To effectively communicate using sound, animals have to hear well in the frequency range of their calls. In frogs, body size is a major predictor of both the dominant frequency of the mating call, and the frequency of best sensitivity of the ear, which tend to match each other. Various pathways are known to receive sound in frogs. Eardrums receive high-frequency sound, lungs receive low-frequency sound and forelegs, via the opercularis system, receive seismic frequencies. Túngara frogs are an anomaly among amphibians for having a low frequency mate-identification call, relative to their body size, but they also do not appear to fit the pattern of sound reception pathways described above. Using laser vibrometry, I evaluated the vibration response of the eardrum and body wall to airborne sound. The results revealed a clear mismatch between the tuning of both middle ear and lungs, and that of the brain, with the eardrums and lungs tuned to approximately 2500 Hz and the brain tuned to 500 Hz. Both eardrums and lungs are well tuned to receive chucks, an ornamental part of the call. However, a pathway that is tuned to the whine, which is the mate-identification call where the brain is tuned, has yet to be found.

The purpose of this study was to compare CT and radiography for diagnosing the presence and severity of middle ear disease in dogs with chronic otitis externa. Thirty-one dogs that were presented for a total ear canal ablation and bulla osteotomy were recruited. Three normal dogs served as controls. All dogs were examined using radiography and CT. Three radiologists independently evaluated imaging studies in random order. A visual analog scale method was used for scoring certainty and severity of middle ear disease. Surgical findings were recorded intra-operatively. Bulla lining samples were submitted for histopathology and scored by a single pathologist who also used a visual analog scale system. Findings from both modalities agreed more closely with surgical findings than with histopathology findings. With either surgery or histopathology as the gold standard, CT was more sensitive than and as specific as radiographs for predicting presence and severity of middle ear disease. Overall severity of middle ear disease was lower in the right versus the left ears. For CT, inter-observer variance of middle ear certainty was 217.04 while radiographic variance was 126.14 on the side with lower severity estimates. Both radiography and CT were more accurate for predicting the severity of the disease than its presence. Findings indicate that CT is more accurate and reliable than radiography in diagnosing middle ear disease for dogs with chronic otitis externa, but only when severity of disease is moderate or high. With low severity of disease, reader diagnostic certainty for both modalities becomes more variable. / Master of Science

Thesis (MSc)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Strain ST4SA, isolated from soya beans, was identified as Enterococcus mundtii. BacST4SA, a bacteriocin produced by strain ST4SA inhibited the growth of Acinetobacter baumannii, Bacillus cereus, Clostridium tyrobutyricum, Enterococcus faecalis, Enterococcus faecium, Lactobacillus sakei, Propionibacterium spp., Streptococcus caprinus, Pediococcus sp., Listeria monocytogenes, Staphylococcus aureus, Streptococcus pneumoniae, and unidentified middle ear isolates A, BW, DW, F, G, and H. BacST4SA was active against Pseudomonas aeruginosa G, BG, I, J, B and E, although variable degrees of resistance were observed for some strains. BacST4SA is positively charged, hydrophobic, contains the YGNGV sequence in the N-terminal, a double-glycine processing site and a disulphide bridge, all of which is typical of a class IIa bacteriocin. The operon, which contains a structural-, ATP-dependent transporter- and immunity gene, is located on a 50-kb plasmid. The 58-amino acid prepeptide is homologous to mundticin KS, mundticin AT06 and bacteriocin QU 2, and differs from enterocin CRL35 by only two amino acids. The 674-amino acid ATP-dependent transporter, consisting of a peptidase C39B domain, an ABC-transporter and an ABC-DLP family domain, displayed 98.9% homology to mundticin KS and 99.25% to enterocin CRL35. The 98-amino acid immunity gene of bacST4SA is completely homologous to enterocin CRL35 and 96.9% to mundticin KS. BacST4SA is 3.950 kDa in size, based on electron spray mass spectrometry. The peptide was isolated from the cell-free supernatant, precipitated with 80% saturated ammonium sulphate, dialysed and freeze-dried to 1 638 400 AU (arbitrary units) per ml. No change in antimicrobial activity was recorded when bacST4SA was incubated in buffer ranging from pH 2 to 12, heated to 100 °C for 90 min and 121 °C for 20 min, and when incubated in the presence of Tween 20, Tween 80, Triton X-100, SDS, urea, EDTA, middle ear fluid and blood. Optimal levels of bacST4SA production (51 200 AU/ml) was recorded after 14 h of growth in MRS broth at 30°C. Maximum production (102 400 AU/ml) was recorded in modified MRS media supplemented with tryptone, yeast extract, a combination of tryptone and yeast extract, K2HPO4 (10.0 or 20.0 g/l), or with the addition of DL-6,8-thoictic acid, L-ascorbic acid, and thiamine, respectively. BacST4SA is bactericidal towards E. faecium HKLHS and bacteriostatic towards S. pneumoniae 40 and middle ear isolates F, BW and H. The peptide adsorbed maximal (94%) to S. pneumoniae 40, P. aeruginosa 25 and E. faecium HKLHS. BacST4SA forms pores in the cytoplasmic membrane of sensitive cells, leading to dissipation of the cell membrane and leakage of cytoplasmic material. BacST4SA was compared with various other antimicrobial treatment agents, and revealed similar to a higher activity towards a number of these agents. BacST4SA revealed a similar level of activity against E. faecium HKLHS and middle ear pathogens P. aeruginosa J and S. pneumoniae 27 when compared with tetracycline (30μg). However, bacST4SA revealed much higher activity when compared to nasal sprays, aminoglycosides, cephalosporins, fluoroquinolones, lincosamides, macrolides, nitroimidazole, penicillin, quinolones, sulfonamides, chloramphenicol, furanzolidone, fusidic acid, rifampicin, trimethoprim, trimethoprim-sulfamethoxazole and vancomycin when tested in vitro. / AFRIKAANSE OPSOMMING: Stam ST4SA, geïsoleer uit sojabone, is as Enterococcus mundtii geidentifiseer. BacST4SA, ‘n bakteriosien geproduseer deur stam ST4SA het die groei van Acinetobacter baumannii, Bacillus cereus, Clostridium tyrobutyricum, Enterococcus faecalis, Enterococcus faecium, Lactobacillus sakei, Propionibacterium spp., Streptococcus caprinus, Pediococcus sp., Listeria monocytogenes, Staphylococcus aureus, Streptococcus pneumoniae en ongeïdentifiseerde middeloor isolate A, BW, DW, F, G, en H geinhibeer. BacST4SA is aktief teen Pseudomonas aeruginosa stamme G, BG, I, J, B en E, alhoewel effense weerstand soms waargeneem is. BacST4SA het ‘n netto positiewe lading, is hidrofobies, bevat die YGNGV-volgorde in die N-terminaal, ‘n dubbel-glisien prosesserings setel en ‘n disulfied brug, kenmerkend van klas IIa bakteriosiene. Die operon, wat bestaan uit ‘n strukturele geen, ‘n ATP-afhanklike transport sisteem geen en ‘n immuniteits-geen, is op ‘n 50 kb plasmied gelokaliseer. Die voorloper peptied (58 aminosure lank), is homoloog aan mundticin KS, mundticin AT06 en bakteriosien QU 2 en verskil van enterocin CRL35 met slegs twee aminosure. Die ATP-afhanklike transporter (674 aminosure lank) bestaan uit ‘n peptidase C39B domein, ‘n ABC-transporter en ‘n ABC-DLP tipe domein en is 98.9% homoloog aan mundticin KS and 99.25% aan enterocin CRL35. Die immuniteits-geen (98 aminosure lank) van bacST4SA is ten volle homoloog aan enterocin CRL35 en 96.9% homoloog aan mundticin KS. BacST4SA is 3.950 kDa groot, gebaseer op elektrosproei-massa spektrometrie. Die peptied is uit selvrye supernatant geïsoleer, met 80% versadigde ammonium sulfaat gepresipiteer, gedialiseer en gevriesdroog tot ’n finale konsentrasie van 1 638 400 AE (arbitrêre eenhede) per ml. Geen verandering in antimikrobiese aktiwiteit is waargeneem tydens inkubasie van bacST4SA in buffer van pH 2 tot 12, tydens verhitting (100 °C vir 90 min en 121 °C vir 20 min) en tydens inkubasie in die teenwoordigheid van Tween 20, Tween 80, Triton X-100, SDS, ureum, EDTA, middeloor vloeistof en bloed. Optimale vlakke van bacST4SA produksie (51 200 AE/ml) is na 14 h groei in MRS media by 30°C waargeneem. Maksimale vlakke van die peptied (102 400 AE/ml) is geproduseer in gemodifiseerde MRS medium, aangevul met triptoon, gisekstrak, ‘n kombinasie van triptoon en gisekstrak, K2HPO4 (10.0 of 20.0 g/l), of met byvoeging van DL-6,8-thioktiensuur, L-askorbiensuur, en tiamien onderskeidelik. BacST4SA is bakteriosidies teenoor E. faecium HKLHS en bakteristaties teenoor S. pneumoniae 40 en middeloor isolate F, BW en H. Die peptied adsorbeer optimaal (94%) aan S. pneumoniae 40, P. aeruginosa 25 en E. faecium HKLHS. BacST4SA vorm porieë in die selmembraan van sensitiewe selle en lei tot vernietiging van die selmembraan en lekkasie van die sitoplasma inhoud. In vergelykende studies het bacST4SA ‘n soortgelyke en selfs hoër antimikrobiese aktiwiteit teenoor ‘n aantal bekende antimikrobiese middels getoon. Die aktiwiteit van bacST4SA is soortgelyk aan dié van tetrasiklien (30μg) in toetse teen E. faecium HKLHS en middeloor patogene P. aeruginosa J en S. pneumoniae 27. BacST4SA het egter in ’n in vitro vergelyking met neussproeie, aminoglisiedes, cephalosporiene, fluoroquinolone, lincosamides, makroliede, nitroimidazole, penisilien, quinolone, sulfonamide, chloramphenicol, furanzolidone, fusiensuur, rifampisien, trimethoprim, trimethoprim-sulfamethoxazool en vankomisien ‘n baie hoër aktiwiteit teen patogene getoon.

published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

Die Optimierung der Akquisitionstechniken führte zu einer verbesserten Abgrenzbarkeit klinisch relevanter Bilddetails und war gleichzeitig Voraussetzung für die Erzeugung bildqualitativ hochwertiger dreidimensionaler Bildrekonstruktionen. Die Kombination aus hochauflösenden Akquisitionstechniken und der dreidimensionalen Visualisierung mittels Volume Rendering ermöglichte die nicht-invasive endoluminale Darstellung im Sinne einer virtuellen Oto- bzw. Neuroendoskopie. Trotz weitgehender Übereinstimmung zwischen der realen und virtuell dargestellten Pathomorphologie ossikulärer Strukturen in der Mittelohr-Bildgebung zeigten sich methodische Limitationen in der Erfassung der Pathophysiologie. Die 3D-Bildgebung des Innenohrs gewährleistete eine detaillierte Darstellung pathoanatomisch komplexer Veränderungen und erlaubte dadurch Rückschlüsse auf die Pathogenese. Insbesondere in der Bildgebung des Mittelohrs und Kleinhirn-Brückenwinkels erwiesen sich die virtuell-endoskopischen Ansichten als komplementäre Darstellungstechniken, deren Ergebnisse im Zusammenhang mit den primären Schnittbilddaten und den klinischen Untersuchungsergebnissen zu interpretieren sind. Prospektiv ist aufgrund neuer Gerätetechnologien in der Bilddaten-Erfassung (z.B. 16-Schicht-Spiral-CT) sowie höheren Rechnerleistungen in der Daten-Nachverarbeitung von einer zunehmenden Verbreitung dreidimensionaler Bildgebungstechniken auszugehen. / Optimized data acquisition resulted in an improved delineation of critical image elements and was a prerequisite for generating 3D reconstructions of high image quality. Combining high-resolution data acquisition and 3D visualization by means of volume rendering allowed for the noninvasive endoluminal assessment known as virtual oto- and neuroendoscopy. Despite a high degree of agreement between the intraoperatively verified ossicular pathomorphology and that visualized by virtual otoscopy in middle ear imaging methodological limitations were encountered with respect to pathophysiological evaluation. 3D imaging provided detailed views of even complex pathoanatomical conditions, thus permitting conclusions regarding the underlying pathogenesis. As far as imaging of the middle ear and cerebellopontine angle was concerned, virtual endoscopic views proved to be complementary visualization techniques whose results have to be interpreted in the context of the primary cross-sectional data and clinical findings. Prospectively, a more widespread use of 3D imaging techniques may be expected from upcoming acquisition technologies (for example 16-slice helical CT) as well as from more powerful computers with improved image data postprocessing capacities.

L'audiométrie tonale liminaire est l'outil de référence pour évaluer le fonctionnement auditif, mais c'est un outil subjectif qui mesure des élévations de seuils témoignant de dégâts irréversibles sur le système auditif. La mesure des produits de distorsions acoustiques (PDAs), reflet du fonctionnement cochléaire, permet de dépister précocement des altérations de l'oreille interne causées par le bruit ou certains solvants ototoxiques. A partir d'un paradigme de mesure basé sur un enregistrement continu du PDA cubique (2f1-f2) et une stimulation controlatérale, nous avons pu expliquer, chez le rat, les effets pharmacologiques du toluène. Ce solvant aromatique agirait en particulier sur les centres nerveux impliqués dans le réflexe de protection acoustique de l'oreille moyenne. Devant les résultats obtenus chez l'animal, un prototype d'appareil adapté à l'homme a été mis au point, baptisé EchoScan. L'EchoScan a été testé sur 50 volontaires sains normo-entendant lors d'un premier protocole de recherche clinique pour vérifier la reproductibilité des mesures. Un second protocole a ensuite été conduit pour tester l'outil chez des salariés en entreprise, selon plusieurs conditions d'exposition : témoins non exposés, salariés exposés au bruit, exposés aux solvants, exposés au bruit et aux solvants. Les résultats des deux premières conditions sont présentés dans ce mémoire. Ils confirment la pertinence de la mesure du seuil du réflexe de l'oreille moyenne pour évaluer les effets de l'exposition au bruit. Les résultats des sujets exposés aux solvants évalueront la sensibilité de l'EchoScan dans la détection, voir la caractérisation des effets pharmacologiques de substances chimiques (inclusions en cours). Si l'avenir de l'EchoScan apparaît prometteur en médecine du travail, d'autres applications sont envisagées, comme l'étude des effets pharmacologiques des anesthésiques sur le réflexe de l'oreille moyenne / The pure-tone audiometry is a reference tool to assess auditory function but it is able to measure only threshold elevations showing irreversible damages. Measurement of distortion products oto-acoustic emissions (DPOAEs), reflecting the cochlear function, allows early detection of alterations in the inner ear caused by noise or some ototoxic solvents. From paradigm based on a continuous record of cubic DPOAEs (2f1-f2) and a contralateral stimulation triggering the middle-ear reflex, we could explain, in rats, the pharmacological effects of toluene. This aromatic solvent can act on the centers involved in the middle-ear acoustic protection reflex. With the results obtained in animals, a device adapted to humans has been developed, called EchoScan. The EchoScan was tested on 50 healthy volunteers with normal hearing in a first clinical research protocol to verify in particular the reproducibility of its measurements. A second research protocol was then conducted to test this tool among company employees, according to several exposure conditions: unexposed controls, workers exposed to noise, exposed to solvents, exposed to noise and solvents. The results of the first two conditions are presented in this thesis. They confirm the relevance of the measurement of the middle ear reflex threshold in assessing the effects of noise exposure. The results of subjects exposed to solvents will further evaluate the sensitivity of EchoScan in detection of the pharmacological effects, and even in the characterization of chemical substances exposure (in progress). In the future, EchoScan should be particularly promising in occupational medicine, but other applications are already considered, such as the study of pharmacological effects of anesthetics on the middle ear reflex

No description available.

ABSTRACT Thus far, literature is scant in assessing the ability of children with conductive hearing impairment to understand everyday speech. This assessment is important in determining the functional ability of children with conductive hearing impairment. In order to identify the hearing ability of children with conductive hearing impairment, many assessments to date have used speech stimuli, such as syllables, words and sentences, to measure how well children perform. In general, these tests are useful in measuring speech recognition ability, but are not adequate in measuring the functional ability of children to understand the conversations they encounter in their daily lives. In addition, many of these tests are not designed to be interesting or engage the children whom they are assessing. The University of Queensland Understanding of Everyday Speech (UQUEST) Test was developed to address the above issues by providing a stimulating speech perception assessment for children aged 5 to 10 years. This overall objectives of this thesis were to: (1) determine the applicability of a computer-based, self-driven assessment of speech comprehension, the UQUEST, (2) establish normative UQUEST data for school children, (3) compare the UQUEST results in children with and without histories of otitis media in understanding everyday speech, and (4) measure speech understanding in noise by children with minimal conductive hearing impairment. A total of 1094 children were assessed using the UQUEST. All children were native speakers of English and attended schools in the Brisbane Metropolitan and Sunshine Coast regions within the state of Queensland, Australia. All children were firstly assessed using otoscopic examination, pure tone audiometry testing and tympanometry. Children with sensorineural hearing impairment were excluded from the study. Following the initial audiological assessments, the UQUEST was administered to all participants. Three experiments were performed on three cohorts of children selected from the pool of 1094 children. Experiment 1 aimed to assess whether the UQUEST is a feasible speech perception assessment tool for school children and to establish normative data in a sample of normally hearing children. ix In this experiment, participants were a total of 99 children (55 boys / 44 girls), attending Grade 3 and grade 4 (41/58, mean age = 8.3 yr, range = 7 – 10 yr, SD = 0.7). The results showed that the UQUEST is a feasible test of speech understanding in children aged 7 to 10 years. In general, the UQUEST scores decreased as the signal-to-noise-ratio (SNR) decreased from 10 to 0 dB. Normative data based on the scores of six passages of equal difficulty were established for the 0 dB and 5 dB SNR conditions. In addition, the children appeared to be captivated with the UQUEST task and the attention of all the children was sustained throughout the duration of the test. Experiment 2 determined whether children with histories of otitis media (experimental group) performed worse on the UQUEST in comparison to those children without histories of otitis media (OM). A total of 484 children (246 boys / 238 girls), attending Grade 3 (272, mean age = 8.25 yr, SD = 0.43) and Grade 4 (212, mean age = 9.28 yr, SD = 0.41), were assessed. Children were grouped according to the number of episodes of otitis media as per parental report (control: < 4 episodes; mild history group: 4-9 episodes; and moderate history group: > 9 episodes OM). All children had normal hearing as determined by otoscopy, pure tone audiometry screening and tympanometry results. Results showed no significant difference in UQUEST scores between the control group in comparison to the experimental groups. However, children with a history of OM demonstrated varying speech comprehension abilities. Some children had severe difficulty with the speech comprehension task, suggesting that in cases with extensively reported episodes of OM, performance on the UQUEST was compromised. Experiment 3 determined the prevalence of conductive hearing loss in the Australian primary school population and investigated the ability of school children with minimal conductive hearing loss to understand everyday speech under noisy conditions. Based on a sample of 1071 children (mean age = 7.7 yr; range = 5.3 - 11.7 yr), 10.2% of children were found to have conductive hearing loss in one or both ears. To evaluate the binaural speech comprehension ability of children, a sample of 542 children were divided into four groups according to their audiological assessment results: Group 1: 63 children (34 boys, 29 girls, mean age = 7.7 yr, SD = 1.5) who failed the pure tone audiometry and tympanometry tests in both ears; Group 2: 38 children (17 x boys, 21 girls, mean age = 7.5 yr, SD = 1.2) who passed pure tone audiometry and tympanometry in one ear but failed both tests in the other ear; Group 3 (control group): 357 children (187 boys, 170 girls, mean age = 7.8 yr, SD = 1.3) who passed pure tone audiometry and tympanometry in both ears; Group 4: 84 children (41 boys, 43 girls, mean age = 7.2 yr, SD = 1.3) who passed pure tone audiometry in both ears, but failed tympanometry in one or both ears. The results showed that Group 1 had the lowest mean scores of 60.8% - 69.3% obtained under noise conditions. Their scores were significantly lower than the corresponding scores of 69.3% - 75.3% obtained by children in Group 4; 70.5% - 76.5% obtained by children with unilateral conductive hearing loss (Group 2); and 72.0% - 80.3% obtained by their normally hearing peers (Group 3). This study confirmed that young children, who are known to have poorer speech understanding in noise than adults, show further disadvantage when a bilateral conductive hearing loss is present In summary, the UQUEST has been found to be a useful tool to measure children‟s understanding of everyday speech. This test could be successfully used as a measure of speech comprehension in background noise in children. The UQUEST met expectations of being an interesting and engaging test for children aged 5-10 years. In addition, the UQUEST scores showed that children performed worse when challenged by the more difficult noise conditions incorporated in the test design. The findings from this thesis demonstrated that, at the group level, children with histories of OM did not perform any differently from those without significant histories of OM. However, at the individual level, children with significant OM histories had degraded functional performance with low UQUEST scores. Lastly, this thesis provided much needed speech comprehension data obtained from children with minimal conductive hearing impairment and provided evidence that young children were more affected by the co-occurrence of environmental noise and bilateral conductive hearing loss than their normally hearing peers in understanding everyday speech.

Introduktion: Sekretorisk media otit (SOM) är den vanligaste öronsjukdomen och uppkommer oftast i efterförloppet till akut media otit (AOM). Om barnet får SOM leder det till hörselnedsättning som kan påverka språklig utveckling och ge beteendeproblem. Etiologin bakom SOM anses vara multifaktoriell. Barnets tryck i mellanörat kan påverkas vid flaskmatning. Allergier, bakteriella/virus infektioner och inflammationer har också betydelse för utvecklandet av SOM. Syfte: att studera frekvensen av att använda nappflaska och liggande position vid flaskmatning relaterat till sekretorisk media otit och akut media otit i samband med rörbehandling. Metod: En deskriptiv tvärsnittsstudie med kvantitativ ansats. Datainsamling skedde via enkäter som besvarades av närstående till barn 2- 5 år som genomgått rörinsättning på öronoperation. Resultat: 103 barn med närstående deltog i studien. 87% av barnen som genomgick rörinsättning använde eller hade använt nappflaska och av dessa barn låg 55% i planläge. Hereditet gällande SOM kunde skönjas. Konklusion: Studien visade hög frekvens av flaskmatning där lite mer än hälften, 55% låg i planläge men studiens begränsning kunde inte åskådligöra samband med planläge och SOM. Det är av vikt att belysa faktorer som har betydelse för utveckling av SOM för att minska behov av rörbehandling. Dessa faktorer kan sjuksköterskan informera närstående om via hälsoundervisning för att öka barn och närståendes empowerment. / Introduction: Otitis Media with Effusion (OME) is the most common ear disease and arises mostly in the end of akut media otit (AOM). If a child contracts OME, it will result in a hearing loss which can affect the verbal development and may lead to behavior difficulties. The etiology behind OME is considered to be multifactorial. A child’s middle ear pressure may be affected by bottle nursing. Furthermore, the development of OME may be caused by allergies, bacterial/virus infections and inflammations. Purpose: To study the frequency of using a feeding bottle while the child is lying down related to OME and AOM when tube insertion. Method: A descriptive cross-sectional study with a quantitative approach. A survey data collection was used wherein the people who were surveyed were close family to two to five year old children, who have had ear tubes inserted. Result: 103 children with their close family participated in the study. 90% of these children who went through an ear tube insertion used or had used a feeding bottle and 50% of them lied down as they were fed. The heredity regarding SOM could be picked out. Conclusion: The study showed a high frequency of bottle nursing where just over the half (55%) lied down, but the restriction of the study could however not visualize the relation between lying down and SOM. Moreover, it is important to bring up the factors that are significant for the development of SOM to decrease the need of ear tube treatment/insertion. The nurse can inform close family about these factors through health education in order to increase children and close family´s empowerment.

Fragestellung: Mögliche Interaktionen zwischen Mittelohrdruck und Gleichgewichtsstörungen werden seit vielen Jahren diskutiert. Der Rolle der druckausgelösten Trommelfellbewegungen, die bei degenerativ fixierten Ossikelgelenken aufgrund des Hydraulikfaktors eine viel grössere Kraft ausüben als der direkte Druck an den Innenohrfenstern, wurde dabei nur geringe Aufmerksamkeit gewidmet. Patienten und Methodik: Wir untersuchten bei 19 Patienten mit einseitigem Morbus Ménière die durch wechselnde Drucke im äusseren Gehörgang (analog zur Tympanometrie) ausgelösten Interaktionen zwischen Trommelfellauslenkungen und vestibulären Reaktionen in der Elektronystagmographie und in der Posturographie. Ergebnisse und Schlussfolgerungen: Bei schnellen und langsamen Druckwechseln konnten zwischen –600 und +400 daPa weder auf dem gesunden noch auf dem erkrankten Ohr im Elektronystagmogramm Nystagmen nachgewiesen werden. Die posturographische Aufzeichnung der vestibulospinalen Reaktionen auf einer Luzerner Messplatte erwies sich dagegen als sensibler. Die Längenzunahme der Schwankungslinie zeigte bei beiden durchgeführten Druckwechseln auf dem kranken Ohr signifikante Unterschiede gegenüber der Messung bei Reizung des gesunden Ohres. Diese Methode ist somit der klassischen Prüfung des Hennebertschen Fistelsymptoms überlegen. Das vestibulospinale System reagiert möglicherweise empfindlicher als das vestibulookuläre auf Druckschwankungen der Perilymphe. Darüber hinaus könnte der nachgewiesene Zusammenhang der druckausgelösten Trommelfellbewegungen mit cochleovestibulären Symptomen bei einigen Patienten mit M. Ménière den Erfolg einer Paukenröhrcheneinlage erklären, da hiermit aussendruckinduzierte Trommelfellbewegungen und damit verbundene Perilymphschwankungen von vornherein unterbunden werden. / Objectives: Interactions between middle ear pressure and vestibular disturbances have been discussed for many years. Less attention has been paid to the influence of ear drum movements caused by pressure changes in the external auditory meatus. Because of the hydraulic amplification in case of fixed ossicular joints the impact of these movements is bigger than the direct pressure on the internal ear windows. Material and Patients: We examined the interaction between ear drum movements and vestibular reactions caused in the external auditory meatus of 19 patients suffering from unilateral Ménière’s disease. Results and Conclusions: Both fast as well as slow pressure changes between –600 and +400 daPa were not able to induce nystagmus in the electronystagmogram of either the healthy or the damaged ear. Posturographic recordings of the vestibulospinal responses on the ‘Luzerner measuring platform’ were significantly more sensitive. The increase in length of the postural staggering line showed significant differences between the healthy and the damaged ear for fast and for slow pressure changes compared to calibration. In conclusion, the sensitivity of this examination is superior to the classical examination of Hennebert’s fistula symptom. The vestibulospinal system is more sensitive towards pressure changes of the perilymph than the vestibuloocular system. The proven correlation between ear drum movements and internal ear symptomatology could explain the success of the treatment of patients suffering from Ménière’s disease with tympanic grommets. Thus grommets prevent the pressure-induced ear drum movements and avoid perilymph movements induced by pressure changes. / Chez les patients souffrant de la maladie de Ménière, les variations de pression entraıˆnent des mouvements du tympan, influant ainsi sur les réactions vestibulaires. Objectifs: Si l’on s’est longtemps intéressé aux possibles interactions entre la pression de l’oreille moyenne et les troubles de l’équilibre, on a en revanche prêté moins d’attention à l’influence que peuvent exercer les mouvements du tympan dus aux variations de pression dans le conduit auditif externe. Or, lorsque les articulations ossiculaires sont bloquées, l’amplification hydraulique fait que ces mouvements ont un impact plus important que la pression directe exercée aux fenêtres de l’oreille interne. Méthodes et patients: Chez 19 malades souffrant d’un syndrome de Ménière unilatéral, nous avons étudié par ENG et posturographie la relation entre les réactions vestibulaires et les mouvements du tympan que déclenchent les variations de pression dans le conduit auditif externe. Résultats et conclusions: Qu’il s’agisse de variations de pression lentes ou rapides (entre –600 et +400 daPa), de l’oreille saine ou déficiente, l’ENG n’a révélé aucun nystagmus. En revanche, les enregistrements posturographiques des réactions vestibulo-spinales sur la plate-forme de mesure de Lucerne ont été plus sensibles. L’allongement de la courbe de variation a montré des différences significatives entre l’oreille saine et déficiente, que ce soit lors de variations de pression rapides ou lentes. En conclusion, la précision de ce type d’examen se révèle nettement supérieure à celle de l’examen classique du signe de la fistule d’Hennebert (signe d’Hennebert). Le système vestibulo-spinal réagit apparemment de manière plus sensible que le système vestibulo-oculaire aux variations de pression du périlymphe. De plus, la relation que l’on a établie entre les mouvements du tympan dus aux variations de pression et les symptômes vestibulo-cochléaires pourrait expliquer les succès de la pose de diabolos chez certains patients souffrant de la maladie de Ménière. Ces diabolos empêchent les mouvements du tympan liés au changement de pression, évitant ainsi les mouvements du périlymphe. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.