Attachment of the utricular and saccular maculae to the temporal bone

A morphometric comparison of the ductus reuniens in humans and guinea pigs, with a note on its evolutionary importance

The mammalian inner ear contains the sensory organs responsible for balance (semicircular canals, utricle, and saccule) and hearing (cochlea). While these organs are functionally distinct, there exists a critical structural connection between the two: the ductus reuniens (DR). Despite its functional importance, comparative descriptions of DR morphology are limited, hindering our understanding of the evolutionary diversification of hearing and balance systems among mammals. Using virtual 3D models derived from micro-CT, we examine the morphology of the DR and its relationship to the bony labyrinth in humans compared to that in a commonly used animal model, the guinea pig. Anatomical reconstructions and univariate measurements were carried out in the software 3D Slicer. Data indicate similarities in DR morphology between humans and guinea pigs in terms of overall shape. However, there are considerable differences in relative DR length and width between humans and guinea pigs. Humans possess a relatively shorter and narrower DR but with wider openings to the saccule and cochlear duct. This results in a relatively more constricted DR lumen in humans which may differentially limit fluid transfer between the saccule and cochlea. Our results reveal previously hidden morphological diversity in the communication between the hearing and balance systems of the mammalian inner ear which may indicate alternative strategies for isolating the Organ of Corti from the peripheral vestibular system throughout mammalian evolution.

First evidence of the link between internal and external structure of the human inner ear otolith system using 3D morphometric modeling

Our sense of balance is among the most central of our sensory systems, particularly in the evolution of human positional behavior. The peripheral vestibular system (PVS) comprises the organs responsible for this sense; the semicircular canals (detecting angular acceleration) and otolith organs (utricle and saccule; detecting linear acceleration, vibration, and head tilt). Reconstructing vestibular evolution in the human lineage, however, is problematic. In contrast to considerable study of the canals, relationships between external bone and internal membranous otolith organs (otolith system) remain largely unexplored. This limits our understanding of vestibular functional morphology. This study combines spherical harmonic modeling and landmark-based shape analyses to model the configuration of the human otolith system. Our approach serves two aims: (1) test the hypothesis that bony form covaries with internal membranous anatomy; and (2) create a 3D morphometric model visualizing bony and membranous structure. Results demonstrate significant associations between bony and membranous tissues of the otolith system. These data provide the first evidence that external structure of the human otolith system is directly related to internal anatomy, suggesting a basic biological relationship. Our results visualize this structural relationship, offering new avenues into vestibular biomechanical modeling and assessing the evolution of the human balance system.

Multifrequency Narrowband Chirp Evoked Cervical Vestibular Myogenic Potentials: Evaluation of Responses in Normal-Hearing Young Adults

Purpose:

The study aimed to explore the various parameters of multifrequency narrowband Claus Elberling chirp (NB CE-chirp) evoked cervical vestibular evoked myogenic potentials (cVEMPs) in normal-hearing healthy young adults. The study also attempted to define the optimal frequency tuning characteristic of NB CE-chirp evoked cVEMPs.

Method:

cVEMP was performed on 26 young healthy adults using four different NB CE-chirps centered at 500, 1000, 2000, and 4000 Hz. The neck torsion method was applied for electrode placement. To have the acute recording, visual feedback of sternocleidomastoid muscle contraction was provided, and electromyography (EMG) scaling was done.

Results:

cVEMPs were present for 100% across all frequencies except at 4000 Hz. Amplitudes between each pair of frequencies were significantly different for EMG scaled and unscaled conditions. Frequency tuning was observed at 500 Hz regardless of scaling done. Positive peak 1 of cVEMP (P1) latencies showed no differences between frequencies while both negative peak 1 of cVEMP and the complex of positive peak 1 and negative peak 1 of cVEMP (P1N1) interpeak latency values decreased with increasing frequency. Interaural amplitude asymmetry ratio showed no difference between scaled and unscaled amplitudes. Intraclass correlation revealed a range of test–retest reliability across frequencies. EMG unscaled amplitude were having relatively lower test–retest reliability consistently across frequencies

Conclusions:

Differences in amplitudes between frequencies with a maximum at 500 Hz can be attributed to the low frequency centered saccular response. No differences in P1 were observed. Yet, N1 latency and P1N1 interpeak latency difference gradually shortened with the decrement in the stimulus duration as the stimulation frequency increased. The lower reliability of EMG unscaled amplitude across frequencies supports the need to use EMG scaling to avoid confounding variables related to muscle contraction.

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.

Cochlear implant surgery and perioperative dizziness is associated with utricular hyperfunction

BACKGROUND

Dizziness is a common perioperative complication after cochlear implantation (CI). To date, the exact cause behind this phenomenon remains unclear. There is recent evidence to suggest that otolith function, specifically utricular, may be affected shortly after CI surgery, however whether these changes are related to patient symptoms has not yet been investigated.

OBJECTIVE

To determine whether CI surgery and perioperative dizziness is associated with changes on utricular function.

METHODS

We performed an observational study on patients undergoing routine CI surgery. Utricular function was assessed using the Subjective Visual Vertical (SVV), and perioperative dizziness was determined using a questionnaire. The study followed patients before surgery and then again 1-day, 1-week and 6-weeks after implantation.

RESULTS

Forty-one adult CI recipients participated in the study. The SVV deviated away from the operated ear by an average of 2.17° a day after implantation, 0.889° 1 week and -0.25° 6 weeks after surgery. Dizziness contributed to a tilt of 0.5° away from the implanted ear. These deviations were statistically significant.

CONCLUSIONS

CI surgery causes utricular hyperfunction in the operated ear that resolves over 6 weeks. SVV tilts were greater in participants experiencing dizziness, suggesting that utricular hyperfunction may contribute to the dizziness.

Three-dimensional visualization of the human membranous labyrinth: The membrana limitans and its role in vestibular form

The inner ear contains the end organs for balance (vestibular labyrinth) and hearing (cochlea). The vestibular labyrinth is comprised of the semicircular canals (detecting angular acceleration) and otolith organs (utricle and saccule, which detect linear acceleration and head tilt relative to gravity). Lying just inferior to the utricle is the membranous membrana limitans (ML). Acting as a keystone to vestibular geometry, the ML provides support for the utricular macula and acts as a structural boundary between the superior (pars superior) and inferior (pars inferior) portions of the vestibular labyrinth. Given its importance in vestibular form, understanding ML morphology is valuable in establishing the spatial organization of other vestibular structures, particularly the utricular macula. Knowledge of the 3D structure and variation of the ML, however, remain elusive. Our study addresses this knowledge gap by visualizing, in 3D, the ML and surrounding structures using micro-CT data. By doing so, we attempt to clarify: (a) the variation of ML shape; (b) the reliability of ML attachment sites; and (c) the spatial relationship of the ML to the stapes footplate using landmark-based Generalized Procrustes, Principal Component and covariance analyses. Results indicate a consistent configuration of three distinct bony ML attachments including an anterolateral, medial, and posterior attachment which all covary with bony structure. Our results set the stage for further understanding into vestibular and more specifically, utricular macula spatial configuration within the human head, offering the potential to aid in clinical and evolutionary studies which rely on a 3D understanding of vestibular spatial configuration.

The Anatomical and Physiological Basis of Clinical Tests of Otolith Function. A Tribute to Yoshio Uchino

Otolithic receptors are stimulated by gravitoinertial force (GIF) acting on the otoconia resulting in deflections of the hair bundles of otolithic receptor hair cells. The GIF is the sum of gravitational force and the inertial force due to linear acceleration. The usual clinical and experimental tests of otolith function have used GIFs (roll tilts re gravity or linear accelerations) as test stimuli. However, the opposite polarization of receptors across each otolithic macula is puzzling since a GIF directed across the otolith macula will excite receptors on one side of the line of polarity reversal (LPR at the striola) and simultaneously act to silence receptors on the opposite side of the LPR. It would seem the two neural signals from the one otolith macula should cancel. In fact, Uchino showed that instead of canceling, the simultaneous stimulation of the oppositely polarized hair cells enhances the otolithic response to GIF—both in the saccular macula and the utricular macula. For the utricular system there is also commissural inhibitory interaction between the utricular maculae in each ear. The results are that the one GIF stimulus will cause direct excitation of utricular receptors in the activated sector in one ear as well as indirect excitation resulting from the disfacilitation of utricular receptors in the corresponding sector on the opposite labyrinth. There are effectively two complementary parallel otolithic afferent systems—the sustained system concerned with signaling low frequency GIF stimuli such as roll head tilts and the transient system which is activated by sound and vibration. Clinical tests of the sustained otolith system—such as ocular counterrolling to roll-tilt or tests using linear translation—do not show unilateral otolithic loss reliably, whereas tests of transient otolith function [vestibular evoked myogenic potentials (VEMPs) to brief sound and vibration stimuli] do show unilateral otolithic loss. The opposing sectors of the maculae also explain the results of galvanic vestibular stimulation (GVS) where bilateral mastoid galvanic stimulation causes ocular torsion position similar to the otolithic response to GIF. However, GVS stimulates canal afferents as well as otolithic afferents so the eye movement response is complex.

Correlation between High-Resolution Computed Tomography Scan Findings and Histological Findings in Human Vestibular End Organs and Surgical Implications

BACKGROUND

Histological study of vestibular end organs has been challenging due to the difficulty in preserving their structures for histological analysis and due to their complex geometry. Recently, radiology advances have allowed to deepen the study of the membranous labyrinth.

SUMMARY

A review and analysis of surgical implications related to the anatomy of the vestibular end organ is performed. Radiological advances are key in the advancement of the knowledge of the anatomy and pathology of the vestibule. Thus, application of such knowledge in the development or improvement of surgical procedures may facilitate the development of novel techniques. Key Messages: During the last few decades, the knowledge of the anatomy of the auditory system through histology and radiology had improved. Technological advances in this field may lead to a better diagnosis and therapeutic approach of most common and important diseases affecting the inner ear.

Concepts and Physiological Aspects of the Otolith Organ in Relation to Electrical Stimulation

BACKGROUND

This paper discusses some of the concepts and major physiological issues in developing a means of electrically stimulating the otolithic system, with the final goal being the electrical stimulation of the otoliths in human patients. It contrasts the challenges of electrical stimulation of the otolith organs as compared to stimulation of the semicircular canals. Electrical stimulation may consist of trains of short-duration pulses (e.g., 0.1 ms duration at 400 Hz) by selective electrodes on otolith maculae or otolithic afferents, or unselective maintained DC stimulation by large surface electrodes on the mastoids - surface galvanic stimulation.

SUMMARY

Recent anatomical and physiological results are summarized in order to introduce some of the unique issues in electrical stimulation of the otoliths. The first challenge is that each otolithic macula contains receptors with opposite polarization (opposing preferred directions of stimulation), unlike the uniform polarization of receptors in each semicircular canal crista. The puzzle is that in response to the one linear acceleration in the one macula, some otolithic afferents have an increased activation whereas others have decreased activation. Key Messages: At the vestibular nucleus this opposite receptor hair cell polarization and consequent opposite afferent input allow enhanced response to the one linear acceleration, via a "push-pull" neural mechanism in a manner analogous to the enhancement of semicircular canal responses to angular acceleration. Within each otolithic macula there is not just one uniform otolithic neural input to the brain - there are very distinctly different channels of otolithic neural inputs transferring the neural data to the brainstem. As a simplification these channels are characterized as the sustained and transient systems. Afferents in each system have different responses to stimulus onset and maintained stimulation and likely different projections, and most importantly different thresholds for activation by electrical stimulation and different adaptation rates to maintained stimulation. The implications of these differences are considered.

Three-dimensional study of vestibular anatomy as it relates to the stapes footplate and its clinical implications: an augmented reality development

BACKGROUND

The anatomy of the membranous labyrinth within the vestibule has direct implications for surgical intervention. The anatomy of the otoliths has been studied, but there is limited information regarding their supporting connective tissue structures such as the membrana limitans in humans.

METHODS

One guinea pig and 17 cadaveric human temporal bones were scanned using micro computed tomography, after staining with 2 per cent osmium tetroxide and preservation with Karnovsky's solution, with a resolution from 1 µm to 55 µm. The data were analysed using VGStudio Max software, rendered in three-dimensions and published in augmented reality.

RESULTS

In 50 per cent of ears, the membrana limitans attached directly to the postero-superior part of the stapes footplate. If attachments were present in one ear, they were present bilaterally in 100 per cent of cases.

CONCLUSION

Micro computed tomography imaging allowed three-dimensional assessment of the inner ear. Such assessments are important as they influence the surgical intervention and the evolution of future innovations.

Otolithic Receptor Mechanisms for Vestibular-Evoked Myogenic Potentials: A Review

Air-conducted sound and bone-conduced vibration activate otolithic receptors and afferent neurons in both the utricular and saccular maculae, and trigger small electromyographic (EMG) responses [called vestibular-evoked myogenic potentials (VEMPs)] in various muscle groups throughout the body. The use of these VEMPs for clinical assessment of human otolithic function is built on the following logical steps: (1) that high-frequency sound and vibration at clinically effective stimulus levels activate otolithic receptors and afferents, rather than semicircular canal afferents, (2) that there is differential anatomical projection of otolith afferents to eye muscles and neck muscles, and (3) that isolated stimulation of the utricular macula induces short latency responses in eye muscles, and that isolated stimulation of the saccular macula induces short latency responses in neck motoneurons. Evidence supports these logical steps, and so VEMPs are increasingly being used for clinical assessment of otolith function, even differential evaluation of utricular and saccular function. The proposal, originally put forward by Curthoys in 2010, is now accepted: that the ocular vestibular-evoked myogenic potential reflects predominantly contralateral utricular function and the cervical vestibular-evoked myogenic potential reflects predominantly ipsilateral saccular function. So VEMPs can provide differential tests of utricular and saccular function, not because of stimulus selectivity for either of the two maculae, but by measuring responses which are predominantly determined by the differential neural projection of utricular as opposed to saccular neural information to various muscle groups. The major question which this review addresses is how the otolithic sensory system, with such a high density otoconial layer, can be activated by individual cycles of sound and vibration and show such tight locking of the timing of action potentials of single primary otolithic afferents to a particular phase angle of the stimulus cycle even at frequencies far above 1,000 Hz. The new explanation is that it is due to the otoliths acting as seismometers at high frequencies and accelerometers at low frequencies. VEMPs are an otolith-dominated response, but in a particular clinical condition, semicircular canal dehiscence, semicircular canal receptors are also activated by sound and vibration, and act to enhance the otolith-dominated VEMP responses.

A Review of the Possible Perceptual and Physiological Effects of Wind Turbine Noise

This review considers the nature of the sound generated by wind turbines focusing on the low-frequency sound (LF) and infrasound (IS) to understand the usefulness of the sound measures where people work and sleep. A second focus concerns the evidence for mechanisms of physiological transduction of LF/IS or the evidence for somatic effects of LF/IS. While the current evidence does not conclusively demonstrate transduction, it does present a strong prima facia case. There are substantial outstanding questions relating to the measurement and propagation of LF and IS and its encoding by the central nervous system relevant to possible perceptual and physiological effects. A range of possible research areas are identified.

The new vestibular stimuli: sound and vibration-anatomical, physiological and clinical evidence

The classical view of the otoliths-as flat plates of fairly uniform receptors activated by linear acceleration dragging on otoconia and so deflecting the receptor hair bundles-has been replaced by new anatomical and physiological evidence which shows that the maculae are much more complex. There is anatomical spatial differentiation across the macula in terms of receptor types, hair bundle heights, stiffness and attachment to the overlying otolithic membrane. This anatomical spatial differentiation corresponds to the neural spatial differentiation of response dynamics from the receptors and afferents from different regions of the otolithic maculae. Specifically, receptors in a specialized band of cells, the striola, are predominantly type I receptors, with short, stiff hair bundles and looser attachment to the overlying otoconial membrane than extrastriolar receptors. At the striola the hair bundles project into holes in the otolithic membrane, allowing for fluid displacement to deflect the hair bundles and activate the cell. This review shows the anatomical and physiological evidence supporting the hypothesis that fluid displacement, generated by sound or vibration, deflects the short stiff hair bundles of type I receptors at the striola, resulting in neural activation of the irregular afferents innervating them. So these afferents are activated by sound or vibration and show phase-locking to individual cycles of the sound or vibration stimulus up to frequencies above 2000 Hz, underpinning the use of sound and vibration for clinical tests of vestibular function.

Assessing morphology and function of the semicircular duct system: introducing new in-situ visualization and software toolbox

The semicircular duct system is part of the sensory organ of balance and essential for navigation and spatial awareness in vertebrates. Its function in detecting head rotations has been modelled with increasing sophistication, but the biomechanics of actual semicircular duct systems has rarely been analyzed, foremost because the fragile membranous structures in the inner ear are hard to visualize undistorted and in full. Here we present a new, easy-to-apply and non-invasive method for three-dimensional in-situ visualization and quantification of the semicircular duct system, using X-ray micro tomography and tissue staining with phosphotungstic acid. Moreover, we introduce Ariadne, a software toolbox which provides comprehensive and improved morphological and functional analysis of any visualized duct system. We demonstrate the potential of these methods by presenting results for the duct system of humans, the squirrel monkey and the rhesus macaque, making comparisons with past results from neurophysiological, oculometric and biomechanical studies. Ariadne is freely available at http://www.earbank.org.

The response of guinea pig primary utricular and saccular irregular neurons to bone-conducted vibration (BCV) and air-conducted sound (ACS)

This study sought to characterize the response of mammalian primary otolithic neurons to sound and vibration by measuring the resting discharge rates, thresholds for increases in firing rate and supra-threshold sensitivity functions of guinea pig single primary utricular and saccular afferents. Neurons with irregular resting discharge were activated in response to bone conducted vibration (BCV) and air conducted sound (ACS) for frequencies between 100 Hz and 3000 Hz. The location of neurons was verified by labelling with neurobiotin. Many afferents from both maculae have very low or zero resting discharge, with saccular afferents having on average, higher resting rates than utricular afferents. Most irregular utricular and saccular afferents can be evoked by both BCV and ACS. For BCV stimulation: utricular and saccular neurons show similar low thresholds for increased firing rate (around 0.02 g on average) for frequencies from 100 Hz to 750 Hz. There is a steep increase in rate change threshold for BCV frequencies above 750 Hz. The suprathreshold sensitivity functions for BCV were similar for both utricular and saccular neurons, with, at low frequencies, very steep increases in firing rate as intensity increased. For ACS stimulation: utricular and saccular neurons can be activated by high intensity stimuli for frequencies from 250 Hz to 3000 Hz with similar flattened U-shaped tuning curves with lowest thresholds for frequencies around 1000-2000 Hz. The average ACS thresholds for saccular afferents across these frequencies is about 15-20 dB lower than for utricular neurons. The suprathreshold sensitivity functions for ACS were similar for both utricular and saccular neurons. Both utricular and saccular afferents showed phase-locking to BCV and ACS, extending up to frequencies of at least around 1500 Hz for BCV and 3000 Hz for ACS. Phase-locking at low frequencies (e.g. 100 Hz) imposes a limit on the neural firing rate evoked by the stimulus since the neurons usually fire one spike per cycle of the stimulus.

CONCLUSION

These results are in accord with the hypothesis put forward by Young et al. (1977) that each individual cycle of the waveform, either BCV or ACS, is the effective stimulus to the receptor hair cells on either macula. We suggest that each cycle of the BCV or ACS stimulus causes fluid displacement which deflects the short, stiff, hair bundles of type I receptors at the striola and so triggers the phase-locked neural response of primary otolithic afferents.

A theory to explain some physiological effects of the infrasonic emissions at some wind farm sites

For at least four decades, there have been reports in scientific literature of people experiencing motion sickness-like symptoms attributed to low-frequency sound and infrasound. In the last several years, there have been an increasing number of such reports with respect to wind turbines; this corresponds to wind turbines becoming more prevalent. A study in Shirley, WI, has led to interesting findings that include: (1) To induce major effects, it appears that the source must be at a very low frequency, about 0.8 Hz and below with maximum effects at about 0.2 Hz; (2) the largest, newest wind turbines are moving down in frequency into this range; (3) the symptoms of motion sickness and wind turbine acoustic emissions "sickness" are very similar; (4) and it appears that the same organs in the inner ear, the otoliths may be central to both conditions. Given that the same organs may produce the same symptoms, one explanation is that the wind turbine acoustic emissions may, in fact, induce motion sickness in those prone to this affliction.

How does high-frequency sound or vibration activate vestibular receptors?

The mechanism by which vestibular neural phase locking occurs and how it relates to classical otolith mechanics is unclear. Here, we put forward the hypothesis that sound and vibration both cause fluid pressure waves in the inner ear and that it is these pressure waves which displace the hair bundles on vestibular receptor hair cells and result in activation of type I receptor hair cells and phase locking of the action potentials in the irregular vestibular afferents, which synapse on type I receptors. This idea has been suggested since the early neural recordings and recent results give it greater credibility.

Ex vivo visualization of the mouse otoconial layer compared with micro-computed tomography

HYPOTHESIS

Micro-computed tomography (micro-CT) is useful for assessing the 3-dimensional (3D) morphology and age-related changes of the otoconial layer.

BACKGROUND

Wriggle mouse Sagami (WMS) is a mutant of the plasma membrane Ca2+ ATPase type2 gene (Atp2b2) with deficits in the saccular otoconia. We examined the effectiveness of micro-CT in evaluating the otoconial layer of WMS and C57BL/6J mice.

METHODS

Otic capsules of C57BL/6J mice at different fixation time were examined using micro-CT to evaluate the effects of the fixation time on the otoconial layer. Otic capsules of Atp2b2(wri/wri), Atp2b2(wri/+), and Atp2b2(+/+) mice at P14, P21, and the age of 3 months were used to analyze age-related changes in the otoconial layer. A series of cross-section and 3D reconstructed images of the otoconial layer were obtained. The micro-CT findings were compared with the otic capsule findings cleared in methyl salicylate using stereomicroscopy.

RESULTS

Micro-CT produced high-resolution images of the otoconial layer, thereby providing information regarding the spatial configuration and 3D curvature. There were no changes between the different fixation times. In the Atp2b2(wri/+) and Atp2b2(+/+) mice, the saccular and utricular otoconial layers were normal among all age groups. In the Atp2b2(wri/wri) mice, the saccular otoconial layer decreased on P14 and was absent on P21, whereas the utricular otoconial layer disappeared at 3 months of age.

CONCLUSION

We obtained precise information regarding the mouse otoconial layer with minimum artifacts. This method is expected to improve our understanding of the physiologic function and age-related changes in otolith organs.

The effect of alcohol on cervical and ocular vestibular evoked myogenic potentials in healthy volunteers

OBJECTIVE

We investigated the effect of alcohol on the cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs). As alcohol produces gaze-evoked nystagmus (GEN), we also tested the effect of nystagmus independent of alcohol by recording oVEMPs during optokinetic stimulation (OKS).

METHODS

The effect of alcohol was tested in 14 subjects over multiple rounds of alcohol consumption up to a maximum breath alcohol concentration (BrAC) of 1.5‰ (mean 0.97‰). The effect of OKS was tested in 11 subjects at 5, 10 and 15deg/sec.

RESULTS

oVEMP amplitude decreased from baseline to the highest BrAC level by 27% (range 5-50%, P<0.001), but there was no significant effect on oVEMP latency or cVEMP amplitude or latency. There was a significant negative effect of OKS on oVEMP amplitude (16%, P=0.006).

CONCLUSIONS

We found a selective effect of alcohol on oVEMP amplitude, but no effect on the cVEMP. Vertical nystagmus elicited by OKS reduced oVEMP amplitude.

SIGNIFICANCE

Alcohol selectively affects oVEMP amplitude. Despite the effects of alcohol and nystagmus, both reflexes were reliably recorded in all subjects and conditions. An absent response in a patient affected by alcohol or nystagmus indicates a vestibular deficit.

Sensory epithelia of the fish inner ear in 3D: studied with high-resolution contrast enhanced microCT

Introduction

While a number of studies have illustrated and analyzed 3D models of inner ears in higher vertebrates, inner ears in fishes have rarely been investigated in 3D, especially with regard to the sensory epithelia of the end organs, the maculae. It has been suggested that the 3D curvature of these maculae may also play an important role in hearing abilities in fishes. We therefore set out to develop a fast and reliable approach for detailed 3D visualization of whole inner ears as well as maculae.

Results

High-resolution microCT imaging of black mollies Poecilia sp. (Poeciliidae, Teleostei) and Steatocranus tinanti (Cichlidae, Teleostei) stained with phosphotungstic acid (PTA) resulted in good tissue contrast, enabling us to perform a reliable 3D reconstruction of all three sensory maculae of the inner ears. Comparison with maculae that have been 3D reconstructed based on histological serial sections and phalloidin-stained maculae showed high congruence in overall shape of the maculae studied here.

Conclusions

PTA staining and subsequent high-resolution contrast enhanced microCT imaging is a powerful method to obtain 3D models of fish inner ears and maculae in a fast and more reliable manner. Future studies investigating functional morphology, phylogenetic potential of inner ear features, or evolution of hearing and inner ear specialization in fishes may benefit from the use of 3D models of inner ears and maculae.

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.

Dynamic visual acuity testing for screening patients with vestibular impairments

Dynamic visual acuity (DVA) may be a useful indicator of the function of the vestibulo-ocular reflex (VOR) but most DVA tests involve active head motion in the yaw plane. During gait the passive, vertical VOR may be more relevant and passive testing would be less likely to elicit compensatory strategies. The goal of this study was to determine if testing dynamic visual acuity during passive vertical motion of the subject would differentiate normal subjects from patients with known vestibular disorders. Subjects, normals and patients who had been diagnosed with either unilateral vestibular weaknesses or were post-acoustic neuroma resections, sat in a chair that could oscillate vertically with the head either free or constrained with a cervical orthosis. They viewed a computer screen 2 m away that showed Landholt C optotypes in one of 8 spatial configurations and which ranged in size from 0.4 to 1.0 logMAR. They were tested while the chair was stationary and while it was moving. Scores were worse for both groups during the dynamic condition compared to the static condition. In the dynamic condition patients' scores were significantly worse than normals' scores. Younger and older age groups differed slightly but significantly; the sample size was too small to examine age differences by decade. The data suggest that many well-compensated patients have dynamic visual acuity that is as good as age-matched normals. Results of ROC analyses were only moderate, indicating that the differences between patients and normals were not strong enough, under the conditions tested, for this test to be useful for screening people to determine if they have vestibular disorders. Modifications of the test paradigm may make it more useful for screening potential patients.

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.

Irregular primary otolith afferents from the guinea pig utricular and saccular maculae respond to both bone conducted vibration and to air conducted sound

This study sought to identify in guinea pig the peripheral sense organ of origin of otolith irregular primary vestibular afferent neurons having a very sensitive response to both air-conducted sound (ACS) and bone-conducted vibration (BCV). Neurons responding to both types of stimuli were labelled by juxtacellular labelling by neurobiotin. Whole mounts of the maculae showed that some vestibular afferents activated by both ACS and BCV originate from the utricular macula and some from the saccular macula - there is no "afferent specificity" by one sense organ for ACS and the other for BCV - instead some afferents from both sense organs have sensitive responses to both stimuli. The clinical implication of this result is that differential evaluation of the functional status of the utricular and saccular maculae cannot rely on stimulus type (ACS vs BCV), however the differential motor projections of the utricular and saccular maculae allow for differential evaluation of each sense organ.

Tuning of the ocular vestibular evoked myogenic potential to bone-conducted sound stimulation

Ocular vestibular evoked myogenic potentials (oVEMPs) are a recently described clinical measure of the vestibulo-ocular reflex. Studies demonstrating differences in frequency tuning between air-conducted and bone-conducted (BC) oVEMPs suggest a separate vestibular (otolith) origin for each stimulus modality. In this study, 10 healthy subjects were stimulated with BC stimuli using a hand-held minishaker. Frequencies were tested in the range of 50–1,000 Hz using both a constant-force and constant-acceleration method. Subjects were stimulated at the mastoid process and the forehead. For constant-force stimulation at both sites, maximum acceleration occurred around 100 Hz, in differing axes. Both forms of stimulation had low-frequency peaks of oVEMP amplitudes (constant force: mastoid, 80–150 Hz; forehead, 50–125 Hz; constant acceleration: mastoid, 100–200 Hz; forehead, 80–150 Hz), for both sites of application, despite differences in the magnitude and direction of evoked head acceleration. For mastoid stimulation, ocular responses changed from out of phase to in phase for 400 Hz and above. Our results demonstrate that BC stimuli show tuning around 100 Hz, independent of stimulus site, that is not due to skull properties. The findings are consistent with an effect on a receptor with a resonance around 100 Hz, most likely the utricle.

The basis for using bone-conducted vibration or air-conducted sound to test otolithic function

Extracellular single neuron recordings of primary vestibular neurons in Scarpa's ganglion in guinea pigs show that low-intensity 500 Hz bone-conducted vibration (BCV) or 500 Hz air-conducted sound (ACS) activate a high proportion of otolith irregular neurons from the utricular and saccular maculae but few semicircular canal neurons. In alert guinea pigs, and humans, 500 Hz BCV elicits otolith-evoked eye movements. In humans, it also elicits a myogenic potential on tensed sternocleidomastoid muscles. Although BCV and ACS activate both utricular and saccular maculae, it is possible to probe the functional status of these two sense organs separately because of their differential neural projections. Saccular neurons have a strong projection to neck muscles and a weak projection to the oculomotor system. Utricular afferents have a strong projection to eye muscles. So measuring oculomotor responses to ACS and BCV predominantly probes utricular function, while measuring neck muscle responses to these stimuli predominantly probes saccular function.

Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders

CONCLUSION

This study showed that the ocular vestibular evoked myogenic potential (oVEMP) in response to air-conducted sound (ACS) reflects functions of different parts of the vestibular labyrinth from cervical VEMP (cVEMP).

OBJECTIVE

To determine whether the origin of the vestibular end organs of the oVEMP in response to ACS (500 Hz tone bursts) is the same as that of cVEMP.

METHODS

Twenty patients definitively diagnosed with unilateral Meniere's disease (MD), 6 patients with unilateral vestibular neuritis (VN), and 7 healthy subjects were enrolled. In these subjects, the oVEMP and cVEMP to air-conducted 500 Hz tone bursts (125 dBSPL) were measured. The patients also underwent caloric tests.

RESULTS

The MD patients did not show a significant association between their ACS oVEMP findings and ACS cVEMP findings but there was an association of ACS oVEMP findings with caloric test findings. When the MD patients were classified into four stages based on their hearing levels, the patients showed abnormal findings at earlier stages on ACS cVEMP than on other tests. While all six VN patients showed abnormal findings on ACS oVEMP and caloric tests, only two patients showed abnormal ACS cVEMPs. These findings support the hypothesis that the oVEMP in response to ACS predominantly reflects utricular functions while ACS cVEMP reflects saccular functions.

Vestibular primary afferent responses to sound and vibration in the guinea pig

This study tested whether air-conducted sound and bone-conducted vibration activated primary vestibular afferent neurons and whether, at low levels, such stimuli are specific to particular vestibular sense organs. In response to 500 Hz bone-conducted vibration or 500 Hz air-conducted sound, primary vestibular afferent neurons in the guinea pig fall into one of two categories--some neurons show no measurable change in firing up to 2 g peak-to-peak or 140 dB SPL. These are semicircular canal neurons (regular or irregular) and regular otolith neurons. In sharp contrast, otolith irregular neurons show high sensitivity: a steep increase in firing as stimulus intensity is increased. These sensitive neurons typically, but not invariably, were activated by both bone-conducted vibration and air-conducted sound, they originate from both the utricular and saccular maculae, and their sensitivity underpins new clinical tests of otolith function.

Responses of the ear to low frequency sounds, infrasound and wind turbines

Infrasonic sounds are generated internally in the body (by respiration, heartbeat, coughing, etc) and by external sources, such as air conditioning systems, inside vehicles, some industrial processes and, now becoming increasingly prevalent, wind turbines. It is widely assumed that infrasound presented at an amplitude below what is audible has no influence on the ear. In this review, we consider possible ways that low frequency sounds, at levels that may or may not be heard, could influence the function of the ear. The inner ear has elaborate mechanisms to attenuate low frequency sound components before they are transmitted to the brain. The auditory portion of the ear, the cochlea, has two types of sensory cells, inner hair cells (IHC) and outer hair cells (OHC), of which the IHC are coupled to the afferent fibers that transmit "hearing" to the brain. The sensory stereocilia ("hairs") on the IHC are "fluid coupled" to mechanical stimuli, so their responses depend on stimulus velocity and their sensitivity decreases as sound frequency is lowered. In contrast, the OHC are directly coupled to mechanical stimuli, so their input remains greater than for IHC at low frequencies. At very low frequencies the OHC are stimulated by sounds at levels below those that are heard. Although the hair cells in other sensory structures such as the saccule may be tuned to infrasonic frequencies, auditory stimulus coupling to these structures is inefficient so that they are unlikely to be influenced by airborne infrasound. Structures that are involved in endolymph volume regulation are also known to be influenced by infrasound, but their sensitivity is also thought to be low. There are, however, abnormal states in which the ear becomes hypersensitive to infrasound. In most cases, the inner ear's responses to infrasound can be considered normal, but they could be associated with unfamiliar sensations or subtle changes in physiology. This raises the possibility that exposure to the infrasound component of wind turbine noise could influence the physiology of the ear.

Ocular and cervical vestibular-evoked myogenic potentials to bone conducted vibration in Ménière's disease during quiescence vs during acute attacks

OBJECTIVE

Two indicators of otolithic function were used to measure dynamic otolith function in the same patients both during an acute attack of Ménière's disease (MD) and in the quiescent period between attacks.

METHODS

The early negative component (n10) of the ocular vestibular-evoked myogenic potential (the oVEMP) to brief 500 Hz bone conducted vibration (BCV) stimulation of the forehead, in the midline at the hairline (Fz) was recorded by surface EMG electrodes just beneath both eyes while the patient looked up. It has been proposed that the n10 component of the oVEMP to 500 Hz Fz BCV indicates utricular function. It has been proposed that the early positive component (p13) of the cervical vestibular-evoked myogenic potential (the cVEMP) recorded by surface electrodes on both tensed SCM neck muscles to 500 Hz Fz BCV indicates saccular function.

RESULTS

Sixteen healthy control subjects tested on two occasions showed no detectable change in the symmetry of oVEMPs or cVEMPs to 500 Hz Fz BCV. In response to 500 Hz Fz BCV 15 early MD patients tested at both attack and quiescent phases showed a dissociation: there was a significant increase in contralesional of n10 of the oVEMP during the attack compared to quiescence but a significant decrease in the ipsilesional p13 of the cVEMP during the attack compared to quiescence.

CONCLUSIONS

During an MD attack, dynamic utricular function in the affected ear as measured by the n10 of the oVEMP to 500 Hz Fz BCV is enhanced, whereas dynamic saccular function in the affected ear as measured by the p13 of the cVEMP to 500 Hz Fz BCV is not similarly affected.

SIGNIFICANCE

The MD attack appears to affect different otolithic regions differentially.

A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli

In addition to activating cochlear receptors, air conducted sound (ACS) and bone conducted vibration (BCV) activate vestibular otolithic receptors, as shown by neurophysiological evidence from animal studies--evidence which is the foundation for using ACS and BCV for clinical vestibular testing by means of vestibular-evoked myogenic potentials (VEMPs). Recent research is elaborating the specificity of ACS and BCV on vestibular receptors. The evidence that saccular afferents can be activated by ACS has been mistakenly interpreted as showing that ACS only activates saccular afferents. That is not correct - ACS activates both saccular and utricular afferents, just as BCV activates both saccular and utricular afferents, although the patterns of activation for ACS and BCV do not appear to be identical. The otolithic input to sternocleidomastoid muscle appears to originate predominantly from the saccular macula. The otolithic input to the inferior oblique appears to originate predominantly from the utricular macula. Galvanic stimulation by surface electrodes on the mastoids very generally activates afferents from all vestibular sense organs. This review summarizes the physiological results, the potential artifacts and errors of logic in this area, reconciles apparent disagreements in this field. The neurophysiological results on BCV have led to a new clinical test of utricular function - the n10 of the oVEMP. The cVEMP tests saccular function while the oVEMP tests utricular function.

Nystagmus as a sign of labyrinthine disorders--three-dimensional analysis of nystagmus

In order to diagnose the pathological condition of vertiginous patients, a detailed observation of nystagmus in addition to examination of body equilibrium and other neurotological tests are essential. How to precisely record the eye movements is one of the goals of the researchers and clinicians who are interested in the analysis of eye movements for a long time. For considering that, one has to think about the optimal method for recording eye movements. In this review, the author introduced a new method, that is, an analysis of vestibular induced eye movements in three-dimensions and discussed the advantages and limitations of this method.

Low-frequency tuning in the human vestibular-ocular projection is determined by both peripheral and central mechanisms

We recently reported that a major contribution to the low-frequency tuning and sensitivity of the human vestibular system is the biomechanical properties of the vestibular end-organs. In the current paper, we investigate the contribution of additional mechanisms to low-frequency tuning. We compared the response properties of the vestibular system in 6 human volunteers to trains of 2 ms pulses of sound and transmastoid vibration using pulse repetition frequencies of 12.5, 25, 50, 100, 200 and 400 Hz. Measurements were made using two separate pathways arising from the vestibular apparatus: to the neck using vestibular evoked myogenic potentials (VEMPs), and to the eyes using ocular vestibular evoked myogenic potentials (OVEMPs). For both sound and vibration the two response pathways produced different tuning to pulse trains. The vestibulo-ocular pathway was characterised by a band-pass tuning with best frequency of 100 Hz whereas the vestibulo-collic pathway showed a peak at 400 Hz with sound only. These results suggest that properties of the vestibulo-ocular pathway also contribute to the low-frequency tuning that occurs for the OVEMP, in addition to previously reported end-organ effects.

State of the art: 3T imaging of the membranous labyrinth

This article reviews the anatomy of the membranous labyrinth and demonstrates the ability of high-resolution MR imaging at 3T to visualize the neurosensory epithelium by using the latest fast spin-echo techniques.