RESUMO
PURPOSE: In this study, we aimed to determine whether or not COM leads to loss of spiral and Scarpa ganglion neurons. METHODS: From the human temporal bone (HTB) collection at the University of Minnesota we selected human temporal bones with COM, defined as the presence of clinically intractable tissue abnormalities in the middle ear (cholesteatoma, perforation of the eardrum, granulation tissue, fibrosis, tympanosclerosis, and cholesterol granuloma). We also selected HTBs from donors with no ear diseases as controls. We quantitatively analyzed the number of spiral and Scarpa ganglion cells and compared the results obtained in the control and study groups. RESULTS: In both COM and control groups we observed a significant negative correlation between age and number of both spiral (R = -0.632; P < 0.001; 95% CI - 0.766 to - 0.434) and Scarpa ganglion (R = - 0.404; P = 0.008; 95% CI - 0.636 to - 0.051) cells. We did not find any significant differences in the number of spiral ganglion cells (in total or per segment) or in the density of Scarpa ganglion cells (in each vestibular nerve or both) in the COM group as compared with controls (P > 0.05). CONCLUSIONS AND RELEVANCE: Our results did not demonstrate significant loss of cochlear or vestibular peripheral ganglion neuron loss in HTBs with COM as compared with controls.
Assuntos
Otite Média , Nervo Vestibular , Cóclea , Humanos , Neurônios , Gânglio Espiral da Cóclea , Osso TemporalRESUMO
BACKGROUND: The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not. METHODS: We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale". RESULTS: Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed. CONCLUSION: Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.
Assuntos
Otite Média/complicações , Equilíbrio Postural/fisiologia , Transtornos de Sensação/etiologia , Vestíbulo do Labirinto/fisiopatologia , Humanos , Otite Média/fisiopatologia , Transtornos de Sensação/fisiopatologiaRESUMO
OBJECTIVE: Although prolonged use of antibiotics is very common in cystic fibrosis (CF) patients, no studies have assessed the changes in both cochlear and peripheral vestibular systems in this population. METHODS: We used human temporal bones to analyze the density of vestibular dark, transitional, and hair cells in specimens from CF patients who were exposed to several types of antibiotics, as compared with specimens from an age-matched control group with no history of ear disease or antibiotic use. Additionally, we analyzed the changes in the elements of the cochlea (hair cells, spiral ganglion neurons, and the area of the stria vascularis). Data was gathered using differential interference contrast microscopy and light microscopy. RESULTS: In the CF group, 83% of patients were exposed to some ototoxic drugs, such as aminoglycosides. As compared with the control group, the density of both type I and type II vestibular hair cells was significantly lower in all structures analyzed; the number of dark cells was significantly lower in the lateral and posterior semicircular canals. We noted a trend toward a lower number of both inner and outer cochlear hair cells at all turns of the cochlea. The number of spiral ganglion neurons in Rosenthal's canal at the apical turn of the cochlea was significantly lower; furthermore, the area of the stria vascularis at the apical turn of the cochlea was significantly smaller. CONCLUSIONS: Deterioration of cochlear and vestibular structures in CF patients might be related to their exposure to ototoxic antibiotics. Well-designed case-control studies are necessary to rule out the effect of CF itself.
Assuntos
Aminoglicosídeos/efeitos adversos , Fibrose Cística/complicações , Orelha Interna/efeitos dos fármacos , Células Ciliadas Auditivas/efeitos dos fármacos , Células Ciliadas Vestibulares/efeitos dos fármacos , Infecções Respiratórias/tratamento farmacológico , Osso Temporal/efeitos dos fármacos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Orelha Interna/patologia , Feminino , Células Ciliadas Auditivas/patologia , Células Ciliadas Vestibulares/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Temporal/patologia , Adulto JovemRESUMO
OBJECTIVE: To evaluate the histopathologic changes of dark, transitional, and hair cells of the vestibular system in human temporal bones from patients with chronic otitis media. STUDY DESIGN: Comparative human temporal bone study. SETTING: Otopathology laboratory. SUBJECTS AND METHODS: To compare the density of vestibular dark, transitional, and hair cells in temporal bones with and without chronic otitis media, we used differential interference contrast microscopy. RESULTS: In the chronic otitis media group (as compared with the age-matched control group), the density of type I and type II hair cells was significantly decreased in the lateral semicircular canal, saccule, and utricle (P < .05). The density of type I cells was also significantly decreased in the chronic otitis media group in the posterior semicircular canal (P = .005), but that of type II cells was not (P = .168). The mean number of dark cells was significantly decreased in the chronic otitis media group in the lateral semicircular canal (P = .014) and in the posterior semicircular canal (P = .002). We observed no statistically significant difference in the density of transitional cells between the 2 groups (P > .1). CONCLUSION: The findings of our study suggest that the decrease in the number of vestibular sensory cells and dark cells could be the cause of the clinical symptoms of imbalance of some patients with chronic otitis media.
Assuntos
Células Ciliadas Auditivas/patologia , Células Ciliadas Vestibulares/patologia , Otite Média/patologia , Osso Temporal/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To analyze temporal bones of deaf Dalmatian dogs from 5 days after birth to adulthood to better understand the pathogenesis of cochleosaccular dysplasia. METHODS: This is an experimental animal histopathological temporal bone study that included two groups of temporal bones. Group I consisted of 41 temporal bones from deaf Dalmatian dogs and group II of 25 temporal bones from 15 "normal" aged-matched, hearing Black Labradors. Morphometric analysis included: stria vascularis and spiral ligament area measurements, and cell counts of spiral ganglion, Scarpa's ganglion, and hair cells of saccular macula. RESULTS: The following findings were significantly less in deaf Dalmatian group compared to hearing Labradors: (1) cellular area of the stria vascularis in all cochlear turns; (2) cellular area of spiral ligament in the inferior part of the basal turn; (3) cellular density of spiral ganglion cells within segments III and IV; (4) number of Scarpa's ganglion cells; and (5) density of saccular hair cells types I and II. A borderline negative correlation was found between average density of spiral ganglion cells of segments III and IV and age in group I. Young deaf animals showed some cochlear hair cells, however in adult dogs all hair cells were replaced by supporting cells. CONCLUSION: General pattern of cochleosaccular dysplasia is variable, even when only one etiology, the genetic one, is involved. The gradual degeneration of inner ear elements in the cochleosaccular degeneration might indicate that early intervention might be crucial to stop the progression of cochleosaccular dysplasia.
Assuntos
Cóclea/patologia , Surdez/congênito , Osso Temporal/patologia , Animais , Cães , Células Ciliadas Auditivas Internas/patologia , Órgão Espiral/patologia , Sáculo e Utrículo/patologia , Gânglio Espiral da Cóclea/patologia , Estria Vascular/patologiaRESUMO
OBJECTIVE: The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media. STUDY DESIGN: Transversal. MATERIAL AND METHODS: The temporal bones were examined under light microscopy and then described. Chronic otitis media was defined by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less affected ear. To compare the qualitative variables, the chi test was used. Spearman's nonparametric test was used for correlations. P values less than or equal to .05 were considered significant. RESULTS: We studied 85 pairs of temporal bones. Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of contralateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%), and tympanic membrane retractions (35%). There was a direct and moderately strong correlation between the extent of granulation tissue in the more damaged ear and the contralateral ear (r(s) = 0.345, P = .004). A strong correlation was observed between the extent of cholesteatoma in the more damaged ear and in the contralateral ear (rs = 0.617, P < .001). CONCLUSION: We observed a high prevalence of changes in the contralateral ear. There was a direct correlation between the extent of both granulation tissue and cholesteatoma between the two ears, demonstrating that the more extensive the manifestation of these pathologies in the more damaged ear, the greater they will be in the contralateral ear.
Assuntos
Colesteatoma da Orelha Média/patologia , Otite Média/patologia , Otosclerose/patologia , Adulto , Colesteatoma da Orelha Média/epidemiologia , Colesterol/metabolismo , Doença Crônica , Estudos Transversais , Feminino , Granuloma , Granuloma de Corpo Estranho/epidemiologia , Granuloma de Corpo Estranho/metabolismo , Granuloma de Corpo Estranho/patologia , Humanos , Masculino , Otite Média/epidemiologia , Otosclerose/epidemiologia , Prevalência , Índice de Gravidade de Doença , Membrana Timpânica/patologiaRESUMO
OBJECTIVE: The objective of this study was to perform a morphometric analysis of a series of temporal bones with cochleosaccular dysplasia to clarify the extent of inner ear changes in this disease. STUDY DESIGN: This human temporal bone histopathologic study of a series of deaf-mute cases involves morphometric analysis, including stria vascularis and spiral ligament area measurements and spiral ganglion and hair cells counts. SUBJECTS: Thirteen temporal bones were selected from 35 with deaf mutism based on the histopathologic findings described by Scheibe. Twenty normal age-matched control subjects were used for comparisons. RESULTS: All temporal bones had the main histopathologic findings described by Scheibe, as well as severe affected stria vascularis. Seven temporal bones had cystic areas in the stria and three had concretions. Cross-sectional strial areas in temporal bones with cochleosaccular dysplasia were smaller than normal in all cochlear turns; however, no difference was found in spiral ligament cross-sectional areas. Reissner's membrane was hydropic in three temporal bones and the organ of Corti was absent in at least one cochlear turn in five. Concretions were present in the macula of seven temporal bones. Twelve temporal bones showed some level of spiral ganglion cell loss. No hair cells were observed in any temporal bone. A familial history of deafness was found in three cases. CONCLUSION: Pathologic findings were variable and limited to the saccule and scala media. The variation, perhaps, reflects the different etiologies involved in the origin of cochleosaccular dysplasia.
Assuntos
Doenças do Desenvolvimento Ósseo/patologia , Cóclea/patologia , Surdez/congênito , Sáculo e Utrículo/patologia , Osso Temporal/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Criança , Pré-Escolar , Surdez/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Ligamentos/patologia , Masculino , Pessoa de Meia-Idade , Órgão Espiral/patologia , Gânglio Espiral da Cóclea/patologia , Estria Vascular/patologiaAssuntos
Humanos , Masculino , Feminino , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Cabeça/anatomia & histologia , Cabeça/fisiologia , Pescoço/anatomia & histologia , Pescoço/fisiologia , Pescoço/embriologia , Cirurgia Plástica/reabilitação , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Doenças da Traqueia/cirurgia , Doenças da Traqueia/congênito , Doenças do Esôfago/cirurgia , Doenças do Esôfago/congênito , Doenças do Esôfago/fisiopatologia , Doenças Faríngeas/cirurgia , Doenças Faríngeas/congênito , Doenças da Boca/cirurgia , Doenças da Boca/congênito , Doenças da Boca/fisiopatologiaAssuntos
Humanos , Masculino , Feminino , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Cabeça/anatomia & histologia , Cabeça/fisiologia , Pescoço/anatomia & histologia , Pescoço/fisiologia , Pescoço/embriologia , Cirurgia Plástica/reabilitação , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Doenças da Traqueia/cirurgia , Doenças da Traqueia/congênito , Doenças do Esôfago/cirurgia , Doenças do Esôfago/congênito , Doenças do Esôfago/fisiopatologia , Doenças Faríngeas/cirurgia , Doenças Faríngeas/congênito , Doenças da Boca/cirurgia , Doenças da Boca/congênito , Doenças da Boca/fisiopatologiaAssuntos
Humanos , Masculino , Feminino , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Cabeça/anatomia & histologia , Cabeça/fisiologia , Pescoço/anatomia & histologia , Pescoço/fisiologia , Pescoço/embriologia , Cirurgia Plástica/reabilitação , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Doenças da Traqueia/cirurgia , Doenças da Traqueia/congênito , Doenças do Esôfago/cirurgia , Doenças do Esôfago/congênito , Doenças do Esôfago/fisiopatologia , Doenças Faríngeas/cirurgia , Doenças Faríngeas/congênito , Doenças da Boca/cirurgia , Doenças da Boca/congênito , Doenças da Boca/fisiopatologiaAssuntos
Humanos , Masculino , Feminino , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Cabeça/anatomia & histologia , Cabeça/fisiologia , Pescoço/anatomia & histologia , Pescoço/fisiologia , Pescoço/embriologia , Cirurgia Plástica/reabilitação , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Doenças da Traqueia/cirurgia , Doenças da Traqueia/congênito , Doenças do Esôfago/cirurgia , Doenças do Esôfago/congênito , Doenças do Esôfago/fisiopatologia , Doenças Faríngeas/cirurgia , Doenças Faríngeas/congênito , Doenças da Boca/cirurgia , Doenças da Boca/congênito , Doenças da Boca/fisiopatologiaRESUMO
A otite média crônica supurativa tem sido clinicamente definida como a saída de secreçäo crônica do ouvido médio associada a uma perfuraçäo da membrana timpânica. Cento e quarenta e quatro ossos temporais humanos com otite média crônica foram divididos em dois grupos: aqueles com membranas timpânicas íntegras (26) e aqueles com tímpanos perfurados (118). Os seguintes achados patológicos foram documentados: tecido de granulaçäo, alteraçöes ossiculares, granulomas de colesterol, colesteatomas e timpanosclerose. As seguintes regiöes foram pesquisadas para a presença destes achados: epitímpano, aditus and antrum, seio timpânico, nicho da janela redonda, hipotímpano e membrana timpânica
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Otite Média Supurativa/patologia , Idoso de 80 Anos ou mais , Doença Crônica , Membrana Timpânica/patologia , Otite Média Supurativa/diagnóstico , Osso Temporal/patologiaRESUMO
O diagnóstico etiológico de um paciente vertiginoso nem sempre é fácil, pois a complexidade do quadro, as interaçöes de eventos, a concomitância e similaridade de sintomas associados e muitas vezes a ansiedade obstaculizam a elaboraçäo de um raciocínio mais lógico. O objetivo deste trabalho é apresentar um roteiro clínico que aplicamos em nosso Serviço e que nos possibilita chegar ao diagnóstico etiológico da vertigem na maioria dos pacientes que nos procuram com este sintoma
Assuntos
Humanos , Tontura/diagnóstico , Vertigem/diagnóstico , Diagnóstico Diferencial , Vertigem/etiologiaRESUMO
O diagnostico etiologico de um paciente vertiginoso nem sempre e facil, pois a complexidade do quadro, as interacoes de eventos, a concomitancia e similaridade de sintomas associados e muitas vezes a ansiedade obstaculizam a elaboracao de um raciocinio mais logico. O objetivo deste trabalho e apresentar um roteiro clinico que aplicamos em nosso Servico e que nos possibilita chegar ao diagnostico etiologico da vertigem na maioria dos pacientes que nos procuram com este sintoma.