Neurophysiologic assessment of endolymphatic hydrops

A comparison of three methods of using transtympanic electrocochleography for the diagnosis of Meniere's disease: click summating potential measurements, tone burst summating potential amplitude measurements, and biasing of the summating potential using a low frequency tone

CONCLUSION

Stimulus biasing modulated the amplitude of the tone burst evoked summating potential (SP) in ears affected by Meniere's disease less than in normal ears. A reduced SP bias ratio added diagnostic accuracy for the diagnosis of Meniere's disease.

OBJECTIVES

To evaluate the effect of stimulus biasing on the human tone burst SP, and to determine if stimulus biasing could contribute to the electrocochleography as a means of confirming the diagnosis of Meniere's disease.

PATIENTS AND METHODS

Patients referred for transtympanic electrocochleography (TT ECochG) were assessed prospectively on clinical grounds according to the AAO-HNS criteria and a scale devised by one of the authors. A Meniere's group of ears and a non-Meniere's group of ears was determined. The ears opposite a Meniere's ear were not included in the analysis. The ratio of the click SP amplitude and the action potential (AP) amplitude (SP/AP ratio), the tone burst SP amplitude at 500 Hz,1 kHz, 2 kHz and 8 kHz, and the effect of stimulus biasing on the tone burst SP were measured.

RESULTS

A unipolar stimulus biasing ratio established for the modulation of the 1 kHz tone burst SP separated the Meniere's ears from the non-Meniere's ears with a sensitivity of 85% at a specificity of 80.6% and the difference between groups reached statistical significance (p=0.016). The 1 kHz SP amplitude measurements and the stimulus biasing measurements were superior to the click SP/AP ratio for identifying the Meniere's group. A combination of 1 kHz SP amplitude measurements and SP bias ratio separated the Meniere's ears from the non-Meniere's ears with an accuracy of 85%.

Phase-dependent audiometry with low-frequency masking revisited

Low-frequency masking is a psychoacoustical phenomenon, describing the modulation of a high-frequency probe tone burst by a low-frequency masker tone. The probe tone threshold is increased, if the probe tone is presented at a low-frequency phases around 90 degrees and 270 degrees . At these phases, the low-frequency masker tone induces a displacement of the basilar membrane of the inner ear which modulates the sensitivity of the inner hair cells. Measuring the modulation depth is partially applied in clinical routine to diagnose the endolymphatic hydrops. Although the modulation depth differs between normal ears and those which reveal an endolymphatic hydrops, the significance of these tests seems debatable. Here, we describe a new experimental setup, completely consisting of commercially available devices. Further, a user interface was developed to enable the application in the clinical routine. The experimental setup was approved with ten normal hearing listeners. All reveal a modulation of the probe stimulus threshold by different phases of the low-frequency masker stimulus. With this experimental setup, custom-made modifications of the essential parameters are feasible. This would be a contribution to solve open questions on the clinical relevance of the low-frequency masking phenomenon.

Chronological changes in the eighth cranial nerve compound action potential (CAP) in experimental endolymphatic hydrops: the effects of altering the polarity of click sounds

CONCLUSION

Using a guinea pig model of experimental endolymphatic hydrops, click sounds of altered polarity showed different latencies and amplitudes in hydropic compared with normal cochleae. Latency changes appeared as early as 1 week after endolymphatic obstruction. This method can help diagnose endolymphatic hydrops.

OBJECTIVE

The goal of the study was to develop an objective electrophysiological diagnosis of endolymphatic hydrops.

MATERIALS AND METHODS

Endolymphatic hydrops were created surgically in guinea pigs. The latency and the amplitude of the eighth cranial nerve compound action potential (CAP) for click sounds of altered polarity were measured up to 8 weeks after the surgery.

RESULTS

At early stages after surgery, the latency for condensation clicks became longer, and at later stages the latencies for both condensation and rarefaction became longer. The discrepancy in the latencies for rarefaction and condensation click sounds (rarefaction minus condensation) became larger by the first week after surgery, but no further discrepancy occurred thereafter. Compared with latency changes, amplitude changes in the CAP were rapid and progressive following surgery, suggesting ongoing damage to hair cells.

Evaluation of low-frequency biasing as a diagnostic tool in Menière patients

Although it is generally accepted that endolymphatic hydrops is the cause of complaints in patients suffering from Menière's disease, it has not been possible up to now to prove the presence of an endolymphatic hydrops in living humans. This study evaluated the psychophysical method introduced by Mrowinski et al. [Mrowinski D., Gerull G., Nubel K., Scholz G., 1995. Masking and pitch shift of tone bursts and clicks by low-frequency tones. Hear. Res. 85, 95-102; Mrowinski D., Scholz G., Krompass S., Nubel K., 1996. Diagnosis of endolymphatic hydrops by low-frequency masking. Audiol. Neurootol. 1, 125-134] to diagnose endolymphatic hydrops. These authors used low frequency biasing to differentiate between individuals with and individuals without Menière's disease. In the present study no statistically significant differences in masking parameters could be found between a large number (n=91) of ears with Menière's disease and ears (n=52) with comparable sensorineural hearing losses, but without symptoms of Menière's disease. Our results support the idea that results deviating from normal in low frequency biasing measurements are not due to endolymphatic hydrops itself, but to other pathological changes of the inner ear. An explanation could be that with increasing hearing loss the gain of the cochlear amplifier decreases, leading to smaller modulation depths.

Basilar membrane displacement related to endolymphatic sac volume

OBJECTIVE

To demonstrate that the amount of basilar membrane displacement toward the scala tympani and its attachment to the bony wall of the scala tympani (i.e., interscalar septum) in hydropic temporal bones is related to the intraosseous endolymphatic sac volume.

STUDY DESIGN

A retrospective analysis of temporal bones from individuals with the histopathologic diagnosis of "endolymphatic hydrops."

METHODS

Fifty-two temporal bones, from 38 patients, with the histopathologic findings of "endolymphatic hydrops" were analyzed microscopically. Data were obtained regarding the displacement of the basilar membrane, endolymphatic sac volume, hair cell loss, strial atrophy, ganglion cell loss, and last measured auditory thresholds. The relationships between these variables were examined statistically.

RESULTS

Nineteen of the 52 temporal bones (36.5%) with endolymphatic hydrops showed displacement of the basilar membrane toward the scala tympani in the apical and middle segments of the cochlea. A reduced volume of the endolymphatic sac was significantly related to increased severity of basilar membrane deformation (Rho = -.646; P < or = .001). Multiple regression analysis showed that severity of basilar membrane deformation was the single best predictor of low frequency thresholds while loss of hair cells was the best predictor of pure-tone average threshold.

CONCLUSIONS

The displacement of the basilar membrane in the apical and middle segments that may occur with endolymphatic hydrops, to the extent that it impinges on the interscalar septum, is related to a reduction in the intraosseous endolymphatic sac volume.

Phase-dependent suppression of transient evoked and distortion product otoacoustic emissions by a low-frequency tone

The subjective recording of the masked threshold of short acoustical stimuli with a loud tone of 30 Hz (phase audiogram) has been used for the clinical diagnosis of endolymphatic hydrops (EH). In normally-hearing subjects, a marked modulation of the threshold was found, depending on the phase of the low-frequency tone. A very small dependence was found in patients with Menière's disease, due to the micromechanical changes in the basilar membrane (BM). The same phase relationship becomes apparent in low-frequency suppression of otoacoustic emissions. The amplitudes of TEOAEs are controlled by the phase-dependent displacement of the BM. The suppressed TEOAEs have to be measured separately in each phase relationship. During recording of suppressed DPOAEs, the low-frequency suppressor is permanently superimposed on the pair of primary tones. After time averaging and a moving short-time FFT, the spectral values of the DPOAEs are obtained depending on the phase of the low-frequency tone. Modulation depends also on the masker level, the levels of the primary tones, and on their frequency range. The method of low-frequency suppressed DPOAEs is an objective method to diagnose EH and could be a useful tool in human inner ear research.

Low-frequency modulation of the 2f1-f2 distortion product otoacoustic emissions in the human ear

Low-frequency masking is a recent clinical procedure for the differential diagnosis of sensory hearing loss. Currently this requires the recording of the phase-dependent masked subjective threshold, which is time consuming and not always accurate. As an objective method, the recording of modulated distortion product otoacoustic emissions (DPOAEs) can be performed continuously, and with better frequency specificity. Results of measurements of the low-frequency modulated two-tone DPOAE 2f1-f2 in the human ear, and its dependence on various acoustic parameters, are presented here for the first time. Similar to the masked hearing threshold, the pattern of the phase-dependent modulated DPOAEs displayed two minima, at the phases of maximal rarefaction and condensation, respectively, with a latency of about 4 ms (suppressor frequency 32.8 Hz). The smaller dip, at maximal condensation, appeared only for a high suppressor level, and for a low level of the primary tone f2. The modulating effect measured for the primary frequencies f1 = 2.5 kHz and f2 = 3 kHz, decreased for 4 and 4.8 kHz, and vanished for 5 and 6 kHz. The results are discussed using a cubic distortion model based on the Boltzmann function for mechano-electrical transduction of the hair cells. The saturation behavior of the increase of the DPOAE level at different phases is compared with the growth rates of the DPOAE level in normal hearing and in sensory hearing loss.

Sensorineural hearing loss associated with otitis media with effusion in children

Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.

Low-frequency masking for detection of endolymphatic hydrops in patients with glaucoma

The coincidence of various eye and ear abnormalities has been described in the literature. Some authors discuss the possible existence of endolymphatic hydrops in patients with glaucoma. Whereas the current diagnostic tests for glaucoma are well-defined and evident, those for endolymphatic hydrops are not so reliable. This has made it difficult to accurately study the coincidence of endolymphatic hydrops and glaucoma. For better detection of endolymphatic hydrops, we performed low-frequency masking tests in 23 patients with primary open-angle glaucoma without signs of Ménìere's disease. The phase dependent sensitivity of the organ of Corti to a short test stimulus can be measured by applying a low-frequency masker tone to determine the modulation depth. Whereas the modulation depth in the normal hearing population is around 20-35 dB, the modulation depth in patients with Ménière's disease may be significantly decreased (5-10 dB), depending on the stage of disease. A decreased modulation depth was found in at least one ear in 19 of our 23 patients with glaucoma. Correlations between homeostatic mechanisms and their histological characteristics, e.g. melanocytes and their hormonal and enzymatic regulation, will be discussed. If the common pathogenesis of eye and ear lesions is better understood, it may be possible to develop new and more effective strategies for prevention and therapy.

Masking and pitch shift of tone bursts and clicks by low-frequency tones

From experiments in animals and investigations in humans it is known that the normally phase-dependent masking of a short stimulus by a low-frequency continuous tone does not occur in the case of endolymphatic hydrops. The recording of the masked threshold of short tone stimuli in a loud tone of 30 Hz is to be evaluated for the clinical diagnostics of Ménière's disease. To this purpose, the main parameters of the measurements (type, frequency, duration of the stimulus, and intensity of the masker) and their effect of phase-dependent masking and pitch-shift are investigated. Stimuli above 2 kHz are masked less than those of lower frequencies. Wide-band stimuli are less useful, since only the low-frequency component of their spectrum is masked. The tone stimuli should be short (1 - 2 ms) in order to make the measurement of the phase dependence more accurate. With increasing masker level the masking at phase 0 degree corresponds to the increase in level, at phase 270 degrees the amount is twice as much. The pitch shift which is perceived in low-tone masking depends on the phase of the stimulus, and on the levels of the stimulus and the masking tone. The use of brain stem recordings in the investigation of phase-dependent low tone masking is problematic since well-synchronizing stimuli with high frequency spectral components are masked poorly.

Low-frequency biasing of round window responses in guinea pigs and chinchillas

The acoustic biasing technique using low-frequency sound is of increasing interest to investigators, not only as a means of studying cochlear transduction but also as a promising tool for assessing cochlear pathology such as endolymphatic hydrops. We compared normal modulation patterns of round window responses in guinea pigs and chinchillas, whose low-frequency auditory characteristics are known to be different. A 50-Hz sine wave (90 dB SPL for guinea pigs and 80 dB SPL for chinchillas), which evoked an equivalent magnitude of cochlear microphonics (CM) in both species, was used to modulate the compound action potential (CAP) and the summating potential (SP) elicited by 8-kHz tone bursts. Overall patterns of CAP and SP modulation were almost identical between the two species except for a difference in the phase of 50 Hz CM. The phase of maximum SP enlargement was in accord with that of maximum CAP suppression, which led to inferred basilar membrane (BM) position at maximum scala tympani displacement by between 45 and 90 degrees. More complex or hysteresis effects seemed to be involved in the modulation of CAP and SP magnitude, in addition to the biasing effect owing solely to BM displacement.

Osmotically induced pressure difference in the cochlea and its effect on cochlear potentials

The electrophysiological effects observed during scala tympani displacements in low-frequency biasing experiments, an increase of the summating potential (SP) together with a decrease of the compound action potential (CAP), correlate well with the effects found in guinea pigs with evoked endolymphatic hydrops. This contributes to the hypothesis that displacement of the basilar membrane underlies the changes found in endolymphatic hydrops. A major difference between both experimental situations is that in low-frequency biasing the basilar membrane is continuously moving, whereas in hydrops the hypothesized displacement would be static. To evaluate the importance of this difference, experiments were performed which attempted to evoke a static displacement of the basilar membrane by perfusing the perilymphatic spaces with perfusates of various osmolalities. Perfusion with hypotonic perfusate (183 mOsm/kg) increased the SP and decreased the CAP (4 kHz stimulation) whereas perfusion with a hypertonic perfusate (397 mOsm/kg) decreased both these potentials. The cochlear microphonics were hardly affected. These data demonstrate that both experimental situations (biasing, i.e. dynamic displacement and osmotic pressure, i.e. static displacement) cause similar changes in the SP and the CAP and the data support the hypothesis that basilar membrane displacement towards scala tympani is an important contributing factor to the electrophysiologic changes in endolymphatic hydrops.

Functional changes associated with experimentally induced endolymphatic hydrops

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

Low-frequency modulation of compound action potential in experimental perilymphatic fistula and endolymphatic hydrops

We have tested the hypothesis that the cause of cochlear dysfunction associated with perilymphatic fistula (PLF) is closely related to endolymphatic hydrops (ELH). Using guinea pigs, we studied the tone-burst elicited compound action potential (CAP) and its modulation as caused by a 50 Hz biasing tone in experimental PLF. We compared these results with those of experimental ELH. Following perilymph aspiration through the perforated round window membrane, mild but significant elevations of CAP thresholds at tested frequencies were found. A reduction in the amplitude of cochlear microphonics (CM) for a 50 Hz sine wave appeared to correlate with these CAP threshold changes. However, there were no significant changes in the modulation effect of the 50 Hz biasing tone on the CAP elicited by an 8 kHz tone burst. This finding differed from that in ears with experimental ELH, in which significant reductions of both 50 Hz CM and the degree of CAP modulation were consistently observed. We concluded that it is unlikely that the underlying mechanisms of a modification to the low frequency response of the base of the cochlea following perilymph aspiration is linked to that of experimental ELH.

Tympanic electrocochleography: normal and abnormal patterns of response

Electrocochleography has been widely used in human and animal studies of endolymphatic hydrops. A variety of response patterns have been reported in normal and hydropic ears. Recent clinical studies have focused almost exclusively on the amplitude ratio of the summating potential (SP) and action potential (AP) derived from alternating polarity click responses. In this report normal response patterns are described with a tympanic membrane electrode employing condensation, rarefaction and alternating polarity clicks and tone burst stimulation. A variety of response abnormalities are described in patients with suspected endolymphatic hydrops. The exclusive use of alternating polarity clicks is not adequate to reveal the nature of these abnormalities.

Cellular changes in Reissner's membrane in endolymphatic hydrops

A quantitative morphologic study of the cellular changes in human Reissner's membrane (RM) was performed under light microscopy on 30 normal temporal bones from 15 subjects, and on 20 temporal bones from 10 subjects with endolymphatic hydrops. The cellular density of the epithelial and mesothelial layers of normal RMs decreased with increasing age. In endolymphatic hydrops, cellular proliferation and decreased cellular density of a distended RM were observed, and these changes occurred more remarkably in epithelial cells. Decreased cellular density in RM was correlated to the degree of endolymphatic hydrops. These findings indicate an involvement of the epithelial cellular changes in the pathogenesis of endolymphatic hydrops. Our results suggest that cellular changes in RM may cause dysfunction of radial flow leading to ionic disturbance of endolymph, which provides a possible mechanism of hearing loss in endolymphatic hydrops.

The influence of noise exposure on endolymphatic hydrops. An experimental study

The influence of noise exposure on endolymphatic hydrops was examined morphologically. Endolymphatic hydrops was produced experimentally in guinea pigs by means of endolymphatic sac obliteration. Approximately 2 months later, the animals were subjected to noise exposure for 2 h and, as a result, the following findings were obtained: Vascular and circulatory disturbances in the 3rd and 4th turns of cochlea, i.e., vasoconstriction-like changes in the upper coiled arterioles and capillaries in the stria vascularis, as well as blood cell sludge. In addition, the outer hair cells in Corti's organ at the same turns disappeared sporadically. No changes were observed in the opposite, control, ear of the same animal which was free from endolymphatic hydrops. On the basis of these results, it is argued that endolymphatic hydropic ears are highly vulnerable to noise exposure.

Low-frequency masking of brainstem potentials

The phase and intensity dependence of masking a click by a loud low-frequency tone was examined with brainstem potentials. Wave V latency is practically unaffected; its amplitude, however, is maximally suppressed at a phase of 270 degrees, i.e. rarefaction in the ear canal and basilar membrane displacement towards the scala tympani. Corresponding to subjective threshold, a minor suppression is also observed for the opposite deflection. In the phase of maximal suppression, wave V can be cancelled by a 30 Hz tone of 115 dB SPL up to click intensities of 40 dB HL. With cochlear damage, total suppression can be achieved at even higher click intensities as long as they are close to the subjective threshold. Low-frequency suppression is discussed as a tool applicable for early diagnosis of endolymphatic hydrops.

Quantification of the relation between electrophysiologic and morphologic changes in experimental endolymphatic hydrops

The degree of hydrops in guinea pig ears that had undergone unilateral endolymphatic sac and duct obliteration was quantified. For 15 guinea pigs from a prior study, the correlation between the degree of hydrops and several electrophysiologic measures of the functional state of the cochlea was determined. A significant correlation between the degree of hydrops and a reduction in the low-frequency cochlear microphonic evoked by a 29-Hz tone was found. No correlation was found between the degree of hydrops and the magnitude of the summating potential evoked by 8-kHz probes. A weak correlation was found between the degree of hydrops and a reduction in the compound action potential evoked by 2-kHz probes. Possible differences in the way the endolymphatic duct obliteration exerts its effect on the different cochlear potentials are discussed.

Effects of carbon dioxide in the middle ear cavity upon the cochlear potentials and cochlear pH

To elucidate the effects of CO2 in the middle ear upon the cochlea, measurements were made of the cochlear potentials (compound action potential and endocochlear potential) and of the pH of the inner ear fluids and the organ of Corti. Gas containing CO2 did not affect the AP threshold, except for a slight decrease in AP threshold elicited by an 8 kHz tone burst with 10% CO2 flow. The EP did not vary with CO2 gas. The CO2 gas mixture reduced the pH in perilymph significantly, by 0.11 +/- 0.05 with 5% CO2 and by 0.17 +/- 0.04 with 10% CO2, in comparison with 100% N2. The CO2 gas slightly but significantly decreased the endolymph pH, by 0.05 +/- 0.04 with 5% CO2 and by 0.09 +/- 0.06 with 10% CO2. The removal of perilymph led to a greater acidification of endolymph with CO2 gas. Acidification of the organ of Corti was also noted with the CO2 gas flush. These findings indicate that CO2 in the middle ear influences the acid-base regulation of inner ear fluids and the cochlear function.

Cochlear potentials and their modulation by low-frequency sound in early endolymphatic hydrops

Seventeen guinea pigs were unilaterally operated to produce endolymphatic hydrops. After 2 wk (9 animals) or 4 wk (8 animals), extracochlear electrophysiological responses to tone bursts of several frequencies were recorded in both the operated and non-operated ears. In addition, modulation by low-frequency (29 Hz sinusoidal bias) sound of the responses to 8 kHz tonebursts was measured. After the electrophysiological measurements, the animals were killed and examined histologically. Four weeks after the operation, cochlear microphonics in response to a 500 Hz tone burst and to the 29 Hz bias were significantly smaller in the operated ears. The summating potential showed a tendency to be larger in the operated ears. The compound action potential input-output curves for 2 kHz probes showed a small threshold shift accompanied by steep slopes, reminiscent of recruitment. Modulation of summating potentials by the low-frequency bias was smaller on the operated side. In most cochleae an endolymphatic hydrops was observed. Three cochleae showed a collapse of Reissner's membrane.

Evolution of recruitment at different frequencies during the development of endolymphatic hydrops in the guinea pig

The study of human temporal bones has identified endolymphatic hydrops as a common feature of several diseases. In particular it is systematically found in those bones removed from patients with premortem Menière's disease. Menière's disease is known to induce sensorineural pathology with recruitment, which changes with the evolution of the hearing loss, and is suspected to induce a cochlear conductive loss by a possible increase in static pressure of endolymph. Amplitude/intensity functions of sensorineural responses can reflect recruitment and/or conduction loss. Experimentally induced hydrops in animals provokes cochlear physiological alterations, some of which closely resemble certain features of Menière's disease. In the present study using a guinea-pig animal model, we have examined amplitude/intensity functions at the round window for cochlear microphonics (RWCM), summating potentials (RWSP) and action potentials (CAP) at different stages of hearing loss in experimentally induced hydrops. During the period of fluctuating thresholds there was reduction of maximal RWCM amplitude, no change in RWSP and recruitment on the CAP. At a later stage when the audiogram was flat and fluctuations were no longer seen, RWCM remained unchanged. At this time RWSP could show recruitment while CAP amplitudes at all intensities were reduced, indicating either a cochlear conductive loss and/or a general depression of neural activity.

Independent fluctuations of the round-window summating potential and compound action potential following the surgical induction of endolymphatic hydrops in the guinea pig

The diagnosis of Menière's disease is classically based on the triad of symptoms including fluctuating hearing loss, tinnitus and vertigo. Modifications to the electrocochleographic response have been searched as a possible help in the diagnosis. Various authors have reported a tendency for an increased ratio of the summating potential (SP) to action potential (AP) which is generally thought to be due to an enhanced SP. However, the large variability between patients has precluded any clear-cut conclusion. This dispersion of data might represent real individual differences or might be attributed to unavoidable technical variations, such as electrode placement and/or precise control of stimulus levels. As an attempt to answer this issue, we employed an animal model of experimental hydrops in which these difficulties can be overcome by chronic implantation of round-window electrodes and carefully controlling the stimulus level. In the present study, the SP and AP were monitored over several months for different frequencies and different intensities. In the early period of fluctuating thresholds at low and mid frequencies, AP amplitude varied in loose correspondence with the fluctuating audiogram. The SP amplitude also varied apparently not associated with AP or threshold changes and no consistent increase in SP was observed. At a later stage when all thresholds were elevated both SP and AP diminished. In normal ears increases in the stimulus intensity induce an augmentation of SP/AP. In hydropic ears, at the period of fluctuating thresholds, the SP/AP growth curve was at first similar to that of controls but later became very variable for different animals, but in general much larger than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural findings in a case of Menière's disease

The temporal bones of an individual with documented unilateral Meniere's disease were prepared for light and electron microscopy. A morphometric analysis was performed on hair cells, spiral ganglion cells, dendritic fibers in the osseous spiral lamina, afferent and efferent endings, and afferent synaptic contacts. In the ear with Meniere's disease, we found hair cell damage, including disruption of the cuticular bodies and basalward displacement of some outer hair cells. There was no significant difference in the number of hair cells or spiral ganglion cells on the two sides. There was a significant decrease, however, in the number of afferent nerve endings and afferent synapses at the base of both inner and outer hair cells in the ear with Meniere's disease as compared to the contralateral ear.

Hydrostatic pressure measurements of endolymph and perilymph in a guinea pig model of endolymphatic hydrops

The primary histologic correlate of Menière's disease is endolymphatic hydrops. From this, many investigators have postulated the existence of endolymphatic hypertension, although there have been no measurements published to substantiate this concept. Seventy guinea pigs, surgically treated with right endolymphatic duct obstruction, were later assessed by use of a micro-electrode technique that measured their endolabyrinthine hydrostatic pressures. For 21 of these animals, the pressures of both scala tympani (Pst) and scala media (Psm) of both ears of each animal were successfully measured. Similar measurements were made in a control group of 25 guinea pigs that had not undergone any previous surgery. For normal ears--as well as those with hydrops-pressure differences between perilymph and endolymph (Psm - Pst) varied around 0 +/- 2.0 mm Hg. When only the right (obstructed) ears were considered, there appeared to be a slight, relative pressure elevation (p less than 0.05) in scala media during the first 7 days after endolymphatic duct obstruction-and in those ears with EP, less than 70 mV. The magnitude of this pressure difference that can be attributed to the state of endolymphatic hydrops-and not to natural variability-is calculated (within 95% confidence limits) to be less than 0.5 mm Hg.

Auditory brainstem responses to single-slope stimuli. The influence of steepness and polarity

Click polarity has little influence on brainstem potentials. We applied an auditory stimulus similar to a step function generated in a closed acoustic system. The influence of stimulus onset steepness (comprising rise time and intensity) on wave V latency and amplitude was investigated. A remarkable latency prolongation was observed for condensation (C) compared with rarefaction (R), if a sharp bend at the foot of the slope was avoided. The C latency lag was nearly the amount of rise time. The effect can be explained by cochlear travel time. Wave V amplitude for R slopes was significantly enhanced. At high intensity and short rise time, it reached twice the values found with C slopes, or with clicks of either polarity. Although the explanations found are not yet satisfactory, a clinical application in cochlear diagnosis is predictable.

Summating potential and water balance in Meniere's disease

The summating potentials (SP) to free-field 1-, 2-, 4-, and 8-kHz, 90-dB HL tone bursts were recorded by means of transtympanic electrocochleography in 45 patients divided into three groups: those with Meniere's disease, those whose diagnosis was uncertain, and control subjects. The similarities across frequencies between the human SP (promontory) and the experimental SP (DIF component from basal turn) suggest that the SP recorded in electrocochleography originates mostly from the base of the cochlea; negative values were observed at low frequencies (1 to 2 kHz), positive values at high frequencies (8 kHz). Patients with Meniere's disease showed significantly larger SP values than control subjects. The effect of orally administered glycerol on the SP and action potential amplitudes was evaluated by means of automated recordings repeated every 5 minutes. Summating potential values were remarkably constant in the control group. A decrease in SP absolute amplitude was observed in most patients with Meniere's disease and some subjects with uncertain diagnoses, specifically at low frequencies. These changes were frequently associated with action potential amplitude and auditory threshold improvements at low frequencies. It is assumed that the glycerol-induced SP changes at low frequencies are related to modifications in the low frequency mechanical response of the basilar membrane at the basal turn.