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Feitosa TBF, Lopes TJP, Alves IS, Passos UL, Gebrim ES. "PRACTICAL IMAGING FOR MÉNIÈRE'S DISEASE". Semin Ultrasound CT MR 2024:S0887-2171(24)00068-4. [PMID: 39393655 DOI: 10.1053/j.sult.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
Ménière's disease (MD) is a chronic disorder of the inner ear characterized by vertigo, hearing loss, tinnitus, and aural fullness. The pathophysiology of Ménière's disease involves endolymphatic hydrops (EH), an abnormal accumulation of endolymph fluid, although the exact cause remains unclear, potentially involving genetic, environmental, and autoimmune factors. Recent advancements in magnetic resonance imaging (MRI) have significantly enhanced diagnostic capabilities. This technique uses gadolinium-based contrast agents (GBCA) to differentiate between endolymph and perilymph. Imaging techniques such as 3D-FLAIR and 3D-real-IR sequences are used to classify EH into grades based on the severity of dilation in the cochlea and vestibule. The degree of perilymphatic enhancement (PE), indicative of blood-labyrinthine barrier breakdown, further aids in diagnosing Ménière's disease. Accurate diagnosis relies on distinguishing between perilymphatic and endolymphatic enhancement patterns and recognizing mimicking conditions.
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Affiliation(s)
- Thiago B F Feitosa
- Head and Neck Radiology and Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Thiago J P Lopes
- Head and Neck Radiology and Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Isabela S Alves
- Head and Neck Radiology and Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Ula L Passos
- Head and Neck Radiology and Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil; Head and Neck Radiology Section, Department of Radiology, Hospital do Servidor Público Estadual de Sao Paulo (IAMSPE), Sao Paulo, Brazil.
| | - Eloisa S Gebrim
- Head and Neck Radiology Section, Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil; Head and Neck Radiology Section, Department of Radiology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Maniaci A, Briglia M, Allia F, Montalbano G, Romano GL, Zaouali MA, H’mida D, Gagliano C, Malaguarnera R, Lentini M, Graziano ACE, Giurdanella G. The Role of Pericytes in Inner Ear Disorders: A Comprehensive Review. BIOLOGY 2024; 13:802. [PMID: 39452111 PMCID: PMC11504721 DOI: 10.3390/biology13100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 10/02/2024] [Accepted: 10/06/2024] [Indexed: 10/26/2024]
Abstract
Inner ear disorders, including sensorineural hearing loss, Meniere's disease, and vestibular neuritis, are prevalent conditions that significantly impact the quality of life. Despite their high incidence, the underlying pathophysiology of these disorders remains elusive, and current treatment options are often inadequate. Emerging evidence suggests that pericytes, a type of vascular mural cell specialized to maintain the integrity and function of the microvasculature, may play a crucial role in the development and progression of inner ear disorders. The pericytes are present in the microvasculature of both the cochlea and the vestibular system, where they regulate blood flow, maintain the blood-labyrinth barrier, facilitate angiogenesis, and provide trophic support to neurons. Understanding their role in inner ear disorders may provide valuable insights into the pathophysiology of these conditions and lead to the development of novel diagnostic and therapeutic strategies, improving the standard of living. This comprehensive review aims to provide a detailed overview of the role of pericytes in inner ear disorders, highlighting the anatomy and physiology in the microvasculature, and analyzing the mechanisms that contribute to the development of the disorders. Furthermore, we explore the potential pericyte-targeted therapies, including antioxidant, anti-inflammatory, and angiogenic approaches, as well as gene therapy strategies.
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Affiliation(s)
- Antonino Maniaci
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
- Department of Surgery, ENT Unit, Asp 7 Ragusa, 97100 Ragusa, Italy
| | - Marilena Briglia
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Fabio Allia
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Giuseppe Montalbano
- Zebrafish Neuromorphology Laboratory, Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy;
| | - Giovanni Luca Romano
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Mohamed Amine Zaouali
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy, University of Monastir, Avicenne Street, 5019 Monastir, Tunisia;
| | - Dorra H’mida
- Department of Cytogenetics and Reproductive Biology, Farhat Hached Hospital, 4021 Sousse, Tunisia;
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Roberta Malaguarnera
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Mario Lentini
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
- Department of Surgery, ENT Unit, Asp 7 Ragusa, 97100 Ragusa, Italy
| | - Adriana Carol Eleonora Graziano
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
| | - Giovanni Giurdanella
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.); (F.A.); (G.L.R.); (C.G.); (R.M.); (G.G.)
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Matsui K, Yoshida T, Sugimoto S, Kobayashi M, Naganawa S, Sone M. Correlation of Endolysmphatic Duct Signal Intensity With Clinical Features in Otological Diseases. Otol Neurotol 2024; 45:e624-e629. [PMID: 39264918 DOI: 10.1097/mao.0000000000004309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
OBJECTIVE Bilateral high signal intensity (SI) in the endolymphatic duct (ED) on magnetic resonance imaging (MRI) has been reported as a common characteristic in ears with large vestibular aqueduct syndrome (LVAS). However, the significance of bilateral high SI in the ED remains unknown. The present study aimed to compare the correlation between SI in the ED and the clinical manifestations in various otological disorders and consider the significance of the MRI findings. STUDY DESIGN Retrospective study. SETTING University hospital. PATIENTS The study included 2,450 ears from 1,225 patients with various otological disorders. INTERVENTION All ears underwent 3T enhanced MRI and were evaluated for the degree of endolymphatic hydrops (EH) and the SI ratios (SIRs; i.e., the calculation between SIs in the ED and those in the cerebellum). MAIN OUTCOME MEASURE The imaging findings were compared with their clinical symptoms. RESULTS Ears with bilateral high SIRs in the ED tended to have considerably less occurrence of EH in both the cochlea and vestibule than those with bilateral low SIRs. Ears with SIR ≥8 showed significantly elevated hearing thresholds at lower frequencies on pure-tone audiometry, although they exhibited a markedly lower incidence of cochlear EH than those with SIR <8. Moreover, ears with vertigo exhibited notably higher SIRs than those without vertigo. CONCLUSION Bilateral high SI in the ED on MRI may reflect pathophysiology underlying sensorineural hearing loss and vestibular symptoms, which are not associated with EH formation.
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Affiliation(s)
- Kosumo Matsui
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kobayashi M, Yoshida T, Fukunaga Y, Hara D, Naganawa S, Sone M. Perilymphatic enhancement and endolymphatic hydrops: MRI findings and clinical associations. Laryngoscope Investig Otolaryngol 2024; 9:e1312. [PMID: 39397881 PMCID: PMC11470371 DOI: 10.1002/lio2.1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/06/2024] [Accepted: 07/12/2024] [Indexed: 10/15/2024] Open
Abstract
Objective In this study, we aimed to summarize magnetic resonance imaging (MRI) findings of perilymphatic enhancement (PE) and endolymphatic hydrops (EH) of the inner ear, which are associated with vestibular and cochlear symptoms. Methods We analyzed data on ears with definite Meniere's disease (MD), sensorineural hearing loss (SNHL), vertigo, and listening difficulties (LiD) from 508 ears of 254 patients who underwent contrast-enhanced 3-Tesla MRI between April 2021 and March 2023. We evaluated the degree of endolymphatic hydrops (EH), signal intensity ratios (SIRs) between the basal turns of the cochlea and cerebellum, and hearing levels for all ears. Ears with definite MD were also assessed for changes in vestibular and cochlear symptoms within 6 months. Results Ears with definite MD exhibited significantly higher percentages of EH in both the vestibule and cochlea compared with ears with other diseases. Furthermore, ears with MD or sensorineural hearing loss (SNHL) had significantly higher SIRs of PE compared with ears with other diseases or asymptomatic ears. Among patients with definite MD, those experiencing hearing fluctuations or vertigo attacks within the last 6 months had significantly higher SIRs of PE compared with those who did not experience any symptoms. Conclusion Significant EH in the vestibule and cochlea was a major finding for the imaging diagnosis of definite MD. A high SIR of PE was a good indicator for assessing MD activity, reflecting vestibular and cochlear symptoms and fluctuations.Level of Evidence: 4.
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Affiliation(s)
- Masumi Kobayashi
- Department of OtorhinolaryngologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Tadao Yoshida
- Department of OtorhinolaryngologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yukari Fukunaga
- Department of RehabilitationNagoya University Graduate School of MedicineNagoyaJapan
| | - Daisuke Hara
- Department of RehabilitationNagoya University Graduate School of MedicineNagoyaJapan
| | - Shinji Naganawa
- Department of RadiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Michihiko Sone
- Department of OtorhinolaryngologyNagoya University Graduate School of MedicineNagoyaJapan
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Kim M, Lee HJ, Lee S, Lee J, Kang Y. Three-dimensional heavily T2-weighted FLAIR in the detection of blood-labyrinthine barrier leakage in patients with sudden sensorineural hearing loss: comparison with T1 sequences and application of deep learning-based reconstruction. Eur Radiol 2024; 34:5379-5388. [PMID: 38231393 DOI: 10.1007/s00330-023-10580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Blood-labyrinthine barrier leakage has been reported in sudden sensorineural hearing loss (SSNHL). We compared immediate post-contrast 3D heavily T2-weighted fluid-attenuated inversion recovery (FLAIR), T1 spin echo (SE), and 3D T1 gradient echo (GRE) sequences, and heavily T2-weighted FLAIR (hvT2F) with and without deep learning-based reconstruction (DLR) in detecting perilymphatic enhancement. METHODS Fifty-four patients with unilateral SSNHL who underwent ear MRI with three sequences were included. We compared asymmetry scores, confidence scores, and detection rates of perilymphatic enhancement among the three sequences and obtained 3D hvT2F with DLR from 35 patients. The above parameters and subjective image quality between 3D hvT2F with and without DLR were compared. RESULTS Asymmetry scores and detection rate of 3D hvT2F were significantly higher than 3D GRE T1 and SE T1 (respectively, 1.37, 0.11, 0.19; p < 0.001). Asymmetry scores significantly increased with DLR compared to 3D hvT2F for experienced and inexperienced readers (respectively, 1.77 vs. 1.40, p = 0.036; 1.49 vs. 1.03, p = 0.012). The detection rate significantly increased only for the latter (57.1% vs. 31.4%, p = 0.022). Patients with perilymphatic enhancement had significantly higher air conduction thresholds on initial (77.96 vs. 57.79, p = 0.002) and 5 days after presentation (63.38 vs. 41.85, p = 0.019). CONCLUSION 3D hvT2F significantly increased the detectability of perilymphatic enhancement compared to 3D GRE T1 and SE T1. DLR further improved the conspicuity of perilymphatic enhancement in 3D hvT2F. 3D hvT2F and DLR are useful for evaluating blood-labyrinthine barrier leakage; furthermore, they might provide prognostic value in the early post-treatment period. CLINICAL RELEVANCE STATEMENT Ten-minute post-contrast 3D heavily T2-weighed FLAIR imaging is a potentially efficacious sequence in demonstrating perilymphatic enhancement in patients with sudden sensorineural hearing loss and may be further improved by deep learning-based reconstruction. KEY POINTS • 3D heavily T2-weighted FLAIR (3D hvT2F) is a sequence sensitive in detecting low concentrations of contrast in the perilymphatic space. • 3D hvT2F sequences properly demonstrated perilymphatic enhancement in sudden sensorineural hearing loss compared to T1 sequences and were further improved by deep learning-based reconstruction (DLR). • 3D hvT2F and DLR are efficacious sequences in detecting blood-labyrinthine barrier leakage and with potential prognostic information.
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Affiliation(s)
- Mingyu Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seokhwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | | | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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Sung CYW, Hayase N, Yuen PST, Lee J, Fernandez K, Hu X, Cheng H, Star RA, Warchol ME, Cunningham LL. Macrophage depletion protects against cisplatin-induced ototoxicity and nephrotoxicity. SCIENCE ADVANCES 2024; 10:eadk9878. [PMID: 39047106 PMCID: PMC11268410 DOI: 10.1126/sciadv.adk9878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/18/2024] [Indexed: 07/27/2024]
Abstract
Cisplatin is a widely used anticancer drug with notable side effects including ototoxicity and nephrotoxicity. Macrophages, the major resident immune cells in the cochlea and kidney, are important drivers of both inflammatory and tissue repair responses. To investigate the roles of macrophages in cisplatin-induced toxicities, we used PLX3397, a U.S. Food and Drug Administration-approved inhibitor of the colony-stimulating factor 1 receptor, to eliminate tissue-resident macrophages. Mice treated with cisplatin alone had considerable hearing loss (ototoxicity) and kidney injury (nephrotoxicity). Macrophage ablation resulted in significantly reduced hearing loss and had greater outer hair cell survival. Macrophage ablation also protected against cisplatin-induced nephrotoxicity, as evidenced by markedly reduced tubular injury and fibrosis. Mechanistically, our data suggest that the protective effect of macrophage ablation against cisplatin-induced ototoxicity and nephrotoxicity is mediated by reduced platinum accumulation in both the inner ear and the kidney. Together, our data indicate that ablation of tissue-resident macrophages represents an important strategy for mitigating cisplatin-induced ototoxicity and nephrotoxicity.
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Affiliation(s)
- Cathy Yea Won Sung
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, Bethesda, MD, USA
| | - Naoki Hayase
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - Peter S. T. Yuen
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - John Lee
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, Bethesda, MD, USA
| | - Katharine Fernandez
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, Bethesda, MD, USA
| | - Xuzhen Hu
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - Hui Cheng
- Bioinformatics and Biostatistics Collaboration Core, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, Bethesda, MD, USA
| | - Robert A. Star
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - Mark E. Warchol
- Department of Otolaryngology, School of Medicine, Washington University, Saint Louis, MO, USA
| | - Lisa L. Cunningham
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, Bethesda, MD, USA
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Cosentino A, Agafonova A, Modafferi S, Trovato Salinaro A, Scuto M, Maiolino L, Fritsch T, Calabrese EJ, Lupo G, Anfuso CD, Calabrese V. Blood-Labyrinth Barrier in Health and Diseases: Effect of Hormetic Nutrients. Antioxid Redox Signal 2024; 40:542-563. [PMID: 37565276 DOI: 10.1089/ars.2023.0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Significance: The stria vascularis, located in the inner ear, consists of three layers, one of which is the blood-labyrinth barrier (BLB). It is formed by endothelial cells, sealed together to prevent the passage of toxic substances from the blood to the inner ear, by pericytes and perivascular-resident macrophage-like melanocyte. Recent Advances: There are various causes that lead to hearing loss, and among these are noise-induced and autoimmune hearing loss, ear disorders related to ototoxic medication, Ménière's disease, and age-related hearing loss. For all of these, major therapeutic interventions include drug-loaded nanoparticles, via intratympanic or intracochlear delivery. Critical Issues: Since many pathologies associated with hearing loss are characterized by a weakening of the BLB, in this review, the molecular mechanisms underlying the response to damage of BLB cellular components have been discussed. In addition, insight into the role of hormetic nutrients against hearing loss pathology is proposed. Future Directions: BLB cellular components of neurovascular cochlear unit play important physiological roles, owing to their impermeable function against all ototoxic substances that can induce damage. Studies are needed to investigate the cross talk occurring between these cellular components to exploit their possible role as novel targets for therapeutic interventions that may unravel future path based on the use of hormetic nutrients. Antioxid. Redox Signal. 40, 542-563.
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Affiliation(s)
- Alessia Cosentino
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Aleksandra Agafonova
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Sergio Modafferi
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Angela Trovato Salinaro
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Maria Scuto
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Luigi Maiolino
- Department of Medical, Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | | | - Edward J Calabrese
- Department of Environmental Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Gabriella Lupo
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Carmelina Daniela Anfuso
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
| | - Vittorio Calabrese
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine; Surgical and Advanced Technologies "G. F. Ingrassia"; University of Catania, Catania, Italy
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Tavazzani E, Spaiardi P, Contini D, Sancini G, Russo G, Masetto S. Precision medicine: a new era for inner ear diseases. Front Pharmacol 2024; 15:1328460. [PMID: 38327988 PMCID: PMC10848152 DOI: 10.3389/fphar.2024.1328460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
The inner ear is the organ responsible for hearing and balance. Inner ear dysfunction can be the result of infection, trauma, ototoxic drugs, genetic mutation or predisposition. Often, like for Ménière disease, the cause is unknown. Due to the complex access to the inner ear as a fluid-filled cavity within the temporal bone of the skull, effective diagnosis of inner ear pathologies and targeted drug delivery pose significant challenges. Samples of inner ear fluids can only be collected during surgery because the available procedures damage the tiny and fragile structures of the inner ear. Concerning drug administration, the final dose, kinetics, and targets cannot be controlled. Overcoming these limitations is crucial for successful inner ear precision medicine. Recently, notable advancements in microneedle technologies offer the potential for safe sampling of inner ear fluids and local treatment. Ultrasharp microneedles can reach the inner ear fluids with minimal damage to the organ, collect μl amounts of perilymph, and deliver therapeutic agents in loco. This review highlights the potential of ultrasharp microneedles, combined with nano vectors and gene therapy, to effectively treat inner ear diseases of different etiology on an individual basis. Though further research is necessary to translate these innovative approaches into clinical practice, these technologies may represent a true breakthrough in the clinical approach to inner ear diseases, ushering in a new era of personalized medicine.
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Affiliation(s)
- Elisa Tavazzani
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- ICS-Maugeri IRCCS, Pavia, Italy
| | - Paolo Spaiardi
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, Pavia, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
| | - Donatella Contini
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Giulio Sancini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Nanomedicine Center, Neuroscience Center, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giancarlo Russo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sergio Masetto
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Kobayashi M, Yoshida T, Sugimoto S, Naganawa S, Sone M. Disruption of the Blood-Perilymph Barrier Preceding Endolymphatic Hydrops Formation in Meniere's Disease. Otol Neurotol 2023; 44:e766-e767. [PMID: 37590878 DOI: 10.1097/mao.0000000000003981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shi X. Research advances in cochlear pericytes and hearing loss. Hear Res 2023; 438:108877. [PMID: 37651921 PMCID: PMC10538405 DOI: 10.1016/j.heares.2023.108877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Pericytes are specialized mural cells surrounding endothelial cells in microvascular beds. They play a role in vascular development, blood flow regulation, maintenance of blood-tissue barrier integrity, and control of angiogenesis, tissue fibrosis, and wound healing. In recent decades, understanding of the critical role played by pericytes in retina, brain, lung, and kidney has seen significant progress. The cochlea contains a large population of pericytes. However, the role of cochlear pericytes in auditory pathophysiology is, by contrast, largely unknown. The present review discusses recent progress in identifying cochlear pericytes, mapping their distribution, and defining their role in regulating blood flow, controlling the blood-labyrinth barrier (BLB) and angiogenesis, and involvement in different types of hearing loss.
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Affiliation(s)
- Xiaorui Shi
- Department of Otolaryngology/Head & Neck Surgery, Oregon Hearing Research Center (NRC04), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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Sekulic M, Puche R, Bodmer D, Petkovic V. Human blood-labyrinth barrier model to study the effects of cytokines and inflammation. Front Mol Neurosci 2023; 16:1243370. [PMID: 37808472 PMCID: PMC10551159 DOI: 10.3389/fnmol.2023.1243370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Hearing loss is one of the 10 leading causes of disability worldwide. No drug therapies are currently available to protect or restore hearing. Inner ear auditory hair cells and the blood-labyrinth barrier (BLB) are critical for normal hearing, and the BLB between the systemic circulation and stria vascularis is crucial for maintaining cochlear and vestibular homeostasis. BLB defects are associated with inner ear diseases that lead to hearing loss, including vascular malformations, inflammation, and Meniere's disease (MD). Antibodies against proteins in the inner ear and cytokines in the cochlea, including IL-1α, TNF-α, and NF-kβ, are detected in the blood of more than half of MD patients. There is also emerging evidence of inner ear inflammation in some diseases, including MD, progressive sensorineural hearing loss, otosclerosis, and sudden deafness. Here, we examined the effects of TNF-α, IL6, and LPS on human stria vascularis-derived primary endothelial cells cultured together with pericytes in a Transwell system. By measuring trans-endothelial electrical resistance, we found that TNF-α causes the most significant disruption of the endothelial barrier. IL6 had a moderate influence on the barrier, whereas LPS had a minimal impact on barrier integrity. The prominent effect of TNF-α on the barrier was confirmed in the expression of the major junctional genes responsible for forming the tight endothelial monolayer, the decreased expression of ZO1 and OCL. We further tested permeability using 2 μg of daptomycin (1,619 Da), which does not pass the BLB under normal conditions, by measuring its passage through the barrier by HPLC. Treatment with TNF-α resulted in higher permeability in treated samples compared to controls. LPS-treated cells behaved similarly to the untreated cells and did not show differences in permeability compared to control. The endothelial damage caused by TNF-α was confirmed by decreased expression of an essential endothelial proteoglycan, syndecan1. These results allowed us to create an inflammatory environment model that increased BLB permeability in culture and mimicked an inflammatory state within the stria vascularis.
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Affiliation(s)
- Marijana Sekulic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raoul Puche
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Bodmer
- University Hospital Basel, Clinic for Otorhinolaryngology, Basel, Switzerland
| | - Vesna Petkovic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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12
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Coon A, Setzen G, Musah RA. Mass Spectrometric Interrogation of Earwax: Toward the Detection of Ménière's Disease. ACS OMEGA 2023; 8:27010-27023. [PMID: 37546591 PMCID: PMC10399190 DOI: 10.1021/acsomega.3c01943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
Many diseases remain difficult to identify because the occurrence of characteristic biomarkers within traditional matrices such as blood and urine remain unknown. Disease diagnosis could, therefore, benefit from the analysis of readily accessible, non-traditional matrices that have a high chemical content and contain distinguishing biomarkers. One such matrix is cerumen (i.e., earwax), whose chemical complexity can pose challenges when analyzed by conventional methods. A combination of cerumen chemical profiles analyzed by gas chromatography-mass spectrometry (GC-MS) and direct analysis in real time-high-resolution mass spectrometry (DART-HRMS) were investigated to ascertain the possible presence of the rare otolaryngological disorder Ménière's disease. This illness is currently identified via "diagnosis by exclusion" in which the disease is distinguished from others with overlapping symptoms by the process of elimination. GC-MS revealed a chemical profile difference between those with and without a Ménière's disease diagnosis by a visually apparent diminution of the compounds present in the Ménière's disease samples. DART-HRMS revealed that the two classes could be differentiated using three fatty acids: cis-9-hexadecenoic acid, cis-10-heptadecenoic acid, and cis-9-octadecenoic acid. These compounds were subsequently quantified by GC-MS and overall, the amounts of these fatty acids were decreased in Ménière's disease patients. The average levels for non-Ménière's disease samples were 7.89 μg/mg for cis-9-hexadecenoic acid, 0.87 μg/mg for cis-10-heptadecenoic acid, and 4.94 μg/mg for cis-9-octadecenoic acid. The average levels for Ménière's disease samples were 1.70 μg/mg for cis-9-hexadecenoic acid, 0.13 μg/mg for cis-10-heptadecenoic acid, and 2.07 μg/mg for cis-9-octadecenoic acid. The confidence levels for cis-9-hexadecenoic acid, cis-10-heptadecenoic acid, and cis-9-octadecenoic acid were 98.7%, 99.9%, and 95.4%, respectively. The results suggest that assessment of the concentrations of these fatty acids could be a useful clinical tool for the more rapid and accurate detection of Ménière's disease.
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Affiliation(s)
- Allix
Marie Coon
- Department
of Chemistry, University at Albany, State
University of New York, 1400 Washington Avenue, Albany, New York 12222, United States
| | - Gavin Setzen
- Albany
ENT and Allergy Services, 123 Everett Rd, Albany, New York 12205, United States
| | - Rabi Ann Musah
- Department
of Chemistry, University at Albany, State
University of New York, 1400 Washington Avenue, Albany, New York 12222, United States
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13
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Zhang M, Zhao T, Feng Y, Li X, Song N, Ma X, Yang X, Sui R. The value of postcontrast delayed 3D fluid-attenuated inversion recovery MRI in the diagnosis of unilateral peripheral vestibular dysfunction. Quant Imaging Med Surg 2023; 13:5072-5088. [PMID: 37581086 PMCID: PMC10423377 DOI: 10.21037/qims-22-1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/23/2023] [Indexed: 08/16/2023]
Abstract
Background Clinically, unilateral peripheral vestibular dysfunction (UPVD) with dizziness or vertigo as the chief complaint is quite common. This study aimed to investigate the correlations between 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) findings and cochleovestibular function test results in patients with UPVD and to explore the possible etiologies of UPVD. Methods This retrospective study enrolled 76 patients with UPVD. Endolymphatic hydrops (EH) and perilymphatic enhancement (PE) in the vestibule and cochlea on 3D-FLAIR images, their correlations with the parameters of the cochleovestibular function test and vascular risk factors, and the immunological findings of patients with EH and PE were assessed. Results Of the included patients, 48.7% showed positive MRI findings (the presence of EH and PE on 1 side). The pure-tone average (PTA) was higher in patients with cochlear PE than in those with vestibular (P=0.014) and cochlear EH (P=0.02). The canal paresis (CP) value was also higher in patients with vestibular PE than in those with vestibular (P=0.002) and cochlear EH (P=0.003). Video head impulse test (vHIT) gains were lower in patients with vestibular and cochlear PE than in those with vestibular and cochlear EH (P<0.001). A positive correlation was observed between the degree of vestibular and cochlear EH and PTA (both P values <0.001). PTA and CP with a cutoff value of 32 dB and 46.5%, respectively, yielded high sensitivity and specificity in determining positive MRI findings (P<0.001 and P=0.029, respectively). The prevalence of vascular risk factors was significantly higher in patients with PE than in those with EH (P=0.033). Conclusions (I) Nearly half of the patients UPVD exhibited abnormal MRI findings. Cutoff values for PTA and CP of 32 dB and 46.5%, respectively, indicated that patients were more likely to have abnormal imaging findings. (II) The severity of EH was positively correlated with hearing impairment. (III) Patients with PE showed severe hearing impairment and vestibular dysfunction, which was presumed to be associated with vascular damage.
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Affiliation(s)
- Menglu Zhang
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Tongtong Zhao
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yufei Feng
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ning Song
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xinyan Ma
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Rubo Sui
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Bertagnoli LE, Seist R, Batts S, Stankovic KM. Potential Ototoxicity of Insulin-like Growth Factor 1 Receptor Signaling Inhibitors: An In Silico Drug Repurposing Study of the Regenerating Cochlear Neuron Transcriptome. J Clin Med 2023; 12:jcm12103485. [PMID: 37240591 DOI: 10.3390/jcm12103485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Spiral ganglion neurons (SGNs) connect cochlear hair cells with higher auditory pathways and their degeneration due to drug toxicity (ototoxicity) contributes to hearing loss. This study aimed to identify drug classes that are negatively correlated with the transcriptome of regenerating SGNs. Human orthologs of differentially expressed genes within the regenerating neonatal mouse SGN transcriptome were entered into CMap and the LINCS unified environment and perturbation-driven gene expression was analyzed. The CMap connectivity scores ranged from 100 (positive correlation) to -100 (negative correlation). Insulin-like growth factor 1/receptor (IGF-1/R) inhibitors were highly negatively correlated with the regenerating SGN transcriptome (connectivity score: -98.87). A systematic literature review of clinical trials and observational studies reporting otologic adverse events (AEs) with IGF-1/R inhibitors identified 108 reports (6141 treated patients). Overall, 16.9% of the treated patients experienced any otologic AE; the rate was highest for teprotumumab (42.9%). In a meta-analysis of two randomized placebo-controlled trials of teprotumumab, there was a significantly higher risk of hearing-related (pooled Peto OR [95% CI]: 7.95 [1.57, 40.17]) and of any otologic AEs (3.56 [1.35, 9.43]) with teprotumumab vs. a placebo, whether or not dizziness/vertigo AEs were included. These results call for close audiological monitoring during IGF-1-targeted treatment, with prompt referral to an otolaryngologist should otologic AEs develop.
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Affiliation(s)
- Lino E Bertagnoli
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
- Paracelsus Medical University, 5020 Salzburg, Austria
| | - Richard Seist
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
- Paracelsus Medical University, 5020 Salzburg, Austria
| | - Shelley Batts
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA 94305, USA
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15
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Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression. J Neurol 2023; 270:82-100. [PMID: 36255522 DOI: 10.1007/s00415-022-11399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/07/2023]
Abstract
Combining magnetic resonance imaging (MRI) sequences that permit the determination of vestibular nerve angulation (NA = change of nerve caliber or direction), structural nerve integrity via diffusion tensor imaging (DTI), and exclusion of endolymphatic hydrops (ELH) via delayed gadolinium-enhanced MRI of the inner ear (iMRI) could increase the diagnostic accuracy in patients with vestibular paroxysmia (VP). Thirty-six participants were examined, 18 with VP (52.6 ± 18.1 years) and 18 age-matched with normal vestibulocochlear testing (NP 50.3 ± 16.5 years). This study investigated whether (i) NA, (ii) DTI changes, or (iii) ELH occur in VP, and (iv) to what extent said parameters relate. Methods included vestibulocochlear testing and MRI data analyses for neurovascular compression (NVC) and NA verification, DTI and ELS quantification. As a result, (i) NA increased NVC specificity. (ii) DTI structural integrity was reduced on the side affected by VP (p < 0.05). (iii) 61.1% VP showed mild ELH and higher asymmetry indices than NP (p > 0.05). (iv) "Disease duration" and "total number of attacks" correlated with the decreased structural integrity of the affected nerve in DTI (p < 0.001). NVC distance within the nerve's root-entry zone correlated with nerve function (Roh = 0.72, p < 0.001), nerve integrity loss (Roh = - 0.638, p < 0.001), and ELS volume (Roh = - 0.604, p < 0.001) in VP. In conclusion, this study is the first to link eighth cranial nerve function, microstructure, and ELS changes in VP to clinical features and increased vulnerability of NVC in the root-entry zone. Combined MRI with NVC or NA verification, DTI and ELS quantification increased the diagnostic accuracy at group-level but did not suffice to diagnose VP on a single-subject level due to individual variability and lack of diagnostic specificity.
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16
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Anfuso CD, Cosentino A, Agafonova A, Zappalà A, Giurdanella G, Trovato Salinaro A, Calabrese V, Lupo G. Pericytes of Stria Vascularis Are Targets of Cisplatin-Induced Ototoxicity: New Insights into the Molecular Mechanisms Involved in Blood-Labyrinth Barrier Breakdown. Int J Mol Sci 2022; 23:ijms232415790. [PMID: 36555432 PMCID: PMC9781621 DOI: 10.3390/ijms232415790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
The stria vascularis (SV) contributes to cochlear homeostasis and consists of three layers, one of which contains the blood-labyrinthic barrier (BLB), with a large number of bovine cochlear pericytes (BCPs). Cisplatin is a chemotherapeutic drug that can damage the SV and cause hearing loss. In this study, cell viability, proliferation rate, cytotoxicity and reactive oxygen species production were evaluated. The protein content of phospho-extracellular signal-regulated kinases (ERK) 1/2, total ERK 1/2, phospho-cytosolic phospholipase A2 (cPLA2), total cPLA2 and cyclooxygenase 2 (COX-2) and the release of prostaglandin E2 (PGE2) and vascular endothelial growth factor (VEGF) from BCPs were analyzed. Finally, the protective effect of platelet-derived growth factor (PDGF-BB) on BCPs treated with cisplatin was investigated. Cisplatin reduced viability and proliferation, activated ERK 1/2, cPLA2 and COX-2 expression and increased PGE2 and VEGF release; these effects were reversed by Dexamethasone. The presence of PDGF-BB during the treatment with cisplatin significantly increased the proliferation rate. No studies on cell regeneration in ear tissue evaluated the effect of the PDGF/Dex combination. The aim of this study was to investigate the effects of cisplatin on cochlear pericytes and propose new otoprotective agents aimed at preventing the reduction of their vitality and thus maintaining the BLB structure.
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Affiliation(s)
- Carmelina Daniela Anfuso
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Alessia Cosentino
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Aleksandra Agafonova
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Agata Zappalà
- Section of Physiology, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | | | - Angela Trovato Salinaro
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Vittorio Calabrese
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Gabriella Lupo
- Section of Medical Biochemistry, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy
- Correspondence:
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17
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Denton AJ, Godur DA, Mittal J, Bencie NB, Mittal R, Eshraghi AA. Recent Advancements in Understanding the Gut Microbiome and the Inner Ear Axis. Otolaryngol Clin North Am 2022; 55:1125-1137. [PMID: 36088154 DOI: 10.1016/j.otc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The gut microbiome and its dynamic association with organ systems beyond the gastrointestinal tract, such as the nervous and cardiovascular systems, is an emerging area of research. Although the role of the gut microbiome has been extensively characterized in the gut-brain axis, the implications of gut dysbiosis in inner ear inflammation and hearing deficits have still not been explored. With some similarities outlined between the blood-brain barrier (BBB) and the blood labyrinth barrier (BLB) of the inner ear, this review aims to explore the axis between the gut microbiome and the inner ear as it pertains to their bidirectional communication.
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Affiliation(s)
- Alexa J Denton
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dimitri A Godur
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeenu Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nathalie B Bencie
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rahul Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adrien A Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA; Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.
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18
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Veit JGS, Birru B, Wang Y, Singh R, Arrigali EM, Park R, Miller B, Firpo MA, Park AH, Serban MA. An Evaluation of the Drug Permeability Properties of Human Cadaveric In Situ Tympanic and Round Window Membranes. Pharmaceuticals (Basel) 2022; 15:ph15091037. [PMID: 36145258 PMCID: PMC9501436 DOI: 10.3390/ph15091037] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
It is estimated that hearing loss currently affects more than 1.5 billion people, or approximately 20% of the global population; however, presently, there are no Food and Drug Administration-approved therapeutics or prophylactics for this condition. While continued research on the development of otoprotective drugs to target this clear unmet need is an obvious path, there are numerous challenges to translating promising therapeutic candidates into human clinical testing. The screening of promising drug candidates relies exclusively on preclinical models. Current models do not permit the rapid high-throughput screening of promising drug candidates, and their relevance to clinical scenarios is often ambiguous. With the current study, we seek to understand the drug permeability properties of the cadaveric tympanic and round window membranes with the goal of generating knowledge that could inform the design and/or evaluation of in vitro organotypic models. The development of such models could enable the early high-throughput screening of topical therapeutic candidates and should address some of the limitations of currently used animal models.
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Affiliation(s)
- Joachim G. S. Veit
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT 59812, USA
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT 59812, USA
| | - Bhaskar Birru
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT 59812, USA
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT 59812, USA
| | - Yong Wang
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Ruby Singh
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT 59812, USA
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT 59812, USA
| | - Elizabeth M. Arrigali
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT 59812, USA
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT 59812, USA
| | - Ryan Park
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Briggs Miller
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Matthew A. Firpo
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Albert H. Park
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Monica A. Serban
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT 59812, USA
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT 59812, USA
- Correspondence:
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19
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Ishii M, Ishiyama G, Ishiyama A, Kato Y, Mochizuki F, Ito Y. Relationship Between the Onset of Ménière's Disease and Sympathetic Hyperactivity. Front Neurol 2022; 13:804777. [PMID: 35370896 PMCID: PMC8970286 DOI: 10.3389/fneur.2022.804777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The pathogenesis of Ménière's disease is still largely unknown; however, it is known to be strongly associated with stress. Excessive stress can cause hyperactivity of the sympathetic autonomic nervous system. With the aim of understanding changes in sympathetic hyperactivity before and after Ménière's disease, we compared autonomic nervous function in patients in a stable phase of Ménière's disease and that in healthy adults. We also gathered data over about 10 years on autonomic nervous function immediately before a Ménière's attack. Study Design Prospective study. Patients Autonomic nervous function was analyzed in 129 patients in a stable phase of Ménière's disease 31 healthy adult volunteers. In nine patients, autonomic nervous function was also measured immediately before and after treatment of a vertigo attack. Main Outcome Measure Power spectrum analysis of heart rate variability (HRV) of EEG/ECG and an infrared electronic pupillometer were used. Sympathetic and parasympathetic nervous function was measured. Results There were no statistically significant differences in autonomic nervous function determined by HRV and electronic pupillometry between patients in a stable phase of Ménière's disease and healthy adults. Sympathetic function as measured by electronic pupillometry parameters VD and T5 showed no difference between the affected and unaffected sides in the baseline data measured in the stable phase (VD: affected side is 31.02 ± 6.16 mm/sec, unaffected side is 29.25 ± 5.73 mm/sec; T5: affected side is 3.37 ± 0.43 msec, unaffected side is 3.25 ± 0.39 msec). In contrast, all nine patients whose HRV data had been obtained just before an attack showed marked suppression of the parasympathetic nervous system and activation of the sympathetic nervous system. Electronic pupillometry also revealed an overactivation of the sympathetic nervous system on the affected side, just before the attacks. Analysis of sequential changes after the onset of an attack revealed that overactivation on the affected side was reduced after treatment, and no difference between affected and unaffected sides was observed 3 days after treatment. Conclusion Detailed analysis of autonomic nervous function showed that immediately before an attack of Ménière's disease, the sympathetic nervous system on the affected side was strongly overactivated.
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Affiliation(s)
- Masanori Ishii
- Department of Otorhinolaryngology, Japan Community Health Care Organization (JCHO) Tokyo Shinjuku Medical Center, Tokyo, Japan
- Department of Otorhinolaryngology and Head & Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
- *Correspondence: Masanori Ishii
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Yujin Kato
- Department of Otorhinolaryngology and Head & Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiro Mochizuki
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Ito
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
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20
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Association between Late-Onset Ménière's Disease and the Risk of Incident All-Cause Dementia. J Pers Med 2021; 12:jpm12010019. [PMID: 35055334 PMCID: PMC8780200 DOI: 10.3390/jpm12010019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 12/05/2022] Open
Abstract
Studies reported an association between impaired hearing and vestibular function with the risk of dementia. This study investigated the association between Ménière’s disease (MD) and the risk of dementia using a nationwide cohort sample of data obtained from the South Korea National Health Insurance Service. The MD group (n = 496) included patients aged over 55 years and diagnosed between 2003 and 2006. The comparison group was selected using propensity score matching (n = 1984). Cox proportional hazards regression models were used to calculate incidence and hazard ratios for dementia events. The incidence of dementia was 14.3 per 1000 person–years in the MD group. After adjustment for certain variables, the incidence of dementia was higher in the MD group than in the comparison group (adjusted hazard ratio (HR) = 1.57, 95% confidence interval = 1.17–2.12). Subgroup analysis showed a significantly increased adjusted HR for developing Alzheimer’s disease (1.69, 95% confidence interval = 1.20–2.37) and vascular dementia (1.99, 95% confidence interval = 1.10–3.57) in the MD group. Patients with dementia experienced a higher frequency of MD episodes than those without dementia. Our findings suggest that late-onset MD is associated with an increased incidence of all-cause dementia, and it might be used as a basis for an earlier diagnosis of dementia.
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21
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Iinuma R, Okuda H, Obara N, Matsubara Y, Aoki M, Ogawa T. Increased Monocyte Chemotactic Protein-1 Accompanying Pro-Inflammatory Processes are Associated with Progressive Hearing Impairment and Bilateral Disability of Meniere's Disease. Audiol Neurootol 2021; 27:208-216. [PMID: 34903680 DOI: 10.1159/000518839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The progression of hearing impairment and the bilateral involvement of Meniere's disease (MD) may depend on the disease duration and aging. Recent studies reported that MD might involve dysfunction of the microvascular circulation damaged due to inflammatory changes. OBJECTIVES The aim of this study was to determine that the progress of the MD's hearing impairment and bilateral disability may be associated with the pathogenesis of several pro-inflammatory processes. PATIENTS AND METHODS We recruited 30 unilateral MD patients (56.8 ± 14.7 years old), 7 bilateral MD patients (65.3 ± 13.9 years old), and 17 age-matched control subjects (53.5 ± 14.4 years old, p > 0.05). We measured the plasma vascular endothelial growth factor (VEGF), plasma interleukin-6 (IL-6), plasma tumor-necrosis factor α (TNFα), and plasma monocyte chemotactic protein-1 (MCP-1). RESULTS The bilateral MD group and the unilateral MD group had higher plasma MCP-1 (204.7 ± 41.0 pg/mL and 169.5 ± 32.0 pg/mL) than the control group (149.2 ± 30.7 pg/mL) (p < 0.05). There was no significant difference in plasma TNFα, IL-6, and VEGF among 3 groups (p > 0.05). There was a strong correlation between the plasma MCP-1 and age in MD patients (r = 0.58, p < 0.01); however, no significant correlation between the plasma MCP-1 and age was found in control subjects (p > 0.05). The plasma MCP-1 significantly correlated with the average hearing level of 500, 1,000, 2,000, and 4,000 Hz, and the maximum slow phase eye velocity in caloric test in the better side (p < 0.05). Also, the plasma MCP-1 showed significant positive correlations with the plasma IL-6 (r = 0.49, p < 0.01) and plasma TNFα (r = 0.32, p < 0.05) in MD group. CONCLUSIONS Our results suggest that the increased plasma MCP-1 accompanying pro-inflammatory processes are associated with the progression of the hearing impairment and the bilateral disability of MD.
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Affiliation(s)
- Ryota Iinuma
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Hiroshi Okuda
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Natsuko Obara
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Yoshitaka Matsubara
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan.,Medical IT Support Department, HRS Co., LTD., Nagoya City, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan.,Center for Healthcare Information Technology (C-HiT), Tokai National Higher Education and Research System, Nagoya City, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu City, Japan
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22
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de Pont LMH, van Steekelenburg JM, Verhagen TO, Houben M, Goeman JJ, Verbist BM, van Buchem MA, Bommeljé CC, Blom HM, Hammer S. Hydropic Ear Disease: Correlation Between Audiovestibular Symptoms, Endolymphatic Hydrops and Blood-Labyrinth Barrier Impairment. Front Surg 2021; 8:758947. [PMID: 34805261 PMCID: PMC8601159 DOI: 10.3389/fsurg.2021.758947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
Research Objective: To investigate the correlation between clinical features and MRI-confirmed endolymphatic hydrops (EH) and blood-labyrinth barrier (BLB) impairment. Study Design: Retrospective cross-sectional study. Setting: Vertigo referral center (Haga Teaching Hospital, The Hague, the Netherlands). Methods: We retrospectively analyzed all patients that underwent 4 h-delayed Gd-enhanced 3D FLAIR MRI at our institution from February 2017 to March 2019. Perilymphatic enhancement and the degree of cochlear and vestibular hydrops were assessed. The signal intensity ratio (SIR) was calculated by region of interest analysis. Correlations between MRI findings and clinical features were evaluated. Results: Two hundred and fifteen patients with MRI-proven endolymphatic hydrops (EH) were included (179 unilateral, 36 bilateral) with a mean age of 55.9 yrs and median disease duration of 4.3 yrs. Hydrops grade is significantly correlated with disease duration (P < 0.001), the severity of low- and high-frequency hearing loss (both P < 0.001), and the incidence of drop attacks (P = 0.001). Visually increased perilymphatic enhancement was present in 157 (87.7%) subjects with unilateral EH. SIR increases in correlation with hydrops grade (P < 0.001), but is not significantly correlated with the low or high Fletcher index (P = 0.344 and P = 0.178 respectively). No significant differences were found between the degree of EH or BLB impairment and vertigo, tinnitus or aural fullness. Conclusion: The degree of EH positively correlates with disease duration, hearing loss and the incidence of drop attacks. The BLB is impaired in association with EH grade, but without clear contribution to the severity of audiovestibular symptoms.
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Affiliation(s)
- Lisa M H de Pont
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Thijs O Verhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands
| | - Maartje Houben
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Claire C Bommeljé
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Henk M Blom
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands.,Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
| | - Sebastiaan Hammer
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
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23
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Samocha-Bonet D, Wu B, Ryugo DK. Diabetes mellitus and hearing loss: A review. Ageing Res Rev 2021; 71:101423. [PMID: 34384902 DOI: 10.1016/j.arr.2021.101423] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022]
Abstract
Diabetes (type 2) and sensorineural hearing loss are common health problems manifested with ageing. While both type 1 and type 2 diabetes have been associated with hearing loss, a causal link has been difficult to establish. Individuals with diabetes have twice the incidence of hearing loss compared to those without diabetes and those with prediabetes have a 30% higher rate of hearing loss. Whether hearing loss is associated with diabetes independent of glycemic control remains to be determined. Hearing loss has its own set of risk factors and shares others with diabetes. This review will summarize the complex relationship between diabetes and sensorineural hearing loss.
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Affiliation(s)
- Dorit Samocha-Bonet
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, UNSW Sydney, Darlinghurst, NSW, 2010, Australia.
| | - Buffy Wu
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia; School of Medical Sciences, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - David K Ryugo
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia; School of Medical Sciences, UNSW Sydney, Kensington, NSW, 2052, Australia; Department of Otolaryngology Head and Neck and Skull Base Surgery, St. Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
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24
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Asgarbeik S, Vahidi A, Yazdani N, Tajdini A, Amoli MM. VEGFA gene haplotypes in Meniere's disease. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Isolated Saccular Hydrops on High-resolution MRI Is Associated With Full Spectrum Menière's Disease. Otol Neurotol 2021; 42:876-882. [PMID: 33481544 DOI: 10.1097/mao.0000000000003051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the clinical presentation of patients with isolated saccular endolymphathic hydrops (EH) detected. STUDY DESIGN Clinical case series. SETTING University-based tertiary referral center. PATIENTS All subjects presenting with vertigo or hearing loss who had isolated saccular EH detected. INTERVENTION High-resolution delayed-contrast magnetic resonance imaging (MRI) conducted between November 2015 and November 2016. MAIN OUTCOME MEASURES Audiovestibular testing results and analysis of clinical histories. RESULTS Isolated saccular EH was detected in 18 subjects. Sixteen met criteria for definite Menière's disease (MD, n = 12) or delayed endolymphatic hydrops (DEH, n = 4). One had a history of sudden sensorineural hearing loss (SSNHL) and 3 years after MRI developed recurrent vertigo characteristic of DEH. One patient had a history of atypical DEH (Tumarkin falls without vertigo following SSNHL). Four patients had Tumarkin falls. Most (83%) demonstrated mild-to-severe low-frequency fluctuating loss, and six (33.3%) had a history of ipsilateral sudden profound SNHL. Nine of the 17 (53%) patients tested had an ipsilateral caloric paresis ranging from 26 to 67%. Ipsilateral vestibular-evoked myogenic potentials showed reduced or absent responses in 5 of the 17 tested (29%). CONCLUSIONS The full spectrum of MD may be associated with saccular hydrops. We propose that MD and DEH often begin in the saccule, and MRI may provide clues to the pathophysiology of MD. Saccular hydrops was present in one patient with SSNHL who did not develop vertigo spells until 3 years after MRI, indicating that saccular hydrops may be the first manifestation of MD or DEH.
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26
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Alonso JE, Ishiyama GP, Fujiwara RJT, Pham N, Ledbetter L, Ishiyama A. Cochlear Meniere's: A Distinct Clinical Entity With Isolated Cochlear Hydrops on High-Resolution MRI? Front Surg 2021; 8:680260. [PMID: 34222320 PMCID: PMC8242163 DOI: 10.3389/fsurg.2021.680260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Describe the clinical characteristics of patients with isolated cochlear endolymphatic hydrops (EH). Study design: Clinical case series. Setting: Tertiary Neurotology referral clinic. Patients: All subjects presenting to a University Neurotology clinic during a 1-year period from July 2015 until August 2016 who had isolated cochlear EH on MRI. Patients with a history of temporal bone surgery prior to the MRI were excluded. Intervention: High-resolution delayed-intravenous contrast MRI. Main outcome measures: Audiometric and vestibular testing, clinical history analysis. Results: 10 subjects demonstrated isolated, unilateral cochlear hydrops on MRI. None of these patients met the criteria for Meniere's disease. Mean age of the group was 66.4 years and most were males (70%). Unilateral aural fullness (70%), tinnitus (80%), and hearing loss (90%) were frequently observed. Only one patient presented with unsteadiness (10%) and one patient had a single isolated spell of positional vertigo 1 month prior to the MRI (10%) but no further vertigo spells in the 4 years following the MRI. The mean PTA was 37.8 dB which was significantly decreased from the non-affected ear with PTA of 17.9 (p < 0.001). One patient developed vertiginous spells and unsteadiness 4 years after initial presentation and a repeat MRI revealed progression to utricular, saccular and cochlear hydrops. Vestibular testing was obtained in five patients with one patient presenting with 50% caloric paresis and all others normal. The most common treatment tried was acetazolamide in seven patients with 86% reporting subjective clinical improvement. Two out of the 10 patients had a history of migraine (20%). Conclusions: Patients with MRI exhibiting isolated cochlear EH present with predominantly auditory symptoms: mild to moderate low-frequency hearing loss, aural fullness, tinnitus without significant vertigo. Isolated cochlear hydrops is more common in males, average age in mid-60's and there is a low comorbidity of migraine headaches. This contrasts significantly with patients with isolated saccular hydrops on MRI from our prior studies. We believe that isolated cochlear EH with hearing loss but no vertigo is distinct from Meniere's disease or its variant delayed endolymphatic hydrops. We propose that cochlear Meniere's disease represents a distinct clinical entity that could be a variant of Meniere's disease.
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Affiliation(s)
- Jose E Alonso
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gail P Ishiyama
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rance J T Fujiwara
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nancy Pham
- Department of Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Luke Ledbetter
- Department of Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
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27
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Song CI, Pogson JM, Andresen NS, Ward BK. MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review. Front Neurol 2021; 12:662264. [PMID: 34093410 PMCID: PMC8173087 DOI: 10.3389/fneur.2021.662264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Capillaries within the inner ear form a semi-permeable barrier called the blood-labyrinth barrier that is less permeable than capillary barriers elsewhere within the human body. Dysfunction of the blood-labyrinth barrier has been proposed as a mechanism for several audio-vestibular disorders. There has been interest in using magnetic resonance imaging (MRI) with intravenous gadolinium-based contrast agents (GBCA) as a marker for the integrity of the blood labyrinth barrier in research and clinical settings. This scoping review evaluates the evidence for using intravenous gadolinium-enhanced MRI to assess the permeability of the blood-labyrinth barrier in healthy and diseased ears. Methods: A systematic search was conducted of three databases: PubMed, EMBASE, CINAHL PLUS. Studies were included that used GBCA to study the inner ear and permeability of the blood-labyrinth barrier. Data was collected on MRI protocols used and inner ear enhancement patterns of healthy and diseased ears in both human and animal studies. Results: The search yielded 14 studies in animals and 53 studies in humans. In healthy animal and human inner ears, contrast-enhanced MRI demonstrated gradual increase in inner ear signal intensity over time that was limited to the perilymph. Signal intensity peaked at 100 min in rodents and 4 h in humans. Compared to controls, patients with idiopathic sudden sensorineural hearing loss and otosclerosis had increased signal intensity both before and shortly after GBCA injection. In patients with Ménière's disease and vestibular schwannoma, studies reported increased signal at 4 h, compared to controls. Quality assessment of included studies determined that all the studies lacked sample size justification and many lacked adequate control groups or blinded assessors of MRI. Conclusions: The included studies provided convincing evidence that gadolinium crosses the blood-labyrinth barrier in healthy ears and more rapidly in some diseased ears. The timing of increased signal differs by disease. There was a lack of evidence that these findings indicate general permeability of the blood-labyrinth barrier. Future studies with consistent and rigorous methods are needed to investigate the relationship between gadolinium uptake and assessments of inner ear function and to better determine whether signal enhancement indicates permeability for molecules other than gadolinium.
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Affiliation(s)
- Christopher I Song
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jacob M Pogson
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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28
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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29
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Abstract
: The relationship between Menière's disease and endolymphatic hydrops is ambiguous. On the one hand, the existence of cases of endolymphatic hydrops lacking the classic symptoms of Menière's disease has prompted the assertion that endolymphatic hydrops alone is insufficient to cause symptoms and drives the hypothesis that endolymphatic hydrops is a mere epiphenomenon. Yet, on the other hand, there is considerable evidence suggesting a relationship between the mechanical pressure effects of endolymphatic hydrops and resultant disordered auditory physiology and symptomatology. A critical appraisal of this topic is undertaken, including a review of key histopathologic data chiefly responsible for the epiphenomenon hypothesis. Overall, a case is made that A) the preponderance of available evidence suggests endolymphatic hydrops is likely responsible for some of the auditory symptoms of Menière's disease, particularly those that can be modulated by mechanical manipulation of the basilar membrane and cochlear microphonic; B) Menière's disease can be reasonably considered part of a larger spectrum of hydropic inner ear disease that also includes some cases that lack vertigo. C) The relationship with endolymphatic hydrops sufficiently robust to consider its presence a hallmark defining feature of Menière's disease and a sensible target for diagnostic detection.
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30
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Tang S, Yonezawa T, Maeda Y, Ono M, Maeba T, Miyoshi T, Momota R, Tomono Y, Oohashi T. Lack of collagen α6(IV) chain in mice does not cause severe-to-profound hearing loss or cochlear malformation, a distinct phenotype from nonsyndromic hearing loss with COL4A6 missense mutation. PLoS One 2021; 16:e0249909. [PMID: 33848312 PMCID: PMC8043391 DOI: 10.1371/journal.pone.0249909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Congenital hearing loss affects 1 in every 1000 births, with genetic mutations contributing to more than 50% of all cases. X-linked nonsyndromic hereditary hearing loss is associated with six loci (DFNX1-6) and five genes. Recently, the missense mutation (c.1771G>A, p.Gly591Ser) in COL4A6, encoding the basement membrane (BM) collagen α6(IV) chain, was shown to be associated with X-linked congenital nonsyndromic hearing loss with cochlear malformation. However, the mechanism by which the COL4A6 mutation impacts hereditary hearing loss has not yet been elucidated. Herein, we investigated Col4a6 knockout (KO) effects on hearing function and cochlear formation in mice. Immunohistochemistry showed that the collagen α6(IV) chain was distributed throughout the mouse cochlea within subepithelial BMs underlying the interdental cells, inner sulcus cells, basilar membrane, outer sulcus cells, root cells, Reissner's membrane, and perivascular BMs in the spiral limbus, spiral ligament, and stria vascularis. However, the click-evoked auditory brainstem response analysis did not show significant changes in the hearing threshold of Col4a6 KO mice compared with wild-type (WT) mice with the same genetic background. In addition, the cochlear structures of Col4a6 KO mice did not exhibit morphological alterations, according to the results of high-resolution micro-computed tomography and histology. Hence, loss of Col4a6 gene expression in mice showed normal click ABR thresholds and normal cochlear formation, which differs from humans with the COL4A6 missense mutation c.1771G>A, p.Gly591Ser. Therefore, the deleterious effects in the auditory system caused by the missense mutation in COL4A6 are likely due to the dominant-negative effects of the α6(IV) chain and/or α5α6α5(IV) heterotrimer with an aberrant structure that would not occur in cases with loss of gene expression.
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Affiliation(s)
- Shaoying Tang
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Yonezawa
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail:
| | - Yukihide Maeda
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Maeba
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryusuke Momota
- Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuko Tomono
- Division of Molecular and Cell Biology, Shigei Medical Research Institute, Okayama, Japan
| | - Toshitaka Oohashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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31
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Ishiyama G. Selected Otologic Disorders Causing Dizziness. ACTA ACUST UNITED AC 2021; 27:468-490. [PMID: 34351115 DOI: 10.1212/con.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. RECENT FINDINGS The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. SUMMARY This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
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Perin P, Marino F, Varela-Nieto I, Szczepek AJ. Editorial: Neuroimmunology of the Inner Ear. Front Neurol 2021; 12:635359. [PMID: 33633679 PMCID: PMC7899967 DOI: 10.3389/fneur.2021.635359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Paola Perin
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology University of Insubria, Varese, Italy
| | - Isabel Varela-Nieto
- Institute for Biomedical Research "Alberto Sols" (IIBM), Spanish National Research Council-Autonomous University of Madrid (CSIC-UAM), Madrid, Spain.,Rare Diseases Networking Biomedical Research Centre, Centro de Investigación Biomédica en Red, Carlos III Institute of Health, Madrid, Spain.,La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
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33
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Bae SH, Yoo JE, Choe YH, Kwak SH, Choi JY, Jung J, Hyun YM. Neutrophils infiltrate into the spiral ligament but not the stria vascularis in the cochlea during lipopolysaccharide-induced inflammation. Am J Cancer Res 2021; 11:2522-2533. [PMID: 33456557 PMCID: PMC7806478 DOI: 10.7150/thno.49121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/06/2020] [Indexed: 12/16/2022] Open
Abstract
It has been challenging to apply intravital imaging for monitoring the inner ear, as the anatomical location and intricate structure hamper the access of imaging instruments to the inner ear of live mice. By employing intravital imaging of the cochlea in live mice with two-photon microscopy, we investigated neutrophil infiltration into the cochlea tissue and its characteristics under a lipopolysaccharide (LPS)-induced inflammatory state. Methods: Cochlea inflammation was induced by LPS injection to the middle ear. Using two-photon intravital microscopy with specifically designed surgical exteriorization of the cochlea in live mice, we investigated the dynamic features of neutrophils in the lateral wall of the cochlea. The molecular expression pattern of the cochlea lateral wall was also investigated during the LPS-induce inflammation. Results: Despite the contention of whether neutrophils are recruited to the spiral ligament (SL) during inflammation, we observed that LPS-induced inflammation of the middle ear, which mimics acute otitis media, triggered neutrophil migration to the SL in the lateral wall. Notably, massive neutrophil infiltration to the SL occurred 2 days after LPS inoculation, but there was no neutrophil infiltration into the stria vascularis (SV) region. At 1 day after LPS-induced cochlear inflammation, increased mRNA expression of interleukin-1β, interleukin-6 were identified in both the SL and SV, while the ICAM-1 mRNA expression increased only in the SL. The differential reactivity of ICAM-1 is likely responsible for the different neutrophil recruitment pattern in the cochlea. Conclusion: Intravital imaging of the cochlea revealed that neutrophil recruitment and infiltration during inflammation are spatially controlled and exclusively observed in the SL but not in the SV and organ of Corti.
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34
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State of the Art Imaging in Menière’s Disease. Tips and Tricks for Protocol and Interpretation. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Menière’s disease (MD) is a burdensome and not well understood inner ear disorder that has received increasing attention of scientists over the past decade. Until 2007, a certain diagnosis of endolymphatic hydrops (EH) required post-mortem histology. Today, dedicated high-resolution magnetic resonance imaging (MRI) protocols enable detection of disease-related changes in the membranous labyrinth in vivo. In this review, we summarize the current status of MR imaging for MD.
Recent Findings
The mainstays of hydrops imaging are inversion recovery sequences using delayed acquisition after intravenous or intratympanic contrast administration. Based on these techniques, several methods have been developed to detect and classify EH. In addition, novel imaging features of MD, such as blood-labyrinth barrier impairment, have recently been observed.
Summary
Delayed contrast enhanced MRI has emerged as a reliable technique to demonstrate EH in vivo, with promising application in the diagnosis and follow-up of MD patients. Therefore, familiarity with current techniques and diagnostic imaging criteria is increasingly important.
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Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
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Labyrinthine enhancement on 3D black blood MR images of the brain as an imaging biomarker for cisplatin ototoxicity in (lung) cancer patients. Neuroradiology 2020; 63:81-90. [PMID: 32761280 DOI: 10.1007/s00234-020-02504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer patients treated with platinum-based chemotherapy can present with ototoxicity symptoms. The purpose of this work is to report the imaging features related to cisplatin ototoxicity. METHODS Between December 2015 and March 2019, a cohort of 96 consecutive patients with lung cancer was selected. Only patients who received cisplatin chemotherapy and underwent an imaging protocol consisting of a Gd-enhanced 3D-BB and 3D-T1W sequence, as well as T2W sequence to exclude metastases, were included. Labyrinthine enhancement was assessed, and all findings regarding the auditory and vestibular function were retrieved from the clinical files. RESULTS Twenty-one patients met the inclusion criteria. The Gd-enhanced 3D-BB images were used to divide them into the labyrinth enhancement group (LEG) and the labyrinth non-enhancement group (LNEG). None of these patients demonstrated enhancing regions on the 3D-T1W images. The labyrinthine fluid remained high on the T2 images in all patients, excluding metastases. The LEG consisted of 6 patients. The cochlea and semicircular canals were the most frequently affected regions. All the LEG patients that presented with hearing loss (4/6) had cochlear enhancement. Patients with normal hearing had no cochlear enhancement. Five patients (5/6) showed vestibular enhancement. Four of these patients had vestibular symptoms. CONCLUSION Labyrinthine enhancement as an imaging feature related to cisplatin ototoxicity is unreported. This study demonstrates a correlation between hearing loss and cochlear enhancement and also between vestibular impairment and vestibular/semicircular enhancement on 3D-BB images, which remained invisible on the 3D-T1W images. The labyrinthine enhancement on 3D-BB images in the presence of normal signal intensity of the intralabyrinthine fluid can be used as an imaging biomarker for cisplatin toxicity in daily clinical practice and should not be mistaken for intralabyrinthine metastases.
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Abstract
OBJECTIVE In this review the authors discuss evidence from the literature concerning vitamin D and temporal bone diseases (benign paroxysmal positional vertigo [BPPV], Menière's disease [MD], vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss). Common features shared by Menière's disease, glaucoma, and the possible influence by vitamin D are briefly discussed. DATA SOURCES, STUDY SELECTION Publications from 1970 until recent times have been reviewed according to a keyword search (see above) in PubMed. CONCLUSIONS MD, BPPV, vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss may all have several etiological factors, but a common feature of the current theories is that an initial viral infection and a subsequent autoimmune/autoinflammatory reaction might be involved. Additionally, in some of these entities varying degrees of demyelination have been documented. Given the immunomodulatory effect of vitamin D, we postulate that it may play a role in suppressing an eventual postviral autoimmune reaction. This beneficial effect may be enhanced by the antioxidative activity of vitamin D and its potential in stabilizing endothelial cells. The association of vitamin D deficiency with demyelination has already been established in other entities such as multiple sclerosis and experimental autoimmune encephalitis. Mice without vitamin D receptor show degenerative features in inner ear ganglia, hair cells, as well as otoconia. The authors suggest further studies concerning the role of vitamin D deficiency in diseases of the temporal bone. Additionally, the possible presence and degree of demyelination in these entities will have to be elucidated more systematically in the future.
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Endolymphatic hydrops evaluation on MRI: Practical considerations. Am J Otolaryngol 2020; 41:102361. [PMID: 31784143 DOI: 10.1016/j.amjoto.2019.102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Ménière's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space. In patients with a unilateral clinical presentation of Ménière's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Ménière's disease tends to undergo bilateral evolution over time.
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rAAV-Mediated Cochlear Gene Therapy: Prospects and Challenges for Clinical Application. J Clin Med 2020; 9:jcm9020589. [PMID: 32098144 PMCID: PMC7073754 DOI: 10.3390/jcm9020589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Over the last decade, pioneering molecular gene therapy for inner-ear disorders have achieved experimental hearing improvements after a single local or systemic injection of adeno-associated, virus-derived vectors (rAAV for recombinant AAV) encoding an extra copy of a normal gene, or ribozymes used to modify a genome. These results hold promise for treating congenital or later-onset hearing loss resulting from monogenic disorders with gene therapy approaches in patients. In this review, we summarize the current state of rAAV-mediated inner-ear gene therapies including the choice of vectors and delivery routes, and discuss the prospects and obstacles for the future development of efficient clinical rAAV-mediated cochlear gene medicine therapy.
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Ishiyama G, Lopez IA, Acuna D, Ishiyama A. Investigations of the Microvasculature of the Human Macula Utricle in Meniere's Disease. Front Cell Neurosci 2019; 13:445. [PMID: 31636542 PMCID: PMC6787152 DOI: 10.3389/fncel.2019.00445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
The integrity and permeability of the blood labyrinthine barrier (BLB) in the inner ear is important to maintain adequate blood supply, and to control the passage of fluids, molecules and ions. Identifying the cellular and structural components of the BLB, the vascular endothelial cells (VECs), pericytes, and the perivascular basement membrane, is critical to understand the pathophysiology of the inner ear microvasculature and to design efficient delivery of therapeutics across the BLB. A recent study of the normal and pathological ultrastructural changes in the human macula utricle microvasculature demonstrated that the VECs are damaged in Meniere’s disease (MD), and further studies identified oxidative stress markers (iNOS and nitrotyrosine) in the VECs. Using fluorescence microscopy, the microvasculature was studied in the macula utricle of patients diagnosed with MD that required transmastoid labyrinthectomy for intractable vertigo (n = 5), and patients who required a translabyrinthine approach for vestibular schwannoma (VS) resection (n = 3). Normal utricles (controls) were also included (n = 3). VECs were identified using rabbit polyclonal antibodies against the glucose transporter-1 (GLUT-1) and pericytes were identified using mouse monoclonal antibodies against alpha-smooth muscle actin (α-SMA). Immunofluorescence (IF) staining was made in half of the utricle and flat mounted. The other half was used to study the integrity of the BLB using transmission electron microscopy (TEM). GLUT-1-IF, allowed delineation of the macula utricle microvasculature (located in the stroma underneath the sensory epithelia) in both MD and VS specimens. Three sizes of vessels were present in the utricle vasculature: Small size (<15 μm), medium size (15–25 μm) and large size >25 μm. α-SMA-IF was present in pericytes that surround the VECS in medium and thick size vessels. Thin size vessels showed almost no α-SMA-IF. AngioTool software was used for quantitative analysis. A significant decreased number of junctions, total vessel length, and average vessel length was detected in the microvasculature in MD specimens compared with VS and control specimens. The deeper understanding of the anatomy of the BLB in the human vestibular periphery and its pathological changes in disease will enable the development of non-invasive delivery strategy for the treatment of hearing and balance disorders.
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Affiliation(s)
- Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ivan A Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dora Acuna
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Kim JY, Ko I, Cho BJ, Kim DK. Association of Obstructive Sleep Apnea With the Risk of Ménière's Disease and Sudden Sensorineural Hearing Loss: A Study Using Data From the Korean National Health Insurance Service. J Clin Sleep Med 2019; 15:1293-1301. [PMID: 31538600 PMCID: PMC6760412 DOI: 10.5664/jcsm.7922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Several studies have reported an association between obstructive sleep apnea (OSA) and neuro-otologic diseases, such as Ménière's disease or sudden sensorineural hearing loss (SSNHL). However, the exact relationship between OSA and those diseases has not been fully evaluated. Therefore, the aim of this study was to investigate the prospective link between OSA and Ménière's disease or SSNHL. METHODS We used a nationwide cohort sample of data for 2002-2013 representing approximately 1 million patients. The OSA group (n = 942) included patients diagnosed between 2004 and 2006; the comparison group was selected using propensity score matching (n = 3,768). We investigated Ménière's disease and SSNHL events over a 9-year follow-up period. Survival analysis, log-rank test, and Cox proportional hazards regression models were used to calculate incidence, survival rate, and hazard ratios for each group. RESULTS In the OSA group, the incidences of Ménière's disease and SSNHL were 7,854.4 and 7,876.3 person-years, respectively. Cox proportional hazards analysis revealed no overall association between patients with OSA and the risk of subsequent Ménière's disease or SSNHL. In a subgroup analysis, female and middle-aged patients with OSA were independently associated with a two-fold higher incidence of subsequent Ménière's disease, compared to those without OSA. However, we could not find any significant association between patients with OSA and SSNHL even in the subgroup analysis. CONCLUSIONS Our findings suggest that female or middle-aged patients with OSA are associated with an increased incidence of Ménière's disease. However, there was no association between OSA and SSNHL. CITATION Kim J-Y, Ko I, Cho B-J, Kim D-K. Association of obstructive sleep apnea with the risk of Ménière's disease and sudden sensorineural hearing loss: a study using data from the Korean National Health Insurance Service. J Clin Sleep Med. 2019;15(9):1293-1301.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Conte G, Lo Russo F, Caschera L, Zanetti D, Castorina P, Sina C, Triulzi F, Di Berardino F. Audiovestibular Phenotypes and Advanced Magnetic Resonance Imaging Features of Cochlin Gene Mutation Carriers. Audiol Neurootol 2019; 24:166-173. [PMID: 31390618 DOI: 10.1159/000501292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe clinical and imaging findings in a group of patients affected by nonsyndromic deafness A9 (DFNA9), using advanced magnetic resonance imaging (MRI) with 3-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) sequence. METHOD A retrospective case review was conducted in a tertiary referral center in Italy. Four sequential adult DFNA9-affected patients, who had undergone MRI at our Department between January 2017 and June 2018, were enrolled (male = 2, female = 2; median age: 65.6 years; 8 diseased ears analyzed). Three patients were relatives; the fourth was unrelated. The main outcome measures - age, sex, records of audiological and vestibular testing, genetic assessment, MRI findings - were analyzed. RESULTS All subjects suffered from bilateral progressive sensorineural hearing loss, more severely at the high frequencies and with a typical clinical pattern of bilateral chronic degenerative cochleovestibular deficit. Aural fullness was reported at the onset of the disease. All patients revealed a pathogenic heterozygous mutation in the Limulus factor C, Coch-5b2 and Lgl1 domain of cochlin. None of the patients showed a significant vestibular and cochlear endolymphatic hydrops at MRI, while high bilateral contrast enhancement on 4-h delayed postcontrast 3D FLAIR sequence was observed in all ears. CONCLUSIONS Increased perilymph enhancement on 4-h delayed postcontrast 3D FLAIR sequence is the common imaging feature of DFNA9 ears, suggesting that blood-labyrinthine barrier breakdown may play the main role in the pathophysiology of this disease. Significant hydrops has been excluded by MRI. This finding might be clinically useful in differentiating DFNA9 disease from other pathologies with similar clinical findings like Ménière's disease.
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Affiliation(s)
- Giorgio Conte
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Lo Russo
- Postgraduation School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy,
| | - Luca Caschera
- Postgraduation School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Diego Zanetti
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pierangela Castorina
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Clara Sina
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federica Di Berardino
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Li Y, Sha Y, Wang F, Lu P, Liu X, Sheng Y, Zhang Z, Liu M. Comprehensive comparison of MR image quality between intratympanic and intravenous gadolinium injection using 3D real IR sequences. Acta Otolaryngol 2019; 139:659-664. [PMID: 31130050 DOI: 10.1080/00016489.2019.1600719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Intratympanic and intravenous gadolinium administration is used to visualise endolymphatic hydrops. Aims/objectives: The goal of this study was to compare the image quality between intratympanic (IT-method) and intravenous (IV-method) gadolinium administration using three-dimensional inversion recovery with real reconstruction (3D real IR) sequences. Materials and methods: A number of 152 patients with Meniere's disease were included. The 3D real IR sequence was performed 24 h after IT administration or 4 h after IV administration. The detection rate of endolymphatic hydrops, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the two methods were compared. Specifically, the average image scores of the two methods were evaluated by two radiologists. Results: The SNRROI and CNRs of the IT-method were higher than those of the IV-method, whereas no significant difference between the IT-method and IV-method with regard to the SNRB was found. The average image scores were 3.49 ± 0.12 and 3.30 ± 0.12 for the IT-method and IV-method, respectively (p = .229). No statistically significant difference was found between two methods in terms of the detection rate of endolymphatic hydrops. Conclusions and significance: IT-method images can display endolymphatic hydrops more precisely than IV-method images. The IV-method can be used as an alternative to the IT-method in clinical applications to some extent.
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Affiliation(s)
- Yang Li
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Feng Wang
- Department of Ultrasound, Weifang People’s Hospital, Weifang, China
| | - Ping Lu
- Department of Radiology, Suzhou Municipal Hospital, Suzhou, China
| | - Xilan Liu
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yaru Sheng
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
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Lopez IA, Ishiyama G, Acuna D, Ishiyama A. Otopetrin-2 Immunolocalization in the Human Macula Utricle. Ann Otol Rhinol Laryngol 2019; 128:96S-102S. [PMID: 31092032 PMCID: PMC6767922 DOI: 10.1177/0003489419834952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the present study, we investigated the localization of otopetrin-2-a member of the otopetrin family that encodes proton-selective ion channels-in the human macula utricle using immunohistochemistry. METHODS Macula utricle were acquired at surgery from patients who required transmastoid labyrinthectomy for intractable vertigo due to Meniere's disease (MD; n = 3) and/or vestibular drops attacks (VDA; n = 2) and from temporal bones (n = 2) acquired at autopsy from individuals with no balance disorders. Immunofluorescence staining with otopetrin-2 (rabbit affinity purified polyclonal antibody) and GFAP (mouse monoclonal antibody) to identify vestibular supporting cells was made in formalin fixed cryostat sections or whole microdissected utricle (for flat mount preparations). Secondary antibodies against rabbit and mouse were used for the identification of both proteins. Digital fluorescent images were obtained using a high-resolution laser confocal microscope. RESULTS Using cryostat sections and flat mount preparations otopetrin-2 immunofluorescence was seen as punctated signal throughout the supporting cells cytoplasm. GFAP immunofluorescence was present in the supporting cell cytoplasm. The distribution of otopetrin-2 was similar in the macula utricle obtained from MD, VDA, or autopsy normative patients. CONCLUSIONS Otopetrin-2 was localized in supporting cells in a similar fashion that otopetrin-1 previously reported in the mouse macula utricle. The differential expression of otopetrin-2 in the supporting cells of the human macula utricle suggest an important role in the vestibular sensory periphery homeostasis and otolith maintenance.
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Affiliation(s)
- Ivan A. Lopez
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dora Acuna
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Akira Ishiyama
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
Visualization of the morphologic substrate of Ménière disease, the endolymphatic hydrops, can be performed using noncontrast or contrast-enhanced MR imaging techniques. Noncontrast MR imaging uses a heavily T2-weighted sequence; however, its reproducibility remains to be confirmed. Contrast-enhanced MR imaging techniques mainly use a 3-dimensional fluid-attenuated inversion recovery sequence after intratympanic gadolinium administration or after a 4-hour delayed intravenous gadolinium administration. The latter technique is most frequently used and is able to detect and grade Ménière disease. It is a reliable technique with a high diagnostic accuracy, enabling visualization of endolymphatic hydrops.
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Affiliation(s)
- Anja Bernaerts
- Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, Wilrijk 2610, Belgium.
| | - Bert De Foer
- Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, Wilrijk 2610, Belgium
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The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière's disease on MRI. Neuroradiology 2019; 61:421-429. [PMID: 30719545 PMCID: PMC6431299 DOI: 10.1007/s00234-019-02155-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
Purpose There is still a clinical-radiologic discrepancy in patients with Menière’s disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière’s disease (MD). Methods This retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen’s Kappa and multivariate logistic regression were used for analysis. Results The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value. Conclusions MRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.
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Englinger B, Pirker C, Heffeter P, Terenzi A, Kowol CR, Keppler BK, Berger W. Metal Drugs and the Anticancer Immune Response. Chem Rev 2018; 119:1519-1624. [DOI: 10.1021/acs.chemrev.8b00396] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bernhard Englinger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
| | - Christine Pirker
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
| | - Petra Heffeter
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Alessio Terenzi
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Christian R. Kowol
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Bernhard K. Keppler
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
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Marques P, Duan M, Perez-Fernandez N, Spratley J. Gentamicin delivery to the inner ear: Does endolymphatic hydrops matter? PLoS One 2018; 13:e0207467. [PMID: 30440019 PMCID: PMC6237362 DOI: 10.1371/journal.pone.0207467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Middle ear application of gentamicin is a common medical treatment for uncontrolled Ménière’s disease. The objective of the study was to evaluate the impact of endolymphatic hydrops on inner ear delivery. Methods Perilymph gentamicin concentrations and correlation with endolymphatic hydrops in an animal model were assessed. A group of 24 guinea pigs was submitted to surgical obstruction of the endolymphatic sac and duct of the right ear. Gentamicin was applied either to the right ear’s round window niche or through a transtympanic injection. Perilymph specimens were collected at different times. Histologic morphometry was used to evaluate both turn-specific and overall hydrops degree. Results In animals with endolymphatic hydrops, lower concentrations of gentamicin were observed after 20 or 120 minutes of exposure and in both types of administration, when compared to controls. This difference reached statistical significance in the round window niche application group (Mann-Whitney, p = 0,007). A negative correlation between perilymphatic gentamicin concentration and hydrops degree could be observed in both groups, after 120 minutes of exposure (Spearman correlation, round window niche p<0,001; TT p = 0,005). Conclusions The study indicates that the endolymphatic hydrops degree has a negative interference on the delivery of gentamicin into the inner ear following middle ear application.
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Affiliation(s)
- Pedro Marques
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- * E-mail:
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology, Head and Neck Surgery, Karolinska Universisty Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Jorge Spratley
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto Medical School, Porto, Portugal
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Detection of intralabyrinthine abnormalities using post-contrast delayed 3D-FLAIR MRI sequences in patients with acute vestibular syndrome. Eur Radiol 2018; 29:2760-2769. [PMID: 30413960 DOI: 10.1007/s00330-018-5825-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE 3D-FLAIR sequences with delayed acquisition after contrast medium injection have demonstrated new insights into blood-labyrinthine barrier (BLB) abnormalities in various diseases. The aim of this study was to assess the BLB in patients referred with unilateral acute vestibular syndrome (UAVS). MATERIALS AND METHODS In this retrospective multicenter imaging study, we performed 3D-FLAIR and steady-state free precession (SSFP) sequences 4 h after contrast medium administration in 26 healthy volunteers and in 30 patients with UAVS. Two radiologists, blinded to the clinical data, independently assessed the asymmetrical enhancement of the labyrinthine structures and the vestibular nerve on 3D-FLAIR sequences, and the signal of the labyrinthine structures on SSFP sequences. Inter-reader agreement tests were performed. RESULTS An asymmetrical enhancement of the semicircular canals was observed in 26 out of 30 ears (86.6%, p < 0.001) and never observed in healthy subjects. An asymmetrical enhancement of the vestibular nerve was never observed in either patients or healthy subjects. An asymmetrical enhancement of the cochlea was observed on the 3D-FLAIR sequence in 6 out of 30 ears only in the patients' group (20%, p = 0.03) and always associated with an enhancement of at least one semicircular canal. A low signal on SSFP sequences was observed only in 11 out of 30 symptomatic ears (36.7%, p < 0.001), involving the utricle in 7 ears and the superior semicircular canal in 4 ears. CONCLUSION Patients with typical UAVS presented with semicircular canal enhancement on MRI, while an asymmetrical enhancement of the vestibular nerve was not displayed. TRIAL REGISTRATION NCT02529475 KEY POINTS: • Patients with typical vestibular neuronitis presented with semicircular canal enhancement on MRI in 87% of cases. • An enhancement of the vestibular nerve was never displayed.
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