Hearing Loss in Athyroid Pax8 Knockout Mice and Effects of Thyroxine Substitution

Pax8-/- mice do not develop thyroid follicular structures and thus provide an ideal animal model to study the consequences of congenital hypothyroidism. Despite their athyroidism, Pax8-/- mice survive up to postnatal day 21 (P21). No auditory brain stem responses (ABR) to sound could be recorded in these animals at 130 dB SPL, even at P21, when hearing reaches adult sensitivity in control mice. Abnormalities in the outer and middle ear structures were found in a considerable percentage of Pax8-/- animals. Maturation of the inner ear appeared delayed by about 1 week with respect to euthyroid controls. Hearing of adult Pax8-/- mice could be nearly normalized by early postnatal substitution with thyroxine (T(4)), but structural and functional restoration of hearing was incomplete. Even when T(4) substitution was initiated at P1, ABR thresholds, measured at 6 weeks of age or more, were increased by about 20 dB, and each day of delay in the start of T(4) substitution resulted in an additional threshold loss of about 4 dB. The most prominent structural deficit in Pax8-/- animals in which T(4) substitution was started at P8 or later was an abnormally thick tectorial membrane. In these late-substituted animals, disarray of stereovilli from inner and outer hair cells was observed and also outer hair cell loss was found, predominantly in the basal part of the cochlea. The degree of structural disorder increased the later T(4) substitution was initiated. The structural and functional consequences of postnatal athyroidism observed in Pax8-/- mice are largely in agreement with and extend those data obtained from hypothyroid animal models in which hypothyroidism was induced by goitrogenic agents (methimazole, propylthiouracil) or animal models with disrupted genes for the TSH receptor or the thyroid hormone receptors. The hearing loss and also the recovery effect by T(4) substitution in Pax8-/- mice is larger than that in the other models. Although Pax8-/- mice are born by euthyroid Pax8+/- dams, the Pax8-/- phenotype could not be completely restored by immediate postnatal T(4) substitution, indicating that some deficits are the consequence of prenatal T(4) deficiency of the offspring.

[Multi-channel cochlear implants in patients with Mondini malformation]

OBJECTIVE

To describe clinical experiences with multi-channel cochlear implantation in patients with Mondini malformation.

METHODS

Among 300 patients who received multi-channel cochlear implants from 1996 to 2002 in Beijing Tongren Hospital, 15 patients were diagnosed with Mondini malformation. A retrospective analysis was performed dealing with the surgical techniques, mapping and rehabilitations characteristics after surgery. 15 patients with normal cochlear structure are consider as control group.

RESULTS

Gusher is found more common than the normal cochlear implantation, most of them are serious. The electrodes are inserted in the "cochleostomy" in full length of 13 Patients, 2 pairs of electrodes remains outside of "cochleostomy" in 2 patients. No serious complications occurred after implantation. All patients have auditory sensations. The impedance of the electrodes, the T level, C level and the hearing threshold are similar with the normal cochlear implantation group. The results have no significant difference in compare with normal cochlear group(P > 0.05).

CONCLUSION

Multi-channel cochlear implantation could be performed safely in patients with Mondini malformation. The primary outcome for patients with Mondini malformation are similar to those with normal cochlear structure following the multi-channel cochlear implantation.

Six1controls patterning of the mouse otic vesicle

Six1 is a member of the Six family homeobox genes, which function as components of the Pax-Six-Eya-Dach gene network to control organ development. Six1 is expressed in otic vesicles, nasal epithelia,branchial arches/pouches, nephrogenic cords, somites and a limited set of ganglia. In this study, we established Six1-deficient mice and found that development of the inner ear, nose, thymus, kidney and skeletal muscle was severely affected. Six1-deficient embryos were devoid of inner ear structures, including cochlea and vestibule, while their endolymphatic sac was enlarged. The inner ear anomaly began at around E10.5 and Six1was expressed in the ventral region of the otic vesicle in the wild-type embryos at this stage. In the otic vesicle of Six1-deficient embryos,expressions of Otx1, Otx2, Lfng and Fgf3,which were expressed ventrally in the wild-type otic vesicles, were abolished,while the expression domains of Dlx5, Hmx3, Dach1and Dach2, which were expressed dorsally in the wild-type otic vesicles, expanded ventrally. Our results indicate that Six1functions as a key regulator of otic vesicle patterning at early embryogenesis and controls the expression domains of downstream otic genes responsible for respective inner ear structures. In addition, cell proliferation was reduced and apoptotic cell death was enhanced in the ventral region of the otic vesicle, suggesting the involvement of Six1 in cell proliferation and survival. In spite of the similarity of otic phenotypes of Six1- and Shh-deficient mice, expressions of Six1 and Shhwere mutually independent.

The homeobox gene Emx2 underlies middle ear and inner ear defects in the deaf mouse mutant pardon

The semi-dominantly inherited mouse mutation pardon (Pdo) was isolated due to the lack of a Preyer reflex (ear flick) in response to sound from a large-scale N -ethyl- N -nitrosourea (ENU) mutagenesis programme. Dissection of the middle ear revealed malformations in all three ossicles, rendering the ossicular chain incomplete. Hair cell counts in the apical turn of the organ of Corti revealed a significant 22.7% increase in the number of outer hair cells. Raised compound action potential thresholds in Pdo/+ mutants suggested a combined sensorineural/conductive hearing loss. We show that a missense mutation in the homeobox gene Emx2 is responsible for these defects, identifying a new function for this gene in the development of specific structures in the ear.

Binaural interaction of bone-conducted auditory brainstem responses in children with congenital atresia of the external auditory canal

Bilateral bone-conducted auditory brainstem responses (BC-ABRs) were recorded in children with atresia of the external auditory canal bilaterally (AECB) in order to compare the response characteristics to normal hearing adults. The binaural interaction component (BIC) of the ABR occurs when the sum of the monaural-evoked ABR amplitudes are different in amplitude when compared to the binaural-evoked ABR amplitude. Previous electrophysiological work from our lab has shown that children with AECB lateralize bone-conducted (BC) sound. Furthermore, we have found in normal-hearing adults that BICs exist using BC clicks. In adults, BC-BIC occurred in the latency region corresponding to waves IV-VI, whereas for children with AECB corresponding peak latencies occurred earlier. Same as normal-hearing adults, BC-ABR IV-V complex peak amplitudes for sum of the BC-monaural right and BC-monaural left ears were different from binaural response amplitude. Individual peak latencies were similar in children with AECB when compared to normal-hearing adults except for shorter latencies for BIC. These results indicate that: (1) BC-BI is present in children with AECB as well as normal-hearing adults; (2) the gross response properties of BIC are similar in children with AECB and normal-hearing adults; (3) fitting of a bilateral BC hearing aid might be a feasible method to optimize binaural hearing and sound lateralization.

Deletion mapping of split hand/split foot malformation with hearing impairment: a case report

Split hand/split foot malformation (SHFM), which typically appears as lobster-like limb malformation, is a rare clinical condition caused by a partial deletion of chromosome 7q. Hearing impairment sometimes accompanies syndromic SHFM cases; a case of inner and middle ear malformation with SHFM is described in this report. We conducted a genetic evaluation of this patient and found a deleted region that overlaps a previously reported locus of SHFM as well as a DFNB14 locus that can cause nonsyndromic hearing impairment by autosomal recessive inheritance.

Microtia repair

Construction of the congenitally absent ear is a particular challenge. It represents the true essence of plastic surgery in that it not only requires sound surgical principles but artistic skill. Although a solid familiarity with the stages is important, the surgeon's own experience will direct gradual modification.

Inflammation of embryonic connective tissue in the middle ear spaces

OBJECTIVE

Persistent embryonic connective tissue has been considered to be a cause of chronic otitis media with effusion in neonates and of cholesteatoma in later life. As part of a study of pneumatization and resorption of embryonic connective tissue from the middle ear of pre- and postnatal infants, inflammatory processes of variable extents have been observed within the embryonic connective tissue. The aim of the present study was to characterize this inflammation and to detect patterns in its presence and distribution.

MATERIAL AND METHODS

Twenty fetal temporal bones obtained at 4-8 months of development and 31 temporal bones from children who died of sudden infant death syndrome aged < 1 year were studied to assess the inflammation within the middle ear cleft and specifically in the embryonic connective tissue.

RESULTS

Sixteen of 27 (59.3%) pre- and 10/31 (32.2%) postnatal specimens displayed a non-specific inflammatory lymphocytic infiltration without signs of bacterial infection or the presence of or reaction to amniotic contents. Eleven of 27 prenatal temporal bones (40.7%) and 16/31 (51.6%) postnatal specimens showed no evidence of histologic middle ear inflammation. The presence or absence of inflammation was independent of age.

CONCLUSION

Our observations indicate resorption of the embryonic connective tissue with individual variations indicating that genetic factors are responsible for the development of the middle ear spaces during the phases of development studied.

[Malformations of the auricle and their correction]

Owing to the stigma attached to auricular malformations, many patients request surgical correction. According to Weerda, such malformations can be classified into three grades of severity. Since the higher-grade malformations are often associated with malformation of the auditory canal and middle ear, and thus with hardness of hearing, early ENT evaluation of hearing problems is mandatory. Surgical correction of the auricle should not be attempted before the age of 5 years, and partial or total reconstruction in the case of anotia, is not considered before the age of 8. In such cases, autologous rib cartilage is needed to ensure construction of a natural-looking auricle. Standardized surgical procedures are available to correct the whole range of auricular malformations with good cosmetic results and a high level of patient satisfaction.

Difference in facial canal anatomy in terms of severity of microtia and deformity of middle ear in patients with microtia

OBJECTIVE

To study the difference in the facial canal anatomy in terms of the severity of microtia and deformity of the middle ear in patients with microtia using high-resolution computed tomography (HRCT).

STUDY DESIGN

Forty-six ears with microtia were examined by HRCT. These ears were graded based on two systems of classification and scoring, respectively. The HRCT findings of each group were compared with those of other groups by multiple comparison using the Tukey honestly significant difference test.

METHODS

Forty-six ears with microtia (unilateral microtia, n = 12; bilateral microtia, n = 34) were examined by HRCT. These ears were graded based on two systems of classification and scoring, respectively. The HRCT findings and age distribution of each group were compared with those of other groups by multiple comparison using the Tukey honestly significant difference test.

RESULTS

The mastoid portion of the facial nerve was 3 mm more anteriorly displaced in patients with grades II and III microtia than in those with grade I microtia (P <.01). From the scoring system that was used, the course of the facial nerve was not significantly different between patients with a score of 5 points or less and those with a score of 6 points or more.

CONCLUSION

The mastoid portion of the facial nerve in patients with grades II and III microtia would be more anteriorly displaced because of hypoplasia of the second genu.

Valuable use of computer-aided surgery in congenital bony aural atresia

Congenital aural atresia repair is difficult owing to unpredictable anatomy. Benefits may be gained from computer-aided surgery (CAS), but its exact role has yet to be clearly defined. This is a retrospective study of 18 patients with bony type C (Schuknecht classification) congenital atresia. In the first group (n = 9), repair was performed with CAS while in the second group (n = 9), similar intervention was applied without CAS. Intra- and post-operative clinical and audiological findings were compared. CAS computed tomography (CT) images correlated well with intra-operative findings giving the surgeon more security and reducing operative time by 25 minutes. In our estimation, CAS is valuable for type C congenital aural atresia repair. It serves as an educational tool and as a guide for the experienced surgeon in critical situations where anatomical landmarks are distorted and where access is limited.

[Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone]

Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures.

[HRCT findings in congenital aural atresia]

PURPOSE

To define high resolution computed tomography findings in the external, middle and inner ear of patients with congenital aural atresia and to emphasize the importance of these findings in the preoperative evaluation.

MATERIALS AND METHODS

Twenty one patients with congenital aural atresia (14 male, 7 female) aged between 1-30 years were evaluated with high resolution computed tomography of the temporal bone. A Toshiba TCT-600 scanner was used in 11 cases, and a Xvision/GX scanner was used in 10 cases. Sections 1 mm thick were obtained in axial and coronal projections using high bone detail algorithms. Sagittal reformations were also made when necessary.

RESULTS

Forty-two ears in 21 patients with congenital aural atresia were studied. These included 8 patients with high bilateral and 13 with unilateral congenital aural atresia in which 8 patients had right sided and 5 patients had left sided atresia. Stenosis of the external auditory canal was found in 11 ears, complete atresia was found in 13 ears, incomplete atresia was found in 1 ear. There was varied ossicular deformity in 18 ears. Anomalies of the stapes and oval window were found in 6 ears. An anteriorly located mastoid segment of the facial nerve canal was identified in 11 ears. An inferiorly located tympanic segment of the facial nerve canal was identified in 2 ears, and 3 ears had an abnormal posterior orientation of the mandibular condyles. Only 2 patients had associated inner ear deformity.

CONCLUSION

High resolution computed tomography is an effective method for the evaluation of the anomalies of the external, middle and inner ear in patients with congenital aural atresia and for planning the surgical treatment.

Hearing loss in the Treacher-Collins syndrome

About 50% of patients with the TCS have conductive hearing loss, caused by characteristic major and/or minor ear anomalies. It is also common for these patients to have microtia or severe malformation of the pinna. The results of [figure: see text] reconstructive surgery to improve hearing are usually moderate to poor, because of combinations of anomalies. In general, it is recommended to start hearing rehabilitation at the earliest possible stage. Owing to the above-described anomalies, rehabilitation usually involves fitting a BAHA, whether or not in combination with a pinna epithesis.

Familial lateral semicircular canal malformation with external and middle ear abnormalities

We report a family with inner ear lateral semicircular canal (LSC) malformation and external and middle ear abnormalities. The family had no history of known syndromes or toxic exposures. Distinct phenotypic manifestations were found in three family members. A young girl exhibited bilateral LSC malformation with a right-sided preauricular tag, a mildly deformed auricle, a stenotic external auditory canal, and a constricted middle ear cavity. She had moderate conductive hearing loss in the right ear but normal hearing in the left ear. Her younger brother exhibited right-sided LSC malformation, microtia, external auditory canal atresia, a malformed middle ear cavity, and abnormal auditory ossicles. He had severe mixed hearing loss in his right ear. Their mother exhibited left-sided LSC malformation without external and middle ear abnormalities, and the hearing was normal in her left ear. None of the three cases had vestibular symptoms, and their results of balance tests were appropriate for the corresponding ages. In contrast, significantly decreased LSC function was revealed by caloric tests in an ear with LSC malformation. Previously, LSC malformation may have been underdiagnosed in patients presenting with external and middle ear abnormalities and their relatives, since this malformation is frequently associated with normal hearing and balance or conductive hearing loss only. To our knowledge, this condition has not been described previously. This condition supports a genetic basis for the combination of LSC malformation and external and middle ear abnormalities and may represent an autosomal dominant condition with variable expressivity.

Cochlear implantation in Mondini dysplasia

The use of cochlear implantation to treat patients with inner ear malformations such as Mondini dysplasia has been increasingly successful. Until now, conventional hearing aids in these patients have not performed well. Consequently, the hearing problem for patients with this condition has been somewhat improved with the use of cochlear implants. Various results of cochlear implantation have been reported in these patients so far. This is a report of 5 patients with Mondini malformation who have undergone cochlear implant surgery.

[Surgical reconstruction of the abnormalities of earlap, canal and middle ear at one time]

OBJECTIVE

To investigate the surgical reconstruction of the abnormalities of earlap, canal and middle ear at one time.

METHOD

21 patients(21 ears) operated on the canal and middle ears, of which 6 ears were undergone surgical reconstruction of the abnormalities of earlap, canal and middle ear used with the Medpor and PTFE at one time.

RESULT

A term(8-23 months) follow-up of 6 ears demonstrated that 28 dB of the hearing level in 5 ears were improved (pure tone threshold), one ear was kept unchanged, which 6 ears were approved of the figuration of earlap and canal ears.

CONCLUSION

It is an good method to reconstruction the abnormalities of canal, middle ear and earlap using the Medpor and PTFE at one time.

Rate of recovery of taste function after preservation of chorda tympani nerve in middle ear surgery with special reference to type of disease

To study the recovery of function of the chorda tympani nerve, we examined by electrogustometry 79 patients (83 ears) with both preoperative normal function of the nerve and operative preservation of the nerve, every 2 days during hospitalization and at 6 months after surgery. For symptoms such as tongue numbness and taste disturbance, patients with noninflammmatory (NI) diseases (13/20 or 65.0%) showed a significantly higher rate of symptoms than did patients with chronic otitis media (COM; 13/35 or 37.1%) at 2 weeks after surgery (p = .032). The patients with NI diseases (5/20 or 25.0%) tended to show a higher rate of symptoms than did the COM patients (2/35 or 5.7%) or cholesteatoma patients (2/28 or 7.1%) at 6 months after surgery. The rate of recovery of the EGM threshold to normal at 2 weeks after surgery was significantly lower in NI disease patients (6/20 or 30.0%) than in COM patients (23/ 35 or 62.9%) or cholesteatoma patients (19/28 or 67.9%; p = .015 and .008, respectively). Thus, the patients with NI diseases had postoperative symptoms and elevation of EGM threshold more frequently than did the patients with inflammatory diseases.

Fgfr1 regulates patterning of the pharyngeal region

Development of the pharyngeal region depends on the interaction and integration of different cell populations, including surface ectoderm, foregut endoderm, paraxial mesoderm, and neural crest. Mice homozygous for a hypomorphic allele of Fgfr1 have craniofacial defects, some of which appeared to result from a failure in the early development of the second branchial arch. A stream of neural crest cells was found to originate from the rhombomere 4 region and migrate toward the second branchial arch in the mutants. Neural crest cells mostly failed to enter the second arch, however, but accumulated in a region proximal to it. Both rescue of the hypomorphic Fgfr1 allele and inactivation of a conditional Fgfr1 allele specifically in neural crest cells indicated that Fgfr1 regulates the entry of neural crest cells into the second branchial arch non-cell-autonomously. Gene expression in the pharyngeal ectoderm overlying the developing second branchial arch was affected in the hypomorphic Fgfr1 mutants at a stage prior to neural crest entry. Our results indicate that Fgfr1 patterns the pharyngeal region to create a permissive environment for neural crest cell migration.