Hypersensitivity of hydropic ears, at frequencies with normal thresholds, to temporary threshold shifts

Prevalence of Endolymphatic Hydrops in Cochlear Implant Candidates with Idiopathic Profound Sensorineural Hearing Loss

OBJECTIVE

To determine the prevalence of endolymphatic hydrops (EH) in cochlear implant (CI) candidates with idiopathic profound sensorineural hearing loss (SNHL) and its influence on the preservation of audiovestibular function after cochlear implantation.

STUDY DESIGN

Prospective case series.

SETTING

Tertiary referral center.

PATIENTS

CI candidates with idiopathic progressive SNHL, but without classic EH-associated symptoms.

INTERVENTIONS

Delayed intravenous gadolinium-enhanced inner ear fluid-attenuated inversion recovery magnetic resonance imaging as well as pure-tone audiograms, video head impulse tests, and vestibular evoked myogenic potentials before and 4 weeks after cochlear implantation.

MAIN OUTCOME MEASURES

Prevalence of EH before cochlear implantation, audiovestibular function before and after surgery in hydropic and nonhydropic ears.

RESULTS

Thirty-two ears in 16 CI candidates were included. Nine ears (28%) with EH were detected. Although preoperative hearing thresholds, utricular function, and semicircular canal function were not different between the two groups, saccular function was reduced in hydropic ears. Ten subjects received a unilateral CI. Of these, 3 (30%) showed EH on the implanted side. There was no difference regarding postoperative hearing loss between the two groups, but the results point toward a higher vulnerability of hydropic ears with respect to loss of otolith function after cochlear implantation.

CONCLUSIONS

This is the first study showing that EH can be assumed in about one third of CI candidates with idiopathic profound SNHL, but no classic EH-associated symptoms. Preliminary results suggest that EH has no influence on the preservation of cochlear function but could be a risk factor for loss of otolith function after cochlear implantation.

The effects of hyperinsulinemia on cochlear functions

CONTEXT

Hyperinsulinemia is the most common metabolic change associated with cochleovestibular diseases.

AIM

We aimed to investigate the auditory functions in hyperinsulinemic individuals.

SETTINGS AND DESIGN

A total of 164 patients were included in this case-control study. While 76 patients with insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] of ≥2.5) constituted the case group, 88 patients with HOMA-IR values of <2.5 constituted the control group of the study.

MATERIAL AND METHODS

The 75 g oral glucose tolerance test, blood biochemistry tests, hormonal analysis, audiological assessment, electrocochleography (EcochG), and transient evoked otoacoustic emissions (TEOAE) testing were performed.

STATISTICAL ANALYSIS

One-way analysis of variance and Kruskal-Wallis analysis of variance were used for the comparison of the metabolic and ear parameters in the normal glucose tolerance (NGT), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) groups. The chi-square test was used to compare nominal variables. Spearman and Pearson correlation coefficients were used for the correlation analyses of continuous variables.

RESULTS

The pure tone audiometry at 0.5, 1, 2, and 4 kHz was better in the case group than in the control group. A positive correlation was found between HbA1c and right ear 0.5, 1, 4, and 8 kHz threshold values and left ear 2, 4, 6, and 8 kHz threshold values. A negative correlation was found between HbA1c and speech discrimination scores. The right ear 1.00 and 2.83 kHz TEOAE measurements in the individuals with NGT were found higher than those in patients with IGT, and the 1.42 kHz TEOAE measurements and reproducibility were found higher than those in patients with IFG. The left ear 1.00 and 1.42 kHz TEOAE measurements of the IGT patients were found lower than those of IFG and NGT patients.

CONCLUSION

We showed that hearing was worsening in hyperinsulinemic patients and prediabetic conditions were related to hearing function impairment.

Changes in CAP adaptation in experimentally induced endolymphatic hydrops

OBJECTIVE

To determine the effect of experimentally induced endolymphatic hydrops (ELHs) on compound action potential (CAP) adaptation.

METHODS

The CAP was recorded 1 month after surgical treatment to produce ELH. The CAP threshold in response to click stimuli showed no significant differences between the hydropic and control groups. The CAP was elicited from the retroauricular-exposed round window using a silver ball electrode. Click trains consisting of 10 clicks with an interclick interval (Deltat) of either 4 or 8 ms were delivered through a loudspeaker placed in front of the animals' ears. The patterns of adaptation to these click trains were evaluated as functions of Deltat and intensity level.

RESULTS

An abnormal pattern of CAP adaptation was observed in hydropic ears.

CONCLUSIONS

These findings suggest that early ELH influences CAP adaptation.

Ultrastructural changes in the hydropic cochlea of the guinea-pig

Transmission electron microscopy of the cochlear organ of Corti in experimental endolymphatic hydrops revealed two principal features. Starting 1 month after induction of hydrops, osmiophilic inclusions thought to represent lipofuscin accumulation were frequently observed in the subcuticular cytoplasm of the outer hair cells along the length of the cochlea. Starting 3 months after induction of hydrops the efferent terminals on the outer hair cells appeared to be vacuolated. These data suggest that oxidative insult is likely to contribute to the pathology associated with endolymphatic hydrops and thus that free radical scavengers might be useful in the treatment of Menière's disease patients. In addition the early modification of the efferent innervation of the hydropic cochlea might underlie the known hypersensitivity to various insults, including noise stimulation, glycerol administration and hypoxia.

Studies of inner ear blood flow in animals and human beings

This article reviews current studies on inner ear blood flow, discusses their relevance to the maintenance of normal homeostasis of the inner ear, reports for the first time clear changes in fundamental properties of cochlear blood flow in the chronic hydropic ear, and describes the potential of applying laser Doppler flowmetry technology to the measurement of inner ear blood flow in human beings. Studies of the guinea pig in which perfusion pressure is varied demonstrate a broad range of autoregulatory capabilities of the inner ear vasculature. Gain factors range from 0.76 and higher for recovery for less than 1 minute of modified perfusion pressure. This is significantly greater than reports obtained for brain autoregulation. In a series of four investigations of cochlear blood flow in the hydropic ear in guinea pigs, a decreased responsiveness to electrical stimulation and direct stimulation of the superior cervical ganglia was found, indicating a change in sympathetic control of cochlear tone. Reduced vasomotion was observed, and autoregulatory capabilities were reduced. In human investigations, changes in cochlear blood flow were demonstrated with direct electrical stimulation of the round window and warm water irrigation of the ear canal, but not with carbogen breathing. Increased cochlear blood flow was observed with increased systemic blood pressure, and a remarkable decrease in cochlear blood flow was observed with the application of 1:10,000 epinephrine to the round window. These observations indicate the potential for development of laser Doppler flowmetry technology in the diagnosis and treatment of inner ear vascular disorders, and the animal investigations suggest that changes may occur in the chronic hydropic ear that compromise autoregulation and thus increase the sensitivity of the hydropic ear to other stress factors. Treatments can be found to modify such changes in vascular tone.

Alterations of auditory nerve responses by hypoxia in normal and hydropic ears of awake guinea pigs

Total interruption of blood or oxygen supply to the inner ear produces very rapid and drastic effects, whereas moderate decreases can be well tolerated by normal ears. In experimental endolymphatic hydrops some moderate alterations of cochlear vasculature have been described which might affect cochlear adaptation to moderate blood or oxygen deficiencies. In order to test this hypothesis an hypoxia at 5% oxygen was imposed for 30 min in normal and hydropic ears of awake guinea pigs and cochlear function was monitored with an electrode at the round window. Electrophysiological recordings used measures of compound action potential (CAP) amplitudes evoked by high-intensity tones, and of CAP thresholds. In normal ears hypoxia induced threshold elevations at all frequencies and decreases of CAP amplitude only for high frequencies. Hydropic ears presented similar or smaller threshold elevations but showed CAP amplitude decreases extending to lower frequencies and showed a much slower recovery both for CAP thresholds and amplitudes. The data indicate that hypoxia had different effects on auditory nerve responses evoked by high versus low intensity tones. The deleterious effects of hypoxia were increased in hydropic ears. Hypoxia-induced alterations were measured twice at one week intervals during which an anti-ischemic drug was administered to the animals; some beneficial effects of the drug treatment were observed on normal but not on hydropic ears.

The effect of a taurine modified diet on normal and hydropic ears of the guinea pig

Taurine is recognised as the major osmoregulating amino acid in the brain as well as other organs. Its possible influence on normal cochlear function and on hydropic cochleas of the guinea pig was investigated here. Normally hearing adult guinea pigs were placed on either a taurine-depleting diet (B-alanine) or a taurine-supplemented diet. At the end of 6 weeks the compound action potential audiograms (CAP) in the two groups were similar and appeared not to be different from a third control group receiving a non modified diet which suggested that a taurine-modified diet had not affected normal cochlear function. In hydropic ears the taurine-depleting diet was observed, in some cases, to moderately slow down the early phase of the characteristic progression of the CAP sensitivity loss. These data are in favor of a homeostatic role for taurine in the inner ear of the guinea pig under particular conditions such as osmoregulatory stress.

Functional changes associated with experimentally induced endolymphatic hydrops

A guinea pig model with surgically induced endolymphatic hydrops of the inner ear has been developed and studied over the past thirty years. The aim of such studies is to obtain insight into physiological processes associated with endolymphatic hydrops in man and in particular in Menière's disease where endolymphatic hydrops is systematically encountered at post-mortem examination of the temporal bones. The present review attempts to draw together the data pertaining to functional modifications of inner ear function in the animal model. For simplicity the data are categorised under five main titles: electrochemical modifications, electrophysiological modifications, pressure and hydrops, sensitivity to other insults and vestibular dysfunction. One of the most striking observations that can be made is that the data originating from different authors are very variable. There is, however, some evidence suggesting that the evolution of the auditory dysfunction could be considered as consisting of a series of different phases. This kind of information could serve as a basic framework for future research on the animal model.

Transiently evoked otoacoustic emissions in patients with Menière's disease

Transiently evoked otoacoustic emissions (TEOAEs) were stimulated using clicks or 1-kHz tone bursts in both ears of 31 patients with unilateral Meniere's disease. Using click stimuli, responses were present in 29/31 of the non-Meniere's ears and in 26/31 of the Meniere's ears. Stimulation using 1-kHz tone bursts produced responses in 30/31 of the non-Meniere's ears and in 28/31 of the Meniere's ears. Audiometric configuration strongly influenced the presence of TEOAEs in the affected ears. In all but 2 ears with average hearing sensitivity (0.5, 1, 2 kHz) poorer than 25 dB HL, responses were present only when accompanied by at least one pure-tone threshold better than 30 dB HL from 0.75 to 2 kHz. In the opposite ears, all of which had essentially normal hearing, responses were approximately 5 dB lower in level and contained fewer spectral peaks in comparison with results obtained from a normative database. Neither age nor pure-tone results could account for these differences. Thus, TEOAEs obtained from patients with Meniere's disease manifest features that may be considered as atypical either in comparison to results from ears with normal hearing or from ears with relatively flat sensorineural hearing losses due to other etiologies.