Rupture of the round Window Membrane

1976 ◽  
Vol 85 (1) ◽  
pp. 105-110 ◽  
Author(s):  
P. H. Taylor ◽  
P. G. Bicknell
Keyword(s):  
Middle Ear ◽  
Surgical Intervention ◽  
Round Window ◽  
Oval Window ◽  
Round Window Membrane ◽  
Physical Effort ◽  
Cochlear Aqueduct ◽  
Definite Improvement ◽  
History Of ◽  
Pressure Changes

A case of sudden deafness due to rupture of the round window membrane is presented. Nineteen similar cases have previously been reported in the literature. In a review of these twenty patients, it is noted that a history of concurrent physical effort or barotrauma was present in eighteen. This supports the view that the injury is produced by pressure changes acting either along the cochlear aqueduct (the explosive route) or, directly on the middle ear structures (the implosive route). At operation, the rupture may be difficult to see, and a separate leak from the oval window may be present. The timing of any surgical intervention is important. The authors recommend that this should be deferred for one week after the onset of symptoms, as the fistula may heal spontaneously. If no definite improvement has occurred at the end of this time, then tympanotomy should be undertaken during the next week.

Sudden Deafness and Labyrinthine Window Ruptures

1973 ◽  
Vol 82 (1) ◽  
pp. 2-12 ◽  
Author(s):  
Victor Goodhill ◽  
Irwin Harris ◽  
Seymour J. Brockman ◽  
Oscar Hantz
Keyword(s):  
Hearing Loss ◽  
Surgical Intervention ◽  
Round Window ◽  
Vestibular Function ◽  
Sudden Hearing Loss ◽  
Oval Window ◽  
Sudden Deafness ◽  
Scala Tympani ◽  
Cochlear Aqueduct ◽  
History Of

In 1971, one of the authors reported sudden deafness associated with labyrinthine window membrane ruptures. Eighteen additional cases have been explored surgically since then. Data on 21 cases are presented. Sudden profound cochlear deafness has now been encountered in 21 cases which were surgically explored. In 15 instances, fistulae of round, oval, or both windows were encountered and repaired. In 10 of the 15, there was a definite history of sudden exertion or trauma prior to onset. The oval window alone was ruptured in nine patients, the round window alone in one, and both windows were ruptured in five patients. The oldest patient was 62 years and the youngest 11 years of age. Differential audiological studies showed profound losses in all cases. Almost every case was studied by pure tone AC-BC and speech audiometry, Békésy, and impedance tests. Whenever possible other audiologic tests, such as recruitment, tone decay, and SISI were performed. These findings are presented in detail. Vestibular function was studied by electronystagmography (ENG) in 15 of the 21 cases surgically explored. There was evidence of vestibular dysfunction in almost every case with sudden hearing loss. Significant ENG details are presented. Surgical repairs of ruptured window membranes were followed by improvements in some of the patients. Postoperative audiologic data are presented. The theoretical aspects include discussion of possible cerebrospinal fluid (CSF) perilymph pathways between cochlear aqueduct and scala tympani and between internal auditory meatus and scala vestibuli. It is concluded that spontaneous labyrinthine window ruptures must now be added to the etiologic factors in “sudden hearing loss.” It is premature to set down criteria for surgical intervention in such cases. Further careful studies are necessary.

scholarly journals Low-Frequency Sound Pressure and Transtympanic Endoscopy of the Middle Ear in Assessment of “Spontaneous” Perilymphatic Fistula

2012 ◽  
Vol 2012 ◽  
pp. 1-6
Author(s):  
Ilmari Pyykkö ◽  
Ziane Selmani ◽  
Jing Zou
Keyword(s):  
Middle Ear ◽  
Round Window ◽  
Low Frequency ◽  
Oval Window ◽  
Round Window Membrane ◽  
Outer Diameter ◽  
Sound Stimulation ◽  
Perilymphatic Fistula ◽  
Frequency Sound ◽  
First Choice

This study was designed to verify an eventual perilymphatic fistula (PLF) in 264 patients with sensorineural hearing loss (SNHL) and/or vertigo. The patients were exposed to a low-frequency sound stimulation (LFS) on posturography to objectively test Tullio’s phenomenon and Hennebert's sign. Endoscopes with 5 degree and 25 degree of visual angle and an outer diameter of 1.7 mm were used. The round window niche, with its foldings, oval window with stapes superstructure, a part of the facial recess and the area in the fissula ante fenestram were examined and video recorded. In one patient, we endoscopically verified a fistula in the round window membrane (resulting from a diving accident) that was covered with a fibrinous layer. In 4 cases, there was abnormal mucosal shining in the round window but without PLF. In 7 cases, the tympanic cavity could not be visualized because of the adhesive middle ear process, the abnormal anatomy, or the prominent exostoses of the ear canal prohibited vision. In 34 patients, LFS provoked unsteadiness on posturography without PLF. In 6 cases, a postoperative middle ear infection was recorded. No permanent tympanic membrane perforation occurred. It is unlikely that disease entity of “spontaneous PLF” exists. Tympanoscopy should be regarded as the first choice when a PLF is suspected.

scholarly journals Intracochlear Drug Injections through the Round Window Membrane: Measures to Improve Drug Retention

2016 ◽  
Vol 21 (2) ◽  
pp. 72-79 ◽  
Author(s):  
Stefan K. Plontke ◽  
Jared J. Hartsock ◽  
Ruth M. Gill ◽  
Alec N. Salt
Keyword(s):  
Inner Ear ◽  
Round Window ◽  
Fluorescein Isothiocyanate ◽  
Oval Window ◽  
Round Window Membrane ◽  
Fluid Exchange ◽  
Cochlear Aqueduct ◽  
Quantitative Manner ◽  
Almost All ◽  
Inner Ear Pressure

The goal of this study was to develop an appropriate methodology to apply drugs quantitatively to the perilymph of the ear. Intratympanic applications of drugs to the inner ear often result in variable drug levels in the perilymph and can only be used for molecules that readily permeate the round window (RW) membrane. Direct intracochlear and intralabyrinthine application procedures for drugs, genes or cell-based therapies bypass the tight boundaries at the RW, oval window, otic capsule and the blood-labyrinth barrier. However, perforations can release inner ear pressure, allowing cerebrospinal fluid (CSF) to enter through the cochlear aqueduct, displacing the injected drug solution into the middle ear. Two markers, fluorescein or fluorescein isothiocyanate-labeled dextran, were used to quantify how much of an injected substance was retained in the cochlear perilymph following an intracochlear injection. We evaluated whether procedures to mitigate fluid leaks improved marker retention in perilymph. Almost all procedures to reduce volume efflux, including the use of gel for internal sealing and glue for external sealing of the injection site, resulted in improved retention of the marker in perilymph. Adhesive on the RW membrane effectively prevented leaks but also influenced fluid exchange between CSF and perilymph. We conclude that drugs can be delivered to the ear in a consistent, quantitative manner using intracochlear injections if care is taken to control the fluid leaks that result from cochlear perforation.

Role of the Round Window Membrane in Middle Ear Immune Responses

1988 ◽  
Vol 105 (sup457) ◽  
pp. 139-143 ◽  
Author(s):  
E. M. Keithley ◽  
A. F. Ryan ◽  
J. P. Harris
Keyword(s):  
Immune Responses ◽  
Middle Ear ◽  
Round Window ◽  
Round Window Membrane

Anatomical Effects of Sudden Middle Ear Pressure Changes

1979 ◽  
Vol 88 (3) ◽  
pp. 368-376 ◽  
Author(s):  
A. Axelsson ◽  
J. Miller ◽  
M. Silverman
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Round Window ◽  
Applied Pressure ◽  
Positive Pressure ◽  
Air Bubbles ◽  
Scala Tympani ◽  
Middle Ear Pressure ◽  
Contralateral Ear ◽  
Pressure Changes

Acute middle ear (ME) and inner ear changes following brief unilateral phasic ME pressure changes (up to ± 6000/mm H2O) were studied in the guinea pig. Middle ear findings included perforation of the tympanic membrane, serous and serosanguinous exudate and hemorrhage of tympanic membrane and periosteal vessels. Changes were related to magnitude of applied pressure. Perforation and hemorrhage were more commonly seen with negative rather than positive pressure. Air bubbles behind the round window were seen with positive pressures. Occasional distortion, but never perforation of the round window, was noted. Hemorrhage of the scala tympani was observed with both positive and negative pressures; scala vestibuli hemorrhage was found with negative ME pressure. In some instances pressure direction and magnitude related changes were seen in the contralateral ear.

Round window application of an active middle ear implant (AMEI) system in congenital oval window atresia

2015 ◽  
Vol 136 (1) ◽  
pp. 23-33 ◽  
Author(s):  
Shouqin Zhao ◽  
Shusheng Gong ◽  
Demin Han ◽  
Hua Zhang ◽  
Xiaobo Ma ◽  
...  
Keyword(s):  
Middle Ear ◽  
Round Window ◽  
Oval Window ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant

Functional Patency of the Cochlear Aqueduct

1982 ◽  
Vol 91 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Björn Carlborg ◽  
Barbara Densert ◽  
Ove Densert
Keyword(s):  
Cerebrospinal Fluid ◽  
Inner Ear ◽  
Middle Ear ◽  
Ambient Pressure ◽  
Ear Canal ◽  
Cochlear Aqueduct ◽  
Pressure Release ◽  
Release Capacity ◽  
Before And After ◽  
Pressure Changes

The perilymphatic (P P) and cerebrospinal fluid (P CSF) pressures were investigated in relation to pressure variations in the ear canal, middle ear and intracranial compartment before and after occlusion of the cochlear aqueduct (CA). Experiments using intracranial infusion showed that the CA was responsible for a perfect hydrodynamic balance between the CSF and the perilymph. There are indications of additional pressure release factors but their capacities were not sufficient to prevent the appearance of a longstanding and substantial pressure gradient following occlusion of the CA. A gradual P P build-up, from zero to its original level after the CA was opened and occluded, indicated perilymph production within the labyrinth. Investigation of pressure transfer from the ear canal and middle ear to the perilymph showed that the CA was the major pressure release route from the cochlea. Occlusion of the CA reduced the compliance of the inner ear and severely reduced the pressure release capacity. In such a situation the inner ear is almost incapable of equilibrating ambient pressure changes.

Impact of Coupling Techniques of an Active Middle Ear Device to the Round Window Membrane for the Backward Stimulation of the Cochlea

2015 ◽  
Vol 36 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Antoniu-Oreste Gostian ◽  
David Pazen ◽  
Magdalene Ortmann ◽  
Jan-Christoffer Luers ◽  
Andreas Anagiotos ◽  
...  
Keyword(s):  
Middle Ear ◽  
Round Window ◽  
Round Window Membrane ◽  
Coupling Techniques ◽  
Stimulation Of

Round Window Membrane in Serous and Purulent Otitis Media: Structural Study in the Rat

1993 ◽  
Vol 102 (3) ◽  
pp. 227-235 ◽  
Author(s):  
Ulf Johansson ◽  
Sten Hellström ◽  
Matti Anniko
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Structural Changes ◽  
Round Window ◽  
Inflammatory Cells ◽  
Elastic Fibers ◽  
Round Window Membrane ◽  
Connective Tissue Layer ◽  
Structural Alterations ◽  
Inflammatory Conditions

The rat was used as an animal model to reveal structural alterations in the round window membrane (RWM) during serous otitis media (SOM) and purulent otitis media (POM) over a 6-week period. Comparison of POM animals and control animals showed that the RWM in the former became almost six times as thick as that in controls, whereas that of SOM animals was twice as thick. The structural changes in the RWM in POM animals were confined mainly to the epithelium facing the middle ear cavity and the subepithelial space, which was invaded by inflammatory cells and exhibited dilated vessels. The normal flat epithelium was transformed via cuboidal cells to a cylindric epithelium containing both ciliated and goblet cells. In SOM animals, light microscopy revealed only minor changes in the RWM structure. Ultrastructurally, however, the connective tissue layer exhibited dense aggregations of collagen, increased numbers of fibroblasts, and, in one case, elastic fibers. This last phenomenon was not observed in either POM ears or normal ears. The study showed that various inflammatory conditions of the middle ear, both noninfectious (SOM) and infectious (POM), can cause different structural alterations of the RWM. These structural changes may influence passage through the RWM differently.

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