Contralateral delayed endolymphatic hydrops: Clinical features and long term outcome

Background:Contralateral delayed endolymphatic hydrops(CDEH)is a clinical entity characterized by fluctuating low frequency hearing loss and/or vertigo,mimicking Meniere’s disease(MD),that manifests after the appearance of severe non-hydropic hearing loss(NHHL)at the other ear.Objectives:to describe the clinical features and the course of 57 patients affected by CDEH.Method:this is a retrospective study;57 patients affected by CDEH,out of 1065 patients seen in the same period and affected by MD,were subjected to otoscopy,PTA threshold evaluation,impedance testing,ABR,research of positioning nystagmus,vestibular function evaluated by means of bithermal caloric test under video-oculographic,and MRI with gadolinium.Results:the CDEH was definite in 24 cases(42%),probable in 2(4%)and possible in 31(54%).The mean PTA threshold at the hydropic ear was 41 dB.At the last follow-up,40 patients(70%)did not report vertigo or fluctuating hearing loss.Among the 17 patients who still reported symptomatology,11(64%)were affected by fluctuating hearing loss alone,4(23%)reported a subjective worsening of hearing loss and 2(12%)an acute vertigo crisis.Conclusions:contralateral delayed endolymphatic hydrops is a relatively rare form of Meniere disease that manifests more frequently as a definite form or with fluctuating low-frequency hearing loss.The prognosis at a long term follow-up is relatively good in terms of vertigo resolution.Contralateral delayed endolymphatic hydrops rarely determines a severe hearing loss in the better ear.

Long TR three-dimensional inversion recovery sequence with real reconstruction(3D real IR)for quantifying inner ear endolymphatic hydrops

Objective To observe the value of long TR three-dimensional inversion recovery sequence with real reconstruction(3D real IR)for quantifying inner ear endolymphatic hydrops(EH).Methods Totally 46 Ménière's disease(MD)patients and 21 healthy volunteers were prospectively enrolled.MR scanning for inner ear based on 3D real IR and 3D fluid attenuated inversion recovery(3D FLAIR)sequence 4—6 h after administration of contrast agents were performed.The imaging qualities were scored and compared between groups.The endolymphatic space area and the membranous labyrinth area of cochlea and vestibule,as well as endolymph/membranous labyrinth area percentage were calculated,the present or not of EH and the grade of EH were evaluated.EH inner ears of MD patients were enrolled in EH group,while inner ears of healthy volunteers were taken as controls(control group).The endolymphatic space area,membranous labyrinth area and endolymph/membranous labyrinth area percentage of cochlea and vestibule were compared between groups.The receiver operating characteristic(ROC)curve was drawn to calculate the diagnostic efficacy of the above indexes.Results Cochlear and/or vestibular EH were detected in 56 ears,including cochlear EH in 52 ears and vestibular EH in 45 ears among 46 MD patients(EH group),but not in 42 ears in control group.The subjective quality scores of 3D real IR images were higher than those of 3D-FLAIR(both P<0.05).Quantitative analysis based on 3D real IR images revealed that,compared with control group,significantly larger endolymph areas and endolymph/membranous labyrinth area percentages in both cochlea and vestibule were found in EH group(all P<0.001).The area under the curve(AUC)of cochlear or vestibular endolymph/membranous labyrinth area percentage for identifying inner ear EH was 0.999 and 0.985,respectively.Taken 13.64%and 24.13%as the critical value of cochlear or vestibular endolymph,the specificity was 100%and 92.86%,respectively,and the sensitivity was 96.43%and 96.43%,respectively.Conclusion MR long TR 3D real IR was helpful to quantifying inner ear EH.

Dexamethasone does not affect endolymphatic hydrops(EH)in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

Background:Intratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops(EH)using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min.The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methods:In an in vitro study,the potential impact of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA)on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography(HPLC)after mixing with GdDTPA.Ten patients with definite Meniere's disease(MD)were recruited to study the potential interference of dexamethasone on MRI visualization of EH,and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation(hT2FLAIR-MZFI)sequence.Results:The retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA.EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone.Excellent inner ear images were obtained from all patients,and EHs with various grades were displayed.There were significant correlations between diagnosis and cochlear EH(p<0.01,Spearman's Rho),between diagnosis and vestibular EH(p<0.01,Spearman's Rho),and between cochlear and vestibular EH(p<0.01,Spearman's Rho).The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH.Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.Conclusions:Intratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application.Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.

The Role of Endolymphatic Hydrops in Patients with Pantonal Idiopathic Sudden Sensorineural Hearing Loss:A Cause or Secondary Reaction

The purpose of this study was to investigate the presence of endolymphatic hydrops(EH)in both affected and unaffected ears of patients with pantonal unilateral idiopathic sudden sensorineural hearing loss(ISSNHL)using three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging(3D-FLAIR MRI)and further evaluate the significance of EH in this disorder.Twenty-seven ISSHL patients were enrolled in this study.3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium-diethylenetriaminepentaacetic acid(Gd-DPTA).The incidences of EH in the affected ears and contralateral unaffected ears were compared and the correlations of EH with vertigo or prognosis were analyzed using the Chi-square test.The results showed that the incidence of EH was 68.0%(17/25)in the affected ears and 34.8%(8/23)in the unaffected ears.There was a statistically significant difference between affected ears and unaffected ears in regard to the incidence of EH(P<0.05).There were no significant correlations of EH with vertigo(P=1.000)or with prognosis(P=0.359)in the affected ears.In conclusion,there is EH in the inner ear of patients with pantonal ISSNHL;EH is not related to vertigo,a concomitant symptom of ISSNHL,and the prognosis of this condition.The presence of EH may be a secondary reaction following the impairment of the inner ears with pantonal ISSNHL.

Correlation of semi-quantitative findings of endolymphatic hydrops in MRI with the audiometric findings in patients with Meniere's disease

Purpose:To investigate the correlation between vestibular hydrops(VH),cochlearhydrops(CH),vestibular aqueduct non-visibility(VANV),and visually increased perilymphatic enhancement(VIPE)with the findings of pure-tone audiometry(PTA)in Meniere’s disease(MD)patients.Methods:In this cross-sectional study,53 ears belonging to 48 patients were divided into two groups and evaluated.In group“MD patients,”there were 24 ears of 19 patients diagnosed with the definite MD(14 patients with unilateral and 5 patients withbilateral involvements).The“control group”consisted of 29 non-symptomatic ears belonging to patients diagnosed with unilateral sudden sensory-neural hearing loss or unilateral schwannoma.All the patients underwent 2 sessions of temporal bone MRI using the same 3T system:an unenhanced axial T1,T2,and 3D-FLAIR MRI,an intravenous gadoliniumenhanced axial T1 fat-sat,and 4 h after the injection,an axial 3D-T2 cube and 3D-FLAIR session.VH,CH,VANV,and VIPE were assessed.Subsequently,the correlation between EH indices and PTA findings(in three frequency domains of low,middle,and high)were evaluated,and the predictive value of MRI was calculated.Results:VH was significantly correlated with the hearing threshold in the low,middle,and highfrequency domains.CH was also correlated with the hearing threshold in the low and middle domains.Contrarily,VIPE was not associated with hearing thresholds,and VANV was only correlated with the hearing threshold in low frequencies.Conclusion:The grade of VH,CH,and VANV were significantly correlated with the hearing thresholds in PTA.

Endolymphatic hydrops in Meniere's disease secondary to otitis media and visualized by gadolinium-enhanced magnetic resonance imaging

Aimed to test the hypothesis that endolymphatic hydrops in Meniere's disease(MD) may be secondary to otitis media, history of a patient who developed MD as a complication of otitis media was reviewed. The inner ear was imaged using a 3.0 Tesla MR system post-intravenous injection of gadolinium-tetraazacyclododecane-tetraacetic acid(Gd-DOTA) in a standard single dosage(0.1 mmol/kg). Both t2-spc-rst-tra-iso(T2-weighted) and heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging [h T(2)W-3D-FLAIR] sequences were applied. As a result, in the T2-weighted images, the perilymph and endolymph, cerebrospinal fluid surrounding the eighth nerve(N8), and middle ear granulation tissue showed intense signals. In the h T(2)W-3D-FLAIR images, evident enhancement by Gd-DOTA was observed in the middle ear cavity and the perilymphatic compartments of the cochlea. Cochlear endolymphatic hydrops was implicated by the enlarged scala media in the basalturn. In general, the Gd-DOTA uptake in the vestibule was weak, and signs of vestibular endolymphatic hydrops were obvious. The N8 on the diseased side was also significantly enhanced. To conclude, endolymphatic hydrops in MD may be induced by otitis media. Cochlear endolymphatic hydrops in MD secondary to otitis media may not follow the classical pattern.

Changes in Ca^(2+) -ATPase in a guinea pig endolymphatic hydrops model

OBJECTIVE: To investigate the localization of Ca(2+)-ATPase (Ca(2+) pump) in the cochlear and its change after endolymphatic hydrops, and to study the relationship between compound action potential (CAP) threshold and the Ca(2+)-ATPase activety. METHODS: The left endolymphatic sac was ablated to induce endolymphatic hydrops in fourteen healthy guinea pigs with normal action potential thresholds measured after a sliver ball electrode placed on the round window. Ca(2+)-ATPase activity was studied cytochemically using a lead citrate reaction in control and hydropic ears. The reaction product was lead phosphate particles as an expression of Ca(2+)-ATPase activity, observed with an eletron microscope. RESULTS: Ca(2+)-ATPase activity is mainly found on the endolymphatic surface of Reis sner's membrane, the stereocilia and cuticular plate of inner and outer hair cells, and along the infolded plasma membrane of strial marginal cells. CAP thresholds of filtered click are increased and Ca(2+)-ATPase activity significantly decreased after endolymphatic hydrops in the mentioned locations. CONCLUSIONS: CAP thresholds are increased and Ca(2+)-ATPase activity are significantly decreased in the cochlea after endolymphatic hydrops. These results suggest that there is a negative correlation between them.

MRI detection of endolymphatic hydrops in Meniere's disease in 8 minutes using MIIRMR and a 20-channel coil after targeted gadolinium delivery

Background:Endolymphatic hydrops(EH)become visible in vertigo patients,particularly in those with Meniere's disease(MD),in vivo using gadolinium-enhanced MRI.However,the image quality is not satisfying after intravenous injection of gadolinium chelate(GdC),and occasional failure in GdC uptake has been noticed after traditional intratympanic injection.In the present report,targeted delivery of GdC and using a cost-effective MRI system to obtain high quality images of EH in only 8 min will be fntroduced.Methods:39 MD patients were recruited in the study.First,0.1 ml of 20-fold diluted gadolinium-diethylenetriamine acid(Gd-DTPA)was delivered onto the posterior upper part of the tympanic medial wall using a soft-tipped micro-irrigation catheter through an artificially perforated tympanic membrane.Inner ear MRI was performed 24 h after Gd-DTPA administration using a 3T MR machine and a 20-channel head/neck coil with an 8 min sequence of medium inversion time inversion recovery imaging with magnitude reconstruction(MIIRMR).The parameters were as follows:TR 16000 ms,TE 663 ms,inversion time 2700 ms,flip angle 180°,slices per slab 60.Results:Efficient inner ear uptake of Gd-DTPA was detected 24 h after delivery and it created excellent contrast in the inner ear of all cases.High quality images demonstrating EH in the vestibule and cochlea were obtained.Conclusion:Targeted delivery of minimum Gd-DTPA(0.1 ml,20-fold dilution)onto the posterior upper portion of the tympanic medial wall and MRI with MIIRMR in a 3T machine and 20-channel head/neck coil are clinically practical to obtain high quality images displaying EH.

Arginine Vasopressin-Aquaporin-2 Pathway-Mediated Dehydration Effects of Electroacupuncture in Guinea Pig Model of AVP-Induced Endolymphatic Hydrops

Objective: To investigate the effects of electroacupuncture(EA) on endolymphatic hydrops(EH) and the regulation of arginine vasopressin(AVP)-aquaporin-2(AQP2) pathway in guinea pigs. Methods: EH was induced in male guinea pigs by an intraperitoneal injection of AVP. For the treatment, EA was delivered to Baihui(GV 20) and Tinggong(SI 19) acupoints, once per day for 10 consecutive days. In histomorphological studies, cochlear hydrops degree was evaluated by hematoxylin-eosin(HE) staining, and then the ratio of scala media(SM) area to SM + scala vestibuli(SV) area(R value) was calculated. In mechanical studies, a comparison of plasma AVP(p-AVP) concentrations, cyclic adenosine monophosphate(cAMP) levels, vasopressin type 2 receptor(V2R) and AQP2 mRNA expressions in the cochlea were compared among groups. Results: EA significantly reduced cochlear hydrops in guinea pigs(P=0.001). EA significantly attenuated the AVPinduced up-regulation of p-AVP concentrations(P=0.006), cochlear c AMP levels(P=0.003) and AQP2 mRNA expression(P=0.016), and up-regulated the expression of V2R mRNA(P=0.004) in the cochlea. Conclusion: The dehydrating effect of EA might be associated with its inhibition of AVP-AQP2 pathway activation.

Effect of electroacupuncture on arginine vasopressin-induced endolymphatic hydrops

OBJECTIVE: To investigate the influence of electroacupuncture(EA) on experimentally induced endolymphatic hydrops(EH) in guinea pigs, and elucidate the association between the dehydrating effect of EA and changes in stria vascularis ultrastructure and expression of vasopressin type 2 receptor(V2R), cyclic adenosine monophosphate(cAMP),and aquaporin 2(AQP2) in the endolymphatic sac(ES).METHODS: The EH model was established by intraperitoneal injection of arginine vasopressin(AVP).As a treatment, EA was delivered to Baihui(GV 20)and Tinggong(SI 19) acupoints, once daily for 10 consecutive days. For histomorphological studies,degree of cochlear hydrops was evaluated by hematoxylin-eosin staining, and the ratio of scala media(SM) area to SM + scala vestibuli area was calculated. In mechanical studies, ultrastructural changes in stria vascularis tissue were examined by transmission electron microscopy. In addition, cAMP levels and mRNA expression levels of V2 R and AQP2 in the ES were compared among groups.RESULTS: EA treatment significantly reduced cochlear hydrops compared with hydropic guinea pigs(P = 0.015). Furthermore, EA attenuated ultrastructural changes in the stria vascularis tissue following EH, significantly upregulated the expression of V2 R(P = 0.016), and attenuated AVP-induced upregulation of both cAMP(P = 0.038) and AQP2 expression(P = 0.017) in the ES.CONCLUSION: Collectively, the results of the present study suggest that the dehydrating effect of EA is associated with improvement of stria vascularis ultrastructure and V2 R-cAMP-AQP2 signaling pathway regulation in the ES.

Effects of electroacupuncture on cochlear morphology and expression of aquaporins in rats with AVP-induced endolymphatic hydrops

Objective: The objective of this study was to investigate the effects of EA on EH and the regulation of AQP2 and AQP7 protein expression in rats.Methods: Twenty-four rats were allocated randomly to four groups of blank group, EH group,EH+tolvaptan group and EH + EA group(n = 6 per group). EH rat model was established by intraperitoneally injection of arginine vasopressin(AVP). EA was administered at acupoints "Baihui(百会 GV 20)"and "Tinggong(听宫 SI 19)". Rats in the EH + tolvaptan group and EH+ EA group were treated with tolvaptan and EA, respectively, after EH establishment. Hematoxylin-eosin staining was used to measure the cochlear hydrops degree, and then the ratio of scala media(SM) area to SM + scala vestibuli(SV) area(R value) was calculated. Immunohistochemical method was used to observe AQP2/AQP7 protein expression in the rat cochlear lateral wall after treatment.Results: ①There was no endolymphatic hydrops in the blank group. Reissner' s membrane was extended markedly and bulged into SV in cochleae of the EH group and endolymphatic hydrops was noted. Statistical analysis revealed that R value in the EH group showed a significant increase compared with that in the blank group(0.42 ± 0.02 vs. 0.31 ± 0.05, P=0.000). The distension of Reissner's membrane was less obvious in the EH + tolvaptan group and EH + EA group when compared with the EH group. R value in the EH + tolvaptan group and the EH + EA group was significantly less than that in EH group(0.32±0.04 vs. 0.42 ± 0.02, =0.001;0.35 ± 0.05 vs. 0.42 ± 0.02, P=0.012). The degree of the hydrops in the EH + EA group was not different from that in the EH + tolvaptan group(0.35 ± 0.05 vs. 0.32 ±0.04,P= 1.000). ②The AQP2 protein expression in the rat cochlear lateral wall of EH group was significantly increased when compared with the blank group(12.74 ± 5.18 vs. 5.92 ± 1.52, P = 0.014). The AQP2 protein expression in the rat cochlear lateral wall of EH + tolvaptan group and EH + EA group were all lower than that of the EH group(6.52 ± 2.73 vs. 12.74 ± 5.18. P = 0.029;6.95 ± 3.10 vs. 12.74 ± 5.18, P = 0.047).The AQP2 protein expression in the rat cochlear lateral wall of EH + EA group was not different from that in the EH + tolvaptan group(6.95 ± 3.10 vs. 6.52 ± 2.73, P= 1.000).③The AQP7 protein expression in the rat cochlear lateral wall of EH group was significantly increased when compared with the blank group(30.32 ± 6.39 vs 16.64 ± 3.21, P=0.000). The AQP7 protein expression in the rat cochlear lateral wall of EH + tolvaptan group and EH + EA group were all lower than that of the EH group(18.32 ± 2.45 vs.30.32 ± 6.39, P= 0.001;19.54 ± 4.61 vs. 30.32 ± 6.39, P= 0.003). The AQP7 protein expression in the rat cochlear lateral wall of EH + EA group was not different from that in the EH + tolvaptan group(19.54 ±4.61 vs. 18.32 ± 2.45, P= 1.000).Conclusions: These results indicate that repeated EA stimulation exerted the same effects as tolvaptan application on AQPs levels and subsequent aquaretic effects. And dehydrating effect of EA on the inner ear might be associated with its down-regulation of both AQP2 and AQP7 protein expression, thereby provide a potential molecular mechanism involved in the treatment of Meniere's disease by EA.

内耳钆增强磁共振3D CUBE FLAIR序列PPI及HYDROPS图像在诊断内淋巴积水中的价值

目的 探讨经静脉注射钆对比剂行内耳增强磁共振三维快速液体衰减反转恢复序列(three-dimensional fluid attenuated inversion recovery with CUBE,3D CUBE FLAIR)阳性内淋巴影像(positive perilymph image,PPI)及HYDROPS (HYbriD of reversed image of positive endolymph signal and native image of positive perilymph signal)图像在内淋巴积水(endolymphatic hydrops,EH)中的诊断价值。材料与方法 回顾性分析患侧EH、对侧无EH患者资料及MRI图像22例。应用Image J软件在所获图像上勾画感兴趣区,测量同一图像上患侧及健侧的耳蜗底周与同侧小脑白质区信号强度比(signal intensity ratio,SIR)、同一侧前庭外淋巴与内淋巴间隙SIR;对PPI及HYDROPS图像上患侧耳蜗积水数量及前庭积水边界清晰程度评分。评估两种图像对患侧血-迷路屏障(blood-labyrinth barrier,BLB)通透性改变的显示情况、同侧前庭在两种图像上的成像效果、评估两种图像对耳蜗EH敏感性及前庭EH边界的显示情况。结果 PPI图像中患侧及健侧的耳蜗底周与同侧小脑白质区SIR之间的差异具有统计学意义(P<0.001);HYDROPS图像中患侧及健侧耳蜗底周与同侧小脑白质区SIR之间的差异具有统计学意义(P<0.001)。PPI图像及HYDROPS图像上的患侧前庭外淋巴与内淋巴间隙SIR之间的差异具有统计学意义(P<0.001);PPI图像及HYDROPS图像上的健侧前庭外淋巴与内淋巴SIR间隙之间的差异具有统计学意义(P<0.001)。PPI图像及HYDROPS图像诊断耳蜗EH的敏感性之间的差异具有统计学意义(P=0.030)。PPI图像及HYDROPS图像患侧前庭内淋巴间隙边界清晰程度评分之间的差异具有统计学意义(P<0.001)。结论 内耳钆增强磁共振3D CUBE FLAIR序列PPI及HYDROPS图像综合应用,有利于评估患侧BLB通透性、积水部位以及前庭EH边界的显示。

内淋巴管夹闭术治疗梅尼埃病的效果

目的:梅尼埃病(Ménière’s disease,MD)是一种特发性的内耳疾病,临床表现为反复的发作性旋转性眩晕、波动性听力下降、耳鸣和耳闷胀感。内淋巴囊相关的手术主要用于药物治疗无效的MD患者。内淋巴管夹闭术(endolymphatic duct blockage,EDB)是一种治疗MD的新术式,相关临床研究较少。本研究旨在探讨MD患者行EDB后内淋巴积水(endolymphatic hydrops,EH)的改变及手术远期疗效,评估不同类型内淋巴囊的手术效果。方法:回顾性分析33例接受EDB治疗的难治性MD患者,根据患者的内淋巴囊形态分为正常形态组(n=14)和萎缩形态组(n=19)。比较2组患者在术前和术后眩晕症状的发作频率、听力、前庭功能和内耳钆增强MRI的变化。结果:与萎缩形态组比较,正常形态组患者具有更高的眩晕完全控制率、更好的耳蜗和前庭功能以及更低的前庭内淋巴间隙体积占前庭总淋巴体积的比值(均P<0.05)。此外,正常形态组共有7例患者出现EH的逆转,而萎缩形态组术后未检测到EH的逆转。结论:正常形态和萎缩形态内淋巴囊的MD患者对EDB治疗的反应存在差异,提示2种不同病理类型的内淋巴囊可能存在不同的发病机制。

温胆汤通过调控p38 MAPK信号通路干预内淋巴积水形成的研究

目的基于p38丝裂原活化蛋白激酶(p38 MAPK)信号通路探讨温胆汤对内淋巴积水形成的影响。方法将30只豚鼠随机分为对照组、模型组、低剂量温胆汤组、中剂量温胆汤组、高剂量温胆汤组,每组6只。采用腹腔注射6μg/kg醋酸去氨加压素10 d的方法,对除对照组外的其他组豚鼠建立内淋巴积水模型;第11天开始,低、中、高剂量温胆汤组分别灌胃6.1 g/kg、12.2 g/kg、24.4 g/kg温胆汤颗粒剂,对照组和模型组灌胃等量双蒸水。持续灌胃10 d后处死豚鼠,免疫组化法检测耳蜗组织中炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)]和水通道蛋白2(AQP2)阳性表达情况,qRT-PCR法检测耳蜗组织中AQP2和p38 MAPK mRNA表达情况,Western blot法检测耳蜗组织中p38 MAPK、p-p38 MAPK蛋白表达情况。结果与对照组比较,模型组耳蜗组织中IL-1β、IL-6、AQP2阳性表达吸光度值和AQP2 mRNA相对表达量、p-p38 MAPK/p38 MAPK比值均明显升高(P均<0.05),p38MAPK mRNA相对表达量无明显变化(P>0.05);与模型组比较,温胆汤各组耳蜗组织中IL-1β、IL-6、AQP2阳性表达吸光度值和AQP2 mRNA相对表达量、p-p38 MAPK/p38 MAPK比值均明显降低(P均<0.05),p38MAPK mRNA相对表达量均无明显变化(P均>0.05)。结论温胆汤可以有效改善醋酸去氨加压素诱导的豚鼠内淋巴积水,其机制可能与调控p38 MAPK信号通路和AQP2表达有关。

TLR4/NF-κB信号通路在介导睡眠剥夺诱导膜迷路积水中的作用研究

目的探讨TLR4/NF-κB信号通路在介导睡眠剥夺诱导膜迷路积水中的作用。方法选取30只健康SD大鼠,分为空白对照组、大平台对照组、睡眠剥夺2周组、睡眠剥夺3周组、睡眠剥夺4周组,每组6只。睡眠剥夺组大鼠选用改良多平台睡眠剥夺法进行造模,大平台对照组在小平台上放置网格所制大平台,空白对照组不做处理。实验前后对各组大鼠进行旷场实验评估行为学,行听性脑干反应(ABR)检测评估听力水平;ABR检测结束后腹主动脉取血,通过酶联免疫吸附实验(ELISA)法检测血清中TNF-α、MCP-1的水平;解剖耳蜗,HE染色行中阶横截面积(SM)/(中阶+前庭阶横截面积)(SM+SV)比值评价膜迷路积水情况;通过免疫组化染色检测耳蜗中IL-1β、TNF-α、MCP-1、TLR4、NF-κB P65的表达,观察实验后不同睡眠剥夺时间大鼠听力水平、膜迷路积水程度及TLR4/NF-κB信号通路相关蛋白及下游炎症因子表达水平变化规律,分析大鼠听力水平、膜迷路积水程度与TLR4/NF-κB信号通路的相关性。结果睡眠剥夺组大鼠ABR波II反应阈升高,较空白对照组及大平台对照组均有统计学意义(P<0.01);形态学观察:空白对照组及大平台对照组积水率为0,睡眠剥夺2周组积水率为16.67%,睡眠剥夺3周组积水率为25%,睡眠剥夺4周组积水率为25%;睡眠剥夺组大鼠血清中TNF-α、MCP-1浓度均高于空白对照组及大平台对照组,其中睡眠剥夺4周组TNF-α、MCP-1浓度较空白对照组及大平台对照组均具有统计学意义;睡眠剥夺组大鼠耳蜗螺旋神经节、螺旋器、血管纹螺旋韧带IL-1β、TNF-α、MCP-1、TLR4、NF-κB P65表达均高于空白对照组及大平台对照组。结论睡眠剥夺可能通过TLR4/NF-κB信号通路对内耳产生影响从而诱导膜迷路积水。

基于三维真实重建反转恢复序列对比不同评估方法对梅尼埃病内淋巴积水的诊断价值

目的:采用三维真实重建反转恢复(3D-real IR)序列,对比基于耳蜗和前庭的不同评估方法对梅尼埃病(MD)内淋巴积水的检出效能。方法:回顾性收集2018年8月-2022年2月于首都医科大学附属北京友谊医院就诊,符合2017年中华医学会耳鼻咽喉头颈外科学分会诊断标准,且经鼓膜注入钆对比剂24小时后行3D-real IR序列检查的MD患者38例(45耳);同时纳入因单侧耳部症状就诊且行内耳MR钆造影检查、临床纯音测听、声阻抗、声放射检查未见明确异常的患者或MD患者的非症状侧作为对照组,共28例(30耳)。采用国内外最常用的4种基于耳蜗和前庭的评估方法(分别于2009年、2011年、2014年、2019年提出)分别判定有无内淋巴积水,分析每种方法诊断MD内淋巴积水的不同观察者间一致性、敏感度和特异度,采用MedCalc软件绘制受试者操作特征(ROC)曲线,对比不同方法诊断MD内淋巴积水的ROC曲线下面积(AUC)差异。结果:2009年、2011年、2014年、2019年评估方法的不同观察者间Cohen′s K系数分别为0.752、0.911、0.820、0.820,敏感度/特异度分别为91.1%/50%、93.3%/70%、82.2%/56.7%、82.2%/56.7%。2011年方法检出MD内淋巴积水的AUC显著高于其他三种方法(Z_(2009)=2.866,P_(2009)=0.0042;Z_(2014)=2.647,P_(2014)=0.0081;Z2019=2.647,P_(2019)=0.0081)。结论:2011年评估方法在3D-real IR序列上的观察者间一致性好、诊断效能高,推荐临床应用。

醋酸去氨加压素对丝裂原活化蛋白激酶磷酸酶-1在大鼠耳蜗的表达及功能研究

目的检测醋酸去氨加压素(deamino arginine vasopressin,DDAVP)作用后丝裂原活化蛋白激酶磷酸酶-1(mitogen-activated protein kinase phosphatase,MKP-1)在大鼠耳蜗组织的表达情况,探讨MKP-1是否参与梅尼埃病的发生。方法选取SPF级雄性SD大鼠20只,随机分为实验组和对照组,每组10只。实验组腹腔注射DDAVP,对照组腹腔注射等量0.9%氯化钠溶液。造模结束后行听性脑干反应(auditory brainstem response,ABR)检测听力,苏木精-伊红染色观察耳蜗形态变化,免疫组织化学及蛋白质免疫印迹检测MKP-1在耳蜗的表达位置及定量分析。结果实验组ABR阈值较造模前上升约10 dB,差异有统计学意义(P<0.01);实验组耳蜗切片苏木精-伊红染色出现膜迷路积水表现,实验组积水率达80%;免疫组织化学显示,MKP-1广泛表达于血管纹、螺旋韧带、螺旋缘、柯蒂器、以及螺旋神经节。两组血管纹、螺旋韧带及螺旋神经节表达比较,差异均有统计学意义(P<0.05);两组SLM和OC表达比较,差异无统计学意义(P>0.05)。蛋白质免疫印迹显示,实验组MKP-1表达低于对照组,差异有统计学意义(P<0.01)。结论DDAVP可能通过下调MKP-1促进膜迷路积水形成,进而参与梅尼埃病的发病过程。

梅尼埃病患者c VEMPs与内淋巴积水相关性研究进展

梅尼埃病(Meniere’s disease,MD)是常见的耳源性眩晕疾病,主要表现为发作性眩晕,波动性听力下降,耳鸣和耳胀满感。目前病因不明,其主要的病理学特点为内淋巴的产生与吸收失衡导致的内淋巴积水,内耳核磁钆造影使得内淋巴积水可视化,前庭积水导致前庭功能下降,颈前庭诱发肌源性电位各参数异常,已有国内外相关文献报道两者对于梅尼埃病的应用价值。本文旨总结二者在梅尼埃病中的应用价值,分析相关性,以进一步总结归纳梅尼埃病形态变化与功能变化之间的联系,更好地应用于临床,指导梅尼埃病的诊断和治疗。

积水性内耳病发病机制的研究进展

积水性内耳病(HED)是一类复杂的内耳疾病,其主要病理特征是内淋巴积水(ELH),主要临床表现为听力下降、眩晕和耳鸣。本文综述了HED的病因及其发病机制的研究进展,包括ELH、免疫因素、遗传因素、内耳结构异常、内耳缺血、过敏反应、病毒与细菌感染、水通道蛋白失调、离子通道紊乱、水盐代谢激素异常等因素。通过对现有文献的分析,结合临床实践,旨在为HED的诊断和治疗提供新的思路和方法。

突发性聋患者耳蜗电图分析

目的分析突发性聋(简称突聋)患者耳蜗电图无波形引出者听力损失程度及有波形引出者中-SP、AP振幅,探讨该病患者耳蜗电图特点及该病与内淋巴积水的关系。方法记录电极放置在紧贴鼓膜紧张部中央的位置,记录62例突聋患者患耳(66耳)和健耳(51耳)的耳蜗电图,分别测量两组中-SP、AP的振幅,并记录无波引出者的听力损失程度。结果两组-SP振幅分别为:患耳0.30±0.38μV,健耳0.16±0.13μV,差异有统计学意义(P<0.05);AP振幅分别为:患耳0.82±0.85μV,健耳0.69±0.49μV,差异无统计学意义(P>0.05)。-SP/AP比值分别为:患耳0.38±0.15,健耳0.27±0.12,两组比较差异有统计学意义(P<0.01)。31.82%患耳-SP/AP比值异常增高,9.80%健耳-SP/AP异常增高。突聋患者患耳无波形引出者纯音听阈89.0±17.8dBHL,与有波形者纯音听阈(58.1±18.4dBHL)比较,差异有显著统计学意义(P<0.01)。结论突聋患者患耳较多出现-SP/AP比值异常增高,提示突聋可能与内淋巴积水有关。