Objectives/Hypothesis: Recent studies in animal models have shown via physiologic and histologic measures that the administration of exogenous antioxidants is protective against gentamicin-induced oto-vestibulo toxicity. In addition, studies have also shown that sound conditioning increases cochlear antioxidants. The objective of this study is to determine whether sound conditioning provides protection against gentamicin in the cochlear and/or vestibular system.Study Design: Prospective animal study.Methods: Three-month-old gerbils were divided into three groups (A, B, and Q. The gerbils in group A were sound conditioned only (n = 2). In group B, the animals received gentamicin on the round window (n = 2). The gerbils in group C were sound conditioned first and later received gentamicin to the round window (n = 2). The animals were ultimately sacrificed and their right cochlea and posterior crista ampullaris were removed, processed, and sectioned. The specimens were analyzed for inner hair cell (IHC) and outer hair cell (OHC) loss and vestibular supporting and sensory hair cell nuclei per micrometer of vestibular epithelium.Results: The sound-conditioned group (A) had no loss of cochlear hair cells. The gerbils treated with gentamicin only (B) had a 34% decrease of OHCs and 49% decrease of IHCs. The sound-conditioned plus gentamicin-treated group (C) had a 5.5% decrease in OHCs and 12% decrease in IHCs. There were no significant differences with regards to supporting cell nuclei within the posterior crista across all groups. When compared to group A, the gerbils in groups B and C did have a 23 to 42% decrease in the number of sensory cell nuclei per micrometer of vestibular epithelium.Conclusions: Sound conditioning does appear to attenuate the effects of gentamicin in the cochlea, although not significantly altering its vestibulotoxicity. An upregulation of cochlear-specific antioxidants is believed to be an important factor. As we had a small sample size, we can only note trends in the data, but future studies with more animals and measurements of antioxidant levels after sound conditioning would be useful to quantify this effect and determine if it can be exploited clinically.

Benign paroxysmal positional vertigo (BPPV) is reported to be the most common cause of inner ear vertigo seen in otologic practice. Symptoms, although distressing, are usually self-limited and resolve spontaneously over a few days to several weeks. Although conservative management, including repositioning maneuvers, is usually sufficient for relief of the symptoms of BPPV, a small group of patients will have refractory chronic or recurrent symptoms that they consider disabling. Of the options available for surgical treatment of BPPV, posterior canal occlusion seems to offer the most consistent and reproducible results, with excellent cure rates and low incidence of hearing loss and other complications.

For many years, formidable physiologic and anatomic barriers to management of the inner ear have existed, limiting our ability to manage symptoms such as vertigo, tinnitus, and sensorineural hearing loss. Local application of drugs to the inner ear has recently gained favor as a method of managing inner ear disease while avoiding systemic side effects. Clinical efforts, however, have been hampered by a lack of basic science data. Until the past few years, few studies existed upon which to base decisions on delivery system, choice of agent, dosage range and schedule, and duration of therapy. Concepts presented recently provide not only some scientific framework for clinical treatment but also intriguing possibilities for new and innovative therapy. Although much work remains to be done, a basic science foundation for the use of inner ear perfusion is beginning to appear.

Many studies have sought to document ototoxic damage and to study repair and regeneration of mammalian vestibular sensory epithelia. However, linear density analysis of the sensory cells ur use of methods that focus on detection of actin in the stereocilia and cuticular plates at the reticular lamina detect only the disappearance of "hair cells" as defined by a narrow set of criteria. The research presented here focuses on the effects of two ototoxic drugs (gentamicin and streptomycin). We used light microscopic analysis of semithin sections to observe changes in the distribution of sensor) and supporting cell nuclei and to elucidate other, previously undetected, morphological changes that occurred within the vestibular epithelia. Age-matched untreated and vehicle-treated controls showed that the gerbil posterior crista is asymmetrical on either side of the septum cruciatum; the longer end is taller and narrower than the shorter end. In cross sections taken throughout the length of each posterior crista, the thickness of the sensory epithelium along the sides (peripheral zone) is greater than at the apex (central zone). In tissue sections of the sensory epithelium, the ratio of sensory cell nuclei to support cell nuclei is slightly over 1:1.5 in all regions except the septum cruciatum where most sensory cells are absent and supporting cells predominate. In tissue sections from the most damaged drug-treated specimens, there was a decrease in the linear density of nuclei in the sensory cell layer with a compensatory increase in the linear density of nuclei in the support cell layer of the sensory epithelia. In these specimens, linear density of total nuclei/tissue section remained the same. In these regions, the width of the epithelium became up to 50% thinner. The ratio of sensory to supporting cell nuclei changed to 1:6. Drug exposure led additionally to a decrease in length of the cristas, but there was not a linear relationship between the change in length of the crista and length of the septum cruciatum in these shorter cristas. In drug-treated cristas, other changes included a decrease in calculated sur-face area and volume of the epithelia. Thus, while linear density measurements of sensory cell nuclei provide an indication of damage, there are additional anatomic changes to the cristas and caution is advised with regard to interpreting changes as "loss" of cells.

For many years, formidable physiologic and anatomic barriers to treatment of the inner ear have existed, limiting our ability to treat symptoms such as vertigo, tinnitus, and sensorineural hearing loss. Recently, in the United States, there has been renewed interest in the local application of drugs such as aminoglycosides and corticosteroids to the inner ear as a potentially less invasive treatment for Menière's disease and other inner ear diseases. The ability to avoid significant potential side effects known to occur with systemic administration makes direct inner ear delivery particularly attractive. New delivery systems approved by the US Food and Drug Administration raise intriguing possibilities for use as delivery systems for a wide range of agents currently being studied for their potential for rescue, repair, and regeneration. For many years, formidable physiologic and anatomic barriers to treatment of the inner ear have existed, limiting our ability to treat symptoms such as vertigo, tinnitus, and sensorineural hearing loss. Recently, in the United States, there has been renewed interest in the local application of drugs such as aminoglycosides and corticosteroids to the inner ear as a potentially less invasive treatment for Menière's disease and other inner ear diseases. The ability to avoid significant potential side effects known to occur with systemic administration makes direct inner ear delivery particularly attractive. New delivery systems approved by the US Food and Drug Administration raise intriguing possibilities for use as delivery systems for a wide range of agents currently being studied for their potential for rescue, repair, and regeneration.

Otolaryngology–Head and Neck SurgeryVolume 117, Issue 2 p. P169-P169 Scientific Posters Digital Imaging in Otolaryngology Hayes H. Wanamaker MD, Hayes H. Wanamaker MD Syracuse, N.Y.Search for more papers by this author Hayes H. Wanamaker MD, Hayes H. Wanamaker MD Syracuse, N.Y.Search for more papers by this author First published: 01 August 1997 https://doi.org/10.1016/S0194-59989780341-5Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue2August 1997Pages P169-P169 RelatedInformation

Posterior fossa vestibular neurectomy has become one of the most effective surgical procedures for control of vertigo symptoms in Menière's disease. A small group of patients continue to have vertigo and demonstrable vestibular function by electronystagmography (ENG) post-operatively. Another group of patients may have no vertigo, despite residual vestibular function on caloric testing. In an effort to correlate histological findings with clinical outcome, nerve biopsies were taken from seven patients undergoing vestibular neurectomy. Fibre counts of nerve biopsies were compared with clinical, audiometric and ENG results. Results of this study demonstrate that complete reduction of vestibular response (on caloric testing) and clinical cure of vertigo can be obtained despite a variable number of nerve fibres at vestibular neurectomy.

The ability of promontory testing (PT) to differentiate a retrocochlear from a cochlear lesion in a group of 88 patients having unilateral sensorineural hearing loss was assessed. Promontory stimulation was performed, using the Nucleus Promontory Stimulator (model Z10012, Cochlear Corporation, Melbourne, Australia), by placing a needle electrode transtympanically on the basal turn of the cochlea. Patients with measurable hearing gave inconsistent results. Patients who had undergone eighth nerve section or translabyrinthine removal of acoustic neuroma were used as controls. They had no perception of sound in response to electrical stimulation, and were unable to perform any part of the PT. Of nine patients with anacusis secondary to an acoustic neuroma, six were unable to perceive sound in response to electrical stimulation or perform any aspect of the PT. Of the three patients able to perceive sound, only one could perform the temporal difference limen (TDL) and gap detection (GAP) test. In patients with total deafness from other causes, 80 percent (24/30) were able to perceive sound with electrical stimulation, 46 percent (14/30) performed TDL, and 70 percent (21/30) performed the GAP tests. In patients with unilateral total deafness, promontory testing may aid in differentiating retrocochlear from cochlear lesions and help identify patients at risk for acoustic neuroma.

The infiltration of dilute epinephrine solution has been used for many years to provide hemostasis necessary for the safe and precious execution of microsurgery of the ear. Such solutions usually contain epinephrine in concentrations from 1:50,000 to 1:200,000, together with lidocaine, 1% to 2%. These solutions have a long history of safety and efficacy and are used in both local and general anesthetic techniques to reduce bleeding, reduce absorption, and prolong duration of local anesthetics. Although epinephrine toxicity resulting from inadvertent intravenous administration of large (milligram) doses has been reported.P significant cardiovascular effects from injection of epinephine-containing solutions are unusual in otologic surgery. In 1972 Woldorf and Pastore' proposed the existence of a rare "extreme epinephrine sensitivity" and described two cases, one of which was a young white male patient undergoing otologic surgery. No further cases were identified in a computerized literature search. We present two cases of catecholamineinduced cardiovascular crisis, with severe hypertension, ventricular arrhythmias, pulmonary edema, and in one case, cardiac arrest, after subcutaneous infiltration with a solution containing 1% lidocaine and 1:100,000 epinephrine within the "safe dosage" guidelines. We believe these cases, together with the initial report in 1972, lend support to the existence of a rare syndrome of epinephrine sensitivity in young white male patients.

The LaryngoscopeVolume 104, Issue 11 p. 1404-1411 How I Do It Otology And Neurotology A Specific Issue And Its SolutionFree Access Magnetic resonance angiography of vascular anomalies of the middle ear E. Luke Bold Md, Phd, E. Luke Bold Md, Phd Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorHayes H. Wanamaker MD, Hayes H. Wanamaker MD Department of Otolaryngology and Communication Science, State University of New York Health Science Center, SyracuseSearch for more papers by this authorGordon B. Hughes MD, Gordon B. Hughes MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorSam E. Kinney MD, Sam E. Kinney MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorIsaac Eliachar MD, Isaac Eliachar MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorPaul M. Ruggieri MD, Paul M. Ruggieri MD Diagnostic Radiology, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorJonathan S. Lewin MD, Jonathan S. Lewin MD Diagnostic Radiology, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this author E. Luke Bold Md, Phd, E. Luke Bold Md, Phd Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorHayes H. Wanamaker MD, Hayes H. Wanamaker MD Department of Otolaryngology and Communication Science, State University of New York Health Science Center, SyracuseSearch for more papers by this authorGordon B. Hughes MD, Gordon B. Hughes MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorSam E. Kinney MD, Sam E. Kinney MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorIsaac Eliachar MD, Isaac Eliachar MD Departments of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorPaul M. Ruggieri MD, Paul M. Ruggieri MD Diagnostic Radiology, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this authorJonathan S. Lewin MD, Jonathan S. Lewin MD Diagnostic Radiology, Cleveland Clinic Foundation, State University of New York Health Science Center, SyracuseSearch for more papers by this author First published: November 1994 https://doi.org/10.1288/00005537-199411000-00017Citations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume104, Issue11November 1994Pages 1404-1411 ReferencesRelatedInformation

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.

Visible-spectrum lasers (argon, KTP) are becoming common tools in otology. Concern over transmission of disease by homograft tissue has focused attention on synthetic materials such as Silastic, Polycel, hydroxylapatite, and Teflon. This study sought to determine the effects of argon and KTP lasers on materials used in stapes and chronic ear surgery. Silastic sheeting, hydroxylapatite and polycel total ossicular replacement prostheses (TORPs) and partial ossicular replacement prostheses (PORPs), and platinum wire/Teflon stapes prostheses were exposed to argon and KTP laser energy at clinical power settings. Effects of the two lasers were similar. The presence of pigment (char or blood) was necessary to produce any effect. Silastic transmitted energy to underlying material. Hydroxylapatite cracked and shattered. Polycel vaporized and melted, as did Teflon. Clinical implications of these interactions on primary and revision otologic surgeries will be discussed.

The LaryngoscopeVolume 103, Issue 1 p. 94-95 How I Do It. Otology and NeurotologyFree Access Composite torps and porps for ossicular reconstruction Herbert Silverstein MD, Corresponding Author Herbert Silverstein MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this authorHayes H. Wanamaker MD, Corresponding Author Hayes H. Wanamaker MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this authorJohn M. Flanzer MD, Corresponding Author John M. Flanzer MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this author Herbert Silverstein MD, Corresponding Author Herbert Silverstein MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this authorHayes H. Wanamaker MD, Corresponding Author Hayes H. Wanamaker MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this authorJohn M. Flanzer MD, Corresponding Author John M. Flanzer MD Ear Research Foundation, Sarasota, Fla.Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239Search for more papers by this author First published: January 1993 https://doi.org/10.1288/00005537-199301000-00018Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume103, Issue1January 1993Pages 94-95 ReferencesRelatedInformation