Elektrophysiologische Untersuchung zum Einsatz von Streptolysin O und Natrium-Hyaluronat zur Permeabilitätsmodulation der Membran des runden Fensters beim Meerschweinchen

Background: The round window membrane (RWM) acts like a barrier for topically applied substances into the middle ear preventing diffusion into the perilymphatic fluid compartment. Material and Method: In an animal model, modulation of the permeability of the RWM was attempted using Streptolysin-O (SLO) in various concentrations and sodium hyaluronate. Thereafter, the effect of intratympanically applied Lidocain 2% on hearing threshold measured by auditory brainstem response was tested for Lidocain 2 % and Lidocain 2 % in combination with SLO or sodium hyaluronate. Results: The results show that both, SLO and sodium hyaluronate, influence the effect of Lidocain 2 % on hearing thresholds as a…

Intraoperatives Monitoring motorischer Hirnnerven bei Operationen an Hals und Schädelbasis

Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiological monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of 4 cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was employed during 102 skull base operations. Of these 102 operations, 44 were acoustic neuroma removals by translabyrinthine approach and 36 by a middle fossa approach. Various operations including removal of tumours of the jugular foramen and the infratemporal fossa we…

Immunoelectron microscopic localization of nitric oxide synthase III in the guinea pig organ of Corti

Nitric oxide synthase III (NOS III) was identified in the guinea pig cochlea on an ultrastructural level using a post-embedding immunolabeling procedure. Ultrathin sections of London Resin (LR) White-embedded specimens were incubated with various concentrations of a commercially available antibody to NOS III and the immunoreactivity visualized by a gold-labeled secondary antibody. Analysis of ultrathin sections of the organ of Corti in the second turn of the cochlea showed that NOS III could be localized in the endothelial cells of the blood vessels under the basilar membrane, which was comparable to its location in similar cells types in various biological systems. Besides this, NOS III wa…

Morphologic Damage and Changes of Intracellular Calcium-Binding Sites after Acute Noise Trauma in the Organ of Corti of the Guinea Pig

In guinea pigs, an acute acoustic trauma was created by 6 consecutive gunshots. The sound pressure at the ear drum was 156 +/- 4 dB, the frequency maximum was between 4 and 6 kHz. Sixty hours after the noise trauma, the animals were decapitated, and the cochleae were prepared for microscopic analysis of the resulting trauma to the organ of Corti. During the process of fixation, the potassium-pyroantimonate precipitation reaction was performed to localize calcium-binding sites. The pattern of cell morphology and the distribution of calcium-binding sites was compared to that of normal control animals. Morphologic changes of the cells in the organ of Corti correlated with changes of the cellul…

Selective Chemical Vestibulectomy

In an attempt to destroy the peripheral vestibular labyrinth selectively in patients suffering from intractable vertigo as a result of end-stage Meniere’s disease, 25 patients underwent selective chem

Localization of Ca(2+)-stores and tissue compartments with a Ca(2+)-binding capacity in the organ of Corti of the guinea-pig by electron energy-loss spectroscopy.

SUMMARY The addition of 10 mM CaCl2 to glutaraldehyde fixative leads to the formation of small electron-dense deposits in the organ of Corti of the guinea-pig. These precipitates are mainly attached to cell membranes in contact with different extracellular lymphatic fluids. A higher number of precipitates is localized in the acellular parts of tectorial and basilar membrane. Electron energy-loss spectroscopy (EELS) was used to determine the elemental composition of the deposits formed. The spectra showed a prominent signal at the Ca2+ L2,3 ionization edge. Oxygen could also be detected in all the precipitates analysed. EELS analysis of mitochondria of the inner and outer hair cells after co…

Respiratory epithelium exposed to sulfur dioxide--functional and ultrastructural alterations.

The value of morphological investigations of airway mucosa should be compared to a functional method when estimating the toxicity of airborne pollutants. In 34 guinea pig tracheas, mucociliary activity was measured using a modified light beam reflex method before and following exposure to sulfur dioxide for 30 minutes in concentrations ranging between 7.5 and 37.5 mg/m3. Exposure to air served as a control. Simultaneously, specimens were taken for light and electron microscopy. Mucociliary activity decreased from 8.4 +/- 2.9 Hz (control exposure) to 4.0 +/- 2.9 Hz following exposure to 7.5 mg/m3, to 3.4 +/- 2.7 Hz at 15 mg/m3 sulfur dioxide, to 1.8 +/- 2.2 Hz at 22.5 mg/m3 sulfur dioxide, t…

Aktuelle interdisziplinäre Diagnostik und Therapie der endokrinen Orbitopathie*

Progress in electron microscopic diagnostics: semi-quantitative determination of precipitable calcium in different cell types of the organ of Corti in the guinea-pig

Potassium antimonate was used to precipitate calcium in the cochlea of the guinea-pig. The distribution of the calcium antimonate precipitates was analysed by electron microscopy. The precipitate density was determined in different cell types in the organ of Corti by counting the number of calcium binding sites in a 10-micron 2 area. The size of the precipitates varied considerably, and thus the relative amount of the precipitable calcium was estimated only semi-quantitatively. As the prominent carbon signal is superimposed over the nearby small Ca(2+)-edge signals, the combined signal of the antimony M4,5-edge and the oxygen K-edge of the calcium antimonate salt formed was chosen for the s…

Ultrastructural localization of Ca2(+)-binding sites in the middle ear mucosa of the rat.

Cations were precipitated with potassium-pyroantimonate in the middle ear mucosa of the rat and the distribution of the formed precipitates was studied by electron microscopy. The precipitate density in various cells of the different epithelia of the middle ear mucosa was determined on electron micrographs by counting the number of precipitates per unit area. Electron spectroscopic imaging was also performed to obtain information about the spatial distribution of the precipitates and their elemental composition.

B‐Mode ultrasonography of the paranasal sinuses compared with CT findings

Ultrasound as a diagnostic aid in the evaluation of the sinuses has been a controversial issue. Sensitivities have been reported from 29% to 100% and specificities from 55% to 99%. These wide variations in results from previous studies may have resulted from technical differences. However, the "gold standard" most often used for comparison has been a Water's view radiograph, which has been shown to correlate poorly with intraoperative and CT scan findings. To our knowledge, no one in the English language literature has evaluated sonography of the sinuses with computed tomography as the gold standard. In addition, evaluation of the ethmoid sinus has been neglected by previous studies that ha…

The influence of Ca2+ antagonists on the ciliary activity of the guinea pig trachea.

The ciliary activity of the guinea pig tracheal respiratory epithelium was measured using a photoelectric device. Fourteen animals were administered 75 mg diltiazem/kg body weight 2 days, 1 day and 4 h prior to the investigation. Thirteen animals served as controls. In the pretreated group, the mean ciliary stroke frequency (13.4 +/- 3.0 Hz) was significantly lower (P = 0.02) than in the control group (16.6 +/- 3.7 Hz). The application of aerosolized 0.3 mmol/l nifedipine solution on the tracheal preparations of the control animals also significantly reduced the stroke frequency (P = 0.02). The ciliary activity never dropped beyond a frequency of about 8 Hz. The most probable interpretation…

Histochemical localization of calcium ATPase in the cochlea of the guinea pig

The activity of Ca(2+)-ATPase in the inner ear of the guinea pig was studied ultracytochemically by the lead citrate reaction. The electron-dense reaction products as an expression of Ca(2+)-ATPase activity were localized in endolymphatic cells of Reissner's membrane, in outer and inner hair cells and in some supporting cells. The main finding was the difference in the localization of Ca(2+)-ATPase in outer and inner hair cells. In the latter cells the activity sites were mainly intracellular and in apical membrane specializations, whereas in the outer hair cells the enzyme was localized in the apical membrane specializations and the basolateral plasma membrane.

Electron microscopic localization of nitric oxide I synthase in the organ of Corti of the guinea pig

Nitric oxide synthase (NOS) activity has been detected previously in the mammalian cochlea at a light microscopic level. Here we present results of electron microscopic analysis for post-embedding immunoreactivity of neural-type NOS I in the cochlea of the guinea pig. Strong enzyme immunoreactivity was identified in the cytoplasm of inner and outer hair cells. Gold-labeled NOS I antibodies were mainly located in electron-dense areas of the cytoplasm, whereas electron-lucent regions of the receptor cells were nearly free from any immunoreactivity. In both types of hair cells anti-NOS I antibodies were also visible in the cuticular plates, hair bundles and nuclei. Further ultrastructural anal…

Modifications of a nerve integrity monitor useful in skull base surgery.

Bedeutung der Ganzkörper-Skelettszintigraphie im Rahmen des Staging von Malignomen im HNO-Bereich*

Concerning malignant tumours of the oral cavity, pharynx and larynx, bone metastases are in general rarely seen. For the specification to which patients the whole body bone scintigraphy as detection method should be applied, the findings of 370 patients were analysed retrospectively. In respect of primary staging, bone metastases could be found by scintigraphy in only 1.4% of the patients. On the other hand, there was a detection rate of 12% during the further course of the disease, especially in case of clinical symptoms pointing at spreading metastases or in tumour recurrences. Nevertheless, positive scan findings which were not due to metastases could be found in both groups with equal f…

Einsatz des intraoperativen Ultraschalls in der Speicheldrüsenchirurgie

Sonography of the head-and-neck region is well established in the preoperative diagnostic process of tumorous lesions. Its intraoperative use to localise small tumours, however, has been rarely investigated to date. We applied intraoperative ultrasound to 19 patients who underwent parotid surgery and evaluated the following criteria: intraoperative tumour presentation, scan quality, comparison between sonographic visualisation and tumour detection by palpation, histological tumour borders as well as postoperative complications. All lesions were reproduceable by intraoperative ultrasound and could be demonstrated in sufficient quality. None of the 19 parotid tumours could be identified by pa…

Effekt der mikrochirurgischen Entfernung von Vestibularisschwannomen auf das Schmeckvermögen

Patienten mit Vestibularisschwannom berichten neben den bekannten Kardinalsymptomen auch uber Schmeckstorungen. Wenig ist bisher zu diesem Symptom bei dieser Patientengruppe bekannt. Ziel dieser Untersuchung war es, den Einfluss der operativen Therapie auf das Schmeckvermogen mit Hilfe eines standardisierten Schmecktests prospektiv zu untersuchen. Dafur wurde das Schmeckvermogen mit den Schmeckstreifen vor und nach der Operation eines VS untersucht und die Ergebnisse statistisch ausgewertet. 25 Patienten konnten in die Untersuchung eingeschlossen werden. Es zeigte sich im Mittel eine statistisch signifikante, postoperative Abnahme der Schmeckwerte sowohl auf der Tumor- als auch der gesunden…

The role of acoustic rhinometry in the diagnosis of adenoidal hypertrophy in pre-school children.

Adenoidal hypertrophy is a common problem in pre-school children and diagnosis depends mostly on evaluation of clinical symptoms and signs. Investigative techniques to assess adenoidal size often do not add to this information. Recent reports have suggested a role for acoustic rhinometry in this situation. A total of 49 children consecutively referred to the Department of Otorhinolaryngology, University of Mainz, with evidence of adenoidal enlargement underwent acoustic rhinometry pre- and post-operatively and were compared to an age-matched control group from a local kindergarten school. Adenoidal size was visually estimated at surgery and questionnaires were completed by parents of sympto…

Incidence of childhood cancer of the head and neck in Germany.

Background: Only very limited data are available in the literature on the incidence of childhood cancer of the head and neck worldwide. Methods: Based on data obtained from the national German Childhood Cancer Registry, a total of 370 malignancies of the head and neck in children under the age of 15 (199 boys and 171 girls), which were reported to this institution between 1994 and 2003, were analysed in this study. Results: The overall incidence of malignancies of specific sites of the head and neck in Germany is 4.48 per 100000 children. The most frequently observed entities, representing primary tumours, are soft tissue sarcomas (0.39/100000), lymphomas (0.09/100000) and thyroid carcinoma…

Optic nerve decompression in trauma and tumor patients

Optic nerve decompression is a procedure that is now receiving increasing clinical attention. However, there are currently no standardized treatment protocols in the therapy of traumatic or pressure insults to the nerve. The present retrospective study was designed to report our experience with microscopic endonasal transethmoid-sphenoid optic nerve decompression in 24 unilateral trauma cases and 11 unilateral skull base tumor patients. In general preoperative visual acuities in the trauma patients were worse than in the tumor patients. Following surgery, 9 of 11 tumor patients (82%) had at least some improvement of their vision, including 5 complete recoveries. In the group with traumatic …

Calcium-binding sites in the inner ear after pure-tone stimulation

Five guinea pigs were exposed to an interrupted 90 dB SPL pure tone of 3.2 kHz for a total application time of 5 min. Following sound application all animals were decapitated and the cochleae were removed. After that, calcium-binding sites were located by the potassium pyroantimonate precipitation method. Another three animals served as control animals and did not receive the sound treatment. Findings confirmed previous studies showing the spatial arrangements of precipitate rich regions in the inner ear's two acellular structures (the basilar membrane and tectorial membrane) and the two cellular structures (the inner hair cells and Huschke's teeth). By using semiquantitative evaluation we …

Tracheomalacia Repair Using Ceramic Rings

Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance p…

Necrosis of the long process of the incus following stapes surgery: new anatomical observations.

Objectives/Hypothesis: The most frequent complication (generally recognized during revision procedures) following seemingly successful stapedotomies and stapedectomies is necrosis of the long process of the incus. This is currently ascribed to a malcrimped stapes prosthesis or to a compromised blood supply of the incus. The two-point fixation can cause a mucosal injury with a resulting toxic reaction, and also osteoclastic activity. An important aspect in the engineering of ideal stapes prostheses is that they should be fixed circularly to the long process of the incus with appropriate strength. The objective of this study was to compare current knowledge relating to the blood supply of the…

Alteration of loosely bound calcium in the guinea pig organ of Corti after treatment with diltiazem as calcium channel blocker

After oral administration of the organic calcium channel blocker diltiazem to guinea pigs for 7 days, calcium ions were precipitated with potassium antimonate in the cochleae. The spatial distribution of the precipitates was studied by energy-filtering transmission electron microscopy and the amount of the ultrastructural reaction products formed was determined semiquantitatively by an image processing system. Compared with untreated control ears, the number of the formed precipitates was reduced drastically in the inner hair cells after diltiazem treatment. In addition, electron microscopic analysis revealed that the number of calcium precipitates attached at the basolateral membrane of th…

Use of electron spectroscopic imaging to determine element composition of the melanin granules in the stria vascularis of the guinea pig.

Electron spectroscopic imaging (ESI) was used to analyze the element content of melanin granules in the stria vascularis seen in ultrathin sections of Spurr-embedded cochleae of the guinea pig. To determine element composition, ESI images were taken at different ionization edges, and non-specific background signals were subtracted digitally by an image processing system. The presence of calcium and nitrogen in the melanin granules could be demonstrated clearly. The calcium identified in the melanin granules was then compared with the spatial distributions of calcium binding sites after the application of an antimonate precipitation method, which was used to localize loosely bound calcium. D…

Effects of contralateral white noise stimulation on transitory evoked otoacoustic emissions in patients with acoustic neuroma.

Abstract Transitory evoked otoacoustic emissions are normal phenomena observed in most persons with hearing levels greater than 35 dB. Further, masking of the contralateral ear produces amplitude reductions in the transitory evoked otoacoustic emissions. We have undertaken a study of transitory evoked otoacoustic emissions in 20 patients with acoustic neuroma. All patients were assessed for transitory evoked otoacoustic emissions bilaterally, with and without contralateral masking with white band noise at 40, 50, and 60 dB. We found that transitory evoked otoacoustic emissions were present in 30% of ears with tumor and that the presence of transitory evoked otoacoustic emissions is associat…

The effects of short-term immunotherapy using molecular standardized grass and rye allergens compared with symptomatic drug treatment on rhinoconjunctivitis symptoms, skin sensitivity, and specific nasal reactivity.

The efficacy and safety of short-term immunotherapy with molecular standardized allergens (STI) has been demonstrated by double-blind placebo-controlled clinical trials. The aim of this study was to compare STI with symptomatic drug treatment.Forty-eight patients with rhinoconjunctivitis to grass and/or rye pollen were treated either with STI (ALK(7), n = 24) plus anti-allergic drugs or anti-allergic drugs, alone (n = 24) in a prospective, randomized study. Symptoms and use of drugs were reported in patient diaries and titrated nasal provocation and skin prick tests were performed at baseline, before, and after season.Median overall symptom (P = 0.022, U test) and medication scores (P = 0.0…

Sinusitis in Thyroid Associated Ophthalmopathy

In 19 patients with thyroid associated ophthalmopathy undergoing orbital decompression, histologic examination of paranasal sinus mucosa revealed moderate to severe inflammatory alterations in all patients. Only 2/19 patients had a history of chronic sinusitis. In 4/19 patients, mucosal abnormalities of the paranasal sinuses were found on preoperative computed tomography CT scans. Postoperatively, 10/19 patients developed purulent sinusitis. It is suggested that patients suffering from thyroid associated ophthalmopathy have an increased incidence of histologically detectable inflammatory changes of paranasal sinus mucosa. Because of preexisting mucosal inflammation, these patients are pron…