Ove Densert

Functional Patency of the Cochlear Aqueduct

The perilymphatic (P P ) and cerebrospinal fluid (P CSF ) pressures were investigated in relation to pressure variations in the ear canal, middle ear and intracranial compartment before and after occlusion of the cochlear aqueduct (CA). Experiments using intracranial infusion showed that the CA was responsible for a perfect hydrodynamic balance between the CSF and the perilymph. There are indications of additional pressure release factors but their capacities were not sufficient to prevent the appearance of a longstanding and substantial pressure gradient following occlusion of the CA. A gradual P P build-up, from zero to its original level after the CA was opened and occluded, indicated perilymph production within the labyrinth. Investigation of pressure transfer from the ear canal and middle ear to the perilymph showed that the CA was the major pressure release route from the cochlea. Occlusion of the CA reduced the compliance of the inner ear and severely reduced the pressure release capacity. In such a situation the inner ear is almost incapable of equilibrating ambient pressure changes.

Tonsillotomy in Children with Tonsillar Hypertrophy

Tonsillectomy is one of the most frequent surgical procedures carried out on children. Obstructive sleep apnea syndrome, caused by tonsillar hypertrophy, has been attracting increasing interest and tonsillectomy is often performed as a result of this indication. Regardless of the indication, the main aim of tonsillectomy has always been to remove the tonsils completely. The present study was undertaken in order to investigate the effect of two different surgical techniques, tonsillectomy and tonsillotomy, on clinical symptoms in children with symptoms of obstructive sleep apnea syndrome due to tonsillar hypertophy. The study was conducted as a prospective, randomized trial comparing the clinical effects of standard tonsillectomy and tonsillotomy using a CO2 laser. Forty-three children aged 2-9 years were included. Both groups of patients experienced comparable relief from symptoms of snoring and apneas at follow-up after 3 months and 2 years. There was no significant statistical difference between the two groups of patients in terms of both short- and long-term effects on clinical symptoms. Tonsillotomy caused no measurable bleeding during surgery. Postoperative pain and distress were less pronounced in the tonsillotomy group according to visual analog scale evaluations made by patients, parents and nursing staff. In conclusion tonsillotomy appears to be the less traumatic surgical method in cases of upper airway obstruction in children caused by tonsillar hypertrophy.Tonsillectomy is one of the most frequent surgical procedures carried out on children. Obstructive sleep apnea syndrome, caused by tonsillar hypertrophy, has been attracting increasing interest and tonsillectomy is often performed as a result of this indication. Regardless of the indication, the main aim of tonsillectomy has always been to remove the tonsils completely. The present study was undertaken in order to investigate the effect of two different surgical techniques, tonsillectomy and tonsillotomy, on clinical symptoms in children with symptoms of obstructive sleep apnea syndrome due to tonsillar hypertophy. The study was conducted as a prospective, randomized trial comparing the clinical effects of standard tonsillectomy and tonsillotomy using a CO 2 laser. Forty-three children aged 2-9 years were included. Both groups of patients experienced comparable relief from symptoms of snoring and apneas at follow-up after 3 months and 2 years. There was no significant statistical difference between the two groups of patients in terms of both short- and long-term effects on clinical symptoms. Tonsillotomy caused no measurable bleeding during surgery. Postoperative pain and distress were less pronounced in the tonsillotomy group according to visual analog scale evaluations made by patients, parents and nursing staff. In conclusion tonsillotomy appears to be the less traumatic surgical method in cases of upper airway obstruction in children caused by tonsillar hypertrophy.

Transmission of Low Frequency Pressure Steps to the Perilymphatic Fluid

The perilymphatic pressure was investigated in response to low frequency pressure changes in the ear canal and in the middle ear in the cat. the pressure transmission to the inner ear showed nonlinear characteristics with an asymmetry in the perilymphatic response to positive and negative pressure stimulation, respectively. a positive pressure stimulus in the ear canal and middle ear, respectively, caused a larger change in perilymphatic pressure than did a corresponding negative one. When the tympanic cavity was opened there was a substantial reduction in the amount of pressure transmitted to the inner ear from the ear canal. a shift in asymmetry was often also seen towards a greater change in perilymphatic pressure in response to a negative pressure stimulation than in response to a positive one. the stabilization process of the perilymphatic pressure in response to different input levels contained two different time constants indicating the pressure regulating mechanisms of the inner ear. the possibili...

Immediate Restoration of Basal Sensorineural Hearing (Mb Meniere) Using a Pressure Chamber

A new technique for the restoration of basal sensorineural hearing loss in Mb Meniere was described. Three cases with unilateral basal sensorineural hearing loss, fullness of the ear, and tinnitus were reported. In the acute stage of their disease the patients were treated in a pressure chamber where it was possible to increase or decrease the air pressure within the range +/- 110 cm H2O. The equilibration of middle ear pressures to surrounding air pressures was checked. Exposure to underpressure resulted in a rise of the hearing thresholds at low frequencies and relief of subjective symptoms. When the air pressure was increased the hearing thresholds were lowered and the sensation of tinnitus and fullness of the ear was accentuated. Changes in air pressure did not affect the healthy ears or the high frequencies in the diseased ear. Hearing improvement attained at exposure to underpressure seemed to remain at atmospheric pressure level. The investigation was performed on the hypothesis that a distended membranous labyrinth might cause a venous congestion of the vestibular aqueduct, resulting in impaired endolymph absorption in the endolymphatic sac. Possible effects of changes in environmental air pressure on the inner ear were discussed.

Perilymphatic pressure in the cat. Description of a new method for study of inner ear hydrodynamics.

Continuous recordings of the perilymphatic (Pp), cerebrospinal fluid (PCSF), central venous (PCV) and arterial (PA) pressures have been performed on anesthetized cats. The perilymphatic space was reached by an extraural approach that leaves the ear canal and middle ear intact. A conical canal was drilled into the temporal bone down to the vestibule. The position of the canal was later confirmed histologically. A small, threaded, metallic cannula was screwed into the bone. For pressure measurements Millar microtip transducers were used, thus giving minimum measurement volume displacement. The mean PP and PCSF were found to be equal, whereas the maximum pressure during expiration was significantly higher in the CSF. not affected by the given anesthetics. Ligation of the external jugular veins had a minor and temporary effect on the PP and PCSF. The method is considered to be suitable for studies on the inner ear hydrodynamics as well as for audiophysiological measurements with an intact middle ear transmission system.

Synaptic Vesicles in the Cochlea

The cochlea is innervated by afferent, efferent and sympathetic neurons. The afferent synapses and the efferent and sympathetic nerve terminals contain transmitter substances within their synaptic vesicles. These transmitters are likely to be chemically different in each of the three cochlear nerve populations. The character of intra-cochlear synaptic vesicles was investigated in order to throw some light on transmitter identity. Their staining properties were examined using different fixatives and after pretreatment with false transmitter substances and a monoamine depleting drug. The efferent and sympathetic cochlear terminals were identified and differentiated by surgical ablation of either the efferent olivo-cochlear bundle or by cervical sympathectomy. The nature of these terminals could also be ascertained in unoperated animals, but only after pretreatment with false transmitters or after special fixation techniques. In this way a catecholamine appeared to be the transmitter in the sympathetic nerve...

Pressure-Regulating Mechanisms in the Inner Ear

The perilymphatic pressure was studied in relation to pressure step variations in the external ear canal and in the middle ear. The transfer of pressure via the ossicular chain reached its limiting value at quite low pressures. When pressure steps were applied directly to the middle ear, there was almost a direct transfer of pressure for positive changes. Nonlinearities were shown between positive and negative pressure steps. The pressure-regulating ability of the inner ear was illustrated by means of calculating the time constants of the pressure transfer curves.