Gas exchange function of the middle ear in patients with otitis media with effusion

Gas exchange function through the middle ear mucosa was assessed using nitrous oxide (N2O) in patients with otitis media with effusion (OME), as well as in normal ears during elective surgery for unrelated disorders. In all normal ears except one (n = 43), an increase in pressure was observed after N2O inhalation. In 42 of 84 ears with OME, a pressure increase was observed, but not in the remaining 42 ears (50%), indicating that the gas exchange function in these latter ears was impaired. In 21 of the 42 ears showing no middle ear pressure increase following N2O inhalation, the middle ear pressure was again monitored after myringotomy and aspiration of the effusion A pressure increase was found in 16 ears, indicating that the impairment in gas exchange function in ears with OME may be reversible in most cases. Computed tomography of the mastoid was examined preoperatively in 66 ears, with the presence or absence of a middle ear pressure change well correlated in 57 ears with the presence or absence of mastoid aeration.     

Middle ear gas composition and middle ear aeration

Partial pressures of the gases in the middle ears of 14 guinea pigs were measured continuously on-line with a specially designed mass spectrometer. The average values were carbon dioxide 67.55 mm Hg, oxygen 48.91 mm Hg, and nitrogen 596.54 mm Hg. These values confirm earlier measurements and show that the gas composition of the middle ear differs basically from that of air and resembles that of venous blood. These findings are indicative of bilateral diffusion between the middle ear cavity and the blood. We propose that under physiologic as well as under pathologic (ie, atelectatic) conditions, the gas content of the middle ear is also controlled by diffusion. This mechanism fits well with the fluctuating character of atelectatic ears. Thus, a negative middle ear pressure could be secondary to excessive loss of gases through increased and excessive diffusion, although additional mechanisms are probably also involved. A likely contributing factor is poor pneumatization of the mastoid, with consequent absence of a physiologic pressure regulation mechanism by its pneumatic system.     

Sugar-binding sites with specificity for glucosamine in the guinea pig middle ear mucosa

Glucosamine-binding sites were detected in Lowicryl K4M-embedded guinea pig middle ear mucosa by electron microscopy, using glucosaminyl bovine serum albumin. Incubation of ultrathin tissue sections with gold-labeled glucosaminyl bovine serum albumin (GlcN/BSA/gold) resulted in binding mainly on cilia, microvilli, rough endoplasmic reticulum and nuclei. The sugar binding was not inhibited after ultrathin sections had been digested with trypsin or neuraminidase. Various carbohydrates and glycoconjugates were tested as competitive inhibitors of GlcN/BSA/gold labeling on the tissue sections. The sugar specificity range detected by the glucosamine-binding sites included glucosamine, N-acetylglucosamine, mannose and fucose, whereas N-acetylgalactosamine, galactose and glucose were not detectable. A series of endotoxic substances such as Salmonella minnesota Re595 lipid A complex with BSA and lipopolysaccharides (LPS) derived from Escherichia coli 055:B5 or S. minnesota Re595 also competed with GlcN/BSA/gold binding. This indicates that the lipid A backbone glucosamine or other carbohydrate portions of LPS is a part of the structure recognized by glucosamine-binding sites.     

Importance of eustachian tube function in middle ear surgery

Poor eustachian tube function plays a major role in the pathogenesis of chronic secretory otitis media. This is illustrated by epidemiologic studies of secretory otitis media and long-term studies of treated secretory otitis. Evaluation of hearing results demonstrate that effective preoperative and postoperative tubal function is highly important for good surgical outcome in cases of chronic otitis and cholesteatoma.     

Nasal gas composition in humans and its implication on middle ear pressure

Chewing and acid on the tongue evoked a flow of saliva from the duct-cannulated parotid gland of the conscious rat despite pretreatment with atropine and adrenoceptor antagonists. This non-adrenergic, non-cholinergic (NANC) response depended on an intact parasympathetic innervation and was abolished by a tachykinin antagonist. The present findings are consistent with a physiological role for the secretory NANC mechanisms of the salivary glands.     

Inverted papilloma of the middle ear

Inverted papilloma is a benign neoplasm confined almost exclusively to the sinonasal tract. We present the first known case report of an inverted papilloma arising from the middle ear. In this paper we discuss the pathophysiology and review the literature of this interesting clinical entity.     

Eustachian tube function and size of the mastoid air cell system in middle ear surgery

The aortic area (Torlin) for diseased stenotic aortic valves was calculated in 10 patients using two different methods; data obtained in preoperative cardiac catheterization and by intraoperative flowmetric and aortic and left ventricular pressure-recording measurements, and their mutual correlation was tested. The correlation between the aortic valve areas obtained by these methods was very good (r = 0.992), confirming the valve and reliability of the intraoperative flowmetric and pressure recording measurements in clinical work.     

Influence of hyperoxia on in vitro growth of rabbit middle ear epithelium and auditory meatal epithelium

As stated in the conclusion, "life is a thing of macromolecular cohesion in salty water." This brief historical overview shows that "compensatory" organic osmolytes take an essential place in this cohesion. It reviews the major steps of the study of these compounds over more than 100 years, from the early beginnings of 1885 until now, showing some of its fascinating developments and ending on the idea that the most fascinating is still to come. This study can be taken as an example of the richness of the comparative approach.     

Coevolution of the mammalian middle ear and neocortex

Phylogenetic analysis with x-ray computed tomography of fossilized and recent crania implicates differential growth of the neocortex in the evolution and development of the mammalian middle ear. In premammalian tetrapods, the middle ear evolved as a chain of bones attached to the mandible and cranium, but in adult mammals the chain is detached from the mandible and lies behind it. The neocortex evolved concurrently with detachment of the chain. In mammalian development the auditory chain arises connected to the mandible but later detaches, recapitulating the phylogenetic transformation. In modern didelphid development, the auditory chain reaches mature size by the third week after birth and is then separated from the jaw and displaced caudally as the neocortex grows for another 9 weeks.     

Congenital deformities of the middle and external ear

Congenital deformities of the external and middle ears were shown by tomography in 246 patients. Surgical exploration has been undertaken at some time in many of these ears. The appearance of the tomograms and their significance were reviewed in the light of the operative findings and the authors' experience of congenital ear lesions. In nearly every case a middle ear cavity could be demonstrated although this varied from a normally aerated middle ear and mastoid in association with an isolated unilateral atresia of the external auditory meatus to a small slit-like hypotympanum in patients with craniofacial abnormalities. The ossicles were nearly always present but deformed. The typical appearances of the ossicles and the frequently aberrant pathways of the facial nerve are described.     

Adenomatous tumors of the middle ear and mastoid

Three cases of middle ear and mastoid neoplasms are reported as "adenomatous tumors" since in their search of the literature the authors did not find any previously described lesions with a similar histologic appearance and benign biologic behavior. Microscopically, all three tumors are similarly composed of solid cords and nests of closely-packed small cells having an epithelial appearance. Two distinct cell types are present: cuboidal cells, arranged in a rudimentary gland-like pattern, and angular cells forming irregular nests with no distinct pattern. All three tumors developed in patients in their 20's, over a period of months with minimal symptoms; yet in all of the lesions the tympanic membrane was intact at the time of initial examination. None of the neoplasms was diagnosed preoperatively, and, once removed, all three tumors were pathologic enigmas and therapeutic problems in view of the initial and subsequent consultant pathologic opinions; nevertheless, total local excision with preservation of the tympanic membrane would appear to be safe treatment in these cases. The term "adenomatous tumor" is applied to these three neoplasms because: 1. a true glandular epithelial origin warranting the term adenoma or adenocarcinoma cannot be proven; and 2. the biologic behavior and prognosis is not necessarily reflected by the histologic appearance. A more specific term reflecting the origin and behavior of these tumors does not appear possible without the study of further cases.     

Increases in middle ear pressure resulting from counter-diffusion of oxygen and carbon dioxide into the middle ear of monkeys

Bryodin 1 (BD1) is a potent ribosome-inactivating protein (RIP) isolated from the plant Bryonia dioica. It is relatively nontoxic in rodents (LD50 > 40 mg/kg) and represents a potential improvement over other RIPs and bacterial toxins that have been used in immunotoxins. Recombinant BD1, expressed in Escherichia coli, localizes to insoluble inclusion bodies necessitating denaturation and refolding steps to generate active protein. In this report, BD1 was expressed as a soluble recombinant protein in tobacco cell culture (ntBD1) and purified to near homogeneity with yields of up to 30 mg/(L of culture). The protein synthesis inhibition activity of ntBD1 was identical to that of both native BD1 isolated from the roots of B. dioica and recombinant BD1 expressed in E. coli. Toxicology analysis showed that ntBD1 was well tolerated in rats at doses that cannot be achieved with most other toxin components of immunotoxins. Additionally, a single-chain immunotoxin composed of BD1 fused to the single-chain Fv region of the anti-CD40 antibody G28-5 (ntBD1-G28-5 sFv) was expressed in tobacco tissue culture as a soluble protein and was specifically cytotoxic toward CD40 expressing non-Hodgkin's lymphoma cells in vitro. These data indicate that tobacco tissue culture is a viable system for soluble expression of BD1 and BD1-containing immunotoxins.     

Influence of age on cardiac pump function during laparoscopic cholecystectomy--measurements by ear densitography

Using ear densitography, consisting of photoelectric plethysomography and Holter electrocardiography, we measured systolic time intervals (STI) in 21 patients, ASA class 1 and 2, undergoing laparoscopic cholecystectomy using CO2 insufflation under general anesthesia (neuroleptanesthesia with isoflurane in air, FIO2 0.5). The patients were divided into two groups: Y-group (10 patients under 59 years of age) and O-group (11 patients over 60 years of age). We investigated the influence of age on cardiac pump function during pneumoperitoneum non-invasively. Y-group showed improvement of cardiac pump function (reduction of PEP/LVET) from 30 minutes after the beginning of insufflation and quick recovery of cardiac function immediately after deflation. O-group showed a tendency of increasing PaCO2 and arterial diastolic pressure, and delayed recovery of cardiac function (elongation of PEP at 60 minutes, and increase of PEP/LVET at 60 and 90 minutes, respectively, after insufflation). Hypertension and tachycardia were apparent immediately after pneumoperitoneum in the O-group. We conclude that special care and monitoring are mandatory for the aged patients with impaired cardiac or respiratory function during laparoscopic surgery.     

Effects of middle ear effusion on the vestibular system in children

The use of washing machines was investigated in two remote Aboriginal communities in the Anangu Pitjantjatjara homelands. The aim was to look both at machine reliability and to investigate the health aspect of washing clothes. A total of 39 machines were inspected for wear and component reliability every three months over a one-year period. Of these, 10 machines were monitored in detail for water consumption, hours of use and cycles of operation. The machines monitored were Speed Queen model EA2011 (7 kg washing load) commercial units. The field survey results suggested a high rate of operation of the machines with an average of around 1,100 washing cycles per year (range 150 and 2,300 cycles per year). The results were compared with available figures for the average Australian household. A literature survey, to ascertain the health outcomes relating to washing clothes and bedding, confirmed that washing machines are efficient at removal of bacteria from clothes and bedding but suggested that recontamination of clothing after washing often negated the prior removal. High temperature washing (> 60 degrees C) appeared to be advantageous from a health perspective. With regards to larger organisms, while dust mites and body lice transmission between people would probably be decreased by washing clothes, scabies appeared to be mainly transmitted by body contact and thus transmission would be only marginally decreased by the use of washing machines.     

Tuberculosis of the middle ear. A case report

A case of tuberculous otitis media in an immunocompetent 11-year-old boy is reported. The difficult diagnosis is highlighted. The bibliography was reviewed.     

Penetration of ceftibuten into middle ear fluid

The penetration of ceftibuten, an extended-spectrum oral cephalosporin, into middle ear fluid (MEF) was evaluated in pediatric patients during a course of daily oral doses of 9 mg/kg of body weight for 10 days. Plasma and MEF collected at 2, 4, 6, or 12 h after at least 3 days of dosing were analyzed for ceftibuten by a high-pressure liquid chromatography method, and the data were used to calculate pharmacokinetic parameters. Plasma and MEF had almost identical maximum concentrations (Cmax) of ceftibuten (14 micrograms/ml). These Cmax values in MEF during acute otitis media were well in excess of the MIC for 90% of the isolates of each of four major pathogens in this disease. The time to Cmax was longer in MEF (4 h) than in plasma (2 h). Excellent penetration (71%) of ceftibuten into MEF was observed on the basis of the area under the curve ratio (MEF/plasma). These data clearly indicate that ceftibuten penetrated well into the MEF to yield clinically effective concentrations.