Insights into Inner Ear Function and Disease Through Novel Visualization of the Ductus Reuniens, a Seminal Communication Between Hearing and Balance Mechanisms

The sensory end-organs responsible for hearing and balance in the mammalian inner ear are connected via a small membranous duct known as the ductus reuniens (also known as the reuniting duct (DR)). The DR serves as a vital nexus linking the hearing and balance systems by providing the only endolymphatic connection between the cochlea and vestibular labyrinth. Recent studies have hypothesized new roles of the DR in inner ear function and disease, but a lack of knowledge regarding its 3D morphology and spatial configuration precludes testing of such hypotheses. We reconstructed the 3D morphology of the DR and surrounding anatomy using osmium tetroxide micro-computed tomography and digital visualizations of three human inner ear specimens. This provides a detailed, quantitative description of the DR's morphology, spatial relationships to surrounding structures, and an estimation of its orientation relative to head position. Univariate measurements of the DR, inner ear, and cranial planes were taken using the software packages 3D Slicer and Zbrush. The DR forms a narrow, curved, flattened tube varying in lumen size, shape, and wall thickness, with its middle third being the narrowest. The DR runs in a shallow bony sulcus superior to the osseus spiral lamina and adjacent to a ridge of bone that we term the "crista reuniens" oriented posteromedially within the cranium. The DR's morphology and structural configuration relative to surrounding anatomy has important implications for understanding aspects of inner ear function and disease, particularly after surgical alteration of the labyrinth and potential causative factors for Ménière's disease.

Inner ear sensory system changes as extinct crocodylomorphs transitioned from land to water

Major evolutionary transitions, in which animals develop new body plans and adapt to dramatically new habitats and lifestyles, have punctuated the history of life. The origin of cetaceans from land-living mammals is among the most famous of these events. Much earlier, during the Mesozoic Era, many reptile groups also moved from land to water, but these transitions are more poorly understood. We use computed tomography to study changes in the inner ear vestibular system, involved in sensing balance and equilibrium, as one of these groups, extinct crocodile relatives called thalattosuchians, transitioned from terrestrial ancestors into pelagic (open ocean) swimmers. We find that the morphology of the vestibular system corresponds to habitat, with pelagic thalattosuchians exhibiting a more compact labyrinth with wider semicircular canal diameters and an enlarged vestibule, reminiscent of modified and miniaturized labyrinths of other marine reptiles and cetaceans. Pelagic thalattosuchians with modified inner ears were the culmination of an evolutionary trend with a long semiaquatic phase, and their pelagic vestibular systems appeared after the first changes to the postcranial skeleton that enhanced their ability to swim. This is strikingly different from cetaceans, which miniaturized their labyrinths soon after entering the water, without a prolonged semiaquatic stage. Thus, thalattosuchians and cetaceans became secondarily aquatic in different ways and at different paces, showing that there are different routes for the same type of transition.

Inner ear sensory system changes as extinct crocodylomorphs transitioned from land to water

Major evolutionary transitions, in which animals develop new body plans and adapt to dramatically new habitats and lifestyles, have punctuated the history of life. The origin of cetaceans from land-living mammals is among the most famous of these events. Much earlier, during the Mesozoic Era, many reptile groups also moved from land to water, but these transitions are more poorly understood. We use computed tomography to study changes in the inner ear vestibular system, involved in sensing balance and equilibrium, as one of these groups, extinct crocodile relatives called thalattosuchians, transitioned from terrestrial ancestors into pelagic (open ocean) swimmers. We find that the morphology of the vestibular system corresponds to habitat, with pelagic thalattosuchians exhibiting a more compact labyrinth with wider semicircular canal diameters and an enlarged vestibule, reminiscent of modified and miniaturized labyrinths of other marine reptiles and cetaceans. Pelagic thalattosuchians with modified inner ears were the culmination of an evolutionary trend with a long semiaquatic phase, and their pelagic vestibular systems appeared after the first changes to the postcranial skeleton that enhanced their ability to swim. This is strikingly different from cetaceans, which miniaturized their labyrinths soon after entering the water, without a prolonged semiaquatic stage. Thus, thalattosuchians and cetaceans became secondarily aquatic in different ways and at different paces, showing that there are different routes for the same type of transition.

The evolution of the vestibular apparatus in apes and humans

Phylogenetic relationships among extinct hominoids (apes and humans) are controversial due to pervasive homoplasy and the incompleteness of the fossil record. The bony labyrinth might contribute to this debate, as it displays strong phylogenetic signal among other mammals. However, the potential of the vestibular apparatus for phylogenetic reconstruction among fossil apes remains understudied. Here we test and quantify the phylogenetic signal embedded in the vestibular morphology of extant anthropoids (monkeys, apes and humans) and two extinct apes (Oreopithecus and Australopithecus) as captured by a deformation-based 3D geometric morphometric analysis. We also reconstruct the ancestral morphology of various hominoid clades based on phylogenetically-informed maximum likelihood methods. Besides revealing strong phylogenetic signal in the vestibule and enabling the proposal of potential synapomorphies for various hominoid clades, our results confirm the relevance of vestibular morphology for addressing the controversial phylogenetic relationships of fossil apes.

Bionic balance organs: progress in the development of vestibular prostheses

The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.

Gender Differences in Perception of Self-Orientation: Software or Hardware?

We evaluated the contribution of attentional strategy to the perception of self-orientation with and without a body tilt in the median plane. Reinking et al (1974 Journal of Personality and Social Psychology30 807–811) found that the frame dependence of females on the rod-and-frame test could be mediated by instructions prompting them to focus on internal cues (ie arising from inside of the body). Here, we measured the influence of attentional instructions on the perception of the morphological horizon. Eleven females and thirteen males estimated their morphological horizon in an upright and a 45° body tilt in the median plane under three instruction conditions. All participants first performed without attentional instructions. Then, participants performed under both internal and external attentional instructions. For females, but not for males, perception of morphological horizon was more footward in the supine than in the upright orientation. Although instructions did not eliminate gender differences, internal instructions allowed females to reduce their perceptual bias in the supine orientation.

Anatomy of the para-vestibular canaliculus

A histologic study of the para-vestibular canaliculus (PVC), its contents, and its relationship to the vestibular aqueduct (VA), is presented. 20 normal human temporal bones were fixed in 10% formalin solution, embedded in celloidin, and sectioned horizontally at intervals of 20 micrometers. Every tenth section was stained with hematoxylin and eosin (HE) and studied under a light microscope. Three significant observations were made. First, in 80% of the specimens, two rather than one PVC were found in the area of the vestibular orifice of the VA. Second, in 70% of the specimens, the PVC was found to merge with the VA rather than to enter the posterior cranial fossa (PCF) separately. Third, in all the specimens examined, a vein was seen to traverse the entire length of the PVC. However, in 17 specimens, no artery could be identified within the PVC. In the 13 (65%) specimens in which arteries could be identified in the PVC, the arteries extended only half the length of the PVC, from the PCF to the VA. In no specimen examined could arteries be seen extending the full length of the PVC from the PCF to the vestibule.

Nobel Prize centenary: Robert Bárány and the vestibular system

The hundredth anniversary of Robert Bárány's Nobel Prize in Medicine offers the opportunity to highlight the importance of his discoveries on the physiology and pathophysiology of the vestibular organs. Bárány developed the method of caloric vestibular stimulation that revolutionized the investigation of the semicircular canals and that is still widely used today. Caloric vestibular stimulation launched experimental vestibular research that was relevant to comprehend the evolution of human locomotion, and Bárány's tests continue to be used in neuroscience to understand the influence of vestibular signals on bodily perceptions, cognition and emotions. Only during the last 20 years has caloric vestibular stimulation been merged with brain imaging to localize the human vestibular cortex.

The anatomical and physiological framework for vestibular prostheses

This article reviews the structure function of the vestibular system and its pathology with respect to requirements for the design and construction of a functional vestibular prosthesis. The ultimate goal of a vestibular prosthesis is to restore balance and equilibrium through direct activation of vestibular nerve fibers. An overview of the peripheral and central vestibular systems that highlights their most important functional aspects re: the design of a prosthesis is provided. Namely, the peripheral labyrinth faithfully transduces head motion and gravity in both the time and frequency domains. These signals are described in hopes that they may be prosthetically replicated. The peripheral and central connections of the vestibular nerve are also discussed in detail, as are the vestibular nuclei in the brainstem that receive VIIIth nerve innervation. Lastly, the functional effector pathways of the vestibular system, including the vestibulo-ocular, vestibulo-spinal, vestibulo-colic, vestibulo-autonomic, and vestibular efferent innervation of the labyrinth are reviewed.

Vestibular disease: diseases causing vestibular signs

Having determined whether a patient has central or peripheral vestibular disease, clinicians must then determine what diseases are likely to result in such a presentation. This article describes the more common diseases causing vestibular disease in dogs and cats. Having formulated a list of potential causes of vestibular disease, clinicians should proceed through a systematic investigation to diagnose the underlying condition. A companion article describes the anatomy, physiology, and clinical signs associated with vestibular disease.

[Histological changes of peripheral vestibular organs in the inner ears of Smad4 conditional knockout mice]

OBJECTIVE

To investigate the histological changes in the vestibular endorgans of Smad4 gene conditional knockout mice and to explore the influence of the Smad4 gene on vestibular development.

METHODS

Histological changes of periphery vestibular organs in inner ear of Smad4 conditional knockout mice were investigated by frozen sections, immunofluorescence, confocal microscopy, scanning electron microscopy and transmission electron microscopy.

RESULTS

There was no Smad4 expression in the inner ear cartilage capsule of Smad4-/- mice. In Smad4+/- mice, Smad4 expression in the same cartilage capsule was positive, and it was strong positive in Smad4+/+ mice. Smad4 expression in vestibular sense epithelium, crista ampullaris and macula, was positive. And no difference was found among these three genotypes. Studying at scanning electron microscopy and transmission electron microscopy levels and anti-filament immunofluorescence showed that no pathological changes were observed in all the three genotype mice.

CONCLUSION

Although the Smad4 gene was knockout effectively in the auricular cartilage capsule of Smad4 conditional knockout mice,the histological changes of Smad4 conditional knockout mice in vestibulum auris internal were slightly.

Vestibular disease: anatomy, physiology, and clinical signs

The vestibular system is responsible for keeping an animal oriented with respect to gravity. It is a sensory system that maintains the position of the eyes, body, and limbs in reference to the position of the head. Proper interpretation of neurologic deficits and precise neuroanatomic localization are essential to diagnose and prognosticate the underlying disorder. Neurologic examination can confirm whether the vestibular dysfunction is of peripheral or central nervous system origin. Idiopathic vestibular syndrome is the most common cause of peripheral vestibular disease in dogs and, despite its dramatic clinical presentation, can improve without intervention. Central vestibular diseases generally have a poorer prognosis.

A mathematical model of human semicircular canal geometry: a new basis for interpreting vestibular physiology

We report a precise, simple, and accessible method of mathematically measuring and modeling the three-dimensional (3D) geometry of semicircular canals (SCCs) in living humans. Knowledge of this geometry helps understand the development and physiology of SCC stimulation. We developed a framework of robust techniques that automatically and accurately reconstruct SCC geometry from computed tomography (CT) images and are directly validated using micro-CT as ground truth. This framework measures the 3D centroid paths of the bony SCCs allowing direct comparison and analysis between ears within and between subjects. An average set of SCC morphology is calculated from 34 human ears, within which other geometrical attributes such as nonplanarity, radius of curvature, and inter-SCC angle are examined, with a focus on physiological implications. These measurements have also been used to critically evaluate plane fitting techniques that reconcile many of the discrepancies in current SCC plane studies. Finally, we mathematically model SCC geometry using Fourier series equations. This work has the potential to reinterpret physiology and pathophysiology in terms of real individual 3D morphology.

Inner ear of a notoungulate placental mammal: anatomical description and examination of potentially phylogenetically informative characters

We provide the first detailed description of the inner ear of a notoungulate, an extinct group of endemic South American placental mammals, based on a three-dimensional reconstruction extracted from CT imagery of a skull of Notostylops murinus. This description provides new anatomical data that should prove to be phylogenetically informative, an especially significant aspect of this research given that both the interrelationships of notoungulates and the position of Notoungulata within Placentalia are still unresolved. We also assess the locomotor agility of Notostylops based on measurements of the semicircular canals. This is the best available data on the locomotion of a notostylopid because significant postcranial remains for this group have not been described. The cochlea of Notostylops has 2.25 turns, and the stapedial ratio is 1.6. The stapedial ratio is one of the lowest recorded for a eutherian, which typically have ratios greater than 1.8. The fenestra cochleae is located posterior to the fenestra vestibuli, a condition previously only reported for some stem primates. The separation of the saccule and utricule of the vestibule is visible on the digital endocast of the bony labyrinth. The posterior arm of the LSC and the inferior arm of the PSC are confluent, but these do not form a secondary crus commune, and the phylogenetic or functional significance of this confluence is unclear at this time. Locomotor agility scores for Notostylops suggest a medium or 'average' degree of agility of motion compared to extant mammals. In terms of its locomotion, we tentatively predict that Notostylops was a generalized terrestrial mammal, with cursorial tendencies, based on its agility scores and the range of locomotor patterns inferred from postcranial analyses of other notoungulates.

Assessment of the reuniting duct by three-dimensional CT rendering

CONCLUSION

The rendering strategy sometimes induces misunderstanding of the image. We demonstrated a more accurate image of the bony groove of the reuniting duct using three-dimensional (3D) cone beam CT image, which was less affected by artifacts created by the rendering effect.

OBJECTIVE

To obtain a suitable image of the groove of the reuniting duct for future morphological study.

MATERIALS AND METHODS

The grooves of reuniting ducts in 10 healthy human subjects were analyzed by cone beam CT in comparison with a cadaver study.

RESULTS

We could obtain more accurate 3D CT images of the bony groove in human subjects by checking the landmarks of 3D CT images.

Three-dimensional virtual model of the human temporal bone: a stand-alone, downloadable teaching tool

OBJECTIVE

To develop a three-dimensional virtual model of a human temporal bone based on serial histologic sections.

BACKGROUND

The three-dimensional anatomy of the human temporal bone is complex, and learning it is a challenge for students in basic science and in clinical medicine.

METHODS

Every fifth histologic section from a normal 14-year-old male was digitized and imported into a general purpose three-dimensional rendering and analysis software package called Amira (version 3.1). The sections were aligned, and anatomic structures of interest were segmented.

RESULTS

The three-dimensional model is a surface rendering of these structures of interest, which currently includes the bone and air spaces of the temporal bone; the perilymph and endolymph spaces; the sensory epithelia of the cochlear and vestibular labyrinths; the ossicles and tympanic membrane; the middle ear muscles; the carotid artery; and the cochlear, vestibular, and facial nerves. For each structure, the surface transparency can be individually controlled, thereby revealing the three-dimensional relations between surface landmarks and underlying structures. The three-dimensional surface model can also be "sliced open" at any section and the appropriate raw histologic image superimposed on the cleavage plane. The image stack can also be resectioned in any arbitrary plane.

CONCLUSION

This model is a powerful teaching tool for learning the complex anatomy of the human temporal bone and for relating the two-dimensional morphology seen in a histologic section to the three-dimensional anatomy. The model can be downloaded from the Eaton-Peabody Laboratory web site, packaged within a cross-platform freeware three-dimensional viewer, which allows full rotation and transparency control.

Vestibular orientation for craniofacial surgery: application to the management of unicoronal synostosis

BACKGROUND

Standardized cephalometric measurements are necessary to compare skulls of different ages and sizes, in normal and diseased subjects, and in different species. In diseases involving the skull base, classical cephalometry is often impossible because the cranial landmarks are modified. In vestibular orientation (VO), the plane of the lateral semicircular canal (LSCC) of the inner ear, which has a constant relation to gravity, defines the horizontal plane of reference. Defining a reference plane independent of external landmarks is especially important in unicoronal craniosynostosis (UCCS), because the skull base is asymmetrical.

AIM OF THE STUDY

To illustrate the interest of VO in clinical practice, we report on our experience with VO-based correction of UCCS.

MATERIALS AND METHODS

Since 1992, we have used VO-3D computed tomography scanner for surgical planning of all patients with UCCS, measuring the required correction as the discrepancy between the theoretical and the observed midline.

RESULTS

Thirty-eight children were operated under the age of 2 years for UCCS and evaluated after a mean follow-up of 66 months. Thirty-two (84%) were considered perfect, four (11%) had mild imperfection not requiring reoperation, and two (5%) required reoperation because of progressive craniosynostosis involving the sagittal suture. Good surgical results were obtained when the orbits were correctly oriented relative to the plane of the LSCC.

CONCLUSIONS

VO is a useful reference system for the evaluation and surgical planning of UCCS. We hypothesize that the mismatch between the visual and labyrinthic sensorial inputs plays a role in the pathophysiology of UCCS.

Imaging anatomy of the vestibular and visual systems

PURPOSE OF REVIEW

This review will outline the imaging anatomy of the vestibular and visual pathways, using computed tomography and magnetic resonance imaging, with emphasis on the more recent developments in neuroimaging.

RECENT FINDINGS

Technical advances in computed tomography and magnetic resonance imaging, such as the advent of multislice computed tomography and newer magnetic resonance imaging techniques such as T2-weighted magnetic resonance cisternography, have improved the imaging of the vestibular and visual pathways, allowing better visualization of the end organs and peripheral nerves. Higher field strength magnetic resonance imaging is a promising tool, which has been used to evaluate and resolve fine anatomic detail in vitro, as in the labyrinth. Advanced magnetic resonance imaging techniques such as functional magnetic resonance imaging and diffusion tractography have been used to identify cortical areas of activation and associated white matter pathways, and show potential for the future identification of complex neuronal relays involved in integrating these pathways.

SUMMARY

The assessment of the various components of the vestibular and the visual systems has improved with more detailed research on the imaging anatomy of these systems, the advent of high field magnetic resonance scanners and multislice computerized tomography, and the wider use of specific techniques such as tractography which displays white matter tracts not directly accessible until now.

Vestibular function testing

PURPOSE OF REVIEW

This review provides an overview of vestibular function testing and highlights the new techniques that have emerged during the past 5 years.

RECENT FINDINGS

Since the introduction of video-oculography as an alternative to electro-oculography for the assessment of vestibular-induced eye movements, the investigation of the utricle has become a part of vestibular function testing, using unilateral centrifugation. Vestibular evoked myogenic potentials have become an important test for assessing saccular function, although further standardization and methodological issues remain to be clarified. Galvanic stimulation of the labyrinth also is an evolving test that may become useful diagnostically.

SUMMARY

A basic vestibular function testing battery that includes ocular motor tests, caloric testing, positional testing, and earth-vertical axis rotational testing focuses on the horizontal semicircular canal. Newer methods to investigate the otolith organs are being developed. These new tests, when combined with standard testing, will provide a more comprehensive assessment of the complex vestibular organ.

Morphometric investigations of sensory vestibular structures in tadpoles (Xenopus laevis) after a spaceflight: implications for microgravity-induced alterations of the vestibuloocular reflex

In lower vertebrates, gravity deprivation by orbital flights modifies the vestibuloocular reflex. Using the amphibian Xenopus laevis, the experiments should clarify to which extent macular structures of the labyrinth are responsible for these modifications. In particular, the shape of otoconia and number and size of sensory macular cells expressing CalBindin were considered. CalBindin is common in mature sensory cells including vestibular hair cells and is probably involved in otoconia formation. Two developmental stages were used for this study: stage 26/27 embryos, which were unable to perform the roll-induced vestibuloocular reflex (rVOR) at onset of microgravity, and stage 45 tadpoles, which had already developed the reflex. The main observations were that the developmental progress of the animals was not affected by microgravity; that in the young tadpole group with normal body shape the rVOR was not modified by microgravity, while in the older group with microgravity experience, the rVOR was augmented; and that significant effects on the shape of otoconia and on the number and size of CalBindin-expressing cells of the labyrinthine maculae cells were absent. In addition, behavioural data were never significantly correlated with morphological features of macular structures such as size and number of CalBindin-expressing cells. It is postulated that mechanisms of vestibular adaptation to microgravity during early development are probably based on mechanisms located in central structures of the vestibular system.