Evaluation of cochlear function in an acute endolymphatic hydrops model in the guinea pig by measuring low-level DPOAEs

Symptom improvement after transtympanic tube placement in Ménière's disease: preliminary observations

Objective

The treatment of choice for Ménière disease (MD) aims at preventing severity and frequency of vertigo attacks. The purpose of this study was to evaluate the effectiveness of ventilation tube (VT) placement on vertigo control in patients affected by MD with no response to standard medical therapy.

Methods

76 consecutive outpatients diagnosed with definite MD who failed medical therapy received VT insertion at the Department of Otolaryngology Head and Neck Surgery, "Ospedale del Mare", Naples, Italy, with a 3-year follow up.

Results

Over the long term, VT placement was effective in controlling vertigo in 61.8% of patients. In the control group treated with standard preventive care (SPC) alone, all patients continued to experience recurrent vertigo during the entire study. Comparison of survival curves by using the log-rank test shows that significant differences in survival exist between subjects treated with VT placement and the control sample (p = 0.001).

Conclusions

Our long-term follow-up confirms that VT placement is an effective and safe management option in intractable definite MD, especially in the elderly or in those refusing more invasive treatments.

Menière's disease patients improve specific posturographic parameters following diagnostic intratympanic injection

PURPOSE

Evaluation of specific computerized posturographic parameters in patients with Menière's disease (MD) following the intratympanic injection of gadolinium, a contrast agent, used in radiological diagnosing.

MATERIALS AND METHODS

We have observed 12 adult patients with unilateral Menière's Disease subjected to inner ear magnetic resonance imaging (MRI) examination after intratympanic gadolinium injection (ITG). The diagnoses have been performed according to the guidelines of the American Academy of otolaryngology. Before and after 24 h the ITG, all patients were subjected to the clinical evaluation and computerized posturography (CP), in 4 conditions depending on open/closed eyes and with/without foam cushion under feet.

RESULTS

After ITG, in the affected ear the MRI confirmed the endolymphatic hydrops revealing a thin or even disappeared perilymphatic space. The statokinesigram showed improvement of stability only with closed eyes on a foam cushion. The CP performed 24 h after the contrast intratympanic injection showed a significant reduction of Path Length and Confidence Ellipse Area, due to an improvement of vestibular function on static balance. This improvement could be directly dependent to intratympanic pressure modification mediated by volume of contrast liquid, by "columella effect".

CONCLUSIONS

This study demonstrates the absence of vestibular damage in patients undergoing intratympanic gadolinium infiltration and confirms the relationship between intratympanic pressure and vestibular stability modifications providing positive evidences for an applicative use of CP as a functional assessment to better address diagnosis and follow-up in MD patients treated with intratympanic injections.

Experimental Animal Models for Meniere's Disease: A Mini-Review

Several novel animal models that represent the pathophysiological process of endolymphatic hydrops (ELH) of Meniere's disease (MD) have been developed. Animal models are important to identify and characterize the pathophysiology of ELH and to corroborate molecular and genetic findings in humans. This review of the current animal models will be useful in understanding the pathophysiology of and developing proper treatments for MD. Surgical animal models will be replaced by medication-induced animal models. Study models previously developed in guinea pigs will be developed in several smaller animals for ease of conducting molecular analysis. In this review, we provided updated resources including our previous studies regarding the current and desirable animal models for MD.

Relationship between Contrast Enhancement of the Perivascular Space in the Basal Ganglia and Endolymphatic Volume Ratio

PURPOSE

We routinely obtain the endolymphatic hydrops (EH) image using heavily T₂-weighted three dimensional-fluid attenuated inversion recovery (hT₂w-3D-FLAIR) imaging at 4 hours after intravenous administration of a single-dose of gadolinium-based contrast media (IV-SD-GBCM). While repeating the examination, we speculated that the contrast enhancement of the perivascular space (PVS) in the basal ganglia might be related to the degree of EH. Therefore, the purpose of this study was to investigate the relationship between the endolymphatic volume ratio (%EL_volume) and the signal intensity of the PVS (SI-PVS).

MATERIALS AND METHODS

In 20 patients with a suspicion of EH, a heavily T₂-weighted 3D-turbo spin echo sequence for MR cisternography (MRC) and an hT₂w-3D-FLAIR as a positive perilymph image (PPI) were obtained at 4 hours after IV-SD-GBCM. The %EL_volume of the cochlea and the vestibule were measured on the previously reported HYDROPS2-Mi2 image. The PVS in the basal ganglia was segmented on MRC using a region-growing method. The PVS regions were copied and pasted onto the PPI, and the SI-PVS was measured. The larger value of the right and the left ears was employed as the %EL_volume, and the weighted average of both sides was employed as the SI-PVS. The correlation between the %EL_volume and the SI-PVS was evaluated.

RESULT

There was a strong negative linear correlation between the %EL_volume of the cochlea and the SI-PVS (r = -0.743, P < 0.001); however, there was no significant correlation between the %EL_volume of the vestibule and the SI-PVS (r = -0.267, P = 0.256).

CONCLUSION

There was a strong negative correlation between the cochlear %EL_volume and the SI-PVS. Contrast enhancement of PVS might be a biomarker of EH.

Endolymphatic hydrops is prevalent in the first weeks following cochlear implantation

AIM

To explore morphological or electrophysiological evidence for the presence of endolymphatic hydrops (EH) in guinea pig cochleae in the first 3 months after cochlear implantation.

METHODS

Dummy silastic electrodes were implanted atraumatically into the basal turn of scala tympani via a cochleostomy. Round window electrocochleography (ECochG) was undertaken prior to and after implantation. Animals survived for 1, 7, 28 or 72 days prior to a terminal experiment, when ECochG was repeated. The cochleae were imaged using micro-CT after post-fixing with osmium tetroxide to reveal the inner ear soft tissue structure. EH was assessed by visual inspection at a series of frequency specific places along the length of the cochlea, and the extent to which Reissner's membrane departed from its neutral position was quantified. Tissue response volumes were calculated. Using ECochG, the ratio of the summating potential to the action potential (SP/AP ratio) was calculated in response to frequencies between 2 and 32 kHz.

RESULTS

There was minimal evidence of electrode trauma from cochlear implantation on micro-CT imaging. Tissue response volumes did not change over time. EH was most prevalent 7 days after surgery in implanted ears, as determined by visual inspection. Scala media areas were increased, as expected in cases of EH, over the first month after cochlear implantation. SP/AP ratios decreased immediately after surgery, but were elevated 1 and 7 days after implantation.

CONCLUSIONS

EH is prevalent in the first weeks after implant surgery, even in the absence of significant electrode insertion trauma.

Auditory Distortions: Origins and Functions

To enhance weak sounds while compressing the dynamic intensity range, auditory sensory cells amplify sound-induced vibrations in a nonlinear, intensity-dependent manner. In the course of this process, instantaneous waveform distortion is produced, with two conspicuous kinds of interwoven consequences, the introduction of new sound frequencies absent from the original stimuli, which are audible and detectable in the ear canal as otoacoustic emissions, and the possibility for an interfering sound to suppress the response to a probe tone, thereby enhancing contrast among frequency components. We review how the diverse manifestations of auditory nonlinearity originate in the gating principle of their mechanoelectrical transduction channels; how they depend on the coordinated opening of these ion channels ensured by connecting elements; and their links to the dynamic behavior of auditory sensory cells. This paper also reviews how the complex properties of waves traveling through the cochlea shape the manifestations of auditory nonlinearity. Examination methods based on the detection of distortions open noninvasive windows on the modes of activity of mechanosensitive structures in auditory sensory cells and on the distribution of sites of nonlinearity along the cochlear tonotopic axis, helpful for deciphering cochlear molecular physiology in hearing-impaired animal models. Otoacoustic emissions enable fast tests of peripheral sound processing in patients. The study of auditory distortions also contributes to the understanding of the perception of complex sounds.

Changes in utricular function during artificial endolymph injections in guinea pigs

Various theories suggest endolymphatic hydrops may cause a rupture of the membranous labyrinth or may force open the utriculo-saccular duct, resulting in a sudden change in inner ear function. Here, we have used slow injections of artificial endolymph into either scala media or the utricle of anaesthetised guinea pigs to investigate the effects of hydrops. Vestibular function was continuously monitored in addition to the measurements of cochlear function developed in our laboratory (Brown et al. Hear Res, 2013). Scala media injection induced consistent functional changes, which occurred in two stages. Initial changes involved were associated with an increased hydrostatic pressure in scala media that only affected cochlear function. After 3-4 μl of endolymph had been injected, cochlear function spontaneously recovered, and was often shortly followed by a transient increase or decrease in utricular sensitivity, with the effects varying between animals. Endolymph injection directly into the utricle produced variable effects across animals, although in 2 experiments it produced similar changes as those observed for scala media injections, suggesting that the fluid pathway between scala media and the utricle was continuous in these animals. The mechanism underlying the sudden, spontaneous functional changes is not yet clear, but we tentatively suggest that in some cases it may be caused by the utriculo-saccular duct suddenly opening to alleviate an elevated hydrostatic pressure in the pars inferior, resulting in a change in utricular function due to an increase in its volume. These changes are comparable to the sudden or fluctuating functional changes in Ménière's sufferers, and support the hypothesis that endolymphatic hydrops can directly cause some symptoms of this syndrome.

Changes in cochlear function during acute endolymphatic hydrops development in guinea pigs

Previous studies have injected artificial endolymph into scala media in anaesthetized guinea pigs as an acute model of endolymphatic hydrops. Here, we have injected artificial endolymph into scala media in guinea pigs at rates of 40-80 nl/min, whilst monitoring Compound Action Potential (CAP) thresholds, the Summating Potential (SP)/CAP ratio, Cochlear Microphonic (CM) distortion, low-frequency modulated Distortion Product Otoacoustic Emissions (DPOAEs), and the Endocochlear Potential (EP). We found that abrupt recovery of CAP thresholds, SP/CAP ratio, and CM and DPOAE asymmetric distortion could occur several times during a single injection of less than 3 μl, suggesting that endolymph pressure could periodically decrease while the injection was ongoing. Larger volumes are thought to produce a rupture of the membranous labyrinth, however, our results suggest that multiple injections, each larger than 3 μl and within 40 min of each other, cause multiple pressure-related changes, which are difficult to be explained on the basis of a simple labyrinth rupture. We have also examined the morphological changes of the temporal bones ex vivo using X-ray micro-tomography. Both the functional changes and the micro-CT images suggest ruptures of the membranous labyrinth may not always be responsible for abrupt changes in inner ear function. Our results provide a new insight into the changes in cochlear function occurring during acute hydrops development, which compares well to the clinical findings observed in Ménière's Disease. We suggest that hydrops development may be a continual process, yet cause discontinuous functional changes due to mechanisms other than a simple rupture of the membranous labyrinth.

Dynamics of pure tone audiometry and DPOAE changes induced by glycerol in Meniere's disease

The purpose of this study is to follow up the dynamics of pure tone threshold and DPOAE amplitude changes induced by glycerol with reference to its activity in the inner ear. Selection was made among 38 patients with Meniere’s disease for those having positive glycerol test. Pure-tone audiometry and DP-gram were performed in four series: as an initial examination before glycerol intake, 1, 2 and 3 h after. Audiometric changes formed distinct biphasal pattern at all frequencies between 250 and 4,000 Hz. The most dynamic pure tone threshold decrease occurred during the first hour. Between the first and second hour after glycerol ingestion there was a phase of no significant hearing changes. Further pure tone threshold decrease went on within the third hour reaching its top. Observing DPOAE changes, the highest DP amplitude growth occurred after the second and the third hour at DP-gram frequencies 2, 3 and 4 kHz. The fastest DP-amplitude increase was registered as well during the first hour after glycerol ingestion. In 11 persons with both audiometry and DPOAE positive glycerol test, parallel dynamics in the course of the glycerol test was observed. Biphasal glycerol test dynamics suggests the possibility of two mechanisms of glycerol activity in the inner ear.

Unstable distortion-product otoacoustic emission phase in Menière's disease

The presence of endolymphatic hydrops as a marker of Menière's disease (MD) suggests abnormal pressure in the intralabyrinthine compartments of patients and excessive stiffness of sound-sensitive structures. Otoacoustic emissions (OAEs) have been reported to respond to changes in the ear's stiffness, including those produced by intracranial pressure steps, by a characteristic phase shift around 1 kHz, thereby suggesting a noninvasive means of monitoring MD. Here, body tilt was used for modulating intracranial pressure in forty-one patients with definite MD who were tentatively measured at two stages, with and without active symptoms. Their distortion-product OAEs (DPOAEs) were dynamically monitored around 1 kHz every few seconds in response to body tilt. In a control sample of thirty normal ears, the maximum phase rotation of DPOAEs produced by body tilt was between -18° and +37°. In MD ears with the complete set of symptoms, the posture-induced phase shifts in 32 out of 35 tests fell outside the normative interval, and in 10 tests, although DPOAEs were well above noise floor, their phase was always so abnormally erratic that body tilt produced hardly any additional effect. When MD ears were asymptomatic, nine out of 32 posture tests were abnormal. The excessive DPOAE phase shift is consistent with either a too stiff cochlear partition or a displacement of the operating point of outer hair cells by endolymphatic hydrops.

The effect of changes in perilymphatic K+ on the vestibular evoked potential in the guinea pig

To investigate the effect on the functioning of the vestibular system of a rupture of Reissner's membrane, artificial endolymph was injected in scala media of ten guinea pigs and vestibular evoked potentials (VsEPs), evoked by vertical acceleration pulses, were measured. Directly after injection of a sufficient volume to cause rupture, all ears showed a complete disappearance of VsEP, followed by partial recovery. To investigate the effect of perilymphatic potassium concentration on the vestibular sensory and neural structures, different concentrations of KCl were injected directly into the vestibule. The KCl injections resulted in a dose-dependent decrease of VsEP, followed by a dose-dependent slow recovery. This animal model clearly shows a disturbing effect of a higher than normal K(+) concentration in perilymph on the vestibular and neural structures in the inner ear. Potassium intoxication is the most probable explanation for the observed effects. It is one of the explanations for Menière attacks.

Meniere's disease and middle ear pressure: vestibular function after transtympanic tube placement

CONCLUSION

Selected patients with Meniere's disease (MD) show an improvement of disability from vertigo after transtympanic ventilation tube insertion, although an effect on vestibular function is not seen if ipsilateral middle ear pressure lower than -50 daPa is used as a selection criterion.

OBJECTIVES

Transtympanic ventilation tube insertion as a treatment option for MD has been reported but its results have been controversial. So far, no investigations on vestibular function in patients with MD after tube insertion have been carried out.

SUBJECTS AND METHODS

Twenty-two patients with unilateral MD who were intractable to medical treatment and who had an ipsilateral middle ear pressure lower than -50 daPa received a transtympanic ventilation tube. Vestibular evoked myogenic potentials (VEMPs) and sinusoidal harmonic acceleration (SHA) testing were recorded pre- and postoperatively and were compared.

RESULTS

Most patients (68.2%) reported an improvement of vertigo. Before surgery 63.6% of patients did not show VEMPs, whereas vestibulo-collic reflexes were measured in 36.4% of all cases compared with 68.2% of patients without and 31.8% with recorded VEMPs after surgery. No statistically different findings in gain and phase lag of SHA testing were seen postoperatively compared to preoperative findings.

Endolymphatic sac is involved in the regulation of hydrostatic pressure of cochlear endolymph

To clarify the role of the endolymphatic sac (ES) in the regulation of endolymphatic pressure, the effects of isoproterenol, a beta-adrenergic receptor agonist, and acetazolamide, a potent carbonic anhydrase inhibitor, both of which decrease ES direct current potential on cochlear hydrostatic pressure, were examined in guinea pigs. When isoproterenol was applied intravenously, hydrostatic pressures of cochlear endolymph and perilymph were significantly increased with no change in endocochlear potential or the hydrostatic pressure of cerebrospinal fluid. Acetazolamide produced no marked change in the hydrostatic pressure of cochlear endolymph. In ears with an obstructed ES, the action of isoproterenol on the hydrostatic pressure of cochlear endolymph and perilymph was suppressed. These results suggest that the ES may regulate the hydrostatic pressure of the endolymphatic system via the action of the agents such as catecholamines on the ES.

Estimating the operating point of the cochlear transducer using low-frequency biased distortion products

Distortion products in the cochlear microphonic (CM) and in the ear canal in the form of distortion product otoacoustic emissions (DPOAEs) are generated by nonlinear transduction in the cochlea and are related to the resting position of the organ of Corti (OC). A 4.8 Hz acoustic bias tone was used to displace the OC, while the relative amplitude and phase of distortion products evoked by a single tone [most often 500 Hz, 90 dB SPL (sound pressure level)] or two simultaneously presented tones (most often 4 kHz and 4.8 kHz, 80 dB SPL) were monitored. Electrical responses recorded from the round window, scala tympani and scala media of the basal turn, and acoustic emissions in the ear canal were simultaneously measured and compared during the bias. Bias-induced changes in the distortion products were similar to those predicted from computer models of a saturating transducer with a first-order Boltzmann distribution. Our results suggest that biased DPOAEs can be used to non-invasively estimate the OC displacement, producing a measurement equivalent to the transducer operating point obtained via Boltzmann analysis of the basal turn CM. Low-frequency biased DPOAEs might provide a diagnostic tool to objectively diagnose abnormal displacements of the OC, as might occur with endolymphatic hydrops.

Non-invasive measurements of intralabyrinthine pressure changes by electrocochleography and otoacoustic emissions

By varying the mechanical load on the stapes footplate, intralabyrinthine pressure (ILP) influences the stiffness of the middle ear and modifies its transfer function. This results in a characteristic phase shift of the otoacoustic emissions (OAEs) around 1kHz [Buki, B., Avan, P., Lemaire, J.J., Dordain, M., Chazal, J., Ribari, O., 1996. Otoacoustic emissions: a new tool for monitoring intracranial pressure changes through stapes displacements. Hear. Res. 94, 125-139]. This finding provides non-invasive means of monitoring changes of ILP and indirectly of intracranial pressure. Yet the vulnerability of OAEs to sensorineural hearing loss excludes many patients from being monitored in this manner. Being dependent on the middle-ear transfer function, the phase of the cochlear microphonic potential (CM) around 1kHz should also respond to ILP changes while being less affected by impaired hearing than OAEs. Here, normal volunteers were subjected to body tilt resulting in stepwise changes in their intracranial pressure and ILP. Their CM around 1kHz was recorded by extratympanic electrocochleography and its dependence on body position was compared to that of distortion-product OAEs. The posture-induced CM changes were also monitored in ears with sensorineural deafness and impaired OAEs to assess the usefulness of CM in the presence of hearing impairment. Last, OAEs and CM were simultaneously monitored in gerbils during intracranial pressure changes brought about via an intracranial catheter. The phase and level shifts induced by body tilt in man and intracranial pressure changes in gerbils showed up both in distortion-product OAEs and CM with similar time courses. In normally-hearing subjects, the mean phase shifts reached 16.3 degrees for CM and 41.6 degrees for OAEs, and CM remained large enough in hearing-impaired subjects for ILP to be monitored. The ratio of about two of OAEs to CM phase shifts matched the prediction of middle-ear models allowing for the fact that CM does not travel back through the middle ear while OAEs do. It follows that CM phase around 1kHz provides non-invasive access to ILP changes even if OAEs cannot be measured due to sensorineural hearing loss.

Effects of glycerol intake and body tilt on otoacoustic emissions reflect labyrinthine pressure changes in Menière's disease

It is known that by influencing stapes stiffness thus the ear's impedance, changes in intracranial and intralabyrinthine pressure induce a characteristic phase shift in otoacoustic emissions (OAE) around 1 kHz in human ears. Thus, if the regulation of pressure in intralabyrinthine compartments were abnormal in Menière patients, OAEs might help detect it. Body tilt, which acts on intracranial pressure, and administration of an osmotically active substance provide two simple ways of manipulating intralabyrinthine pressure. Here, 14 patients with typical signs of an attack of unilateral endolymphatic hydrops were submitted to postural changes and a glycerol test. Their OAEs initially collected in upright position served as references, then OAEs were measured in supine position, and back to the upright posture one and 3h after glycerol intake. Twenty control subjects were also tested for body tilt. The main effect of body tilt and glycerol was a phase rotation of OAEs peaking around 1 kHz. Its frequency dependence matched the one due to a pressure-related change in stapes or basilar membrane stiffness predicted by the ear model of Zwislocki (1962). The average glycerol-induced phase shifts were similar in size in Menière vs. asymptomatic ear and audiometric thresholds were stable after glycerol intake in line with the model predicting little change in the magnitude of the transfer function. These data support a simple conductive pressure-related mechanism explaining the action of glycerol on inner ear responses. The fact that the mean postural shift was three times larger in Menière than asymptomatic and control ears suggests an additional effect in allegedly hydropic ears.

Changes in CMDP and DPOAE during acute increased inner ear pressure in the guinea pig

During and after an increase of inner ear pressure, induced by injection of artificial perilymph, the 2f₁ − f₂ and f₂ − f₁ distortion products (DPs) in cochlear microphonics (CM) and otoacoustic emissions (OAE) were recorded in the guinea pig. An inner pressure increase of ∼600 Pa gave only small changes in CMDP and DPOAE. Along with a decrease in f₁ amplitude, a small decrease in amplitude of the 2f₁ − f₂ and a small increase in the f₂ − f₁ were measured in CM. This matches a shift from a symmetrical position of the operating point for hair cell transduction, leading to an increase in even-order distortion and a decrease in odd-order distortion. Similar, a decrease in 2f₁ − f₂ DPOAE was expected. This might be the case at the generation sites but this effect was then more than compensated for by a better middle ear transfer, accounting for the increase of 0.4 dB of the 2f₁ − f₂ DPOAE amplitude. In conclusion, changes of overall inner ear fluid pressure have minor effects on cochlear function. This is a relevant finding for further understanding of diseases with changed inner ear fluid volumes, as Ménière’s.

Rupture of Reissner's membrane during acute endolymphatic hydrops in the guinea pig: a model for Ménière's disease?

CONCLUSION

The changes in cochlear function during a destructive acute endolymphatic hydrops were relatively small. This might be consistent with the hypothesis that an endolymphatic hydrops is a marker of disordered inner ear homeostasis rather than the cause of the clinical symptoms of Ménière's disease.

OBJECTIVE

Assessment of cochlear function during induction of a destructive acute endolymphatic hydrops.

MATERIALS AND METHODS

During repetitive microinjections of 0.5 microl of artificial endolymph at a rate of 50 nl/s the 2f1-f2 and f2-f1 cochlear microphonics distortion products (CMDP) and 2f1-f2 distortion products otoacoustic emissions (DPOAE) were recorded in the guinea pig.

RESULTS

A 'catastrophe' occurred in the inner ear when 2.5-3.5 microl of artificial endolymph was injected. A rupture of Reissner's membrane was then found, most often in the apical turn of the cochlea. This rupture had only minor effects on the endocochlear potential, whereas it caused a marked decrease in 2f1-f2 DPOAE amplitude. The 2f1-f2 and f2-f1 CMDP amplitude increased during each injection prior to the rupture. After the rupture the f2-f1 CMDP amplitude decreased during each injection, possibly due to a shift of the cochlear transducer operating point position.

Changes in distortion of two-tone cochlear microphonic and otoacoustic emission signals during an acute endolymphatic hydrops in the guinea pig

An acute endolymphatic hydrops was induced by the injection of 1.1 mul of artificial endolymph into the scala media of guinea pig cochleas. This volume corresponds with an acute endolymphatic hydrops of 23%. During and after the injection, cochlear function was assessed by measuring the 2f(1)-f(2 )and f(2)-f(1) distortion products in cochlear microphonics (CMDP) and the 2f(1)-f(2) distortion product otoacoustic emission (DPOAE). A reversible pressure increase of 23 Pa and a relatively stable endocochlear potential (EP) were accompanied by a mean decrease in 2f(1)-f(2) DPOAE of only 3.4 dB. Similarly, the 2f(1)-f(2) CMDP amplitude change was minimal during and after the injection. The only substantial change was measured in the f(2)-f(1) CMDP amplitude. The measured range of distortion amplitudes during an acute endolymphatic hydrops can be related to small changes in the cochlear transducer operating point.

Morphology of the endolymphatic sac in the guinea pig after an acute endolymphatic hydrops

The role of the endolymphatic sac (ES) in endolymph volume homeostasis is speculative. The present study investigates changes of the ES's epithelia and luminal filling after induction of an acute endolymphatic hydrops. After microinjection of 1.1 mul artificial endolymph into scala media of the cochlea, guinea pigs were terminated immediately (n = 6) or after different time intervals ; 1/2 h (n = 3), 1 h (n = 4) and 2 h (n = 4). Inner ear specimens were processed for light and/or transmission electron microscopy. The non-injected contralateral ear served as a histological control. Correct injection was confirmed by detection of microspheres in the endolymphatic compartment after the same microinjection procedure. In all specimens, ribosome rich cells and intraluminal macrophages appeared to be actively involved in degradation of homogeneous substance (HS) by secreting lytic enzymes and digestion, respectively. Amazingly, in our study no ES differences were found between injected and non-injected ears and no distinct changes were observed in guinea pigs terminated after different time intervals. The ES's luminal HS was always present and often to a large extent. This is in contrast with [Hear. Res. 138, 81] dramatic changes were observed. Endolymph volume homeostasis is a complex mechanism, in which the role of HS remains obscure.