Acta oto-laryngologica. Supplementum最新文献

Conclusion: The factors of tinnitus loudness and Tinnitus Handicap Inventory (THI) score in tinnitus patients have the potential to relate to therapeutic results of tinnitus retraining therapy (TRT).

Objectives: To confirm what factors in tinnitus influence the results of TRT.

Patients and methods: Twelve factors were investigated in 53 patients with tinnitus, examining the relationship between these factors and the results of TRT. A THI score was determined before and 6 months after TRT introduction (pre- and post-TRT). Moreover, the change of THI score from pre- to post-TRT (delta THI) was referred to as the therapeutic effect of TRT. Based on the 12 factors, subjects were respectively divided into two groups, comparing delta THI between groups.

Results: Two groups of greater tinnitus loudness and higher THI score showed significant increases in delta THI, indicating that two factors of tinnitus loudness and THI score were related to the therapeutic effect of TRT.

Conclusion: Immunolocalization of the subtypes of water channel proteins, aquaporins (AQPs), was detected in the mouse eustachian tube (ET). AQPs are located continuously from the serous glands and the capillary vessels to the luminal side in the ET epithelium and may play an important role in the transportation of water to the surface of the ET lumen through the epithelium.

Objectives: Although the water supply to the surface of the ET lumen is considered to be essential for closing of the ET, the pathway of the water in the ET is not fully understood. Since AQPs, a group of water transport proteins, have been reported to regulate water homeostasis, we examined the location of AQPs in the mouse ET.

Materials and methods: Nine subtypes of AQPs were examined in paraffin embedded ETs of adult mice using the avidin-biotin peroxidase complex method of immunohistochemistry.

Results: Four subtypes of AQPs were detected in the mouse ET. AQP-1 was detected in fibroblasts, endothelial cells of capillary vessels and cartilage cells. AQP-3 was distinctly detected in the basal membrane of epithelial cells. AQP-4 was detected in the basal membrane of epithelial cells. AQP-5 was expressed in the luminal side of the ET epithelial cells and also in the apical surface of the cells of the serous glands.

Conclusion: The present study showed a variety of stages of neurogenic degeneration of the muscle fibers and the neuromuscular junctions (NMJs) of the posterior cricoarytenoid (PCA) muscle in multiple system atrophy (MSA). These findings coincide with abductor paralysis of vocal cords. Ultrastructural features of the NMJs of the PCA muscle in MSA were different from those of previous studies on experimental resection of recurrent nerve and amyotrophic lateral sclerosis (ALS).

Objectives: MSA may influence various respiratory functions. Upper airway tracts including larynx are affected without exception during its clinical course. Morphological changes of NMJs of the intrinsic laryngeal muscle in MSA were examined ultrastructurally.

Patient and methods: The patient was a 68-year-old male complaining of recurrent aspiration pneumonia, dysphagia, respiratory disturbance, and abductor paralysis of vocal cords. The motor nerve terminals of the PCA muscle in a patient with MSA were investigated electron microscopically.

Results: The NMJs showed varying degrees of ultrastructural changes by motor nerve degeneration. They were seen in the pre- and post-synaptic regions. Muscle fibers losing nerve terminals showed severe damage in their cytoplasm.

Conclusion: Recent advances in clinical MR imagers, such as the 3-Tesla, multi-channel phased-array coil and novel pulse sequences, allow the evaluation of subtle alterations in the inner ear fluid environments and breakdown of the blood-labyrinthine barrier. Intratympanic injection of Gd-DTPA allows the imaging detection of endolymphatic hydrops in patients.

Objectives: To describe the current status of inner ear MRI and future directions for imaging.

Materials and methods: Based on our experiences and literature research, a brief review of the history and recent developments of inner ear MRI is presented.

Results: The 3D-FLAIR technique can detect abnormalities that could not be visualized previously in many inner ear diseases, such as sudden deafness, otosclerosis, lupus erythematosus, mumps, and Ramsay-Hunt syndrome. Imaging techniques, indications, and findings for the visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA are also discussed. This procedure enabled the visualization of endolymphatic hydrops in vivo. Newly developed 3D-real IR techniques and utilities of 32 channel coil are also presented.

Conclusion: Transtympanic electrocochleography (TT ECochG) is helpful for the confirmation of Meniere's disease using tone burst stimuli to measure the amplitude of the frequency specific summating potentials (SP) but not when using the click evoked summating potential versus action potential ratio (SP/AP).

Objectives: To evaluate the effectiveness of TT ECochG as a means of confirming the clinical diagnosis of Meniere's disease.

Patients and methods: A total of 2,717 patients were referred for TT ECochG between August 1998 and September 2008. Each patient was assessed prospectively on clinical grounds according to the AAOHNS criteria and a scale devised by the author. A Meniere's group and a non-Meniere's group were determined and the TT ECochG results were compared between the groups that had similar hearing levels for the particular stimulus employed.

Results: Click SP/AP measurements did not significantly differentiate between populations of Meniere's ears and non-Meniere's ears. Tone burst SP amplitude measurements were significantly different between the populations, especially using frequencies at 500 Hz, 1 kHz, and 2 kHz.

Conclusion: The 3D models of endolymphatic and perilymphatic spaces enabled us to obtain normal and pathological volumes of each space and helped us to understand the 3D structure of various parts of the inner ear and of endolymphatic hydrops.

Objective: To make a 3D model of the inner ear using sections of temporal bone with and without hydrops.

Materials and methods: Every 10th 20 microm thick section of temporal bone was collected from two ears with endolymphatic hydrops and five ears without hydrops. Using ZedView, 3D Doctor, FreeForm as analytical software, a 3D model of the inner ear was obtained by reconstruction of these sections. The volumes of the endolymphatic (EV) and perilymphatic spaces (PV) were calculated in each part of the cochlea and vestibular apparatus including the semicircular canals, but the endolymphatic duct and sac were not included.

Results: In normal ears (controls), the average cochlear EV was 5.1 microl and the PV was 41.9 microl, and the average vestibular EV was 24.0 microl and the PV 75.7 microl. In one hydropic ear, the cochlear EV was 17.5 microl, cochlear PV 30.7 microl, vestibular EV 42.5 microl, and vestibular PV 33.4 microl. In the other hydropic ear, cochlear EV was 31.2 microl, cochlear PV 30.1 microl, vestibular EV 25.6 microl, and vestibular PV 71.8 microl.

Conclusion: Using three-dimensional real inversion recovery (3D-real IR) and three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI), various degrees of endolymphatic hydrops were observed in the basal and upper turns of the cochlea and in the vestibular apparatus after intratympanic gadolinium (Gd) injection. MRI may contribute to our understanding of inner ear diseases and may be a useful addition to intratympanic drug therapy in the management of inner ear diseases.

Objective: To evaluate 3D-real IR MRI and 3D-FLAIR MRI with clinical symptoms and signs in patients with inner ear disease.

Patients and methods: Gd was diluted in saline and injected intratympanically in 73 patients with inner ear disease. The endolymphatic space was evaluated with 3-Tesla MRI at 1 day after the intratympanic Gd injection.

Results: 3D-real IR MRI was generally better than 3D-FLAIR MRI in discriminating between the perilymphatic space and endolymphatic space in the cochlear turns and in the vestibular apparatus. However, when Gd concentration was insufficient in the perilymph, it was more difficult to visualize the Gd with 3D-real IR MRI than with 3D-FLAIR MRI. Endolymphatic hydrops was observed using MRI in patients with 'probable' Meniere's disease based on the criteria.

Conclusion: The inner ear membranous permeability and leakiness and endolymphatic hydrops can be visualized using gadolinium-enhanced MRI in both rodents and man. Intratympanic administration of contrast agent gives greater perilymphatic loading of gadolinium.

Objectives: Visualization of different types of inner ear dysfunction in MRI with intravenous or intratympanic administration of contrast agent.

Materials and methods: In the animal study, gadolinium was administered intravenously or intratympanically and imaged with 4.7 T MRI. In man, gadolinium was delivered intratympanically and studied with 1.5 T or 3 T MRI.

Results: In the animals, intravenous delivery of gadolinium demonstrated uptake in the perilymph of normal inner ears. The cochlear modiolus appeared to be a critical site for the secretion of perilymph and the location of fluid communication between the perilymphatic scalae. Intense noise exposure and immune reaction caused cochlear injury and accelerated gadolinium passage through the blood-perilymph and blood-endolymph barriers. In man, perilymphatic uptake of gadolinium was only observed in the impaired inner ear when administered intravenously. However, the signal-to-noise ratio of images was improved when gadolinium was delivered intratympanically. MRI demonstrated endolymphatic hydrops in both animal models and patients with Meniere's disease.

Conclusion: Grading of endolymphatic hydrops in the vestibule and the cochlea using magnetic resonance imaging (MRI) is proposed (2008 Nagoya scale).

Objective: To standardize the evaluation of endolymphatic hydrops in both the vestibule and the cochlea using MRI.

Patients and methods: The endolymphatic space was evaluated after intratympanic gadolinium injection using three-dimensional fluid attenuated (3D-FLAIR) MRI and three-dimensional real inversion recovery (3D-real IR) MRI.

Results: A simple three-stage grading system was acceptable for hydrops in both the vestibule and the cochlea: none, mild, and significant. In the vestibule, the grading was determined by the ratio of the area of endolymphatic space to the vestibular fluid space (sum of the endolymphatic and perilymphatic spaces). Patients with no hydrops have a ratio of one-third or less, those with mild hydrops have between one-third and a half, and those with significant hydrops have a ratio of more than 50%. In the cochlea, patients classified as having no hydrops show no displacement of Reissner's membrane; those with mild hydrops show displacement of Reissner's membrane but the area of the endolymphatic space does not exceed the area of the scala vestibuli; and in those with significant hydrops the area of the endolymphatic space exceeds the area of the scala vestibuli.

Conclusion: Using a guinea pig model of experimental endolymphatic hydrops, click sounds of altered polarity showed different latencies and amplitudes in hydropic compared with normal cochleae. Latency changes appeared as early as 1 week after endolymphatic obstruction. This method can help diagnose endolymphatic hydrops.

Objective: The goal of the study was to develop an objective electrophysiological diagnosis of endolymphatic hydrops.

Materials and methods: Endolymphatic hydrops were created surgically in guinea pigs. The latency and the amplitude of the eighth cranial nerve compound action potential (CAP) for click sounds of altered polarity were measured up to 8 weeks after the surgery.

Results: At early stages after surgery, the latency for condensation clicks became longer, and at later stages the latencies for both condensation and rarefaction became longer. The discrepancy in the latencies for rarefaction and condensation click sounds (rarefaction minus condensation) became larger by the first week after surgery, but no further discrepancy occurred thereafter. Compared with latency changes, amplitude changes in the CAP were rapid and progressive following surgery, suggesting ongoing damage to hair cells.