RESUMEN

BACKGROUND: Dizziness affects 20-30%of the general population. A subgroup of dizzy patients with chronic migraine suffers vertigo implying that the migraine has a vestibular component. Vestibular migraine remains a diagnosis of exclusion based on history. OBJECTIVE: A link between headaches and dizziness suggests that these individuals would demonstrate dizziness and instability in complex, dynamic visual environments as a result of an inability to correctly process conflicting visual and vestibular signals. METHODS: A convenience sample of 74 patients (22 men and 52 women; average age 56.2 years) who presented with complaints of dizziness participated. Effects of Visual-Vestibular Mismatch (VVM) were measured using a modified VVM questionnaire. Visual dependence was measured as the error to subjective visual vertical using a computerized Rod and Frame test. RESULTS: Forty-two participants (56.8%) tested positive for VVM. Of these, 68.9%were patients with concomitant complaints of headaches. Visual dependence was present in 41.5%of all patients but showed no significant correlation with headache. 22.2%of patients had visual dependence and complained of headaches. CONCLUSIONS: These results demonstrate that sensory reweighting occurs in patients experiencing dizziness and headache, supports the role of vestibular involvement in this disorder, and provides future direction for novel interventions.

Asunto(s)

Trastornos Migrañosos , Vértigo , Mareo , Femenino , Cefalea , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico

RESUMEN

Iatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accidental injury. High-resolution computed tomography (HRCT) of the temporal bone is used preoperatively to assess middle ear and mastoid anatomy; however, it is unreliable for detecting facial canal dehiscence. In this study, our aim was to determine if preoperative percutaneous FN stimulation could predict middle ear facial canal dehiscence. Between January 2015 and February 2017, we performed preoperative HRCT and percutaneous FN stimulation on adult patients who underwent otologic surgery at our institution. Stimulation was performed with a monopolar probe placed on the skin over the stylomastoid foramen. Electrical stimuli ranged from 0 to 40 milliamperes (mA). Recordings were made from ipsilateral facial muscles. Dependent variables included threshold to compound muscle action potential (CMAP), threshold to maximum amplitude of CMAP, and maximum amplitude of CMAP for each muscle. A retrospective chart review was performed. Seventy patients met inclusion criteria. Of the 24 with an intraoperatively confirmed dehiscence, 10 were identified preoperatively by the attending surgeon on HRCT. Averages of the lowest recorded threshold to CMAP (5.1mA v. 9.1mA), and an average of the threshold to CMAP (8.9 mA. 11.8 mA) of dehiscent versus non-dehiscent nerves were significantly different (p < .05). In conclusion, percutaneous FN stimulation is a simple and cost-effective tool that can give the surgeon important preoperative information about FN anatomy.

Asunto(s)

Traumatismos del Nervio Facial/prevención & control , Nervio Facial/fisiología , Monitorización Neurofisiológica Intraoperatoria/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Hueso Temporal/patología , Adulto , Anciano , Traumatismos del Nervio Facial/etiología , Femenino , Humanos , Enfermedad Iatrogénica/prevención & control , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otológicos/efectos adversos , Estudios Retrospectivos , Adulto Joven

RESUMEN

Osseointegrated auditory devices (OADs) are hearing devices that use an external receiver/processor that stimulates bone conduction of sound via a titanium prosthesis that is drilled into the bone of the cranium. Since their introduction in 1977, OADs have undergone substantial evolution, including changes in manufacturing of the implant, improvements in the external sound processor, and simplification of implantation techniques. Expansion of criteria for patient candidacy for implantation has occurred corresponding with changes in the implants and processors.

Asunto(s)

Audífonos , Pérdida Auditiva/cirugía , Oseointegración/fisiología , Umbral Auditivo , Conducción Ósea/fisiología , Pérdida Auditiva/fisiopatología , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Diseño de Prótesis/historia , Ajuste de Prótesis/instrumentación , Titanio

RESUMEN

OBJECTIVE Temporal lobe encephaloceles and cerebrospinal fluid otorrhea from temporal bone defects that involve the tegmen tympani and mastoideum are generally repaired using middle fossa craniotomy, mastoidectomy, or combined approaches. Standard middle fossa craniotomy exposes patients to dural retraction, which can lead to postoperative neurological complications. Endoscopic and minimally invasive techniques have been used in other surgeries to minimize brain retraction, and so these methods were applied to repair the lateral skull base. The goal of this study was to determine if the use of endoscopic visualization through a middle fossa keyhole craniotomy could effectively repair tegmen defects. METHODS The authors conducted a retrospective review of 6 cases of endoscope-assisted middle fossa repairs of tegmen dehiscences at a tertiary care medical center within an 18-month period. RESULTS All cases were successfully treated using a keyhole craniotomy with endoscopic visualization and minimal retraction. Surgical times did not increase. There were no major postoperative complications, recurrences of encephaloceles, or cerebrospinal fluid otorrhea in these patients. CONCLUSIONS Endoscopic visualization allows for smaller incisions and craniotomies and less risk of brain retraction injury without compromising repair integrity during temporal encephalocele and tegmen repairs.

Asunto(s)

Otorrea de Líquido Cefalorraquídeo/cirugía , Craneotomía/instrumentación , Encefalocele/cirugía , Endoscopios , Lóbulo Temporal , Anciano , Fosa Craneal Media/cirugía , Craneotomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Hueso Temporal/cirugía

RESUMEN

Objective To systematically review the anatomy of the ossicular chain. Data Sources Google Scholar, PubMed, and otologic textbooks. Review Methods A systematic literature search was performed on January 26, 2015. Search terms used to discover articles consisted of combinations of 2 keywords. One keyword from both groups was used: [ ossicular, ossicle, malleus, incus, stapes] and [ morphology, morphometric, anatomy, variation, physiology], yielding more than 50,000 hits. Articles were then screened by title and abstract if they did not contain information relevant to human ossicular chain anatomy. In addition to this search, references of selected articles were studied as well as suggested relevant articles from publication databases. Standard otologic textbooks were screened using the search criteria. Results Thirty-three sources were selected for use in this review. From these studies, data on the composition, physiology, morphology, and morphometrics were acquired. In addition, any correlations or lack of correlations between features of the ossicular chain and other features of the ossicular chain or patient were noted, with bilateral symmetry between ossicles being the only important correlation reported. Conclusion There was significant variation in all dimensions of each ossicle between individuals, given that degree of variation, custom fitting, or custom manufacturing of prostheses for each patient could optimize prosthesis fit. From published data, an accurate 3-dimensional model of the malleus, incus, and stapes can be created, which can then be further modified for each patient's individual anatomy.

Asunto(s)

Osículos del Oído/anatomía & histología , Prótesis Osicular , Osículos del Oído/fisiología , Humanos , Diseño de Prótesis , Planificación Estratégica

RESUMEN

The CRISPR or clustered regularly interspaced short palindromic repeats system is currently the most advanced approach to genome editing and is notable for providing an unprecedented degree of specificity, effectiveness, and versatility in genetic manipulation. CRISPR evolved as a prokaryotic immune system to provide an acquired immunity and resistance to foreign genetic elements such as bacteriophages. It has recently been developed into a tool for the specific targeting of nucleotide sequences within complex eukaryotic genomes for the purpose of genetic manipulation. The power of CRISPR lies in its simplicity and ease of use, its flexibility to be targeted to any given nucleotide sequence by the choice of an easily synthesized guide RNA, and its ready ability to continue to undergo technical improvements. Applications for CRISPR are numerous including creation of novel transgenic cell animals for research, high-throughput screening of gene function, potential clinical gene therapy, and nongene-editing approaches such as modulating gene activity and fluorescent tagging. In this prospect article, we will describe the salient features of the CRISPR system with an emphasis on important drawbacks and considerations with respect to eliminating off-target events and obtaining efficient CRISPR delivery. We will discuss recent technical developments to the system and we will illustrate some of the most recent applications with an emphasis on approaches to eliminate human viruses including HIV-1, JCV and HSV-1 and prospects for the future. J. Cell. Biochem. 118: 3586-3594, 2017. © 2017 Wiley Periodicals, Inc.

Asunto(s)

Investigación Biomédica/métodos , Repeticiones Palindrómicas Cortas Agrupadas y Regularmente Espaciadas , Edición Génica/métodos , Animales , Investigación Biomédica/tendencias , Edición Génica/tendencias , Humanos

RESUMEN

HYPOTHESIS: Custom prostheses could be used to recreate the ossicular chain and improve hearing. BACKGROUND: Ossicular discontinuity or fixation occurs in 55% of cases of conductive hearing loss, with most cases involving the incus. Reconstruction has been achieved by a variety of methods; however, there has been little improvement in hearing outcomes in decades. METHODS: Precise measurements of anatomic dimensions, weight, and center of gravity were taken from 19 cadaveric incudes. These measurements were combined with measurements from the medical literature and micro-computed tomography (micro-CT) of cadaveric temporal bones to generate a rasterizable incus model. As a proof of concept, incudal replacements including possible anatomic variations were then three-dimensionally (3-D) printed and inserted into a cadaveric temporal bone. RESULTS: Our measurements of cadaveric incudes corresponded well with those from the medical literature. These measurements were combined with anatomical information from micro-CT allowing identification of critical features of the incus, which remained constant. Other model features were modified to increase stability and facilitate synthesis, including broadening and thickening of the lenticular process and the incudomalleolar articulation. 3-D printed incudal replacements based on this model readily fit into a cadaveric temporal bone and successfully bridged the gap between malleus and incus. CONCLUSION: We have generated a model for custom 3-D synthesis of incudal prostheses. While current 3-D printing in biocompatible materials at the size required is limited, the technology is rapidly advancing, and 3-D printing of incudal replacements with polylactic acid (PLA) is of the correct size and shape.

Asunto(s)

Prótesis Osicular , Impresión Tridimensional , Diseño de Prótesis/métodos , Materiales Biocompatibles , Cadáver , Oído Medio , Humanos , Microtomografía por Rayos X

RESUMEN

Hemostasis is a critical component of otologic and neurotologic surgery. In these surgeries the surgical field is small; thus, even a small amount of bleeding can obstruct the view of critical and extremely small structures. Additionally, relatively large vascular structures traverse the area; if they are encroached on by trauma or disease, bleeding must be controlled within a very small space in a meticulous fashion that does not encroach on structures of the middle ear and mastoid. The authors discuss several hemostatic agents in the middle ear, mastoid, and lateral skull base, highlighting their origins, mechanisms, advantages, and complications.

Asunto(s)

Pérdida de Sangre Quirúrgica/prevención & control , Enfermedades del Oído/cirugía , Hemostasis Quirúrgica/métodos , Técnicas Hemostáticas , Hemostáticos/farmacología , Procedimientos Neuroquirúrgicos , Procedimientos Quirúrgicos Otológicos , Oído Medio/cirugía , Humanos , Apófisis Mastoides/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Otológicos/efectos adversos , Procedimientos Quirúrgicos Otológicos/métodos , Base del Cráneo/cirugía

RESUMEN

HSV-1 induced illness affects greater than 85% of adults worldwide with no permanent curative therapy. We used RNA-guided CRISPR/Cas9 gene editing to specifically target for deletion of DNA sequences of the HSV-1 genome that span the region directing expression of ICP0, a key viral protein that stimulates HSV-1 gene expression and replication. We found that CRISPR/Cas9 introduced InDel mutations into exon 2 of the ICP0 gene profoundly reduced HSV-1 infectivity in permissive human cell culture models and protected permissive cells against HSV-1 infection. CRISPR/Cas9 mediated targeting ICP0 prevented HSV-1-induced disintegration of promonocytic leukemia (PML) nuclear bodies, an intracellular event critical to productive HSV-1 infection that is initiated by interaction of the ICP0 N-terminus with PML. Combined treatment of cells with CRISPR targeting ICP0 plus the immediate early viral proteins, ICP4 or ICP27, completely abrogated HSV-1 infection. We conclude that RNA-guided CRISPR/Cas9 can be used to develop a novel, specific and efficacious therapeutic and prophylactic platform for targeted viral genomic ablation to treat HSV-1 diseases.

Asunto(s)

Edición Génica/métodos , Genes Virales , Herpesvirus Humano 1/fisiología , Replicación Viral , Animales , Sistemas CRISPR-Cas , Línea Celular , Chlorocebus aethiops , ADN Viral/genética , Herpesvirus Humano 1/genética , Humanos , Mutación INDEL , Eliminación de Secuencia

RESUMEN

HYPOTHESIS: Intrinsic differences in neurons of the vestibular ganglia result in the increased likelihood of superior vestibular ganglion involvement in vestibular neuritis. BACKGROUND: Vestibular neuritis is hypothesized to result from herpes simplex type I (HSV1) infection or reactivation in vestibular ganglia. Involvement of the inferior vestibular ganglion is extremely rare in patients with vestibular neuritis. METHODS: Primary cultures of rat superior and inferior vestibular ganglion neurons (VGNs) were cultivated separately. Neurons were lytically and latently infected with HSV1 with a US11-green fluorescent protein (GFP) chimera. Percentage lytic infection and baseline reactivation was assessed by microscopy for GFP fluorescence. Trichostatin-A (TSA) was used to stimulate HSV1 reactivation. Virion production was assessed by viral titers. Relative numbers of latency-associated (LAT) transcripts were determined by real-time reverse-transcription polymerase chain reaction (real-time RT-PCR). RESULTS: Lytic infection rates were equivalent between the two ganglia (p > 0.05). Lytic infections yielded similar amounts of plaque-forming units (p > 0.05). Relative amounts of LAT transcripts did not differ between latently infected superior and inferior VGNs. Latently infected cultures showed no differences in rates of baseline and TSA-induced HSV1 reactivation (p > 0.05). Production of virions was not significantly different between reactivated, latently infected superior versus inferior VGNs (p = 0.45). CONCLUSION: Differences in prevalence of superior and inferior vestibular neuritis do not result from intrinsic differences in HSV1 infection or virion production of these neurons. Other factors, such as the length and width of the bony canal containing the ganglia and nerves, account for the greater involvement of the superior vestibular ganglion in vestibular neuritis.

Asunto(s)

Ganglios/patología , Nervio Vestibular/patología , Neuronitis Vestibular/patología , Animales , Quimera , Femenino , Ganglios/virología , Proteínas Fluorescentes Verdes/genética , Herpes Simple/patología , Herpes Simple/virología , Herpesvirus Humano 1 , Ácidos Hidroxámicos/farmacología , Masculino , Neuronas/patología , Neuronas/virología , Reacción en Cadena de la Polimerasa , Ratas , Ratas Sprague-Dawley , Nervio Vestibular/virología , Neuronitis Vestibular/etiología , Neuronitis Vestibular/virología , Vestíbulo del Laberinto/patología , Vestíbulo del Laberinto/virología , Activación Viral/efectos de los fármacos , Latencia del Virus

Asunto(s)

Conducto Auditivo Externo/patología , Neoplasias del Oído/patología , Poroma/patología , Neoplasias de las Glándulas Sudoríparas/patología , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

OBJECTIVE: The preferential delayed enhancement of the perilymphatic space enables detection of the non-enhancing endolymphatic hydrops present in patients with Ménière's disease. The aim of this study was to evaluate the diagnostic utility of delayed postcontrast 3D FLAIR images and a color map of fused postcontrast FLAIR and constructive interference steady state (CISS) images in the identification of endolymphatic hydrops in patients with clinically diagnosed Ménière's disease. STUDY DESIGN: Case control, blinded study. SETTING: Tertiary referral center. PATIENTS: Ten patients with Ménière's disease and five volunteer controls. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Two neuroradiologists blinded to the clinical history independently evaluated for the presence of endolymphatic hydrops on the images of both inner ears for test and control subjects. Both the standard gray-scale FLAIR images and the fused color map images were independently reviewed. RESULTS: The gray-scale 3D FLAIR images demonstrated 68.2% sensitivity and 97.4% specificity, and the fused color map images demonstrated 85.0% sensitivity and 88.9% specificity in the identification of endolymphatic hydrops in Ménière's disease. There was significant correlation between the gray-scale 3D FLAIR images and fused color map images with the categorization of involvement (p = 0.002). Inter-evaluator reliability was excellent (kappa = 0.83 for gray-scale images, kappa = 0.81 for fused color map). CONCLUSION: Delayed 3D FLAIR and fused 3D FLAIR-CISS color map images of the inner ears after intravenous contrast administration are potentially useful diagnostic tools in the evaluation of patients with suspected Ménière's disease.

Asunto(s)

Diagnóstico por Imagen/métodos , Oído Interno/patología , Hidropesía Endolinfática/diagnóstico , Enfermedad de Meniere/complicaciones , Adulto , Anciano , Hidropesía Endolinfática/complicaciones , Hidropesía Endolinfática/patología , Femenino , Humanos , Masculino , Enfermedad de Meniere/patología , Persona de Mediana Edad , Reproducibilidad de los Resultados

RESUMEN

A number of viral infections can cause hearing loss. Hearing loss induced by these viruses can be congenital or acquired, unilateral or bilateral. Certain viral infections can directly damage inner ear structures, others can induce inflammatory responses which then cause this damage, and still others can increase susceptibility or bacterial or fungal infection, leading to hearing loss. Typically, virus-induced hearing loss is sensorineural, although conductive and mixed hearing losses can be seen following infection with certain viruses. Occasionally, recovery of hearing after these infections can occur spontaneously. Most importantly, some of these viral infections can be prevented or treated. For many of these viruses, guidelines for their treatment or prevention have recently been revised. In this review, we outline many of the viruses that cause hearing loss, their epidemiology, course, prevention, and treatment.

Asunto(s)

Pérdida Auditiva/virología , Virosis/virología , Audición , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/fisiopatología , Pérdida Auditiva/prevención & control , Pérdida Auditiva/terapia , Humanos , Recuperación de la Función , Factores de Riesgo , Resultado del Tratamiento , Virosis/complicaciones , Virosis/diagnóstico , Virosis/terapia

RESUMEN

OBJECTIVES/HYPOTHESIS: Melanin is a pigmented polymer with a known role in dermal solar protection. In vertebrates, melanogenesis has been reported in leukocyte populations, suggesting a potential role in innate immunity. In this study, we report the novel finding of melanin associated with chronic inflammation and speculate on its potential role in the middle ear and mastoid. STUDY DESIGN: Retrospective review of case series. METHODS: Medical records of six patients who demonstrated melanin in the ear were reviewed. RESULTS: Six patients from 1 to 63 years of age were identified with extracellular melanin and melanin-laden histiocytes within the middle ear and/or mastoid air cells at time of surgery. Concurrent intraoperative findings included cholesteatoma (n = 3), chronic suppurative otitis media (n = 2), and coalescent mastoiditis (n = 1). Histologically, extracellular melanin and melanin-laden histiocytes were identified by Fontana-Masson stain; absence of melanocytes was confirmed by the absence of Melan-A staining. One patient had a positive stain for CD163 (a marker for macrophages). CONCLUSION: This case series is the first demonstration of melanin within middle ear mucosa without melanocytes in immediate proximity or metastatic melanocytic lesions. Melanin's presence in the setting of inflammation suggests that there may be a heretofore unreported link between the pigmentary and immune systems in the middle ear. LEVEL OF EVIDENCE: 4.

Asunto(s)

Colesteatoma del Oído Medio/metabolismo , Líquido Extracelular/metabolismo , Histiocitos/metabolismo , Mediadores de Inflamación/metabolismo , Líquido Intracelular/metabolismo , Melaninas/metabolismo , Adolescente , Adulto , Biopsia con Aguja , Niño , Preescolar , Colesteatoma del Oído Medio/patología , Colesteatoma del Oído Medio/cirugía , Estudios de Cohortes , Femenino , Histiocitos/patología , Humanos , Inmunohistoquímica , Lactante , Masculino , Mastoiditis/metabolismo , Mastoiditis/patología , Mastoiditis/cirugía , Melaninas/análisis , Persona de Mediana Edad , Otitis Media/metabolismo , Otitis Media/patología , Otitis Media/cirugía , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven

RESUMEN

HYPOTHESIS: Pretreatment with antiherpetic medications and steroids decreases likelihood of development of delayed facial paralysis (DFP) after otologic surgery. BACKGROUND: Heat-induced reactivation of herpes simplex virus type 1 (HSV1) in geniculate ganglion neurons (GGNs) is thought to cause of DFP after otologic surgery. Antiherpetic medications and dexamethasone are used to treat DFP. Pretreatment with these medications has been proposed to prevent development of DFP. METHODS: Rat GGN cultures were latently infected with HSV1 expressing a lytic protein-GFP chimera. Cultures were divided into pretreatment groups receiving acyclovir (ACV), acyclovir-plus-dexamethasone (ACV + DEX), dexamethasone alone (DEX), or untreated media (control). After pretreatment, all cultures were heated 43°C for 2 hours. Cultures were monitored daily for reactivation with fluorescent microscopy. Viral titers were determined from culture media. RESULTS: Heating cultures to 43°C for 2 hours leads to HSV1 reactivation and production of infectious virus particles (59 ± 6.8%); heating cultures to 41°C showed a more variable frequency of reactivation (60 ± 40%), compared with baseline rates of 14.4 ± 5%. Cultures pretreated with ACV showed lower reactivation rates (ACV = 3.7%, ACV + DEX = 1.04%) compared with 44% for DEX alone. Viral titers were lowest for cultures treated with ACV or ACV + DEX. CONCLUSION: GGN cultures harboring latent HSV1 infection reactivate when exposed to increased temperatures that can occur during otologic surgery. Pretreatment with ACV before heat provides prophylaxis against heat-induced HSV reactivation, whereas DEX alone is associated with higher viral reactivation rates. This study provides evidence supporting the use of prophylactic antivirals for otologic surgeries associated with high rates of DFP.

Asunto(s)

Aciclovir/uso terapéutico , Antiinflamatorios/uso terapéutico , Antivirales/uso terapéutico , Dexametasona/uso terapéutico , Parálisis Facial/etiología , Parálisis Facial/prevención & control , Procedimientos Quirúrgicos Otológicos/efectos adversos , Complicaciones Posoperatorias/prevención & control , Animales , Células Cultivadas , Ganglio Geniculado/citología , Calor , Neuronas/efectos de los fármacos , Reacción en Cadena de la Polimerasa , Ratas , Ratas Sprague-Dawley , Carga Viral , Activación Viral/efectos de los fármacos , Latencia del Virus

Asunto(s)

Carcinoma Basocelular/secundario , Neoplasias de los Nervios Craneales/secundario , Enfermedades del Nervio Facial/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , Humanos

Asunto(s)

Confusión/etiología , Pérdida Auditiva Sensorineural/etiología , Meningitis/complicaciones , Meningitis/patología , Acúfeno/etiología , Anciano , Antiinflamatorios/uso terapéutico , Audiometría de Tonos Puros , Confusión/psicología , Femenino , Pérdida Auditiva Súbita , Humanos , Imagen por Resonancia Magnética , Meningitis/psicología , Prednisona/uso terapéutico

RESUMEN

Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell's palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers.