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Biomedical subjects

M M Paparella

Publications and source records attributed to M M Paparella.

At least 235 records · Page 13Linked to original sources
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Mondini's deafness. A review of histopathology.

From a histopathological survey of 12 ears (7 cases) of Mondini's deformity and deafness, the following conclusions or interpretations are drawn: 1) Mondini's bony deformity diagnosable by polytomography does not necessarily indicate Mondini's deafness or x-ray diagnosis of Mondini's deafness cannot be specifically relied upon. 2) The pars superior (semicircular canals and utricle) may be absent (aplastic) or the canals may be enlarged leading to interesting questions regarding vestibular physiology in such patients. 3) Enlarged endolymphatic duct and deficient utriculoendolymphatic valve are commonly found associated with absence of endolymphatic hydrops or collapse suggesting an operational longitudinal flow. 4) One and one-half or fewer (instead of 2 1/2) cochlear turns are characteristic; however, end-organ of Corti lesions (aplasia) may be present or absent leading to interesting speculations for further research regarding auditory function, especially in those cases with normal-appearing sensory structures. 5) Mechanisms of hearing loss in Mondini's deafness can be variably explained on the basis of inner ear or middle ear pathology including dysgenesis of the end-organs and associated neural elements sufficient to cause sensorineural hearing loss, aplasia of the oval or round windows which might explain manifest "sensorineural hearing loss" in the presence of normal-appearing organs of Corti and aplasia or infection of the middle ear causing a conductive loss which can be superimposed upon a sensorineural hearing loss.

Aged↗
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Panel of Menière's disease. Endolymphatic sac enhancement surgery for Menière's disease: an extension of conservative therapy.

It is out hypothesis that the primary goal of endolymphatic sac surgery in cases of intractable Menière's disease or syndrome is for the purpose of enhancing absorption of endolymph. Our experience includes 251 cases over a period of 15 years. In this report we discuss rationale, current methods, and results in a series of 176 cases since 1974.

Ear, Inner↗
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The round window membrane: otological observations.

The membrane of the round window serves as a barrier between the middle and inner ear and has a well-established role in cochlear physiology. It is important in many otological conditions: otitis media, otosclerosis, trauma, sequelae to drugs reaching the middle ear, tumors, congenital dysplasia, sudden deafness. We here describe the first electron microscopic findings in round window membranes from adult humans, and various conditions in reference to these findings. Since surgical lesions are made in this membrane during cochlear implantation, and by some otologists in treating vertigo, preliminary findings of a lesioning experiment in animals are presented. Interestingly, early healing resulted from a mesothelial cellular reaction in the adjacent scala tympani, with formation of clots, while in the middle ear the epithelial cellular layer sealed the edges of the perforation, leading to formation of an indentation ("pocket"). Subsequently, the middle layer of the membrane contributed to healing.

Adult↗
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Mucopolysaccharidosis I-H (Hurler's syndrome) and human temporal bone histopathology.

Six temporal bones from three patients with mucopolysaccharidosis I-H are described. All three patients were diagnosed as having mucopolysaccharidosis I-H by enzyme analysis, and all fit the phenotypic criteria of this disease. Family histories of the three cases described were negative for mucopolysaccharide-storage diseases. All three of the patients suffered chronic recurrent otitis media from infancy through death. Common histopathologic findings include otitis media, residual mesenchyme in the round window niche, partial occlusion of the middle ear cavity, and basophilic concretions within the stria vascularis. The common severe histopathologic changes observed in this study and similar findings in the temporal bones described in other studies lead the authors to believe that ear involvement in this disease may be more common than was previously suspected.

Child↗
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Sensorineural hearing loss in otitis media.

Additional evidence is presented to support the hypothesis that both acute purulent otitis media (POM) and chronic suppurative otitis media (COM) can cause high frequency sensorineural hearing loss. In selected patients and in animals (chinchillas) in a pilot study using electrophysiological methods, both temporary threshold shifts and permanent threshold shifts of basal cochlear turn involvement were demonstrated in POM. Data of cochlear involvement in 475 ears with bilateral COM, 607 ears with unilateral COM, and 607 ears serving as controls were obtained from six centers in five countries. In group 1 (15 dB or greater), 43% of ears with unilateral COM and 42% of ears with bilateral COM showed losses, for a combined odds ratio eight times that in controls. In group 2 (30 dB or greater), 16% of ears with unilateral COM and 17% of ears with bilateral COM demonstrated, respectively, seven and ten times that in controls. These statistically significant findings influence clinical considerations.

Acoustic Impedance Tests↗
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Pathology of Meniere's disease.

From review of recent findings, the pathology of Meniere's disease is described and correlated with clinical signs. Since Meniere's disease can be seen only in humans, assessing its natural history is important. A recent survey of 500 patients demonstrated the three major symptoms to be vestibular, auditory, and aural pressure. Meniere's disease (idiopathic) is distinguished from Meniere's syndrome (symptoms with likely cause), which accounted for approximately one fourth of the patients. Atypical forms include vestibular and cochlear Meniere's disease. A recent review of our temporal bone collection and detailed study of the pathological conditions of 134 temporal bones described in the literature revealed characteristic pathological findings. Patients with clear-cut histories of Meniere's disease may demonstrate little or no endolymphatic hydrops at death. Nevertheless, hydrops of the pars inferior remains the most significant pathological correlate of Meniere's disease. On the basis of these findings, the pathogenesis of the disease (malabsorption of endolymph) and the pathophysiology of the symptoms (physical and chemical) are discussed.

Edema↗
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Multiple otopathologic disorders.

Temporal bones (1,383) from 713 patients were studied systematically for multiple pathologic lesions. Eleven percent (152 temporal bones) were found to have more than one pathologic finding. Males (60.5%) had multiple diseases more commonly than did females (37.7%). The most frequently occurring findings were otitis media (71.1%), otosclerosis (43.4%), endolymphatic hydrops (38.8%), labyrinthitis (25.0%), and cancer (24.3%). We conclude that multiple coexisting pathologic conditions can have coincidental or causative relationships. The otolaryngologist should consider multiple pathologic conditions when diagnosing and treating diseases of the ear.

Ear Neoplasms↗
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A longitudinal study of cellular changes in experimental otitis media.

A longitudinal sequential study of otitis media in an experimental animal (cat) using eustachian tube obstruction was done. Fifty animals were used. The continuum of mucoperiosteal changes from one day to six months after obstruction revealed gradual changes that were similar for each animal. Stages were defined, and by using different staining techniques, including immunocytochemistry, an overall middle ear defense system was postulated and documented. Nonspecific as well as specific defense systems, including localized immunity, were described. Effusions were studied in a continuum, and their pathogenesis was discussed.

Animals↗
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Hearing loss following potassium bromate: two case reports.

Bromate has not been regarded as an ototoxic drug. Potassium bromate, marketed as a neutralizer in home permanent cold wave hair kits, has caused several cases of accidental poisoning in children, resulting from the ingestion of this solution. Two cases of hearing loss following ingestion of this solution for the purpose of suicide have been reported here and in the literature review.

Adolescent↗
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Sac decompression for refractory luetic vertigo.

Luetic hydrops can occur in both congenital and acquired lues and otologic manifestations may be indistinguishable from Meniere's disease. Eight endolymphatic sac decompression procedures were performed on 6 patients with refractory luetic vertigo. Of those, 3 had congenital and 3 acquired lues. All cases had received extensive anti-luetic medical therapy without any discernible improvement in the vertiginous attacks. In our 6 patients with luetic hydrops the main complaint was severe refractory vertigo, indeed, disabling in most cases. Postoperatively, all cases remained free from these severe attacks and the vertigo was controlled or eliminated in all cases. Although hearing was improved in one patient, hearing seemed not to improve, generally speaking, as a result of the long-term postoperative follow-up. We describe our method of sac decompression and drainage and suggest that this procedure might be considered for patients with uncontrollable luetic vertigo who have not benefited from adequate medical therapy.

Adult↗
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Bilaterality of Meniere's disease.

The audiometric configurations of a randomly selected group of 360 patients with clinical Meniere's disease were analysed in conjunction with their clinical manifestations. Although 78.6% of the patients had an abnormal pure-tone audiogram in the opposite ear from that which was initially diagnosed as Meniere's disease, based on the entire clinical picture, the disease was found to be definitely bilateral in 32% of the patients. A peaking audiogram type was found to be most common, occurring in about half of the involved ears. In approximately half of those with bilateral disease the second ear became involved within two years of onset of involvement of the first ear, and in another 27% the second ear became involved after a period of 5 years or more. These observations stress the importance of conservation in managing Meniere's disease, especially when considering surgical intervention for intractable disease, with the hope of retaining or restoring labyrinthine function.

Adolescent↗
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The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere's disease and its symptoms (mechanical and chemical).

A clinical classification separates Meniere's disease (MD) of known cause (e.g. infection, trauma, otosclerosis, syphilis, genetic and others) from MD, idiopathic. Atypical forms of MD include vestibular MD and cochlear MD. Temporal bone studies from our laboratory and as reviewed in the literature reveal hydrops of the pars inferior, sometimes with ruptures, most often seen in Reissner's membrane, and sometimes without ruptures, to be the most important pathological correlate. Gross anatomical pathological findings include decreased mastoid and periaqueductal pneumatization and anterior displacement of the lateral sinus which reduces Trautmann's triangle. Such developmental changes most probably influence the endolymphatic absorptive system. Any explanation for the mechanisms of pathogenesis of clinical symptoms must encompass all aspects of the natural history, including vestibular symptoms, auditory symptoms, and aural pressure. Both mechanical and chemical factors best explain the clinical symptoms, and both may be traceable to multifactorial inheritance.

Ear, Inner↗
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Hyperlipidemia and noise in the chinchilla.

Chinchillas were maintained on a 1% cholesterol diet for 6 months. Auditory Brainstem Response (ABR) measurements were obtained before and at 1, 3, 5, and 6 months after initiation of diet. Compound Action Potential (AP) measurements were obtained at sacrifice at 6 months. A significant reduction in ABR was seen at 5 months-on-diet. At 5 months, the animals were exposed to a 2 octave bandpass noise centered at 1 kHz at 105 dB for 220 min. One month following noise exposure, the cholesterol-fed animals exhibited a greater ABR latency shift at low intensities, and an elevated AP threshold at higher frequencies, vis-à-vis a control group.

Animals↗
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Diet-induced hyperlipidemia and auditory dysfunction.

Chinchillas rendered hyperlipidemic by a 1% cholesterol diet or maintained on a normal diet were either exposed to a 2-octave bandpass noise (700-2,800 Hz for 220 min at 105 or 114 dB) or else not exposed to noise. The animals were assessed with tone-burst (2-16 kHz) elicited compound action potentials (CAP). Compared with normal diet animals, the hyperlipidemic animals: not exposed to noise exhibited elevated thresholds at 8 kHz and higher frequencies; exposed to 105-dB noise exhibited elevated thresholds at 16 kHz; and exposed to 114-dB noise exhibited elevated thresholds at 2-16 kH. Surface preparations were made of the left cochleae of all noise-exposed animals. There was essentially no difference in hair cell counts between hyperlipidemic animals exposed to the 105-dB noise and normal animals similarly exposed. The hyperlipidemic animals exposed to the 114-dB noise exhibited a greater hair cell loss in the first turn of the cochlea than did similarly exposed normal animals. We conclude that maintenance on a high-cholesterol diet can cause a high-frequency hearing loss, probably due to vascular pathology resulting from a hyperlipidemic state. Furthermore, maintenance on a high-cholesterol diet can increase susceptibility to noise-induced hearing losses.

Animals↗