scholarly journals Intracochlear Drug Injections through the Round Window Membrane: Measures to Improve Drug Retention

2016 ◽  
Vol 21 (2) ◽  
pp. 72-79 ◽  
Author(s):  
Stefan K. Plontke ◽  
Jared J. Hartsock ◽  
Ruth M. Gill ◽  
Alec N. Salt
Keyword(s):  
Inner Ear ◽  
Round Window ◽  
Fluorescein Isothiocyanate ◽  
Oval Window ◽  
Round Window Membrane ◽  
Fluid Exchange ◽  
Cochlear Aqueduct ◽  
Quantitative Manner ◽  
Almost All ◽  
Inner Ear Pressure

The goal of this study was to develop an appropriate methodology to apply drugs quantitatively to the perilymph of the ear. Intratympanic applications of drugs to the inner ear often result in variable drug levels in the perilymph and can only be used for molecules that readily permeate the round window (RW) membrane. Direct intracochlear and intralabyrinthine application procedures for drugs, genes or cell-based therapies bypass the tight boundaries at the RW, oval window, otic capsule and the blood-labyrinth barrier. However, perforations can release inner ear pressure, allowing cerebrospinal fluid (CSF) to enter through the cochlear aqueduct, displacing the injected drug solution into the middle ear. Two markers, fluorescein or fluorescein isothiocyanate-labeled dextran, were used to quantify how much of an injected substance was retained in the cochlear perilymph following an intracochlear injection. We evaluated whether procedures to mitigate fluid leaks improved marker retention in perilymph. Almost all procedures to reduce volume efflux, including the use of gel for internal sealing and glue for external sealing of the injection site, resulted in improved retention of the marker in perilymph. Adhesive on the RW membrane effectively prevented leaks but also influenced fluid exchange between CSF and perilymph. We conclude that drugs can be delivered to the ear in a consistent, quantitative manner using intracochlear injections if care is taken to control the fluid leaks that result from cochlear perforation.

Rupture of the round Window Membrane

1976 ◽  
Vol 85 (1) ◽  
pp. 105-110 ◽  
Author(s):  
P. H. Taylor ◽  
P. G. Bicknell
Keyword(s):  
Middle Ear ◽  
Surgical Intervention ◽  
Round Window ◽  
Oval Window ◽  
Round Window Membrane ◽  
Physical Effort ◽  
Cochlear Aqueduct ◽  
Definite Improvement ◽  
History Of ◽  
Pressure Changes

A case of sudden deafness due to rupture of the round window membrane is presented. Nineteen similar cases have previously been reported in the literature. In a review of these twenty patients, it is noted that a history of concurrent physical effort or barotrauma was present in eighteen. This supports the view that the injury is produced by pressure changes acting either along the cochlear aqueduct (the explosive route) or, directly on the middle ear structures (the implosive route). At operation, the rupture may be difficult to see, and a separate leak from the oval window may be present. The timing of any surgical intervention is important. The authors recommend that this should be deferred for one week after the onset of symptoms, as the fistula may heal spontaneously. If no definite improvement has occurred at the end of this time, then tympanotomy should be undertaken during the next week.

scholarly journals Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Yann Nguyen ◽  
Francesca Yoshie Russo ◽  
Isabelle Mosnier ◽  
Evelyne Ferrary ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Inner Ear ◽  
Round Window ◽  
Bone Conduction ◽  
Hearing Threshold ◽  
Round Window Membrane ◽  
Prospective Clinical Study ◽  
Local Skin ◽  
Local Skin Reaction ◽  
Bone Conduction Hearing

Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery.Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC) skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance.Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study.Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

Inner Ear Pathology and Otitis Media

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 249-253 ◽  
Author(s):  
Michael M. Paparella ◽  
Marcos V. Goycoolea ◽  
William L. Meyerhoff
Keyword(s):  
Inner Ear ◽  
Otitis Media ◽  
Round Window ◽  
Round Window Membrane

Insidious inner ear complications of otitis media have been and are being studied in our laboratory. The purpose of this paper is to review these studies, coordinate, capsulize and highlight the results with emphasis on the transport role of the round window membrane.

Sudden Deafness and Labyrinthine Window Ruptures

1973 ◽  
Vol 82 (1) ◽  
pp. 2-12 ◽  
Author(s):  
Victor Goodhill ◽  
Irwin Harris ◽  
Seymour J. Brockman ◽  
Oscar Hantz
Keyword(s):  
Hearing Loss ◽  
Surgical Intervention ◽  
Round Window ◽  
Vestibular Function ◽  
Sudden Hearing Loss ◽  
Oval Window ◽  
Sudden Deafness ◽  
Scala Tympani ◽  
Cochlear Aqueduct ◽  
History Of

In 1971, one of the authors reported sudden deafness associated with labyrinthine window membrane ruptures. Eighteen additional cases have been explored surgically since then. Data on 21 cases are presented. Sudden profound cochlear deafness has now been encountered in 21 cases which were surgically explored. In 15 instances, fistulae of round, oval, or both windows were encountered and repaired. In 10 of the 15, there was a definite history of sudden exertion or trauma prior to onset. The oval window alone was ruptured in nine patients, the round window alone in one, and both windows were ruptured in five patients. The oldest patient was 62 years and the youngest 11 years of age. Differential audiological studies showed profound losses in all cases. Almost every case was studied by pure tone AC-BC and speech audiometry, Békésy, and impedance tests. Whenever possible other audiologic tests, such as recruitment, tone decay, and SISI were performed. These findings are presented in detail. Vestibular function was studied by electronystagmography (ENG) in 15 of the 21 cases surgically explored. There was evidence of vestibular dysfunction in almost every case with sudden hearing loss. Significant ENG details are presented. Surgical repairs of ruptured window membranes were followed by improvements in some of the patients. Postoperative audiologic data are presented. The theoretical aspects include discussion of possible cerebrospinal fluid (CSF) perilymph pathways between cochlear aqueduct and scala tympani and between internal auditory meatus and scala vestibuli. It is concluded that spontaneous labyrinthine window ruptures must now be added to the etiologic factors in “sudden hearing loss.” It is premature to set down criteria for surgical intervention in such cases. Further careful studies are necessary.

Relationship of the Cochlear Aqueduct and Inner Ear Pressure in M??ni??re's Disease and in a Normal Population

2001 ◽  
Vol 22 (4) ◽  
pp. 534-538 ◽  
Author(s):  
Cuneyt Yilmazer ◽  
Levent Sennaroglu ◽  
Figen Basaran ◽  
Gonca Sennaroglu
Keyword(s):  
Inner Ear ◽  
Normal Population ◽  
Cochlear Aqueduct ◽  
Relationship Of ◽  
Inner Ear Pressure

Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation

2019 ◽  
Vol 24 (4) ◽  
pp. 183-190
Author(s):  
Ting-Hua Yang ◽  
Yi-Ho Young
Keyword(s):  
Clinical Practice ◽  
Inner Ear ◽  
Morphological Study ◽  
Antifungal Agents ◽  
Clinical Investigation ◽  
Round Window ◽  
Round Window Membrane ◽  
Potential Candidate ◽  
Potential Treatment ◽  
Total Dosage

Background: Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. Objectives: The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. Methods: Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. Results: All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. Conclusion: The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.

Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)

1996 ◽  
Vol 75 (8) ◽  
pp. 468-488 ◽  
Author(s):  
Herbert Silverstein ◽  
Daniel Choo ◽  
Seth I. Rosenberg ◽  
Jeffery Kuhn ◽  
Michael Seidman ◽  
...  
Keyword(s):  
Inner Ear ◽  
Round Window ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Round Window Membrane ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Inner Ear Disease ◽  
Ménière's Disease

Intratympanic instillation of Depo-Medrol® (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser-assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.

Inner ear biocompatibility of lipid nanocapsules after round window membrane application

2011 ◽  
Vol 404 (1-2) ◽  
pp. 211-219 ◽  
Author(s):  
Ya Zhang ◽  
Weikai Zhang ◽  
Marian Löbler ◽  
Klaus-Peter Schmitz ◽  
Patrick Saulnier ◽  
...  
Keyword(s):  
Inner Ear ◽  
Round Window ◽  
Round Window Membrane ◽  
Lipid Nanocapsules
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