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Barry E Hirsch

Publications and source records attributed to Barry E Hirsch.

10 recordsLinked to original sources
PubMed2002

Anomaly of the eustachian tube and its associated structures in patients with multiple congenital malformation: a histopathological and morphometric study.

Two temporal bone-eustachian tube (ET) specimens; one from a 1-day-old female newborn with Townes Syndrome (Case 1) and the other from a 15-year-old female with oral-facial-digital syndrome (Case 2) were studied histopathologically and morphometrically. Both specimens had anomalies of the ET and its associated structures as compared with eight age-matched control cases without anomaly (six cases for Case 1 and two cases for Case 2, respectively). Case 1 had a weak attachment of the tensor veli palatini muscle (TVPM) to a poorly developed lateral lamina (LL) of the ET cartilage, a large voluminous medial lamina (ML) of the ET cartilage, a small voluminous ET lumen with a few ridges of mucosal folds, poorly developed ET glands and a poorly developed levator veli palatini muscle (LVPM). Case 2 had a short and longitudinally elongated ET lumen that was insufficiently covered with a poorly developed ML and LL and an aberrant course of the LVPM. Both cases were accompanied by a mild inner ear anomaly (slightly shortened cochlea). We discuss the implications of the observed anomalies with regard to functional and clinical issues. In particular, we speculate that these ET anomalies may closely be related to potential ET dysfunction with high susceptibility to otitis media.

Abnormalities, Multiple↗
PubMed2002

Pathology and pathophysiology of Meniere's disease.

Histopathologic study of the human temporal bone entails microscopic examination and analysis of a series of histologic sections. This is currently the most effective method for observing the pathologic conditions of MD by examining the entire inner ear. Complete temporal bone histopathology cannot be replaced by either clinical pathologic study of small biopsy specimens obtained during surgery, or experimental animal studies that can create endolymphatic hydrops but not create MD. We believe that the histopathologic findings together with clinical information on MD is valuable in enhancing our understanding of the pathophysiology of the inner ear in MD. For example, a hypoplastic VA and ES in MD seem to indicate that there may be congenital predisposing factors in the development of MD. The exact pathologic findings characteristic of MD remains unclear, however. Many of the temporal bone specimens were obtained years after patients were diagnosed with MD and those specimens were involved with moderate postmortem changes. For these reasons, further collection of temporal bone specimens with fewer postmortem changes, obtained within a shorter premortem time period between occurrence of the disease and the time of the patients' death, and from patients with a well-characterized clinical history of MD, is imperative. Contemporary temporal bone studies now include in situ hybridization histochemistry or polymerase chain reaction (PCR) analysis for protein, enzymes, or viral antigens that can be directed at specimens from patients with MD [54,55]. It is hoped that in the near future such advanced research studies with human temporal bone histology sections will support and enhance the significant contribution of temporal bone histopathology to clinical otology.

Autopsy↗
PubMed2002

Postnatal development of the eustachian tube glands.

OBJECTIVE: To delineate a possible difference in the function of the eustachian tube (ET) between infants and adults. STUDY DESIGN: Morphometric and histopathological examination on the human temporal bones. METHODS: The secretory glands in the ET were studied in serial histological sections through the cartilaginous portion of the human ET obtained from 32 individuals whose ages ranged from 1 day to 19 years. Of these, 26 were normal control cases and 6 were cases with otitis media (OM). RESULTS: In both normal and OM groups, the distribution of the glands was predominantly in the medial side of the cartilaginous portion of the ET, and the volume of the ET glands was directly related to both the volume of the ET lumen and the patients' age. In normal cases, the relative proportion of the three types of acinar cells (mucous, serous, and mixed) varied among the different age groups. The cases in patients under 1 month of age had more mucous glands and fewer serous glands. In cases of the 1-month-old to 7-year-old age group, the three ET gland cell types came to be approximately equal. Relative proportion of the serous glands continuously increased with aging, and in cases of patients older than 7 years of age, serous glands were predominant over the other two components. CONCLUSION: It is assumed that the greater proportion of mucous glands and insufficient serous glands by 7 years of age reflects immature development, which may be one of the associated factors contributing to recurrent OM among infants.

Adolescent↗
PubMed2002

Cochleosaccular pathology after perinatal and postnatal asphyxia: histopathologic findings.

OBJECTIVE: This study describes the histopathologic findings of a patient with severe bilateral sensorineural hearing loss after perinatal and postnatal hypoxia and asphyxia. STUDY DESIGN: Histopathologic examination on the temporal bones. SETTING: The study was performed at the Elizabeth McCullough Knowles Otopathology Laboratory, Division of Otopathology, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. RESULTS: Histopathologic examination on the left temporal bone revealed severe atrophy of the organ of Corti throughout the entire cochlea, decrease in the number of the spiral ganglion cells especially in the basal turn, and mild atrophy of saccular macula. In the right temporal bone, similar abnormalities were observed in the inner ear, but the changes were milder than those in the left temporal bone. No other distinct pathologic finding was observed in either ear. CONCLUSION: These findings suggest that the presence of severe hypoxic ischemia causes cochleosaccular atrophy. To our knowledge, this is the first histopathologic case report describing the long-term effect of perinatal and postnatal hypoxia and asphyxia that produced cochleosaccular abnormalities in the human inner ear.

Asphyxia Neonatorum↗
PubMed2002

Histopathologic study of the temporal bones and Eustachian tubes of children with cholesterol granuloma.

Six temporal bone-eustachian tube (ET) specimens with cholesterol granuloma (CG), obtained from 6 children 6 months to 15 years of age, were studied histopathologically to obtain further information about the pathogenesis of CG. We observed CG in the mastoid air cells in 5 ears, the mastoid antrum in 1 ear, the aditus ad antrum in 2 ears, and the epitympanum in 1 ear. All 6 cases exhibited a large amount of remaining mesenchyme that was in continuity with the hematopoietic bone marrow in the locations in which CG was present. All cases demonstrated otitis media with effusion and inflammation of the ET. Apparent morphological abnormalities of the ET and its associated structures, including hypoplastic ET cartilage and an abnormal tensor veli palatini muscle, were noted in 3 of the 6 cases. Furthermore, the posterior cartilaginous portion of the ET that includes its narrowest portion was completely filled with effusion in 2 of the 3 cases with the ET anomaly. The findings obtained were compared with data from age-matched control cases. Our results suggest that the source of erythrocytes in the remaining mesenchyme is the hematopoietic bone marrow. The pathogenesis of CG in children is likely promoted by ET dysfunction resulting in failure of ventilation of the middle ear.

Adolescent↗
PubMed2002

Analysis of spiral ganglion cell populations in children with normal and pathological ears.

This study analyzed features of total and segmental spiral ganglion cell populations in children with normal ears and those with various pathological conditions. Sixty-three human temporal bone specimens, obtained from 43 children 4 days to 9 years of age, were studied histopathologically. These specimens were divided into 5 diagnostic groups: group 1, normal ears (13 ears); group 2, congenital infectious diseases (13 ears); group 3, chromosomal aberrations (11 ears); group 4, multiple craniofacial anomalies with hereditary or genetic causes (21 ears); and group 5, perinatal and postnatal asphyxia (5 ears). Eighteen of the 63 ears had documented profound deafness. In either normal ears (group 1) or those with various pathological conditions (groups 2 through 5), the total number of ganglion cells did not change as a function of age during the first 10 years. The total number of ganglion cells was significantly larger in group 1 (33,702) than in each of groups 2, 3, 4, and 5 (p < .01), and the number was significantly larger in group 2 than in each of groups 4 and 5 (p < .01 and p < .05, respectively). The ratio of basal to apical ganglion cell populations remained constant in both normal and pathological ears. Each ratio of the number of basal and apical ganglion cells in groups 2, 3, 4, and 5 to the mean number in group 1 (basal and apical survival ratios) was at least approximately 40%. There was no statistical difference between these two ratios in groups 2, 3, 4, and 5. The mean (+/-SD) total number of ganglion cells in ears with documented profound deafness was 15,417 +/- 5,944, which is approximately 40% of those present in normal ears. Our results suggest that normally, cochlear neurons are completely present at birth and minimally regress during the first decade of life. In addition, although intergroup differences among various pathological groups were present, the majority of pathological ears had more than 10,000 spiral ganglion cells present. Cochlear implantation has gradually been recognized as an effective and reliable tool for rehabilitation of children who have profound deafness, even congenitally or prelingually deafened children. On the basis of the results obtained in this study, we discuss the implications for cochlear implantation in children.

Age Factors↗