L’oreille interne est l’organe responsable pour la perception auditive et le maintien de l’équilibre. L’OMS estime que 360 millions personnes dans le monde (plus que 5 % de la population) souffrent d’une perte auditive handicapante, soit 40 dB dans l’oreille qui entend le mieux. Une des principales stratégies de traitement est l’administration systémique de stéroïdes, ex : la dexaméthasone. Ces stéroïdes sont utilisés pour prévenir les inflammations ou œdèmes pouvant endommager les très sensibles cellules ciliées de l’oreille interne.La libération contrôlée de principes actifs (PA) est un vrai challenge car l’oreille interne est protégée par la barrière hémato-cochléaire qui ressemble à la barrière hémato-encéphalique et protège l’oreille de substances toxiques. Par conséquent, il est nécessaire d’utiliser de fortes doses pour obtenir des concentrations thérapeutiques dans l’oreille interne. Ainsi, une libération locale et contrôlée semble une approche prometteuse pour limiter la survenue d’effets secondaires.D’un point de vue clinique, un deuxième obstacle doit être surmonté: la taille minuscule de la cochlée et sa difficulté anatomique d’accès. Les deux membranes semi-perméables (la fenêtre ronde et ovale) qui relient l’oreille moyenne avec l’oreille interne sont une voie possible –mais challenging -pour libérer le PA dans l’oreille interne. L’injection de solutions ou de gels chargés en PA dans l’oreille moyenne à travers la membrane tympanique semble être une méthode fiable et économique pour un traitement à court ou moyen terme. Malheureusement, ces formulations risquent d’être éliminées ou dégradées rapidement et par conséquent requièrent des applications répétées. Un autre désavantage est que l’anatomie varie énormément d’un patient à l’autre menant à des concentrations très diverses dans l’oreille interne.Pour un traitement à long terme une libération à partir d’implants cochléaires semble prometteuse : l’implant étant inséré directement dans l’oreille interne, il permet de libérer le PA de manière contrôlée pendant des mois ou des années. Néanmoins, cette intervention est très invasive et le bénéfice pour chaque patient doit être évalué en détail.L’objectif de cette étude est de développer un implant miniaturisé pour la libération contrôlée de dexaméthasone dans l’oreille interne.Dans un premier temps, de fins films de silicone chargés en PA ont été préparés et caractérisé in vitro. La libération à partir de ces films peut être ajustée en modifiant le type de silicone (ex : le type des chaînes latérales, degré de réticulation) ou en ajoutant différents quantités de PEG 400 ou 1000. Une solution analytique de la seconde loi de Fick a pu être utilisée pour décrire les cinétiques de la libération à partir des films et prédire théoriquement la libération du PA à partir de matrices de taille et de forme diverses.Ensuite, deux types d’implants ont été préparés en se basant sur les systèmes les plus prometteurs. Le premier est l’implant « Ear Cube » ayant une forme prédéfinie avec un cube lié à un cylindre. Ce cylindre est en contact avec la périlymphe de l’oreille interne. Le second est un implant se formant in situ qui s’adapte parfaitement à l’anatomie de l’oreille moyenne en réticulant directement dans l’oreille moyenne. Cet implant est en contact avec l’oreille interne par un orifice. Les deux types d’implants ont été caractérisés in vitro.In vivo, la libération de dexaméthasone à partir d’implant se formant in situ a été évaluée avec des gerbilles. Le PA peut être détecté déjà 20 min après l’implantation et ce jusqu’à au moins 30 jours.Ainsi, les deux implants semblent prometteurs pour contrôler à long terme la libération de dexaméthasone directement dans l’oreille interne. A l’avenir, des études pour évaluer les effets des implants « Ear Cube » seront menées. De plus, ces systèmes pourraient être adaptés pour délivrer d’autres PA, ex : la gentamicine, pour traiter d’autres maladies. / The ear is the organ responsible for the perception of sound and the sense of balance. The WHO estimated that worldwide 360 million people (over 5 % of the population) are suffering from disabling hearing loss, meaning a loss of 40 dB in the better hearing ear in adults. One of the major strategies to treat hearing loss is to administer steroids, e.g. dexamethasone, systemically. Steroids are used to prevent inflammation and oedema damaging the highly sensitive inner ear hair cells.Unfortunately, drug delivery to the inner ear is very challenging due to the blood-cochlea barrier which is similar to the blood-brain barrier and protects the inner ear from drugs or toxic substances from the blood stream. High doses are often required to reach therapeutic drug concentrations in the inner ear. Thus, local drug delivery seems to be a more promising approach to limit adverse effects due to high systemic blood levels.Nevertheless, a second major hurdle has to be overcome in clinical practice: the small dimensions of the cochlea and its difficult anatomical access. The two semipermeable membranes connecting the middle with the inner ear (the round and oval window) are one possible - but challenging - route to deliver drugs locally to the inner ear. Drug loaded solutions or gels administered with an intra-tympanic injection into the middle ear seem to be a relatively safe and economical therapy for a short or mid-term treatment. Unfortunately, they might be washed away or degraded rapidly and, though, often require repeated applications. Additionally, the anatomy of the ear varies from patient to patient leading to different drug concentrations in the inner ear.For long term treatment, intra-cochlear implants seem to be promising: Since the device is inserted directly into the inner ear, the drug concentration is better controlled and – depending on the formulation – the drug can be released over prolonged periods of time. Nevertheless, this approach is rather invasive so that the benefit for the patient has to be discussed in detail.The purpose of this study was to develop a miniaturized implant being able to deliver dexamethasone directly to the inner ear.To facilitate the development of silicone-based implants loaded with dexamethasone, thin drug loaded films have been prepared and thoroughly characterized in vitro as a model system. Drug release can easily be adjusted by varying the type of silicone used (e.g. type of side chain, degree of crosslinking), or by adding various amounts of PEG 400 or 1000. An analytical solution of Fick’s second law could be used to describe the drug release kinetics from the films and to theoretically predict drug release from dosage forms of arbitrary size and shape.Subsequently, two types of implants have been prepared using the most promising silicone systems. The first system, the Ear Cube implant with a predefined shape consists of a cube on top of a cylinder which stays in contact with the perilymph of the inner ear. The second system, the in situ forming implant adapts perfectly to middle ear anatomy because it cures directly in vivo. It also stays in contact with the inner ear fluids via a hole. Both systems have been characterized in vitro.In vivo, the dexamethasone loaded in situ forming silicone-based implants have been evaluated in mongolian gerbils. Interestingly, dexamethasone was detected within the explanted gerbil cochleae already 20 min after implant formation until at least 30 days.Thus, both implants seem to be a good tool to administer dexamethasone locally to the inner ear in a prolonged and time controlled manner. Further studies should be performed to characterize the Ear Cube implants in vivo. Additionally, both systems could be tested with different types of drug, e.g. gentamicin, to treat also other diseases with this new promising inner ear implants.

Thesis problem: Cone beam computed tomography (CBCT) can provide images with identical information and considerable dose reduction compared with reasonably low costs compared to multislice computed tomography (MSCT) especially where multiple follow up imaging studies are needed. The purpose of this study was to evaluate the diagnostic usefulness of CBCT, using i-CAT®'s software, for detection of the anatomical landmarks of the external, middle and inner ear to answer this question whether MSCT Can be replaced by dental CBCT for evaluation of the temporal bone. Material and methods: Cone beam computed tomography (CBCT) images of 63 subjects made with the same machine, with unknown clinical histories and no evidence of pathosis on CBCT images, were evaluated by two oral and maxillofacial radiologists retrospectively. Seven anatomical points (scutum, oval window, incudomalleolar joint, the tympanic/horizontal and mastoid/vertical segments of the facial nerve, anterior and posterior crura of stapes) of the right and left temporal bone (total of 120 temporal bones) were evaluated. The results were provided as percentage of the points identified by each radiologist. The intra and inter observer agreement were calculated using kappa statistic. Results: The scutum, the tympanic/horizontal segment of the facial nerve canal and the oval window of the right and left temporal bone of 63 cases (total 126 temporal bones) were visualized by the first observer as well-defined structures in 100%, 96.03% and 100% of the cases, respectively. The tympanic/horizontal segment of the facial nerve canal was visualized as a poorly-defined structure in 2.38 % and could not be identified in 1.59% of the cases. The anterior and posterior crura of stapes, the mastoid/vertical segments of the facial nerve canal and the incudomalleolar joint were visualized as well-defined structures in 24.60%, 53.17%, 99.21% and 57.94% of the cases, as poorly defined structures in 32.54%, 41.27%, 0.79% and 39.68% of the cases respectively. The anterior and posterior crura of stapes, the mastoid/vertical segments of the facial nerve canal and the incudomalleolar joint could not be identified in 42.86%, 5.56%, 0% and 2.38% of the cases respectively. The intra- and inter-observer agreement ranged from strong for tympanic/horizontal and mastoid/vertical segments of the facial nerve canal to poor for the anterior and posterior crura of stapes and also the incudomalleolar joint. Conclusion: The i-CAT CBCT machine is a promising replacement for MSCT in evaluation of the temporal bone where there is no need for evaluation of the anterior and posterior crura of stapes and the incudomalleolar joint which are the smallest anatomical structures in the temporal bone. Other CBCT machines with higher contrast to noise ratio should be evaluated for detection of those anatomical structures since CBCT can reduce the patient dose substantially where multiple follow up CT studied are needed. Key words: Computed tomography; cone beam CT; multislice helical CT; middle ear; inner ear; temporal bone.

<div><p>Zika virus (ZIKV) is a mosquito-borne pathogen that stayed unnoticed for over half a century. Only after the 2015-16 Brazilian outbreak did the severity of the infectious outcome, particularly the Congenital Zika Syndrome, become apparent. ZIKV is associated with severe neurodevelopmental impairments in human fetuses, including microencephaly, ventriculomegaly, retinopathy, and sensorineural hearing loss. Though the pandemic is now under control in the Latin American countries, several tropical countries could still be at risk of widespread infection. This warrants a better understanding of the congenital Zika syndrome; this project attempts to contribute towards this goal.</p><p><br></p><p>Previous reports examining neural progenitor tropism of ZIKV in organoid and animal models did not address whether the virus infects all neural progenitors uniformly. To explore this, ZIKV was injected into the neural tube of 2-day-old chicken embryos, resulting in non-uniform periventricular infection 3 days later. Recurrent foci of intense infection were present at specific signaling centers that influence neuroepithelial patterning at a distance through secretion of morphogens. ZIKV infection reduced transcript levels for 3 morphogens, SHH, BMP7, and FGF8, expressed at the midbrain basal plate, hypothalamic floor plate, and isthmus, respectively. Levels of Patched1, a SHH-pathway downstream gene, were also reduced and a SHH-dependent cell population in the ventral midbrain was shifted in position. Thus, the diminishment of signaling centers through ZIKV-mediated apoptosis may yield broader, non-cell autonomous changes in brain patterning.</p><p><br></p></div><p>Sensorineural hearing loss is a relatively understudied consequence of congenital Zika syndrome, and balance disorders are essentially unreported to date. ZIKV pathogenesis was explored in the developing inner ear using the accessible chicken embryo model system. One goal was to assess the spatiotemporal susceptibility of otic epithelial-derived structures to ZIKV infectivity. Direct injections of the inner ear or the inner ear primordium were performed <i>in ovo</i>with subsequent harvests at 2 to 8 days-post-infection. The degree of infection in sensory/prosensory organs was evaluated histologically to determine the susceptibility of one auditory and five vestibular organs. ZIKV infection of the sensory as well as non-sensory epithelia was observed at most stages of analysis, with no apparent preference for one over the other. The lagena, the ventral most tip of the chicken inner ear, and the endolymphatic sac/duct were least frequently infected. In this report, two novel findings in sequela of ZIKV infection are presented: the vestibular labyrinth can present with stalled canal morphogenesis, and the auditory ganglion can be severely shrunken, perhaps due to an increased cell death upon early ZIKV infection of the inner ear.</p><p><br></p><p>Additional methods of peripheral infection in the chicken embryos were tested to examine ZIKV transmission to the central nervous system: E3 blood vessel, E4 limb bud, and E10 chorioallantoic membrane infections. Although none of these methods resulted in a histologically significant infection of the developing brain 3 to 6 days-post-infection, evidence of ZIKV genome replication and viremia was detected in several tissue types.<br></p>

No description available.

To understand the pathophysiology of hearing loss, it is necessary to identify genes responsible for embryonic development of neurosensory cells in the inner ear. The aim of this work is to clarify the role of LIM-homeodomain transcription factor ISL1 in the development of these cells. Using Cre-loxP recombination strategy, we generated a mouse line with time and site- specific deletion of Isl1 gene in NEUROD1-Cre expressing cells (Isl1 CKO). Although the early development of stato-acoustic ganglion was not affected by Isl1 deletion, at E14,5, we observed abnormalities in neuronal migration, formation of spiral ganglion and axon guidance in the Isl1 CKO cochlea. The length of the cochlear sensory epithelium was shortened by 20% as a consequence of lower proliferation activity of sensory precursor cells. Our results suggest that ISL1 is necessary for spiral ganglion formation and innervation of the Organ of Corti. Key words: transcription factor ISL1, neurons, Cre-loxP system, mouse model

No description available.

Hearing loss (HL) is one of the most common sensorineural disorders and several dozen genes contribute to its pathogenesis. Establishing a genetic diagnosis of HL is of great importance for clinical evaluation of deaf patients and for estimating recurrence risks for their families. Efforts to identify genes responsible for HL have been challenged by high genetic heterogeneity and different ethnic-specific prevalence of inherited deafness. Here we present the utility of whole exome sequencing (WES) for identifying candidate causal variants for previously unexplained nonsyndromic HL of seven patients from four unrelated Altaian families (the Altai Republic, South Siberia). The WES analysis revealed homozygous missense mutations in three genes associated with HL. Mutation c.2168A>G (SLC26A4) was found in one family, a novel mutation c.1111G>C (OTOF) was revealed in another family, and mutation c.5254G>A (RAI1) was found in two families. Sanger sequencing was applied for screening of identified variants in an ethnically diverse cohort of other patients with HL (n = 116) and in Altaian controls (n = 120). Identified variants were found only in patients of Altaian ethnicity (n = 93). Several lines of evidences support the association of homozygosity for discovered variants c.5254G>A (RAI1), c.1111C>G (OTOF), and c.2168A>G (SLC26A4) with HL in Altaian patients. Local prevalence of identified variants implies possible founder effect in significant number of HL cases in indigenous population of the Altai region. Notably, this is the first reported instance of patients with RAI1 missense mutation whose HL is not accompanied by specific traits typical for Smith-Magenis syndrome. Presumed association of RAI1 gene variant c.5254G>A with isolated HL needs to be proved by further experimental studies.

Introdução: O 1º e 2º arcos faríngeos contribuem com o desenvolvimento craniofacial e interferências no seu desenvolvimento podem resultar em alterações de gravidade variável, envolvendo maxila, mandíbula e orelha. Das anomalias associadas à malformação de orelha externa, a hipoplasia mandibular, o dermóide epibulbar e a anomalia de coluna cervical são as mais freqüentes e, este conjunto de sinais tem sido denominado espectro oculoauriculovertebral. O EOAV é uma condição heterogênea e complexa e o espectro de anomalias inclui desde microtia isolada até outras anomalias cranianas e extracranianas. Objetivo: analisar e descrever a morfologia da mandíbula, com ênfase na articulação temporomandibular (ATM) e investigar orelha média e interna em indivíduos com anomalias de 1º e 2º arcos faríngeos cadastrados no Serviço de Genética Clinica do HRAC USP. Indivíduos estudados e métodos: avaliação genética-clínica e avaliação por imagem enfocando orelha média, interna e côndilo mandibular foram realizadas em 56 indivíduos, cadastrados no Serviço de Genética Clínica do Hospital de Reabilitação de Anomalias Craniofaciais USP. O critério mínimo utilizado foi a presença de microtia isolada ou de microssomia hemifacial com malformação auricular leve, como apêndices pré-auriculares. Resultados e conclusão: anomalias envolvendo côndilo mandibular e/ou mandíbula e anomalias de orelha média mostraram alta freqüência (87.5% e 96.1%, respectivamente) nos indivíduos da presente casuística. Relação preditiva entre a ocorrência e a gravidade das anomalias de côndilo mandibular e/ou mandíbula com o acometimento da orelha externa e, relação preditiva para a ocorrência do acometimento do côndilo mandibular com a ocorrência de anomalias estruturais de orelha média e orelha interna foram observadas. Para a avaliação da ATM, a tomografia computadorizada foi considerada o exame de eleição. A investigação das estruturas do côndilo mandibular, da orelha média e interna deve fazer parte do protocolo de avaliação dos indivíduos com anomalias de 1º e 2º arcos faríngeos. / Introduction: The first and second pharingeal arches contribute to craniofacial development and interferences in normal development of these structures can result in maxillary, mandibular, and ear abnormalities. Mandible hypoplasia, epibulbar dermoids, and spinal vertebral defects are the most frequent anomalies combined with ear anomalies and this group has been called oculoauriculovertebral spectrum. This is a heterogeneous and complex condition that includes isolated microtia until other cranial and extracranial anomalies. Purpose: To analyze and describe the morphology of the mandible, with special approach to the temporomandibular joint and to investigate the middle and inner ear in patients with first and second pharyngeal arches involvement. Methods: Clinical genetics evaluation, radiological and CT scan evaluation with main focus in middle and inner ear structures as well as in mandible. This study was performed in fifty six patients at the Hospital of the Rehabilitation of the craniofacial anomalies USP. Minimal diagnostic criteria were the presence of preauricular tags or mild external ear anomaly associated to facial asymmetry. Results and Conclusions: Condyle and/or mandible and middle ear anomalies showed high frequency (87.5% and 96.1%) for the patients of the present study. Predictive relation between the occurrence and the gravity for condyle anomalies and/or mandible with involvement of the external ear was observed. Other predictive relation was observed between the occurrence of condyle anomalies with involvement of structural anomalies of middle and inner ear. CT scan proved to be the most appropriated tool for temporomandibular joint evaluation. Evaluation of condyle structures, middle and inner ear should be included in protocols for evaluation of conditions with first and second pharingeal arches involvement.

<p>Topical treatment of several inner ear diseases through the round window membrane (RWM) might be feasible in the near future. Bacteria toxins, ototoxic drugs and noise trauma seem to harm the inner ear by a common pathway which involves, excessive outflow of the afferent neurotransmitter glutamate and formation of nitric oxide (NO), which can severely damage cells/nerve endings and lead to cell death.</p><p>In this study we used 98 Sprague-Dawley rats and seven human temporal bones. Various substances were instilled into the middle ear of the rat, such as Pseudomonas Aeruginosa Exotoxin (PaExoA), gentamicin, NO-inhibitor N-Omega-Nitro-L-Arginine Methyl Ester (L-NAME), and glucocorticoids. The effects of the substances were studied by morphological analysis of RWM and the endolymphatic sac (ES) by light and electron microscopic. Hearing level was measured in the rats by ABR technique. The human temporal bones were studied immunomorphologically to search for glutamate.</p><p>In the human inner ear, glutamate receptors and glutamine synthetase, were identified. In the rat, we found, following PaExoA exposure, reversible and permanent hearing loss and morphological changes in the RWM. The ES showed increased numbers of macrophages and thickening of the epithelia. When L-NAME was used as an otoprotector from gentamicin ototoxicity a therapeutic effect in the high frequency area was found. Hydrocortisone (but not dexamethasone) exposure of the RWM resulted in membrane thickening, and adjacent to the membrane, inflammatory cells.</p><p>The importance of the RWM as a portal for toxic substances and topical treatment of inner ear diseases was highlighted in this study. The difficulties of applying drugs in the round window niche were exposed. The results of this study add important knowledge concerning certain mechanisms of inner ear injury and help us to understand possibilities and problems of local treatment of inner ear diseases in patients.</p>

Topical treatment of several inner ear diseases through the round window membrane (RWM) might be feasible in the near future. Bacteria toxins, ototoxic drugs and noise trauma seem to harm the inner ear by a common pathway which involves, excessive outflow of the afferent neurotransmitter glutamate and formation of nitric oxide (NO), which can severely damage cells/nerve endings and lead to cell death. In this study we used 98 Sprague-Dawley rats and seven human temporal bones. Various substances were instilled into the middle ear of the rat, such as Pseudomonas Aeruginosa Exotoxin (PaExoA), gentamicin, NO-inhibitor N-Omega-Nitro-L-Arginine Methyl Ester (L-NAME), and glucocorticoids. The effects of the substances were studied by morphological analysis of RWM and the endolymphatic sac (ES) by light and electron microscopic. Hearing level was measured in the rats by ABR technique. The human temporal bones were studied immunomorphologically to search for glutamate. In the human inner ear, glutamate receptors and glutamine synthetase, were identified. In the rat, we found, following PaExoA exposure, reversible and permanent hearing loss and morphological changes in the RWM. The ES showed increased numbers of macrophages and thickening of the epithelia. When L-NAME was used as an otoprotector from gentamicin ototoxicity a therapeutic effect in the high frequency area was found. Hydrocortisone (but not dexamethasone) exposure of the RWM resulted in membrane thickening, and adjacent to the membrane, inflammatory cells. The importance of the RWM as a portal for toxic substances and topical treatment of inner ear diseases was highlighted in this study. The difficulties of applying drugs in the round window niche were exposed. The results of this study add important knowledge concerning certain mechanisms of inner ear injury and help us to understand possibilities and problems of local treatment of inner ear diseases in patients.