Maurice Schiff

IMMUNOLOGIC ASPECTS OF OTOLOGIC DISEASE: AN OVERVIEW

The immunologic explosion has now reached the field of otology. By having better techniques to measure the changes at cellular and molecular levels, it is now possible to devise experiments to show morphologic anatomic changes as well as functional changes.

Tympanosclerosis: Clinical Implications of the Theory of Pathogenesis

Tympanosclerosis is a preventable disease. Its elimination is more the responsibility of the pediatrician and general practitioner than the otolaryngologists. The education of our colleagues is the most effective way of possibly eliminating this disease process. Cholesteatoma and tympanosclerosis may have similar causative factors, but certainly have different pathogenic developmental patterns; their occurrence together in otologic disease is coincidental. The mechanism of this disease process shows that the subepidermal and submucosal connective tissue layers of the eardrum are the ones involved. The cure for tympanosclerosis may be achieved more easily than its amelioration. This may seem like a strange paradox, but cure is intimately bound up with prevention which is the key for the clinical significance of this theory of pathogenesis. The pediatrician and the general practitioner, or family physician — the first to see the children with their ear problems — are urged to refer patients to an otologist when fluid is turbid. Development of tympanosclerosis must be prevented in the early but treatable stages. Prevention is less costly than repair.

Adaptive immunity of the tympanic membrane

In a previous experiment an antiserum was developed in the rabbit from the lamina propria of the tympanic membrane of the guinea pig. In the present study 18 Hartley guinea pigs were used in an in vivo experiment in which the antiserum (RAGTM IgG) served passively to immunize the animals subjected to various forms of trauma to the right tympanic membrane. Two groups (18 animals) immunized with normal rabbit IgG or normal saline served as controls. The left tympanic membrane remained untouched in all groups and served as an internal control. Various forms of trauma (infection, cauterization, section), various times (one to 21 days), and diverse techniques of staining (immunofluorescence, complement, and immunoperoxidase) were studied. The results indicate that the combination of trauma and sensitization in the first group evokes a particular response in the lamina propria of the tympanic membrane in immunized animals (RAGTM IgG). The form of trauma does not influence the results, but time seems to be an important factor. This work addresses several questions concerning the possible role of the combination of trauma and sensitization in conditions that involve the tympanic membrane and middle ear clinically.

Antigenicity of the Guinea Pig's Tympanic Membrane

The immunogenicity of the middle ear constituents is a matter of prime importance. In this work, the authors were interested in the antigenicity of the guinea pigs tympanic membrane. They reached the conclusion, after developing an antiserum (IgG), that the tympanic membrane of the guinea pig can be antigenic in the rabbit. After purification and absorption, a cross-reactivity remains between the tympanic membrane and the mucosae of the upper respiratory system.

Immune response of guinea pig tympanic membrane.

The authors present the results of their experiment on the immune response of the guinea pig tympanic membraneTM.

What every otolaryngologist should know about hearing aids.

The otolaryngologist does not have to fit hearing aids, but he does have to know with a broad encompassing view what is being done by the hearing aid dispenser and the audiologist in regards to hearing aid fitting and selection. The acquisition of a hearing aid is part of the general care for the hard of hearing. In this particular case, the otolaryngologist should always be the “Captain of the Ship.“ With him, as paramedical advisors and assistors, are the audiologist and the hearing aid dispenser. The ultimate responsibility of the members of this team to see that the patient is properly fitted and cared for is with the otolaryngologist. When problems exist with improper diagnosis or care, the medical‐legal responsibility falls on the shoulders of the otolaryngologist. Having an audiologist work with the otolaryngologist is most desirable for the measurement and recommendations for the hearing aid. The new FDA regulations require an otolaryngologic examination prior to fitting hearing aids, except for personal and religious reasons. Children under 18 years of age require both a medical and audiologic examination.

What Can Be Done for the Recruiting Ear

Probably one of the greatest problems in hearing aid fitting is to try to adapt hearing amplification to the recruiting ear. Sound is not loud enough, and then it is too loud. Microchips have permitted hearing aids to be smaller and smaller. However, they still remain either linear output- or input-compression types. Log-linear amplification permits the “smart aid” to automatically decrease the gain as the input power of speech or noise increases. This together with a patented low-frequency signal processor permits maximum discrimination with minimal violation of the patients threshold of discomfort. This is a considerable step in ameliorating the major problem of the recruiting ear.