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Progressive hearing loss after transverse temporal bone fracture.

Transverse fractures often violate the otic capsule and commonly, although not invariably, result in immediate and profound sensorineural hearing loss. The pathogenic mechanisms producing sensorineural hearing loss include direct trauma to the cochlear nerve, disruption of the membranous labyrinth, vascular compromise or hemorrhage into the inner ear, perilymphatic fistula, and endolymphatic hydrops. The last two mechanisms account for the occasional patient who develops progressive sensorineural hearing loss after the initial insult. On early posttraumatic evaluation three patients were discovered to have transverse fractures and residual auditory function. Deterioration of hearing led to middle-ear exploration with closure of perilymphatic fistulas. Hearing was preserved in two patients. Diagnosis of posttraumatic perilymphatic fistulas requires early audiometric assessment, high-resolution computed tomographic scanning of the temporal bones to detect fracture of the otic capsule and pneumolabyrinth, and a high index of clinical suspicion.

Accidental Falls↗

Neuro-otological findings after radiosurgery for acoustic neurinomas.

OBJECTIVE: To evaluate the neuro-otological complications in patients after radiosurgery for acoustic neurinomas. DESIGN: Inception cohort, retrospective study. SETTING: University hospital. PATIENTS: A consecutive sample of 46 patients with acoustic neurinomas who underwent unilateral gamma knife radiosurgery at the University of Tokyo, Japan, between June 1990 and June 1994 were followed up by otolaryngologists for more than 3 months. INTERVENTION: Gamma knife stereotactic radiosurgery. MAIN OUTCOME MEASURES: Neuro-otological examinations including pure tone audiometry, auditory brain stem response, and caloric test. RESULTS: Tumor growth occurred in 2 patients (4.3%). Seven (18%) of the 38 patients with preserved hearing of any extent became deaf within 1 year. In cases of gradual hearing loss, the average deterioration rate was approximately 8 dB per year. Abnormalities of auditory brain stem response preceded deafness in 2 patients. Caloric response, preserved before treatment in 13 patients, disappeared 4 to 13 months after treatment (median, 8 months) in 9 (69%) of them, whereas their hearing was preserved. Delayed facial palsy and persistent trigeminal neuropathy occurred in 10 (22%) and 7 (15%) of the 46 patients, respectively. Severe facial palsy tended to persist. CONCLUSIONS: The rates of neuro-otological complications of radiosurgery are almost comparable with those previously reported from other institutions. The deafness within 1 year after treatment might be attributed to a lesion in the cochlear nerve. Hearing loss did not parallel vestibular function loss. The persistent severe facial palsy contrasts with previously reported findings. Considering the serious facial nerve complications that occurred in some of our patients, further study to disclose the risk factors for neurological dysfunction would be needed for radiosurgery to become a true, safe alternative to microsurgery.

Adolescent↗

Cochlear ablation alters acoustically induced c-fos mRNA expression in the adult rat auditory brainstem.

Expression of c-fos mRNA was studied in the adult rat brain following cochlear ablations by using in situ hybridization. In normal animals, expression was produced by acoustic stimulation and was found to be tonotopically distributed in many auditory nuclei. Following unilateral cochlear ablation, acoustically driven expression was eliminated or decreased in areas normally activated by the ablated ear, e.g., the ipsilateral dorsal and ventral cochlear nuclei, dorsal periolivary nuclei, and lateral nucleus of the trapezoid body and the contralateral medial and ventral nuclei of the trapezoid body, lateral lemniscal nuclei, and inferior colliculus. These deficits did not recover, even after long survivals up to 6 months. Results also indicated that neurons in the dorsal cochlear nucleus could be activated by contralateral stimulation in the absence of ipsilateral cochlear input and that the influence of the contralateral ear was tonotopically organized. Results also indicated that c-fos expression rose rapidly and persisted for up to 6 months in neurons in the rostral part of the contralateral medial nucleus of the trapezoid body following a cochlear ablation, even in the absence of acoustic stimulation. This response may reflect a release of constitutive excitatory inputs normally suppressed by missing afferent input or changes in homeostatic gene expression related to sensory deprivation. Instances of transient, surgery-dependent increases in c-fos mRNA expression in the absence of acoustic stimulation were observed in the superficial dorsal cochlear nucleus and the cochlear nerve root on the ablated side.

Acoustic Stimulation↗

Superior olivary contributions to auditory system plasticity: medial but not lateral olivocochlear neurons are the source of cochleotomy-induced GAP-43 expression in the ventral cochlear nucleus.

A unilateral cochlear lesion induces expression of the growth and plasticity-associated protein 43 (GAP-43) in fibers and their varicosities on specific types of postsynaptic profiles in the ventral cochlear nucleus (VCN), suggesting the induction of synaptic remodeling. One candidate population from which GAP-43 might emerge was neurons of the lateral olivocochlear (LOC) system residing in the lateral superior olive (LSO). Upon cochleotomy, these neurons express GAP-43 mRNA and GAP-43 protein. However, retrograde axonal tracing with Fast Blue or biotinylated dextran amine from VCN revealed that the number of 6.8 +/- 1.3 neurons in the whole ipsilateral LSO labeled in normal adult rats was distinctly small and did not rise after cochleotomy. Concluding that LOC neurons cannot be the source of GAP-43 in the VCN, we reinvestigated the pattern of GAP-43 in situ hybridization and found that, after cochleotomy, shell neurons in the regions surrounding the LSO and medial olivocochlear (MOC) neurons in the ventral nucleus of the trapezoid body up-regulated GAP-43 mRNA. We then lesioned these regions by means of stereotaxic injections of kainic acid. Destruction of shell neurons preceding an ipsilateral cochleotomy did not change the emergence of GAP-43 immunoreactivity in the VCN. However, if the contralateral MOC system was lesioned, the rise of GAP-43 immunoreactivity in VCN on the side of the cochleotomy was significantly reduced. We conclude that, after cochlear dysfunction, MOC neurons are the major (if not exclusive) source of synaptic reorganization in the VCN that could possibly entail compensatory activation of the affected ascending auditory pathway.

Animals↗

Light and electron microscopic studies of the basilar papilla in the duck, Anas platyrhynchos. II. Embryonic development.

The intent of this study was to describe certain morphological aspects of cytodifferentiation of the basilar papilla in the duck, Anas platyrhynchos. The duck, with a longer incubation period than that of the chicken, has proven useful in identifying the earliest morphological changes during cyto-differentiation of the basilar papilla. Most of these changes occur first at the neural margin of the presumptive genu, at the site of initial contact by cochlear nerve fibers. A wave of differentiation of hair cells radiates abneurally, proximally, and distally, concurrent with the establishment of afferent innervation. Extracellular channels form in the papilla between cell bases just before the nerve fibers penetrate the basal lamina. Nerve fibers abut hair cell bases in the genu at the time the hair cells separate from the basal lamina on day 9. Hair cell bases contain granular vesicles and lie among the nuclei of supporting cells on day 10. Synaptic bodies are present opposite nerve endings on day 11. Efferent nerve endings appear on short hair cells in the genu on day 15 and on tall hair cells on day 17.

Animals↗

Morphogenesis of the brain in the harbour porpoise.

Morphogenesis of the brain in a cetacean species has been investigated by means of reconstructions from serial sections of successive prenatal stages of the harbour porpoise (Phocoena phocoena). Four specimens ranging from 10 to 46 mm crown-rump length (CRL) were selected and three-dimensional reconstructions of the developing brains were obtained with the plate model method. External and internal characteristics, established as criteria for staging embryonic development of primates and rodents, revealed that a common ontogenetic plan regarding the chronological sequence of morphogenetic events exists in mammalian orders as different as primates and odontocetes. Comparison of the 10-mm and 11.5-mm CRL harbour porpoise brains with those in other mammalian embryos of a similar ontogenetic stage (stages 16 and 17) showed a high degree of correspondence in morphological features. This ontogenetic age group therefore might still be considered as a generalized mammalian one. However, during succeeding morphogenesis of the Phocoena brain, qualitative and quantitative divergences from other mammalian groups became manifest, such as those found in the 24-mm CRL specimen (corresponding to mammalian stages 20, 21). Early foetuses of the harbour porpoise (46 and 65 mm CRL) already exhibited a variety of typical odontocete brain features, such as absence of olfactory bulb, thick cochlear nerve, and strong progression of brainstem structures. Morphogenesis of the harbour porpoise brain is discussed from a comparative perspective, incorporating the literature on the development of mammalian brains. Part of this study has been published in abstract form (Buhl and Oelschläger: Acta Anat. (Basel) 120:15-16 (Abstract), '84).

Animals↗

Migration of neuroblasts by perikaryal translocation: role of cellular elongation and axonal outgrowth in the acoustic nuclei of the chick embryo medulla.

The neuroblasts forming nucleus magnocellularis, the avian homologue of the mammalian ventral cochlear nucleus, migrate by growth and elongation of their leading processes and by perikaryal translocation through these processes from the matrix zone of the rhombic lip to the acoustico-vestibular anlage. Golgi methods were used on staged chick embryos to reconstruct the morphogenetic phases of migration and early differentiation in situ. Fluorescence labeling of the living cells in vitro elucidated the role of axonal growth in the migratory process. In situ, branching cochlear nerve fibers, tipped with growth cones, enter the acoustico-vestibular anlage at E4.5-5.5 before migration of the magnocellularis neuroblasts at E.5.5-6.5. The premigratory neuroblasts in the matrix zone of the rhombic lip resemble primitive epithelial cells, which extend branched, curving processes into a characteristic formation, the rhombic whorl. The leading process of the migrating magnocellularis neuroblasts gives rise to a bifurcating axon at the interface between the matrix and mantle zones. The lateral branch becomes the recurrent ipsilateral collateral; the medial branch crosses the midline, heading toward the contralateral target site in the region of the presumptive nucleus laminaris. The cell bodies of the migratory neuroblasts appear in intermediate locations along the migration route as they translocate radially through their leading processes past the axonal bifurcation and then tangentially and obliquely into the mantle zone. Neuroblasts destined for nucleus laminaris migrate coincidentally with magnocellularis neuroblasts. Nucleus angularis neuroblasts migrate later in development, after E6.5. In vitro, injections of a nontoxic fluorescent dye (diI) were made into explants of the medulla in the region of the contralateral target area at the time of neuroblast migration. DiI retrogradely labeled the cell bodies of premigratory magnocellularis neuroblasts in the matrix zone and of migratory neuroblasts in the mantle zone through their medial, crossing axonal branches. The morphology of the living neuroblasts in the explants resembled that in the Golgi impregnations at the corresponding stages of migration. Anterograde axonal transport also occurred. These results demonstrate migration by perikaryal translocation and early axon extension of a specific group of neuroblasts in the central nervous system. The morphology of the migrating neuroblasts is such that a simple radial arrangement of cellular guides, glial or otherwise, would not account for their configurations. The available evidence supports the proposition that cellular elongation and perikaryal translocation constitute the general mode of neuronal migration in the central nervous system. The early extension of axons into their target sites may play a critical role in migration and early development of specific types of neurons.

Animals↗

Anatomy and projection patterns of the superior olivary complex in the Mexican free-tailed bat, Tadarida brasiliensis mexicana.

The superior olivary complex (SOC) is the first station in the ascending auditory pathway that receives binaural projections. Two of the principal nuclei, the lateral superior olive (LSO) and the medial superior olive (MSO), are major sources of ascending projections to the inferior colliculus. Whereas almost all mammals have an LSO, it has traditionally been thought that only animals that hear low frequencies have an MSO. Recent reports, however, suggest that the medial part of the SOC in bats is highly variable and that at least some bats have a well-developed MSO. Thus, the main goal of this study was to evaluate the cytoarchitecture and connections of the principal superior olivary nuclei of the Mexican free-tailed bat, with specific attention directed at the MSO. Cell and fiber stained material revealed that the LSO and the medial nucleus of the trapezoid body (MNTB) are similar to those described for other mammals. There are two medial nuclei we refer to as dorsomedial periolivary nucleus (DMPO) and MSO. Tracer experiments exhibited that the DMPO receives bilateral projections from the cochlear nucleus, and additional projections from the ipsilateral MNTB. The DMPO sends a strong projection to the ipsilateral inferior colliculus. Positive staining for acetylcholinesterase indicates that the DMPO is a part of the olivocochlear system, as it is in other animals. The MSO in the free-tailed bat meets many of the criteria that traditionally define this nucleus. These include the presence of bipolar and multipolar principal cells, bilateral innervation from the cochlear nucleus, a strong projection from the ipsilateral MNTB, and the absence of cholinergic cells. The major difference from traditional MSO features is that it projects bilaterally to the inferior colliculus. Approximately 30% of its cells provide collateral projections to the colliculi on both sides. Functional implications of the MSO for the free-tailed bat are considered in the Discussion.

Acetylcholinesterase↗

Projections to the cochlear nuclei from principal cells in the medial nucleus of the trapezoid body in guinea pigs.

Spherical and globular cells in the cochlear nucleus provide input to the cell groups in the superior olivary complex devoted to the analysis of binaural cues. Descending projections from the superior olivary complex appear to inhibit the spherical and globular cells. It is not known which of the numerous cell types in the superior olive provide this descending input, but recent studies have shown that some of the cells are located in the medial nucleus of the trapezoid body (MTB). The present experiments were designed to determine whether the MTB projections arise from principal cells, which are known to play a role in sound localization, and to determine whether their projections terminate on spherical or globular cells. Principal cells in the MTB are characterized by their contacts with synaptic specializations called calyces, which arise from the axons of cells in the contralateral cochlear nucleus. In the first experiment, a fluorescent tracer was injected into one cochlear nucleus to label the calyces anterogradely. A different tracer was injected into the opposite cochlear nucleus to label cells retrogradely in the MTB. In every case, some of the labeled cells were enveloped by a labeled calyx, demonstrating that principal cells do project to the cochlear nucleus. In the second experiment, fluorescent tracers were injected into different parts of the cochlear nucleus. Analysis of the distribution of labeled cells suggested that MTB projections selectively target the globular cell region of the cochlear nucleus. In a third experiment, the axonal arborizations arising from this projection were labeled with biocytin or wheat germ agglutinin conjugated to horseradish peroxidase. Labeled boutons appeared to contact globular cells but not spherical cells. Multipolar cells in the ventral cochlear nucleus and cells in the dorsal cochlear nucleus were also contacted. The results suggest that MTB projections to the cochlear nucleus arise largely from principal cells and contact, at least in part, cells in the cochlear nucleus that give rise to ascending pathways involved in sound localization.

Animals↗

The suboccipital approach to removal of acoustic neuromas.

This article reviews the author's technique for removing acoustic neuromas by the suboccipital approach. Also discussed are various considerations regarding the selection and use of instruments for this operation. The anatomy of the internal acoustic meatus and the principles involved in facial- and cochlear-nerve preservation are described. A guide is provided for stepwise dissection of the internal acoustic meatus in the laboratory.

Cranial Nerve Neoplasms↗

Protein kinase A and calcium/calmodulin-dependent protein kinase II regulate D-[3H]aspartate release in auditory brain stem nuclei.

We noted previously that after unilateral cochlear ablation (UCA) in young adult guinea pigs, plastic changes in glutamatergic transmitter release in several brain stem auditory nuclei depended on protein kinase C. In this study, we assessed whether such changes depended on protein kinase A (PKA) and calcium/calmodulin-dependent protein kinase II (CaMKII). The electrically-evoked release of D-[3H]aspartate (D-[3H]Asp) was quantified in vitro as an index of glutamatergic transmitter release in the major subdivisions of the cochlear nucleus (CN) and the main nuclei of the superior olivary complex (SOC). In tissues from intact animals, dibutyryl-cyclic adenosine monophosphate (DBcAMP), a PKA activator, elevated D-[3H]Asp release by 1.9-3.7-fold. The PKA inhibitor, H-89 (2 microM), did not alter the evoked release but blocked the stimulatory effects of DBcAMP. These findings suggested that PKA could positively regulate glutamatergic transmitter release. Seven days after the ablation of one cochlea and its cochlear nerve, the stimulatory effect of DBcAMP remained evident. After 145 postablation days, H-89 blocked the plastic elevations of D-[3H]Asp release in the ipsilateral CN and lateral (LSO) and medial (MSO) superior olive. A CaMKII inhibitor, KN-93, produced similar blocks, suggesting that the postablation plasticities in these nuclei depended on PKA or CaMKII. Both H-89 and KN-93 elevated release in the medial nucleus of the trapezoid body (MNTB) and the contralateral MSO, suggesting that either kinase could be used by endogenous mechanisms in these nuclei to downregulate glutamatergic release.

Animals↗

Effects of cochlear ablation on choline acetyltransferase activity in the rat cochlear nucleus and superior olive.

Using microdissection and quantitative microassay, choline acetyltransferase (ChAT) activity was mapped in the cochlear nucleus (CN) and in the source nuclei of the olivocochlear bundle, the lateral superior olive and ventral nucleus of the trapezoid body. In control rats, gradients of ChAT activity were found within the major subdivisions of the CN and in the lateral superior olive. These gradients correlated with the known tonotopic organizations, with higher activities corresponding to locations representing higher sound frequencies. No gradient was found in the ventral nucleus of the trapezoid body. In rats surviving 7 days or 1 or 2 months after cochlear ablation, ChAT activity was increased 1 month after ablation in the anteroventral CN by 30-50% in most parts of the lesion-side and by 40% in the contralateral ventromedial part. ChAT activity in the lesion-side posteroventral CN was increased by approximately 40-50% at all survival times. Little change was found in the dorsal CN. Decreases of ChAT activity were also found ipsilaterally in the lateral superior olive and bilaterally in the ventral nucleus of the trapezoid body. Our results suggest that cholinergic neurons are involved in plasticity within the CN and superior olive following cochlear lesions.

Animals↗

Deafness-related decreases in glycine-immunoreactive labeling in the rat cochlear nucleus.

There is increasing evidence of activity-related plasticity in auditory pathways. The present study examined the effects of decreased activity on immunolocalization of the inhibitory neurotransmitter glycine in the cochlear nucleus of the rat after bilateral cochlear ablation. Specifically, glycine-immunoreactive puncta adjacent to somatic profiles were compared in normal hearing animals and animals deafened for 14 days. The number of glycine-immunoreactive puncta surrounding somatic profiles of spherical and globular bushy cells, glycine-immunoreactive type I stellate multipolar cells, radiate neurons (type II stellate multipolar cells), and fusiform cells decreased significantly. In addition, the number of glycine immunopositive tuberculoventral (vertical or corn) cells in the deep layer of the dorsal cochlear nucleus also decreased significantly. These results suggest that decreased inhibition reported in cochlear nucleus after deafness may be due to decreases in glycine.

Animals↗

Hearing preservation in acoustic tumour surgery.

900 acoustic neurinomas were removed by the suboccipital approach at Nordstadt Neurosurgical Department from 1978 to 1992 by the same surgeon (M. S.). While 247 patients were deaf on the involved side before surgery, there were 653 patients ears with some preoperative hearing. Preservation of the cochlear nerve was always attempted, and the overall-rate of hearing preservation was 38% (249 of 653), regardless of pre- and postoperative quality of hearing or of tumour sizes. In small tumour sizes below 3 cm of diameter preservation rate was 51%, in large tumours above 3 cm of diameter it was 22%. A classification system of hearing quality was made up considering pure tone audiometric hearing losses (PTA HL) at 1 to 3 kHz, and individual maximum speech discrimination scores. The usefulness of the preserved hearing is further evaluated considering the quality of hearing in the contralateral ear, and by application of other classification schemes. Presentation of the surgical strategies and their refinements by personal experience provide the base for discussion questioning whether and how further progress may still be anticipated.

Adult↗

The cellular organization and nervous supply of the basilar papilla in the lizard, Calotes versicolor.

The basilar papilla of the lizard Calotes versicolor contains about 225 sensory cells. These are of two types: the short-haired type A cells in the ventral (apical) part of the organ, and the type B cells with long hair bundles, in the dorsal (basal) part of the organ. The type A cells are unidirectionally oriented and are covered by a tectorial membrane while the type B cells lack a covering structure and their hair bundles are oriented bidirectionally. Apart from those differences, the type A and type B cells are similar. They are columnar, and display the features common to most sensory cells in inner ear epithelia. The sensory cells are separated by supporting cells, which have long slender processes that keep the sensory cells apart. Close to the surface of the basilar papilla a "terminal bar" of specialized junctions interlocks adjacent cells. Below this adjacent supporting cells are linked by an occluding junction. The cochlear nerve enters from the medial (neural) aspect. The fibres of the nerve lose their myelin sheaths as they enter the basilar papilla. Each sensory cell is associated with several nerve endings. All the nerves identified were afferent. Marked variations were seen between nerve endings in the basilar papilla, but no morphological equivalents of any functional differences were observed.

Animals↗

Norepinephrine innervation of the cochlear nuclei by locus coeruleus neurons in the rat.

The cochlear nuclei (CN) contain a moderate concentration of norepinephrine (445 +/- 20 ng/g tissue) with dopamine levels (46 +/- 14 ng/g) that are low and within the precursor range expected for a norepinephrine (NE) terminal system. Lesion and horseradish peroxidase (HRP) experiments indicate that this innervation is bilateral and arises from fusiform and multipolar neurons in the locus coeruleus. Autoradiographic and fluorescence histochemical experiments demonstate that locus coeruleus fibers reach the ipsilateral ventral cochlear nuclei via a rostral pathway that projects from the rostral locus coeruleus laterally through the brain stem to the rostral tip of the ventral nuclei. This pathway is located dorsal to the motor and spinal trigeminal nuclei and ventral to the middle cerebellar peduncle. Descending coeruleo-cochlear fibers travel between the fourth ventricle and the vestibular nuclei to enter the acoustic striae. These fibers innervate both the dorsal and ventral nuclei. Contralateral locus fibers reach the CN by crossing in the pontine central gray at the rostral border of the fourth ventricle and by decussating with the fibers of the mesencephalic trigeminal nucleus ventral to the medial longitudinal fasciculus. The bilateral locus coeruleus innervation of the cochlear nuclei comprises a highly collateralized network of varicose axons which are not topographically organized. Unlike the cochlear nerve fibers in the CN which form specific projections, the locus coeruleus afferents to these sensory nuclei are diffuse and non-specific.

Animals↗

Blink reflex in meningomyelocele, with special reference to its usefulness in the evaluation of brainstem dysfunction.

The electrically elicited blink reflex (BR) was studied in 30 patients with meningomyelocele (MMC), including 21 with Chiari type II malformation. The relationship between the BR and brainstem auditory evoked potentials (BAEPs) is discussed with regard to its usefulness in the evaluation of MMC's brainstem dysfunction. The following results were obtained: (1) The R2 component was abnormal in 90% of these patients. The BR disclosed subclinical lesions in the medulla oblongata which were not detected by BAEPs alone. (2) In all patients in whom the BAEPs suggested the presence of stretched cochlear nerves, the BR indicated the existence of some dysfunction of the medulla oblongata. (3) No close relationship was found between the dysfunction detected by the BR and the degree of hindbrain anomaly on the neuroimaging. (4) Combining results from assessment of the measurement of the BR and BAEPs permits evaluation of the function of the fifth, seventh, and eighth cranial nerves, as well as the brainstem including the medulla oblongata, which is more comprehensive than evaluation by neuroimaging alone.

Adolescent↗