Burkhard Franz

Surgical anatomy of the round window with special reference to cochlear implantation

When the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

Cochlear Implantation in Children: Labyrinthitis following Pneumococcal Otitis Media in Unimplanted and Implanted Cat Cochleas

Pneumococcal otitis media is frequent in young children and could lead to labyrinthitis post-implantation. To assess the risk, and methods of minimizing it by a graft to the round window around the electrode entry point, we have used a cat animal model of pneumococcal otitis media. Twenty-one kittens were used in the study. Thirty-two cochleas were implanted when the kittens were 2 months of age. Fourteen cochleas were implanted without using a graft (12 were available for study); 9 had a fascial graft, and 9 a Gelfoam graft (7 were available for study). The implanted kittens had their bullae inoculated with Streptococcus pneumoniae 2 months after implantation and were sacrificed 1 week later. There were also 9 unimplanted control ears which were inoculated when the animals were 4 months of age. Labyrinthitis occurred in 44% of unimplanted control, 50% of implanted ungrafted, and 6% of implanted grafted (fascia and Gelfoam) cochleas. There was no statistically significant difference between the unimplanted control and the implanted cochleas (p < 0.05). There was, however, a difference between the implanted-ungrafted and implanted grafted cochleas, but not between the use of fascia and Gelfoam to graft the round window entry point. As a result, the data indicates that cochlear implantation does not increase the risk of labyrinthitis following pneumococcal otitis media, but it is desirable to use fascia as a graft to the round window around the electrode entry point.

Effect of experimentally induced otitis media on cochlear implants

Cat cochleas implanted with scala tympani prostheses were investigated histologically after inoculating the bullae with a suspension of group a streptococci. The prosthesis was passed through the round window membrane in one ear. In the other the prosthesis bypassed the round window via an opening anteroinferior to the round window niche. Before death, horseradish peroxidase was administered as a tracer for possible pathways of infection. Results showed that group a streptococci were pathogenic to the cat and caused inflammation in the bulla. The unimplanted round window membrane and the seals around the electrode entry points prevented infection from entering the cochlea. The seals around electrodes inserted either through the round window membrane or an opening drilled anteroinferior to the niche were equally effective. The horseradish peroxidase tracer studies showed, however, that a gap existed between the electrode and membranous seal, and this could be a potentially vulnerable site under certain conditions. Drilling an anteroinferior opening into the cochlea resulted in bony sequestra entering the cochlea. This can be avoided by blue-lining the opening and removing bone with picks before making an opening through the endosteum.

The effect of the sympathetic and sensory nervous system on active eustachian tube function in the rat

Conclusion. We propose that simultaneous activation of the sensory and sympathetic nervous system may adversely affect eustachian tube function, which may have a role in the genesis of Ménières disease. Objective. We have determined the distribution of sympathetic and nociceptive sensory axons in the mucosa of the rat eustachian tube and investigated whether sympathetic or nociceptive neurons influence the function of the eustachian tube. Materials and methods. We tested whether the ability of a rat to equalize air pressure in the middle ear during evoked swallowing was altered by activation or blockade of the local sympathetic nervous system, or by stimulation of nociceptive neurons with capsaicin. Results. Sympathetic axons were sparse, but CGRP-immunoreactive, nociceptive axons formed a dense subepithelial plexus beneath the eustachian tube epithelium. Neither the adrenergic blocking drug, bretylium, nor electrical stimulation of the superior cervical ganglion significantly altered eustachian tube function. Capsaicin alone did not affect eustachian tube function but capsaicin applied with an alpha adrenoceptor agonist impaired the function of the eustachian tube. Capsaicin applied to the bulla also increased spontaneous swallowing in anaesthetized rats and this effect was enhanced by addition of an alpha adrenoceptor agonist and by stimulation of the superior cervical ganglion.

A Model of Active Eustachian Tube Function in the Rat: Effect of Modulating Parasympathetic Innervation

The effect of altering secretion into the Eustachian tube by modulating cholinergic innervation was studied in the anaesthetized rat. Active properties of the Eustachian tube were determined by measuring the ability of reflex-induced swallowing to equalize against an increased pressure level in the bulla. Reflex-induced swallowing was initiated by electrically stimulating the superior laryngeal nerve. Passive properties of the Eustachian tube were determined by increasing middle ear pressure until the Eustachian tube spontaneously opened. Blocking cholinergic neurotransmission with atropine had no effect on active or passive properties of the Eustachian tube. Potentiating cholinergic neurotransmission with neostigmine significantly impaired the ability of active swallowing to equilibrate middle ear pressure, but had no effect on passive properties of the Eustachian tube. The findings show that cholinergic nerve transmission, most likely from the parasympathetic division of the autonomic nervous system, can influence Eustachian tube function. We hypothesize that this effect is due to changes in surface tension in the Eustachian tube as a result of changes in secretion.

Topical application of betahistine improves eustachian tube function in an animal model

Abstract Conclusion: Betahistine dihydrochloride, a drug used widely in the systemic treatment of balance disorders such as Ménières disease, was found to improve eustachian tube function when applied topically in the nasopharynx of rats. Objectives: The study tested the effect of betahistine, a histamine receptor agonist, on eustachian tube function and tested the involvement of H1 and H3 histamine receptors. Methods: Eustachian tube function was measured in anaesthetized rats while middle ear pressure was increased and then monitored during induced swallowing. Betahistine and other drugs were applied topically in the nasopharynx, bulla and epipharynx, and administered intraperitoneally. Results: Systemic application of betahistine hardly changed eustachian tube function, but topical application significantly improved it. The action of topical betahistine was unaffected by the HI receptor antagonist mepyramine and was mimicked by the H3 agonist, ciproxifan.