scholarly journals A Window of Opportunity: Perilymph Sampling from the Round Window Membrane Can Advance Inner Ear Diagnostics and Therapeutics

2022 ◽  
Vol 11 (2) ◽  
pp. 316
Author(s):  
Madeleine St. Peter ◽  
Athanasia Warnecke ◽  
Hinrich Staecker

In the clinical setting, the pathophysiology of sensorineural hearing loss is poorly defined and there are currently no diagnostic tests available to differentiate between subtypes. This often leaves patients with generalized treatment options such as steroids, hearing aids, or cochlear implantation. The gold standard for localizing disease is direct biopsy or imaging of the affected tissue; however, the inaccessibility and fragility of the cochlea make these techniques difficult. Thus, the establishment of an indirect biopsy, a sampling of inner fluids, is needed to advance inner ear diagnostics and allow for the development of novel therapeutics for inner ear disease. A promising source is perilymph, an inner ear liquid that bathes multiple structures critical to sound transduction. Intraoperative perilymph sampling via the round window membrane of the cochlea has been successfully used to profile the proteome, metabolome, and transcriptome of the inner ear and is a potential source of biomarker discovery. Despite its potential to provide insight into inner ear pathologies, human perilymph sampling continues to be controversial and is currently performed only in conjunction with a planned procedure where the inner ear is opened. Here, we review the safety of procedures in which the inner ear is opened, highlight studies where perilymph analysis has advanced our knowledge of inner ear diseases, and finally propose that perilymph sampling could be done as a stand-alone procedure, thereby advancing our ability to accurately classify sensorineural hearing loss.

2021 ◽  
pp. 014556132110091
Author(s):  
Robin Rupp ◽  
Joachim Hornung ◽  
Matthias Balk ◽  
Matti Sievert ◽  
Sarina Müller ◽  
...  

Objective: To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. Methods: Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. Results: Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. Conclusion: Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.


2021 ◽  
Vol 16 (2) ◽  
pp. 178-183
Author(s):  
Iryna Ihorivna SAPIZHAK ◽  
◽  
V. PYSANKO ◽  
T. MALYSHEVA ◽  
◽  
...  

Hearing disorders greatly impair the comfort of life, change a person's emotional state, and when developed in early childhood lead to disorders of psycho-social formation of personality. There are currently no effective treatments for patients with sensorineural hearing loss (SNHL). Therefore, all over the world prefer "substitution tactics", namely - hearing aids for deafness, or cochlear implant for deafness. Aim. To evaluate the influence of NEC in different ways of their introduction on the morphological state of the structures of the inner ear (Corti's organ and the first neuron, vascular strip), as well as the auditory nerve on the background of aminoglycoside ototoxicosis. To investigate the characteristics and directions of reorganization of hemoblood supply and features of cyto - and myeloarchitectonics of structures of the inner ear. Materials and methods. To study the effectiveness of neuronal embryonic cells (NEC) in aminoglycoside ototoxicosis, experimental studies were performed on 40 guinea pigs weighing from 500 to 600 g. SNHL was caused by the introduction of aminoglycoside antibiotic - gentamicin sulfate at a dose of 100 mg/kg for 14 days. The neuronal stem cell suspension was administered in a volume of 2 million cells in 0.5 ml intratympanically and 2 million cells in 0.5 ml suboccipitally on days 1 and 15 of the experiment. Results and discussion. The influence of NEC on different methods of their introduction on the morphological state of the structures of the inner ear (Corti's organ and the first neuron), as well as the auditory nerve on the background of aminoglycoside ototoxicosis was evaluated. The characteristics and directions of reorganization of hemoblood supply and features of cyto - and myeloarchitectonics of structures of an inner ear according to an estimation of neurovasal relations are investigated. Conclusions. The data obtained indicate that intratympanic and suboccipital administration of NEC promotes the regeneration of damaged cell structures of the inner ear. This opens the prospect of using NEC to develop new approaches in the treatment of patients with sensorineural hearing loss.


1998 ◽  
Vol 66 (1) ◽  
pp. 343-346 ◽  
Author(s):  
Frank Engel ◽  
Rosemarie Blatz ◽  
Reinhard Schliebs ◽  
Michael Palmer ◽  
Sucharit Bhakdi

ABSTRACT The passage of radioiodinated streptolysin-O (SLO) and albumin through the round window membrane (RWM) was studied in vivo. When applied to the middle ear, SLO became quantitatively entrapped in this compartment and no passage to the cochlea occurred. However, flux of radioiodinated albumin through the toxin-damaged RWM was observed. We propose that the passage of noxious macromolecules, such as proteases, from a purulent middle-ear effusion may be facilitated by pore-forming toxins, resulting in cochlear damage and sensorineural hearing loss.


2021 ◽  
Vol 162 (51) ◽  
pp. 2055-2060

Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsődleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezőként felmerül a perilymphafistula lehetősége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép műtéti kezelése a dobüreg feltárását követően a belső fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelő hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmű okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követően exploratív tympanotomiát végeztünk, melynek során a belső fül ablakait obliteráltuk. Hallásjavulást ezt követően sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az előzetes kerekablak-obliteráció nem zárja ki a későbbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055–2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055–2060.


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