolateral approach and the bone overlying scala media of the third turn (EL) or scala vestibuli of the first turn (PL) was shaved to a thin layer and a small fenestrum made. For EL sampling, a double-barrelled pipette was inserted through the spiral ligament-stria vascularis complex. One barrel was filled with 150 mM KCl to record the endocochlear potential (EP) and upon the appearance of the positive EP, 0.12–1.22 μl of fluid was aspirated into the other barrel by gentle negative pressure. For PL sampling, a single-barrelled pipette was advanced into scala vestibuli and 0.3–1.6 μl of fluid was collected by capillarity. CSF (0.36–1.75 μl) was obtained from the cisterna magna. The cochleae were removed and processed for light microscopy to determine the extent of tissue damage from the sampling procedure. ATP concentrations (mean ± SEM, nM) for EL, PL and CSF were 12.95±2.4 (n = 10), 10.5 ± 3.9 (n = 11) and 16.1 ± 5.4 (n =11) respectively. Differences in ATP concentrations among fluids were not statistically significant. To test the effect of hypoxia on ATP levels, a group of guinea pigs was subjected to a90 s period of respiratory anoxia prior to sampling of EL, PL or CSF. ATP concentrations were 14.4 ± 3.5 (n = 11), 20.7 ± 4.1 (n = 10) and 13.5 ± 4.6 (n = 4) for EL, PL and CSF, respectively; only PL ATP concentrations were statistically different (P = 0.018, Wilcoxon rank sum test) to basal conditions. This is the first study which demonstrates the presence of free ATP in cochlear fluids. The results indicate that ATP is present in cochlear fluids at concentrations close to those known to cause hair cell depolarization in vitro.     

The effect of furosemide on sodium and potassium concentrations in guinea-pig perilymph

Summary To observe the effects of furosemide on electrolyte concentrations in inner-ear fluids, experiments were performed on 286 normal guinea-pigs. Intravenous injection of furosemide (15 mg/kg) induced increases of Na concentration in scala tympani perilymph, scala vestibuli perilymph, and cerebrospinal fluid (CSF). K concentrations in both perilymphs and CSF were also increased by furosemide. The increased Na concentrations are thought to be due to the dehydration of body fluids induced by the diuretic action of furosemide. The increase of K concentrations in perilymphs could be attributable to either a characteristic action of furosemide on the electrolyte transport in the inner ear or a secondary change caused by a rise of K concentration in the endolymph.     

急性化脓性中耳炎对耳蜗外淋巴离子的影响

本文介绍了10只豚鼠听泡接种金黄色葡萄球菌后，诱发急性化脓性中耳炎，在检测患耳外淋巴时，发现外淋巴K^ 浓度升高（P＜0.01);Na^ 浓度轻度升高，无统计学意义，患耳耳蜗辅片见底回外毛细胞和部分内毛细胞坏死。所以，中耳炎时的内耳毛细胞坏死可伴有离子浓度的改变。     

Effects of glycerol on sodium and potassium concentrations in guinea pig perilymph

Summary Serum, cerebrospinal fluid (CSF), scala vestibuli perilymph, and scala tympani perilymph were collected from 85 normal guinea pigs both before and after i.v. administration of glycerol (1 ml/kg), and the sodium and potassium concentrations were assessed using a microflame photometer. Marked increases in sodium concentrations were observed in scala tympani perilymph and CSF, while there was a slight decrease in the serum and there was no significant change in scala vestibuli perilymph. These increases in sodium concentrations are considered to occur in the dehydration process in the body fluids mentioned above. On the other hand, increase in the potassium concentrations was found only in scala vestibuli perilymph and thus cannot be explained by simple dehydration process. This potassium elevation in scala vestibuli perilymph should be understood by further experiment on endolymph. It became evident that scala vestibuli perilymph differs from scala tympani perilymph and CSF in the dynamics of electrolytes after glycerol administration. In this regard, the nature of the scala vestibuli as fluid space should be studied in future. The above findings obtained in the present study may imply the significance in elucidating the glycerol effect on hearing of endolymphatic hydrops case.This study was funded in part by a grant from the Ministry of Education, Science, and Culture, Japan     

Evidence for a perilymphatic origin of the endolymph: application to the pathophysiology of Ménière's disease

The origin of the endolymph was elucidated by kinetic studies of the entry of water and electrolytes into endolymph and perilymph after intravenous administration of radioactive tracers in rats. The compartmental analysis of the data and the comparison of this study with the results of Konishi and associates (Acta Otolaryngol (Stockh) 86, 22-34 and 176-184, 1978), using perilymphatic perfusion of tracers, indicate that perilymph rather than plasma may be considered the precursor of endolymph. Since the cochlear epithelium was found to be freely permeable to water, an alteration of electrolyte transportation across the membranous labyrinth may be involved in the pathophysiology of Ménière's disease. Chloride transport across the cochlear epithelium was investigated using acetazolamide, a specific carbonic anhydrase inhibitor.     

The reaction of the guinea pig cochlea to perforations of the round window membrane with and without perilymph aspiration

Summary The influence of simple opening of the round window (RW) membrane and the effect of aspiration of perilymph on the electrophysiological characteristics of the cochlea was tested in guinea pigs by measurement of the compound action potentials. We found that perforations of the RW membrane failed to lead to either shortterm or long-term damage in cochlear function. There was only a slight spontaneous escape of perilymph but without measurable functional loss. Additional aspiration of perilymph led to entry of air into the basal turn and to an immediate loss of function of the cochlea. This regressed within 4 weeks in the middle- and low-frequency ranges. Measurable long-term damage persisted only in the high-frequency ranges. We attribute contradictory results of other authors to methodological errors which we avoided by a specific selection of healthy animals and the development of standardized operation, recording and measurement procedures.