Sample records for stapedius

  1. Testing rocuronium-induced neuromuscular blockade at the stapedius muscle using stapedius reflex measurements.

    PubMed

    Sárkány, P; Tassonyi, E; Nemes, R; Timkó, A; Pongrácz, A; Fülesdi, Béla

    2011-12-01

    Neuromuscular monitoring prior to emergence from anaesthesia has been shown to be necessary to achieve adequate airway protection in order to decrease postoperative pulmonary complications. In the present study we hypothesized that stapedius reflex measurement allows the detection of residual neuromuscular blockade using the stapedius muscle following the administration of rocuronium. Parallel stapedius and acceleromyographic measurements were performed on 20 patients undergoing cholecystectomy. Acceleromyographic measurements were continuously performed during the course of anaesthesia, whereas the stapedius reflex was measured on different occasions: (1) after premedication but before anaesthesia induction, (2) after induction, but before administration of muscle relaxant, (3) after administration of muscle relaxant, (4) during the course of surgical anaesthesia at regular intervals, and (5) continuously performed during emergence from anaesthesia, until the stapedius reflex threshold returned to normal. The intensity of the sound energy at which the stapedius reflex is detectable was similar: 89.5 ± 9.9 dB(mean ± SD) after premedication and after anaesthetic induction. However, after administration of rocuronium, when the twitch height decreased to 5%, the stapedius reflex disappeared, indicating a total block of the stapedius muscle.During the recovery phase (twitch>10%) significantly higher sound energies compared to baseline values were necessary to evoke the reflex, indicating residual inhibition of the stapedius muscle. At the point where stapedius reflex threshold returned to normal the twitch height averaged about 50% showing low sensitivity of the tympanometry in detecting residual neuromuscular blockade. The neuromuscular effect of rocuronium on the stapedius muscle can be detected using stapedius reflex measurements. Due to its methodological limitation and low sensitivity, the method cannot be recommended for the monitoring of residual neuromuscular blockade.

  2. Re-examination of the role of the human acoustic stapedius reflex

    NASA Astrophysics Data System (ADS)

    Phillips, Dennis P.; Stuart, Andrew; Carpenter, Michael

    2002-05-01

    The ``rollover'' seen in the word recognition performance scores of patients with Bell's palsy (facial nerve paralysis) has historically been taken as an indicator of the role of the stapedius reflex in the protection from upward spread of masking. Bell's palsy, however, may be a polyneuropathy, so it is not clear that the poor word recognition performance at high levels is necessarily attributable specifically to impaired facial nerve function. The present article reports two new experiments that probe whether an isolated impairment of the stapedius reflex can produce rollover in word recognition performance-intensity functions. In experiment 1, performance-intensity functions for monosyllabic speech materials were obtained from ten normal listeners under two listening conditions: normal and low-frequency augmented to offset the effects of the stapedius reflex on the transmission of low-frequency vibrations to the cochlea. There was no effect of the spectral augmentation on word recognition for stimulus levels up to 107 dB SPL. In experiment 2, six patients who had undergone stapedectomy were tested for rollover using performance-intensity functions. None of the patients showed rollover in their performance-intensity functions, even at stimulus levels in excess of 100 dB HL. These data suggest that if the stapedius reflex has a role in protection from upward spread of masking, then this role is inconsequential for word recognition in quiet.

  3. Evaluation of muscle hyperactivity of the grimacing muscles by unilateral tight eyelid closure and stapedius muscle tone.

    PubMed

    Shiba, Masato; Matsuo, Kiyoshi; Ban, Ryokuya; Nagai, Fumio

    2012-10-01

    Muscle hyperactivity of grimacing muscles, including the orbicularis oculi and corrugator supercilii muscles that cause crow's feet and a glabellar frown line with ageing, cannot be accurately evaluated by surface observation. In 71 subjects, this study investigated the extent to which grimacing muscles are innervated by the bilateral motor cortices, whether the corticofacial projection to the grimacing muscles affects the facially innervated stapedius muscle tone by measuring static compliance of the tympanic membrane, and whether unilateral tight eyelid closure with contraction of the grimacing muscles changes static compliance. Unilateral tight eyelid closure and its subsequent change in the contralateral vertical medial eyebrow position revealed that motor neurons of the orbicularis oculi and corrugator supercilii muscles were innervated by the bilateral motor cortices with weak-to-strong contralateral dominance. The orbicularis oculi, corrugator supercilii, and stapedius muscles innervated by the bilateral motor cortices had increased muscle hyperactivity, which lowered the vertical medial eyebrow position and decreased the static compliance of the tympanic membrane more than those innervated by the unilateral motor cortex. Unilateral enhanced tight eyelid closure with contraction of the grimacing muscles in certain subjects ipsilaterally decreased the static compliance with increased contraction of the stapedius muscle, which probably occurs to immobilise the tympanic membrane and protect the inner ear from loud sound. Evaluation of unilateral tight eyelid closure and the subsequent change in the contralateral vertical medial eyebrow position as well as a measurement of the static compliance for the stapedius muscle tone has revealed muscle hyperactivity of grimacing muscles.

  4. The importance of electrically evoked stapedial reflex in cochlear implant.

    PubMed

    Andrade, Kelly Cristina Lira de; Leal, Mariana de Carvalho; Muniz, Lilian Ferreira; Menezes, Pedro de Lemos; Albuquerque, Katia Maria Gomes de; Carnaúba, Aline Tenório Lins

    2014-01-01

    The most important stage in fitting a cochlear implant is the identification of its dynamic range. The use of objective measures, in particular the electrically elicited stapedius reflex, may provide suitable assistence for initial fitting of cochlear implant, especially in children or adult with multiple disorders, because they provide specific values that serve as the basis of early cochlear implant programming. Verify through a review the use of the electrically elicited stapedius reflex threshold during the activation and mapping process of cochlear implant. Bibliographical search on the Pubmed and Bireme plataforms, and also on Medline, LILACS and SciELO databases, with standard searches until September 2012, using specific keywords. For the selection and evaluation of scientific studies found in the search, criterias have been established, considering the following aspects: author, year/location, grade of recommendation/level of evidence, purpose, sample, age, mean age in years, evaluative testing, results and conclusion. Among 7,304 articles found, 7,080 were excluded from the title, 152 from the abstract, 17 from the article reading, 43 were repeated and 12 were selected for the study. The electrically elicited stapedius reflex may support when programming the cochlear implant, especially in patients with inconsistent responses.

  5. The Dynamics of the Stapedial Acoustic Reflex.

    NASA Astrophysics Data System (ADS)

    Moss, Sherrin Mary

    Available from UMI in association with The British Library. This thesis aims to separate the neural and muscular components of the stapedial acoustic reflex, both anatomically and physiologically. It aims to present an hypothesis to account for the differences between ipsilateral and contralateral reflex characteristics which have so far been unexplained, and achieve a greater understanding of the mechanisms underlying the reflex dynamics. A technique enabling faithful reproduction of the time course of the reflex is used throughout the experimental work. The technique measures tympanic membrane displacement as a result of reflex stapedius muscle contraction. The recorded response can be directly related to the mechanics of the middle ear and stapedius muscle contraction. Some development of the technique is undertaken by the author. A model of the reflex neural arc and stapedius muscle dynamics is evolved that is based upon a second order system. The model is unique in that it includes a latency in the ipsilateral negative feedback loop. Oscillations commonly observed on reflex responses are seen to be produced because of the inclusion of a latency in the feedback loop. The model demonstrates and explains the complex relationships between neural and muscle dynamic parameters observed in the experimental work. This more comprehensive understanding of the interaction between the stapedius dynamics and the neural arc of the reflex would not usually have been possible using human subjects, coupled with a non-invasive measurement technique. Evidence from the experimental work revealed the ipsilateral reflex to have, on average, a 5 dB lower threshold than the contralateral reflex. The oscillatory charcteristics, and the steady state response, of the contralateral reflex are also seen to be significantly different from those of the ipsilateral reflex. An hypothesis to account for the experimental observations is proposed. It is propounded that chemical neurotransmitters, and their effect upon the contralateral reflex arc from the site of the superior olivary complex to the motoneurones innervating the stapedius, account for the difference between the contralateral and ipsilateral reflex thresholds and dynamic characteristics. In the past two years the measurement technique used for the experimental work has developed from an audiological to a neurological diagnostic tool. This has enabled the results from the study to be applied in the field for valuable biomechanical and neurological explanations of the reflex response. (Abstract shortened by UMI.).

  6. Assessment of Middle Ear Function during the Acoustic Reflex Using Laser-Doppler Vibrometry

    DTIC Science & Technology

    2017-08-07

    auditory injury, the model was developed using physiological data from small animals (Kalb & Price 1987), and thus several key assumptions may not hold...Keefe 1999, Silman 2012); whereas the acoustic reflex activates both stapedius and tensor tympani MEMCs in many animals (Forbes & Sherrington 1914...Res, 42, 1029–41. Forbes, A., & Sherrington, C. S. (1914). Acoustic reflexes in the decerebrate cat. American Journal of Physiology --Legacy Content

  7. Underwater Noise and the Conservation of Divers’ Hearing: A Review. Volume 1

    DTIC Science & Technology

    1989-10-01

    reflex attenuation, since the tensor tympani is unaffected and since Bell ’ palsy may affect the VIIIth (auditory) nerve as well as the VIlth (facial...studied acoustic reflexes in patients with acute facial nerve paralysis (Bell’s palsy ). These patients had absent stapedius reflexes on the side of the...voluntary middle ear muscle activation. 24 Bell’s palsy cases; attenuation estimated by shift in reflex amplitude- intensity functions (contralateral), re

  8. Auditory Brainstem Circuits That Mediate the Middle Ear Muscle Reflex

    PubMed Central

    Mukerji, Sudeep; Windsor, Alanna Marie; Lee, Daniel J.

    2010-01-01

    The middle ear muscle (MEM) reflex is one of two major descending systems to the auditory periphery. There are two middle ear muscles (MEMs): the stapedius and the tensor tympani. In man, the stapedius contracts in response to intense low frequency acoustic stimuli, exerting forces perpendicular to the stapes superstructure, increasing middle ear impedance and attenuating the intensity of sound energy reaching the inner ear (cochlea). The tensor tympani is believed to contract in response to self-generated noise (chewing, swallowing) and nonauditory stimuli. The MEM reflex pathways begin with sound presented to the ear. Transduction of sound occurs in the cochlea, resulting in an action potential that is transmitted along the auditory nerve to the cochlear nucleus in the brainstem (the first relay station for all ascending sound information originating in the ear). Unknown interneurons in the ventral cochlear nucleus project either directly or indirectly to MEM motoneurons located elsewhere in the brainstem. Motoneurons provide efferent innervation to the MEMs. Although the ascending and descending limbs of these reflex pathways have been well characterized, the identity of the reflex interneurons is not known, as are the source of modulatory inputs to these pathways. The aim of this article is to (a) provide an overview of MEM reflex anatomy and physiology, (b) present new data on MEM reflex anatomy and physiology from our laboratory and others, and (c) describe the clinical implications of our research. PMID:20870664

  9. Lasers in stapes surgery: a review.

    PubMed

    Young, E; Mitchell-Innes, A; Jindal, M

    2015-07-01

    Lasers in stapes surgery are used to divide the anterior and posterior crus of the stapes, divide the stapedius tendon and perforate the footplate. The ideal laser should not penetrate deeply into the perilymph (thereby increasing its temperature). It should be conducted through optical fibres, allowing easy manipulation, and should have good water absorption, equating to high bone ablation efficiency. This review discusses the various different lasers used in stapes surgery with regard to their properties and suitability for this type of surgery. In particular, the laser parameters used are discussed to facilitate their clinical use.

  10. Aural Acoustic Stapedius-Muscle Reflex Threshold Procedures to Test Human Infants and Adults.

    PubMed

    Keefe, Douglas H; Feeney, M Patrick; Hunter, Lisa L; Fitzpatrick, Denis F

    2017-02-01

    Power-based procedures are described to measure acoustic stapedius-muscle reflex threshold and supra-threshold responses in human adult and infant ears at frequencies from 0.2 to 8 kHz. The stimulus set included five clicks in which four pulsed activators were placed between each pair of clicks, with each stimulus set separated from the next by 0.79 s to allow for reflex decay. Each click response was used to detect the presence of reflex effects across frequency that were elicited by a pulsed broadband-noise or tonal activator in the ipsilateral or contralateral test ear. Acoustic reflex shifts were quantified in terms of the difference in absorbed sound power between the initial baseline click and the later four clicks in each set. Acoustic reflex shifts were measured over a 40-dB range of pulsed activators, and the acoustic reflex threshold was objectively calculated using a maximum 10 likelihood procedure. To illustrate the principles underlying these new reflex tests, reflex shifts in absorbed sound power and absorbance are presented for data acquired in an adult ear with normal hearing and in two infant ears in the initial and follow-up newborn hearing screening exams, one with normal hearing and the other with a conductive hearing loss. The use of absorbed sound power was helpful in classifying an acoustic reflex shift as present or absent. The resulting reflex tests are in use in a large study of wideband clinical diagnosis and monitoring of middle-ear and cochlear function in infant and adult ears.

  11. Endolymphatic sac surgery versus tenotomy of the stapedius and tensor tympani muscles in the management of patients with unilateral definite Meniere's disease.

    PubMed

    Albu, Silviu; Babighian, Gregorio; Amadori, Maurizio; Trabalzini, Franco

    2015-12-01

    This study aims to compare the outcomes of patients with Meniere's disease submitted to either endolymphatic mastoid shunt (ES) or tenotomy of the stapedius and tensor tympani muscles (TSTM). This is a retrospective chart review of patients treated with ES or TSTM between 2000 and 2010 and followed up for at least 12 months. The main outcomes were represented by: (1) vertigo class, hearing stage and functional level according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; (2) adjustment of dizziness handicap inventory (DHI) and (3) complete and substantial vertigo control using the Kaplan-Meier survival method. Sixty-three patients met the inclusion criteria: 34 underwent ES and 29 TSTM. The baseline demographic characteristics, the hearing stage, the functional level, the DHI and hearing levels were not different between the two groups. No significant difference in vertigo class was demonstrated: 66 % of TSTM patients attained class A compared to 44 % in the ES group (p = 0.14). Kaplan-Meier survival curves specific to class A showed significant differences, favoring TSTM (log-rank test, p = 0.022). TSTM patients demonstrated significantly improved functional level (p = 0.0004) and improved DHI scores (p = 0.001). Eight ES patients (25 %) demanded a second surgical attempt compared to none in the TSTM. Aural fullness was significantly improved in TSTM group (p = 0.01), while the difference in tinnitus improvement was non-significant. Hearing preservation was significantly better in TSTM group (p = 0.001). TSTM is a safe surgical procedure, with significant vertigo control rates, and important hearing preservation rates. More patients and longer follow-up are needed to support our preliminary findings.

  12. Multicentre investigation on electrically evoked compound action potential and stapedius reflex: how do these objective measures relate to implant programming parameters?

    PubMed

    Van Den Abbeele, Thierry; Noël-Petroff, Nathalie; Akin, Istemihan; Caner, Gül; Olgun, Levent; Guiraud, Jeanne; Truy, Eric; Attias, Josef; Raveh, Eyal; Belgin, Erol; Sennaroglu, Gonca; Basta, Dietmar; Ernst, Arneborg; Martini, Alessandro; Rosignoli, Monica; Levi, Haya; Elidan, Joseph; Benghalem, Abdelhamid; Amstutz-Montadert, Isabelle; Lerosey, Yannick; De Vel, Eddy; Dhooge, Ingeborg; Hildesheimer, Minka; Kronenberg, Jona; Arnold, Laure

    2012-02-01

    The aims of this study were to collect data on electrically evoked compound action potential (eCAP) and electrically evoked stapedius reflex thresholds (eSRT) in HiResolution(TM) cochlear implant (CI) users, and to explore the relationships between these objective measures and behavioural measures of comfort levels (M-levels). A prospective study on newly implanted subjects was designed. The eCAP was measured intra-operatively and at first fitting through neural response imaging (NRI), using the SoundWave(TM) fitting software. The eSRT was measured intra-operatively by visual monitoring of the stapes, using both single-electrode stimulation and speech bursts (four electrodes stimulated at the same time). Measures of M-levels were performed according to standard clinical practice and collected at first fitting, 3 and 6 months of CI use. One hundred seventeen subjects from 14 centres, all implanted unilaterally with a HiResolution CII Bionic Ear(®) or HiRes 90K(®), were included in the study. Speech burst stimulation elicited a significantly higher eSRT success rate than single-electrode stimulation, 84 vs. 64% respectively. The NRI success rate was 81% intra-operatively, significantly increasing to 96% after 6 months. Fitting guidelines were defined on the basis of a single NRI measurement. Correlations, analysis of variance, and multiple regression analysis were applied to generate a predictive model for the M-levels. Useful insights were produced into the behaviour of objective measures according to time, electrode location, and fitting parameters. They may usefully assist in programming the CI when no reliable feedback is obtained through standard behavioural procedures.

  13. [Comparative study between the level of discomfort and the acoustic reflex in workers].

    PubMed

    Bezerra, Francisca Magnólia Diógenes Holanda; Iório, Maria Cecília Martinelli

    2006-01-01

    Comparative study between the level of discomfort and the acoustic reflex in workers. To observe the hearing behavior, through the assessment of the contraction activity of the stapedius muscle and the level of discomfort, of individuals who are and are not exposed to occupational noise, with the aim of identifying the influence of noise in the behavior of the contraction of the stapedius muscle and in the sensibility of hearing. This study was developed at the Serviço Social da Indústria - SESI - Ce. A hundred and three adults with normal hearing, male and female, with ages varying from 18 to 45 years were divided in three groups: G1 with 41 adults exposed to noise and who used AIPE; G2 with 32 adults exposed to noise and who did not use AIPE; G3 with 30 adults who were not exposed to noise. Participants were submitted to audiologic evaluation, including the analysis of the acoustic reflex level (ARL) and discomfort level (DL) at the frequencies of 500 HZ, 1000Hz, 2000Hz, 3000Hz, 4000Hz and WN. For the statistical analysis the tests of Mann Whitney, Wilcoxon and Kruskal, with significance levels of 5%, were used. No statistically significant difference was identified for the ARL between the three groups, with mean values ranging from 93 to 103dBHL; the ARL was significantly smaller than the DL, with the mean values of DL varying from 111 to 119 dBHL for G1, from 113 to 120dBHL for G2 and from 106 to 114dBHL for G3; the DL is higher in individuals of G1 followed by individuals of G2 and G3. The exposure to noise does not determine changes in the behavior of the ARL; the DL rises with the exposure to occupational noise; the DL is higher than the ARL in 10 to 25dB.

  14. Assessment of Ipsilateral Efferent Effects in Human via ECochG

    PubMed Central

    Verschooten, Eric; Strickland, Elizabeth A.; Verhaert, Nicolas; Joris, Philip X.

    2017-01-01

    Development of electrophysiological means to assess the medial olivocochlear (MOC) system in humans is important to further our understanding of the function of that system and for the refinement and validation of psychoacoustical and otoacoustic emission methods which are thought to probe the MOC. Based on measurements in anesthetized animals it has been hypothesized that the MOC-reflex (MOCR) can enhance the response to signals in noise, and several lines of evidence support such a role in humans. A difficulty in these studies is the isolation of efferent effects. Efferent activation can be triggered by acoustic stimulation of the contralateral or ipsilateral ear, but ipsilateral stimulation is thought to be more effective. However, ipsilateral stimulation complicates interpretation of effects since these sounds can affect the perception of other ipsilateral sounds by mechanisms not involving olivocochlear efferents. We assessed the ipsilaterally evoked MOCR in human using a transtympanic procedure to record mass-potentials from the cochlear promontory or the niche of the round window. Averaged compound action potential (CAP) responses to masked probe tones of 4 kHz with and without a precursor (designed to activate the MOCR but not the stapedius reflex) were extracted with a polarity alternating paradigm. The masker was either a simultaneous narrow band noise masker or a short (20-ms) tonal ON- or OFF-frequency forward masker. The subjects were screened for normal hearing (audiogram, tympanogram, threshold stapedius reflex) and psychoacoustically tested for the presence of a precursor effect. We observed a clear reduction of CAP amplitude by the precursor, for different masking conditions. Even without an MOCR, this is expected because the precursor will affect the response to subsequent stimuli via neural adaptation. To determine whether the precursor also activated the efferent system, we measured the CAP over a range of masker levels, with or without precursor, and for different types of masker. The results show CAP reduction consistent with the type of gain reduction caused by the MOCR. These results generally support psychoacoustical paradigms designed to probe the efferent system as indeed activating the MOCR system, but not all observations are consistent with this mechanism. PMID:28642679

  15. [The endoscopic anatomy of the middle ear (a dissection study)].

    PubMed

    Rzaev, R M; Rzaev, R R

    The objective of the present work was to study the specific endoscopic anatomical features of the middle ear using the dissected temporal bones with the intact tympanic membrane. The 18 cm long endoscopes 4 mm in diameter with a visual angle from 0 to 45 degrees in the combination with some other microinstruments, such as ear pincers, needles, curettes, elevators, and suction tubes, were used during the examination. It was shown that endomeato-transtympanic endosopy provides a panoramic view of almost all structures of the middle ear. After the resection of the posterior bone edge of 'annulus tympanicus', the use of the 45o endoscope ensured the panoramic view not only of certain structures of the middle ear (e.g. the tympanic chord, the stapedius muscle tendon, the entire pyramidal process) but also of the structures of the retrotympanic and anterior epitympanic spaces.

  16. Auditory function at 14 years of age of very-low-birthweight.

    PubMed

    Davis, N M; Doyle, L W; Ford, G W; Keir, E; Michael, J; Rickards, A L; Kelly, E A; Callanan, C

    2001-03-01

    The aim of the study was to determine audiological function at 14 years of age of very-low-birthweight (VLBW < or = 1500 g) children compared with a cohort of normal birthweight (NBW > 2499 g) children. Participants were consecutive surviving preterm children of birthweight < 1000 g born between 1977 and 1982 (n=86) and of birthweight 1000 to 1500 g born between 1980 and 1982 (n=124) and randomly selected NBW children born between 1981 and 1982 (n=60). Audiometric tests included pure tone audiometry, tympanometry, stapedius muscle reflexes, and measures of central auditory processing. Psychometric tests included measures of IQ, academic achievement, and behaviour. There were no significant differences in rates of hearing impairment, abnormal tympanograms, figure-ground problems, or digit recall between VLBW children and NBW control children. VLBW children had higher rates of some central auditory processing problems, which in turn were associated with poorer intellectual, academic, and behavioural progress.

  17. Stapes surgery in residency: the UFPR clinical hospital experience.

    PubMed

    Caldart, Adriano Ulisses; Terruel, Igor; Enge, Dair Jocely; Kurogi, Adriana Sayuri; Buschle, Maurício; Mocellin, Marcos

    2007-01-01

    Surgery of the stapedius remains the established treatment for otosclerosis. Recent publications have showed that success in surgeries done by residents have decreased and hearing results are worse than those obtained by experienced otologic surgeons. To evaluate the experience of the otorhinolaryngology unit, Parana University, relative to stapes surgery done in the residency training program. A retrospective study of 114 stapes surgeries done in the past 9 years in 96 patients. Audiometric results were analysed according to the Committee on Hearing and Equilibrium guidelines and the Amsterdam Hearing Evaluation Plots. The improvement of the airway postoperative gap and thresholds were taken into account. 96 patients were included, most of them female adults (67.7%) and white (93.7%). Stapedectomy was done in 50.9% of cases, mostly under local anesthesia and sedation (96.5%), using mostly the Teflon prosthesis (37.7%). The surgical success rate was 50.88%, there was an 11.4% complication rate. Postoperative hearing gains considered as surgical success were inferior to published results in the literature, done by experienced surgeons.

  18. Severe diarrhea-dehydration in infancy permanently alters auditory function.

    PubMed

    Todd, N Wendell

    2012-02-01

    Of the myriad etiologies of sensorineural hearing impairment, metabolic stress is rarely considered. I posit that severe dehydration in conjunction with hypoxia, at least during infancy, prompts permanent changes in the cochlea. In a population-based prospective study of otitis media, children without otitis were found to have at age 4-8 years, worse auditory thresholds if as an infant had been hospitalized for diarrhea-dehydration. What is more, stapedius reflex thresholds tended to be lower in children who had been hospitalized for diarrhea-dehydration: that is, less acoustic energy for arousal or to be frightening. The hypothesis that the transient metabolic stress of dehydration with hypoxia prompts permanent sensorineural hearing impairment with reduced uncomfortable loudness thresholds, is both (1) consistent in an evolutionary sense with a subsequent survival advantage, and (2) subject to verification both by descriptive studies of children undergoing ECMO (ExtraCorporeal Membrane Oxygenation) or care for congenital diaphragmatic hernia, and by animal studies. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis.

    PubMed

    Céspedes Cruz, Adriana Ivonne; Méndez Núñez, Myriam; Solís Vallejo, Eunice; Zeferino Cruz, Maritza; Torres Jiménez, Alfonso Ragnar; Ocampo Sánchez, Verónica; Flores Meza, Beatriz; Quintana Ruiz, Norma

    2017-09-08

    Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. Quinine reduces the dynamic range of the human auditory system.

    PubMed

    Berninger, E; Karlsson, K K; Alván, G

    1998-01-01

    The aim of the study was to evaluate and quantify quinine-induced changes in the human auditory dynamic range, as a model for cochlear hearing loss. Six otologically normal volunteers (21-40 years old) received quinine hydrochloride (15 mg/kg body weight) in two identical oral doses and one intravenous infusion. Refined hearing tests were performed monaurally at threshold, at moderate hearing levels and at high hearing levels. Quinine induced a maximal pure-tone threshold shift of 23 dB (1000-2000 Hz). The increase in the psychoacoustical click threshold agreed with an increase in the detection threshold of click-evoked otoacoustic emissions. The change in the stimulus-response relationship of the emissions reflected recruitment. The self-attained most comfortable speech level and the acoustic stapedius reflex thresholds were not affected by quinine administration. Quinine is a useful model substance for reversibly inducing complete loudness recruitment in humans as it acts specifically on some parts of the hearing function. Its mechanism of action on the molecular level is likely to reveal further information on the physiology of hearing.

  1. Ultrastructure of spines and associated terminals on brainstem neurons controlling auditory input

    PubMed Central

    Brown, M. Christian; Lee, Daniel J.; Benson, Thane E.

    2013-01-01

    Spines are unique cellular appendages that isolate synaptic input to neurons and play a role in synaptic plasticity. Using the electron microscope, we studied spines and their associated synaptic terminals on three groups of brainstem neurons: tensor tympani motoneurons, stapedius motoneurons, and medial olivocochlear neurons, all of which exert reflexive control of processes in the auditory periphery. These spines are generally simple in shape; they are infrequent and found on the somata as well as the dendrites. Spines do not differ in volume among the three groups of neurons. In all cases, the spines are associated with a synaptic terminal that engulfs the spine rather than abuts its head. The positions of the synapses are variable, and some are found at a distance from the spine, suggesting that the isolation of synaptic input is of diminished importance for these spines. Each group of neurons receives three common types of synaptic terminals. The type of terminal associated with spines of the motoneurons contains pleomorphic vesicles, whereas the type associated with spines of olivocochlear neurons contains large round vesicles. Thus, spine-associated terminals in the motoneurons appear to be associated with inhibitory processes but in olivocochlear neurons they are associated with excitatory processes. PMID:23602963

  2. A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

    PubMed

    Nakamura, Chizuko; Inaba, Yuji; Tsukahara, Keiko; Mochizuki, Mie; Sawanobori, Emi; Nakazawa, Yozo; Aoyama, Kouki

    2018-02-01

    Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course. Copyright © 2017. Published by Elsevier B.V.

  3. Sound attenuation in the ear of domestic chickens (Gallus gallus domesticus) as a result of beak opening

    PubMed Central

    Claes, Raf; Dirckx, Joris J. J.

    2017-01-01

    Because the quadrate and the eardrum are connected, the hypothesis was tested that birds attenuate the transmission of sound through their ears by opening the bill, which potentially serves as an additional protective mechanism for self-generated vocalizations. In domestic chickens, it was examined if a difference exists between hens and roosters, given the difference in vocalization capacity between the sexes. To test the hypothesis, vibrations of the columellar footplate were measured ex vivo with laser Doppler vibrometry (LDV) for closed and maximally opened beak conditions, with sounds introduced at the ear canal. The average attenuation was 3.5 dB in roosters and only 0.5 dB in hens. To demonstrate the importance of a putative protective mechanism, audio recordings were performed of a crowing rooster. Sound pressures levels of 133.5 dB were recorded near the ears. The frequency content of the vocalizations was in accordance with the range of highest hearing sensitivity in chickens. The results indicate a small but significant difference in sound attenuation between hens and roosters. However, the amount of attenuation as measured in the experiments on both hens and roosters is small and will provide little effective protection in addition to other mechanisms such as stapedius muscle activity. PMID:29291112

  4. A prospective study on radiation-induced changes in hearing function

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Herrmann, Franziska; Doerr, Wolfgang; Experimental Center, Medical Faculty Carl Gustav Carus, University of Technology-Dresden, Dresden

    Purpose: To quantitate changes in hearing function after radiotherapy for head-and-neck tumors. Methods and Materials: At the Department of Radiotherapy and Radiation Oncology, 32 patients were irradiated for head-and-neck tumors. Three-dimensional treatment planning was applied. Total tumor doses were 30.0-77.6 Gy, local doses to the inner ear (n = 64) ranged from 1.7 to 64.3 Gy. Audiometry was performed before the onset of radiotherapy (RT), at a tumor dose of 40 Gy or at the end of palliative treatment, at the end of curative RT, and 2-6 months post-RT. Assays applied were frequency-specific threshold measurements for air and bone conduction,more » measurements according to Weber and Rinne, tympanometry and assessment of the stapedius reflex. Results: Age and prior disease significantly decreased, whereas previous or concurrent alcohol consumption significantly increased hearing ability. A significant reduction in hearing ability during RT was found for high frequencies (at 40 Gy) and low frequencies (at end of RT), which persisted after RT. No differences were observed for air or bone conduction. None of the other assays displayed time- or dose-dependent changes. Dose-effect analyses revealed an ED50 (dose at which a 50% incidence is expected) for significant changes in hearing thresholds (15 dB) in the range of 20-25 Gy, with large confidence limits. Conclusions: Radiation effects on hearing ability were confined to threshold audiogram values, which started during the treatment without reversibility during 6 months postradiotherapy.« less

  5. Elastic fiber-mediated enthesis in the human middle ear

    PubMed Central

    Kawase, Tetsuaki; Shibata, Shunichi; Katori, Yukio; Ohtsuka, Aiji; Murakami, Gen; Fujimiya, Mineko

    2012-01-01

    Adaptation to constant vibration (acoustic oscillation) is likely to confer a specific morphology at the bone–tendon and bone–ligament interfaces at the ear ossicles, which therefore represent an exciting target of enthesis research. We histologically examined (i) the bone attachments of the tensor tympani and stapedius muscles and (ii) the annular ligament of the incudostapedial joint obtained from seven elderly donated cadavers. Notably, both aldehyde-fuchsin and elastic-Masson staining demonstrated that the major fibrous component of the entheses was not collagen fibers but mature elastic fibers. The positive controls for elastic fiber staining were the arterial wall elastic laminae included in the temporal bone materials. The elastic fibers were inserted deeply into the type II collagen-poor fibrocartilage covering the ear ossicles. The muscle tendons were composed of an outer thin layer of collagen fibers and an inner thick core of elastic fibers near the malleus or stapes. In the unique elastic fiber-mediated entheses, hyaluronan, versican and fibronectin were expressed strongly along the elastic fibers. The hyaluronan seemed to act as a friction-reducing lubricant for the elastic fibers. Aggrecan was labeled strongly in a disk- or plica-like fibrous mass on the inner side of the elastic fiber-rich ligament, possibly due to compression stress from the ligament. Tenascin-c was not evident in the entheses. The elastic fiber-mediated entheses appeared resistant to tissue destruction in an environment exposed to constant vibration. The morphology was unlikely to be the result of age-related degeneration. PMID:22803514

  6. Fetal development of the elastic-fiber-mediated enthesis in the human middle ear.

    PubMed

    Takanashi, Yoshitaka; Shibata, Shunichi; Katori, Yukio; Murakami, Gen; Abe, Shinichi; Rodríguez-Vázquez, Jose Francisco; Kawase, Tetsuaki

    2013-10-01

    In the human middle ear, the annular ligament of the incudostapedial joint and the insertions of the tensor tympani and stapedius muscles contain abundant elastic fibers; i.e., the elastic-fiber-mediated entheses. Hyaluronan also coexists with the elastic fibers. In the present study using immunohistochemistry, we demonstrated the distribution of elastin not only in the incudostapedial joint but also in the other two joints of the middle ear in adults and fetuses. In adults, the expression of elastin did not extend out of the annular ligament composed of mature elastic fibers but clearly overlapped with it. Electron microscopic observations of the annular ligament demonstrated a few microfibrils along the elastic fibers. Thus, in contrast to the vocal cord, the middle ear entheses seemed not to contain elaunin and oxytalan fibers. In mid-term fetuses (at approximately 15-16 weeks of gestation) before opening of the external acoustic meatus, the incudostapedial joint showed abundant elastic fibers, but the incudomalleolar and stapediovestibular joints did not. At this stage, hyaluronan was not colocalized, but distributed diffusely in loose mesenchymal tissues surrounding the ear ossicles. Therefore, fetal development of elastin and elastic fibers in the middle ear entheses is unlikely to require acoustic oscillation. In late-stage fetuses (25-30 weeks), whose ear ossicles were almost the same size as those in adults, we observed bundling and branching of elastic fibers. However, hyaluronan expression was not as strong as in adults. Colocalization between elastic fibers and hyaluronan appeared to be a result of postnatal maturation of the entheses. Copyright © 2013 Elsevier GmbH. All rights reserved.

  7. Ear Structures of the Naked Mole-Rat, Heterocephalus glaber, and Its Relatives (Rodentia: Bathyergidae)

    PubMed Central

    Mason, Matthew J.; Cornwall, Hannah L.; Smith, Ewan St. J.

    2016-01-01

    Although increasingly popular as a laboratory species, very little is known about the peripheral auditory system of the naked mole-rat, Heterocephalus glaber. In this study, middle and inner ears of naked mole-rats of a range of ages were examined using micro-computed tomography and dissection. The ears of five other bathyergid species (Bathyergus suillus, Cryptomys hottentotus, Fukomys micklemi, Georychus capensis and Heliophobius argenteocinereus) were examined for comparative purposes. The middle ears of bathyergids show features commonly found in other members of the Ctenohystrica rodent clade, including a fused malleus and incus, a synovial stapedio-vestibular articulation and the loss of the stapedius muscle. Heterocephalus deviates morphologically from the other bathyergids examined in that it has a more complex mastoid cavity structure, poorly-ossified processes of the malleus and incus, a ‘columelliform’ stapes and fewer cochlear turns. Bathyergids have semicircular canals with unusually wide diameters relative to their radii of curvature. How the lateral semicircular canal reaches the vestibule differs between species. Heterocephalus has much more limited high-frequency hearing than would be predicted from its small ear structures. The spongy bone forming its ossicular processes, the weak incudo-stapedial articulation, the columelliform stapes and (compared to other bathyergids) reduced cochlear coiling are all potentially degenerate features which might reflect a lack of selective pressure on its peripheral auditory system. Substantial intraspecific differences were found in certain middle and inner ear structures, which might also result from relaxed selective pressures. However, such interpretations must be treated with caution in the absence of experimental evidence. PMID:27926945

  8. Distribution of elastic fibers in the head and neck: a histological study using late-stage human fetuses.

    PubMed

    Kinoshita, Hideaki; Umezawa, Takashi; Omine, Yuya; Kasahara, Masaaki; Rodríguez-Vázquez, José Francisco; Murakami, Gen; Abe, Shinichi

    2013-03-01

    There is little or no information about the distribution of elastic fibers in the human fetal head. We examined this issue in 15 late-stage fetuses (crown-rump length, 220-320 mm) using aldehyde-fuchsin and elastica-Masson staining, and we used the arterial wall elastic laminae and external ear cartilages as positive staining controls. The posterior pharyngeal wall, as well as the ligaments connecting the laryngeal cartilages, contained abundant elastic fibers. In contrast with the sphenomandibular ligament and the temporomandibular joint disk, in which elastic fibers were partly present, the discomalleolar ligament and the fascial structures around the pterygoid muscles did not have any elastic fibers. In addition, the posterior marginal fascia of the prestyloid space did contain such fibers. Notably, in the middle ear, elastic fibers accumulated along the tendons of the tensor tympani and stapedius muscles and in the joint capsules of the ear ossicle articulations. Elastic fibers were not seen in any other muscle tendons or vertebral facet capsules in the head and neck. Despite being composed of smooth muscle, the orbitalis muscle did not contain any elastic fibers. The elastic fibers in the sphenomandibular ligament seemed to correspond to an intermediate step of development between Meckel's cartilage and the final ligament. Overall, there seemed to be a mini-version of elastic fiber distribution compared to that in adults and a different specific developmental pattern of connective tissues. The latter morphology might be a result of an adaptation to hypoxic conditions during development.

  9. Elastic fiber-mediated enthesis in the human middle ear.

    PubMed

    Kawase, Tetsuaki; Shibata, Shunichi; Katori, Yukio; Ohtsuka, Aiji; Murakami, Gen; Fujimiya, Mineko

    2012-10-01

    Adaptation to constant vibration (acoustic oscillation) is likely to confer a specific morphology at the bone-tendon and bone-ligament interfaces at the ear ossicles, which therefore represent an exciting target of enthesis research. We histologically examined (i) the bone attachments of the tensor tympani and stapedius muscles and (ii) the annular ligament of the incudostapedial joint obtained from seven elderly donated cadavers. Notably, both aldehyde-fuchsin and elastic-Masson staining demonstrated that the major fibrous component of the entheses was not collagen fibers but mature elastic fibers. The positive controls for elastic fiber staining were the arterial wall elastic laminae included in the temporal bone materials. The elastic fibers were inserted deeply into the type II collagen-poor fibrocartilage covering the ear ossicles. The muscle tendons were composed of an outer thin layer of collagen fibers and an inner thick core of elastic fibers near the malleus or stapes. In the unique elastic fiber-mediated entheses, hyaluronan, versican and fibronectin were expressed strongly along the elastic fibers. The hyaluronan seemed to act as a friction-reducing lubricant for the elastic fibers. Aggrecan was labeled strongly in a disk- or plica-like fibrous mass on the inner side of the elastic fiber-rich ligament, possibly due to compression stress from the ligament. Tenascin-c was not evident in the entheses. The elastic fiber-mediated entheses appeared resistant to tissue destruction in an environment exposed to constant vibration. The morphology was unlikely to be the result of age-related degeneration. © 2012 The Authors Journal of Anatomy © 2012 Anatomical Society.

  10. Distribution of elastic fibers in the head and neck: a histological study using late-stage human fetuses

    PubMed Central

    Kinoshita, Hideaki; Umezawa, Takashi; Omine, Yuya; Kasahara, Masaaki; Rodríguez-Vázquez, José Francisco; Murakami, Gen

    2013-01-01

    There is little or no information about the distribution of elastic fibers in the human fetal head. We examined this issue in 15 late-stage fetuses (crown-rump length, 220-320 mm) using aldehyde-fuchsin and elastica-Masson staining, and we used the arterial wall elastic laminae and external ear cartilages as positive staining controls. The posterior pharyngeal wall, as well as the ligaments connecting the laryngeal cartilages, contained abundant elastic fibers. In contrast with the sphenomandibular ligament and the temporomandibular joint disk, in which elastic fibers were partly present, the discomalleolar ligament and the fascial structures around the pterygoid muscles did not have any elastic fibers. In addition, the posterior marginal fascia of the prestyloid space did contain such fibers. Notably, in the middle ear, elastic fibers accumulated along the tendons of the tensor tympani and stapedius muscles and in the joint capsules of the ear ossicle articulations. Elastic fibers were not seen in any other muscle tendons or vertebral facet capsules in the head and neck. Despite being composed of smooth muscle, the orbitalis muscle did not contain any elastic fibers. The elastic fibers in the sphenomandibular ligament seemed to correspond to an intermediate step of development between Meckel's cartilage and the final ligament. Overall, there seemed to be a mini-version of elastic fiber distribution compared to that in adults and a different specific developmental pattern of connective tissues. The latter morphology might be a result of an adaptation to hypoxic conditions during development. PMID:23560235

  11. Normative wideband reflectance, equivalent admittance at the tympanic membrane, and acoustic stapedius reflex threshold in adults

    PubMed Central

    Feeney, M. Patrick; Keefe, Douglas H.; Hunter, Lisa L.; Fitzpatrick, Denis F.; Garinis, Angela C.; Putterman, Daniel B.; McMillan, Garnett P.

    2016-01-01

    Objectives Wideband acoustic immittance (WAI) measures such as pressure reflectance, parameterized by absorbance and group delay, equivalent admittance at the tympanic membrane (TM), and acoustic stapedius reflex threshold (ASRT) describe middle-ear function across a wide frequency range, compared to traditional tests employing a single frequency. The objective of this study was to obtain normative data using these tests for a group of normal hearing adults and investigate test-retest reliability using a longitudinal design. Design A longitudinal prospective design was used to obtain normative test and retest data on clinical and WAI measures. Subjects were 13 males and 20 females (mean age = 25 y). Inclusion criteria included normal audiometry and clinical immittance. Subjects were tested on two separate visits approximately one month apart. Reflectance and equivalent admittance at the TM were measured from 0.25 to 8.0 kHz under three conditions: at ambient pressure in the ear canal and with pressure sweeps from positive to negative pressure (downswept) and negative to positive pressure (upswept). Equivalent admittance at the TM was calculated using admittance measurements at the probe tip which were adjusted using a model of sound transmission in the ear canal and acoustic estimates of ear-canal area and length. Wideband ASRTs were measured at tympanometric peak pressure (TPP) derived from the average TPP of downswept and upswept tympanograms. Descriptive statistics were obtained for all WAI responses, and wideband and clinical ASRTs were compared. Results Mean absorbance at ambient pressure and TPP demonstrated a broad band-pass pattern typical of previous studies. Test-retest differences were lower for absorbance at TPP for the downswept method compared to ambient pressure at frequencies between 1.0 and 1.26 kHz. Mean tympanometric peak-to-tail differences for absorbance were greatest around 1.0 to 2.0 kHz and similar for positive and negative tails. Mean group delay at ambient pressure and at TPP were greatest between 0.32 and 0.6 kHz at 200 to 300 μs, reduced at frequencies between 0.8 and 1.5 kHz, and increased above 1.5 kHz to around 150 μs. Mean equivalent admittance at the TM had a lower level for the ambient method than at TPP for both sweep directions below 1.2 kHz, but the difference between methods was only statistically significant for the comparison between the ambient method and TPP for the upswept tympanogram. Mean equivalent admittance phase was positive at all frequencies. Test-retest reliability of the equivalent admittance level ranged from 1 to 3 dB at frequencies below 1.0 kHz, but increased to 8 to 9 dB at higher frequencies. The mean wideband ASRT for an ipsilateral broadband noise activator was 12 dB lower than the clinical ASRT, but had poorer reliability. Conclusions Normative data for the WAI test battery revealed minor differences for results at ambient pressure compared to tympanometric methods at TPP for reflectance, group delay, and equivalent admittance level at the TM for subjects with middle-ear pressure within ±100 daPa. Test-retest reliability was better for absorbance at TPP for the downswept tympanogram compared to ambient pressure at frequencies around 1.0 kHz. Large peak-to-tail differences in absorbance combined with good reliability at frequencies between about 0.7 and 3.0 kHz suggest that this may be a sensitive frequency range for interpreting absorbance at TPP. The mean wideband ipsilateral ASRT was lower than the clinical ASRT, consistent with previous studies. Results are promising for the use of a wideband test battery to evaluate middle-ear function. PMID:28045835

  12. Auditory changes in acromegaly.

    PubMed

    Tabur, S; Korkmaz, H; Baysal, E; Hatipoglu, E; Aytac, I; Akarsu, E

    2017-06-01

    The aim of this study is to determine the changes involving auditory system in cases with acromegaly. Otological examinations of 41 cases with acromegaly (uncontrolled n = 22, controlled n = 19) were compared with those of age and gender-matched 24 healthy subjects. Whereas the cases with acromegaly underwent examination with pure tone audiometry (PTA), speech audiometry for speech discrimination (SD), tympanometry, stapedius reflex evaluation and otoacoustic emission tests, the control group did only have otological examination and PTA. Additionally, previously performed paranasal sinus-computed tomography of all cases with acromegaly and control subjects were obtained to measure the length of internal acoustic canal (IAC). PTA values were higher (p < 0.001 for right ears and p = 0.001 for left ears), and SD scores were (p = 0.002 for right ears and p = 0.002 for left ears) lower in acromegalic patients. IAC width in acromegaly group was narrower compared to that in control group (p = 0.03 for right ears and p = 0.02 for left ears). When only cases with acromegaly were taken into consideration, PTA values in left ears had positive correlation with growth hormone and insulin-like growth factor-1 levels (r = 0.4, p = 0.02 and r = 0.3, p = 0.03). Of all cases with acromegaly 13 (32%) had hearing loss in at least one ear, 7 (54%) had sensorineural type and 6 (46%) had conductive type hearing loss. Acromegaly may cause certain changes in the auditory system in cases with acromegaly. The changes in the auditory system may be multifactorial causing both conductive and sensorioneural defects.

  13. [Subclinical sensorineural hearing loss in female patients with rheumatoid arthritis].

    PubMed

    Treviño-González, José Luis; Villegas-González, Mario Jesús; Muñoz-Maldonado, Gerardo Enrique; Montero-Cantu, Carlos Alberto; Nava-Zavala, Arnulfo Hernán; Garza-Elizondo, Mario Alberto

    2015-01-01

    The rheumatoid arthritis is a clinical entity capable to cause hearing impairment that can be diagnosed promptly with high frequencies audiometry. To detect subclinical sensorineural hearing loss in patients with rheumatoid arthritis. Cross-sectional study on patients with rheumatoid arthritis performing high frequency audiometry 125Hz to 16,000Hz and tympanometry. The results were correlated with markers of disease activity and response to therapy. High frequency audiometry was performed in 117 female patients aged from 19 to 65 years. Sensorineural hearing loss was observed at a sensitivity of pure tones from 125 to 8,000 Hz in 43.59%, a tone threshold of 10,000 to 16,000Hz in 94.02% patients in the right ear and in 95.73% in the left ear. Hearing was normal in 8 (6.84%) patients. Hearing loss was observed in 109 (93.16%), and was asymmetric in 36 (30.77%), symmetric in 73 (62.37%), bilateral in 107 (91.45%), unilateral in 2 (1.71%), and no conduction and/or mixed hearing loss was encountered. Eight (6.83%) patients presented vertigo, 24 (20.51%) tinnitus. Tympanogram type A presented in 88.90% in the right ear and 91.46% in the left ear, with 5.98 to 10.25% type As. Stapedius reflex was present in 75.3 to 85.2%. Speech discrimination in the left ear was significantly different (p = 0.02)in the group older than 50 years. No association was found regarding markers of disease activity, but there was an association with the onset of rheumatoid arthritis disease. Patients with rheumatoid arthritis had a high prevalence of sensorineural hearing loss for high and very high frequencies. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  14. Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations.

    PubMed

    Pérez-Villa, Yolanda E; Mena-Ramírez, María E; Aguirre, Laura E Chamlati; Mora-Magaña, Ignacio; Gutiérrez-Farfán, Ileana S

    2014-01-01

    The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  15. Separating the contributions of olivocochlear and middle ear muscle reflexes in modulation of distortion product otoacoustic emission levels.

    PubMed

    Wolter, Nikolaus E; Harrison, Robert V; James, Adrian L

    2014-01-01

    Mediated by the medial olivocochlear system (MOCS), distortion product otoacoustic emission (DPOAE) levels are reduced by presentation of contralateral acoustic stimuli. Such acoustic signals can also evoke a middle ear muscle reflex (MEMR) that also attenuates recorded DPOAE levels. Our aim is to clearly differentiate these two inhibitory mechanisms and to analyze each separately, perhaps allowing the development of novel tests of hearing function. DPOAE were recorded in real time from chinchillas with normal auditory brainstem response thresholds and middle ear function. Amplitude reduction and its onset latency caused by contralateral presentation of intermittent narrow-band noise (NBN) were measured. Stapedius and tensor tympani muscle tendons were divided without disturbing the ossicular chain, and DPOAE testing was repeated. Peak reduction of (2f1 - f2) DPOAE levels occurred when the center frequency of contralateral NBN approximated the primary tone f2, indicating an f2-frequency-specific response. For a 4.5-kHz centered NBN, DPOAE (f2 = 4.4 kHz) inhibition was 0.1 dB (p < 0.001). This response remained present after tendon division, consistent with an MOCS origin. Low-frequency NBN (center frequency: 0.5 kHz) reduced otoacoustic emission levels (0.1 dB, p < 0.001) across a wide range of DPOAE frequencies. This low-frequency response was abolished by division of the middle ear muscle tendons, clearly indicating MEMR involvement. Following middle ear muscle tendon division, DPOAE inhibition by contralateral stimuli approximating the primary tone f2 persists, whereas responses evoked by lower contralateral frequencies are abolished. This distinguishes the different roles of the MOCS (f2 frequency specific) and MEMR (low frequency only) in contralateral modulation of DPOAE. This analysis helps clarify the pathways involved in an objective test that might have clinical benefit in the testing of neonates.

  16. Evidence of structurally continuous collagen fibrils in tendons.

    PubMed

    Svensson, Rene B; Herchenhan, Andreas; Starborg, Tobias; Larsen, Michael; Kadler, Karl E; Qvortrup, Klaus; Magnusson, S Peter

    2017-03-01

    Tendons transmit muscle-generated force through an extracellular matrix of aligned collagen fibrils. The force applied by the muscle at one end of a microscopic fibril has to be transmitted through the macroscopic length of the tendon by mechanisms that are poorly understood. A key element in this structure-function relationship is the collagen fibril length. During embryogenesis short fibrils are produced but they grow rapidly with maturation. There is some controversy regarding fibril length in adult tendon, with mechanical data generally supporting discontinuity while structural investigations favor continuity. This study initially set out to trace the full length of individual fibrils in adult human tendons, using serial block face-scanning electron microscopy. But even with this advanced technique the required length could not be covered. Instead a statistical approach was used on a large volume of fibrils in shorter image stacks. Only a single end was observed after tracking 67.5mm of combined fibril lengths, in support of fibril continuity. To shed more light on this observation, the full length of a short tendon (mouse stapedius, 125μm) was investigated and continuity of individual fibrils was confirmed. In light of these results, possible mechanisms that could reconcile the opposing findings on fibril continuity are discussed. Connective tissues hold all parts of the body together and are mostly constructed from thin threads of the protein collagen (called fibrils). Connective tissues provide mechanical strength and one of the most demanding tissues in this regard are tendons, which transmit the forces generated by muscles. The length of the collagen fibrils is essential to the mechanical strength and to the type of damage the tissue may experience (slippage of short fibrils or breakage of longer ones). This in turn is important for understanding the repair processes after such damage occurs. Currently the issue of fibril length is contentious, but this study provides evidence that the fibrils are extremely long and likely continuous. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  17. A miniaturized laser-Doppler-system in the ear canal

    NASA Astrophysics Data System (ADS)

    Schmidt, T.; Gerhardt, U.; Kupper, C.; Manske, E.; Witte, H.

    2013-03-01

    Gathering vibrational data from the human middle ear is quite difficult. To this date the well-known acoustic probe is used to estimate audiometric parameters, e.g. otoacoustic emissions, wideband reflectance and the measurement of the stapedius reflex. An acoustic probe contains at least one microphone and one loudspeaker. The acoustic parameter determination of the ear canal is essential for the comparability of test-retest measurement situations. Compared to acoustic tubes, the ear canal wall cannot be described as a sound hard boundary. Sound energy is partly absorbed by the ear canal wall. In addition the ear canal features a complex geometric shape (Stinson and Lawton1). Those conditions are one reason for the inter individual variability in input impedance measurement data of the tympanic membrane. The method of Laser-Doppler-Vibrometry is well described in literature. Using this method, the surface velocity of vibrating bodies can be determined contact-free. Conventional Laser-Doppler-Systems (LDS) for auditory research are mounted on a surgical microscope. Assuming a free line of view to the ear drum, the handling of those laser-systems is complicated. We introduce the concept of a miniaturized vibrometer which is supposed to be applied directly in the ear canal for contact-free measurement of the tympanic membrane surface vibration. The proposed interferometer is based on a Fabry-Perot etalon with a DFB laser diode as light source. The fiber-based Fabry-Perot-interferometer is characterized by a reduced size, compared to e.g. Michelson-, or Mach-Zehnder-Systems. For the determination of the phase difference in the interferometer, a phase generated carrier was used. To fit the sensor head in the ear canal, the required shape of the probe was generated by means of the geometrical data of 70 ear molds. The suggested prototype is built up by a singlemode optical fiber with a GRIN-lens, acting as a fiber collimator. The probe has a diameter of 1.8 mm and a length of 5 mm.

  18. Noise, impulse noise, and other physical factors: combined effects on hearing.

    PubMed

    Pekkarinen, J

    1995-01-01

    In most of the epidemiologic studies conducted during the last 20 years, impulse noise caused increased risk of hearing loss in comparison to continuous noise with the same acoustical energy. The interaction between noise exposure (broadband at 100 dB(A)) and hand-arm vibration (125 Hz at 2 ms-2 acceleration level) has been proven for people having vibration-induced white finger symptoms. This interaction is evidenced as a permanent hearing loss. However, why the interaction is seen only in people with VWF is not known. The mechanisms may be related to individual susceptibility, and hypotheses are given on the role of the autonomous nervous system regulating the peripheral vascular reaction. Whole-body vibration (2-10 Hz, at 10 ms-2 level) seems to increase the TTS when noise (broadband at 90 dB(A)) is present. This effect is more pronounced at higher temperatures. The hypothermia protects hearing against the effects of noise in animal studies. The interaction between noise and temperature decrease seems obvious in animal studies. Exercise has both increased and decreased the TTS during noise exposure. The effects have been successfully explained as the depression of the stapedius reflex. Thus, less protection against noise is provided for the inner ear in exercise conditions. The increase of the blood temperature also has been suggested to increase noise-induced TTS during exercise. Electromagnetic fields have been found to cause acoustical interactions in the inner ear. Animal studies and human studies have given contradictory results on the effects of magnetic coil devices on hearing. The MR imaging devices produce noise levels of 82-93 dB, which is not sufficient to produce the risk of permanent hearing loss when short exposure durations are taken into consideration. More systematic research is needed with accurately defined electromagnetic characteristics to reveal the potential interactions. The interactions seem to exist, but relatively high levels and durations of exposure are needed to produce an observable effect on hearing. More investigations are still needed on the permanent hearing loss in humans caused by simultaneous long-term exposures to interacting environmental factors.

  19. Of mice, moles and guinea pigs: functional morphology of the middle ear in living mammals.

    PubMed

    Mason, Matthew J

    2013-07-01

    The middle ear apparatus varies considerably among living mammals. Body size, phylogeny and acoustic environment all play roles in shaping ear structure and function, but experimental studies aimed ultimately at improving our understanding of human hearing can sometimes overlook these important species differences. This review focuses on three groups of mammals, bringing together anatomical, zoological and physiological information in order to highlight unusual features of their middle ears and attempt to interpret their function. "Microtype" ears, found in species such as mice and bats, are associated with high-frequency hearing. The orbicular apophysis, the focus of some recent developmental studies on mouse ears, is characteristic of microtype mallei but is not found in humans or other "freely mobile" species. The apophysis increases ossicular inertia about the anatomical axis of rotation: its adaptive purpose in a high-frequency ear is still not clear. Subterranean mammals have convergently evolved a "freely mobile" ossicular morphology which appears to favour lower-frequency sound transmission. More unusual features found in some of these animals include acoustically coupled middle ear cavities, the loss of middle ear muscles and hypertrophied ossicles which are believed to subserve a form of inertial bone conduction. Middle ears of the rodent group Ctenohystrica (which includes guinea pigs and chinchillas, important models in hearing research) show some striking characteristics which together comprise a unique type of auditory apparatus requiring a classification of its own, referred to here as the "Ctenohystrica type". These characteristics include a distinctive malleus morphology, fusion of the malleus and incus, reduction or loss of the stapedius muscle, a synovial stapedio-vestibular articulation and, in chinchillas, enormously expanded middle ear cavities. These characteristics may be functionally linked and associated with the excellent low-frequency hearing found in these animals. The application of new experimental and imaging data into increasingly sophisticated models continues to improve our understanding of middle ear function. However, a more rigorous comparative approach and a better appreciation of the complex patterns of convergent and divergent evolution reflected in the middle ear structures of living mammals are also needed, in order to put findings from different species into the appropriate context. This article is part of a special issue entitled "MEMRO 2012". Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions.

    PubMed

    Keefe, Douglas H; Archer, Kelly L; Schmid, Kendra K; Fitzpatrick, Denis F; Feeney, M Patrick; Hunter, Lisa L

    2017-10-01

    Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic. Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications. American Academy of Audiology

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