Arch. Oto-RhinoLaryng. 217, 123- I37 (I977)
Archives of Oto-Rhino-Laryngolo9Y 9 Springer-Verlag 1977
Experimental Study of Sacculotomy in Endolymphatic Hydrops* Robert S. Kimura, Harold F. Schuknecht, Carol Y. Ota, and Diane D. Jones Department of Otolaryngologyat the Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114, USA
Summary. Thirty-nine guinea pigs were used for four groups of experiments: 1. sacculotomy only, 2. sacculotomy and simultaneous obliteration of the endolymphatic duct, 3. sacculotomy followed by obliteration of the endolymphatic duct, and 4. obliteration of the endolymphatic duct followed by sacculotomy. Saccutotomy alone caused only minimal cochlear pathology, whereas sacculotomy on hydropic ears produced severe atrophy of the organ of Corti and cochlear neurons as well as connective cells of the limbus. There was histological evidence that Reissner's membrane in hydropic ears was ruptured by the saeculotomy procedure. The primary cause for the severe atrophic changes is thought to be the toxic effect of intermixing perilymph with a large volume of endolymph. The surgically induced saccular tears appeared to be healed in all ears, and the procedure had no significant effect on the course of endolymphatic hydrops. Although two out of eleven specimens in which sacculotomy was performed on hydropic ears showed tears and collapse of Reissner's membrane, since others with similar tears showed extensive hydrops, the possibility of artifact could not be ruled out. In one specimen with simultaneous sacculotomy and obliteration of the duct, persisting fistulae were noted at the sites of accidental fracture of the osseous spiral lamina; this ear is the only one which failed to develop hydrops following obliteration of the duct. The results of this experiment, namely sacculotomy on hydropic guinea pig ears, suggest that sacculotomy is not a rational procedure for the control of endolymphatic hydrops in M~ni~re's disease for the following reasons: 1. surgically induced tears in the saccular wall are followed by rapid healing and 2. intermixing of perilymph and a large volume of endolymph causes toxic atrophy of the limbus, organ of Corti and cochlear neurons.
Key words: Sacculotomy -- Experimental endolymphatic hydrops -- Fistula -Limbus celt atrophy -- Organ of Corti atrophy. *
This work was supported by U.S. Public Health Grant 5 R01 NS03932-15
Reprinted Issue without Advertisements
~i~~
124
R.S. Kimura et al.
In a previous communication (Kimura and Schuknecht, 1975), we reported the results of creating fistulae in the vestibular labyrinths of guinea pigs with surgically ipduced endolymphatic hydrops. These studies showed prompt healing of fistulae made in the horizontal and superior canals, common crus, or utricle, and no demonstrable effect on the development or progression of the hydrops in the cochlea and saccule. Additionally, the ears showed severe sensorineural atrophy. Because these fistulae were separated from the cochlea and saccule by the utriculo-endolymphatic valve, it is possible that collapse or closure of this valve or the utricular duct could have negated the effect of the fistulae on the cochlea and saccule. The present experiment was undertaken in an attempt to prevent the development of hydrops by fistulizing the saccule, which is in direct line of communication with the endolymphatic duct and cochlea. Sacculotomy has been utilized in patients afflicted with M~ni~re's disease (Fick, 1964). Hearing losses following this procedure have been reported by House (1966), Dawkins (1971), Burgert et al. (1972), Plester (1972), and Palva et al. (1976). The procedure was modified by Cody (1968, 1974) by introducing a tack through the footplate, presumably to accomplish the same objective. Using the experimental guinea pig model, it is possible to determine the effect of sacculotomy on hydrops as well as on the organ of Corti. This experiment in turn might help to determine whether sacculotomy has any rational role in the management of M+ni+re's disease. We formulated four sets of experiments. The basic concept is based on the fact that hydrops consistently develops in the guinea pig when the endolymphatic duct is obliterated, this observation having been made in more than 80 guinea pig cochleae. Three groups of animals had procedures which served as controls: 1. sacculotomy alone, 2. sacculotomy and simultaneous obliteration of the endolymphatic duct, and 3. sacculotomy followed in 21/2 months by obliteration of the endolymphatic duct. Group four was considered to be the most clinically significant and consisted of those animals with obliteration of the endolymphatic duct 2 months prior to sacculotomy. Material and Methods
In each guinea pig only one ear was operated; the opposite ear remained as a control. In the first group of nine animals only the sacculotomy procedure was performed; this group served as a basis for evaluating the changes in groups two and three. In the second group of eleven animals, sacculotomy and obliteration of the endolymphatic duct were performed simultaneously. This experiment was expected to provide information as to whether a saccular fistula would remain open against a steadily increasing endolymph volume associated with blockage of the endolymphatic duct. In the third group of eight animals, sacculotomy was performed 21/2months before obliteration of the endolymphatic duct. In the fourth group of eleven guinea pigs, the duct was obliterated first, thus producing hydrops, and 2 months later sacculotomy was performed. This procedure is somewhat similar to that used in the treatment of M~ni6re's disease, but perhaps more traumatic since the macula sacculi was necessarily damaged in the process of assuring a tear in the membranous saccular wall.
3 3~ 3 3 3 3 3b 3 5
1 2 3 4 5 6 7 8 9
.
.
. --
. -. 1 -.
Cochlear Sens. C.
.
.
.
.
1, 2 1
1
1 1
.
.
Limbus spiralis
.
.
.
.
---
--
--
.
Spiral ganglia
.
. 1 --
--
--
Stria
-C
---
H, S
Re~ssner's membrane
D H , S, D D D D D D D D
Sac.
4 4a 3 3 3b 3 3 3 3 3 3
10 11 12 13 14 15 16 17 18 19 20
3, 4 1,2, 3,4 1 -1 1 1 1 -. . --
Cochlear Sens. C.
-1, 2 1 1, 4 -1 -1 . 1
Limbus spiralis
a F r a c t u r e o f the o s s e o u s spiral l a m i n a
Survival (mos.)
No.
. --
1, 4 1, 2, 3, 4 1 -4 1,4 -1 --
Stria
H, E C,T H , S, C H, E H, E H,E,T H, M H,E H,S,C H,S H,M,C
Reissner's " membrane
H , E, D C,D H , E, D H , E, D H , E, D H , E, T, D H, M, D H,E,D H,E,D H,E,D H,E,D
Sac.
.
. . . .
.
D
. --
.
. . . .
.
Sup.
.
Ampullae
H H H H
H -H H -C
Utr,
h
m
m
L
Sup.
Ampuliae
hydrops, E --extensive, M-
. . . . D .
. H, S
Utr.
.
. . . .
. .
-
Post.
m
L
Horiz.
L
m
Post.
moderate, S --slight, C-
D
.
Horiz.
u B a s i l a r m e m b r a n e p e r f o r a t i o n t h r o u g h the r o u n d w i n d o w in a d d i t i o n to s a c c u l o t o m y
--
4 1, 2, 3, 4 --1 -----
Spiral ganglia
T a b l e 2. S i m u l t a n e o u s s a c c u l o t o m y a n d o b f i t e r a t i o n o f the e n d o l y m p h a t i c d u c t (11 g u i n e a pigs)
a N o r e p l a c e m e n t m e m b r a n e at o v a l w i n d o w u Otitis m e d i a at r o u n d w i n d o w Areas showing degeneration: 1- basal turn, 2- second turn, 3- third turn, 4- apical turn, Itcollapse, T -- tear, D - s e n s o r y cell d e g e n e r a t i o n
Survival (mos.)
No.
T a b l e 1. S a c c u / o t o m y o n l y (9 g u i n e a pigs)
m
=N E"
~
Archives of Oto-Rhino-Laryngolo9Y 9 Springer-Verlag 1977
Experimental Study of Sacculotomy in Endolymphatic Hydrops* Robert S. Kimura, Harold F. Schuknecht, Carol Y. Ota, and Diane D. Jones Department of Otolaryngologyat the Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, Massachusetts 02114, USA
Summary. Thirty-nine guinea pigs were used for four groups of experiments: 1. sacculotomy only, 2. sacculotomy and simultaneous obliteration of the endolymphatic duct, 3. sacculotomy followed by obliteration of the endolymphatic duct, and 4. obliteration of the endolymphatic duct followed by sacculotomy. Saccutotomy alone caused only minimal cochlear pathology, whereas sacculotomy on hydropic ears produced severe atrophy of the organ of Corti and cochlear neurons as well as connective cells of the limbus. There was histological evidence that Reissner's membrane in hydropic ears was ruptured by the saeculotomy procedure. The primary cause for the severe atrophic changes is thought to be the toxic effect of intermixing perilymph with a large volume of endolymph. The surgically induced saccular tears appeared to be healed in all ears, and the procedure had no significant effect on the course of endolymphatic hydrops. Although two out of eleven specimens in which sacculotomy was performed on hydropic ears showed tears and collapse of Reissner's membrane, since others with similar tears showed extensive hydrops, the possibility of artifact could not be ruled out. In one specimen with simultaneous sacculotomy and obliteration of the duct, persisting fistulae were noted at the sites of accidental fracture of the osseous spiral lamina; this ear is the only one which failed to develop hydrops following obliteration of the duct. The results of this experiment, namely sacculotomy on hydropic guinea pig ears, suggest that sacculotomy is not a rational procedure for the control of endolymphatic hydrops in M~ni~re's disease for the following reasons: 1. surgically induced tears in the saccular wall are followed by rapid healing and 2. intermixing of perilymph and a large volume of endolymph causes toxic atrophy of the limbus, organ of Corti and cochlear neurons.
Key words: Sacculotomy -- Experimental endolymphatic hydrops -- Fistula -Limbus celt atrophy -- Organ of Corti atrophy. *
This work was supported by U.S. Public Health Grant 5 R01 NS03932-15
Reprinted Issue without Advertisements
~i~~
124
R.S. Kimura et al.
In a previous communication (Kimura and Schuknecht, 1975), we reported the results of creating fistulae in the vestibular labyrinths of guinea pigs with surgically ipduced endolymphatic hydrops. These studies showed prompt healing of fistulae made in the horizontal and superior canals, common crus, or utricle, and no demonstrable effect on the development or progression of the hydrops in the cochlea and saccule. Additionally, the ears showed severe sensorineural atrophy. Because these fistulae were separated from the cochlea and saccule by the utriculo-endolymphatic valve, it is possible that collapse or closure of this valve or the utricular duct could have negated the effect of the fistulae on the cochlea and saccule. The present experiment was undertaken in an attempt to prevent the development of hydrops by fistulizing the saccule, which is in direct line of communication with the endolymphatic duct and cochlea. Sacculotomy has been utilized in patients afflicted with M~ni~re's disease (Fick, 1964). Hearing losses following this procedure have been reported by House (1966), Dawkins (1971), Burgert et al. (1972), Plester (1972), and Palva et al. (1976). The procedure was modified by Cody (1968, 1974) by introducing a tack through the footplate, presumably to accomplish the same objective. Using the experimental guinea pig model, it is possible to determine the effect of sacculotomy on hydrops as well as on the organ of Corti. This experiment in turn might help to determine whether sacculotomy has any rational role in the management of M+ni+re's disease. We formulated four sets of experiments. The basic concept is based on the fact that hydrops consistently develops in the guinea pig when the endolymphatic duct is obliterated, this observation having been made in more than 80 guinea pig cochleae. Three groups of animals had procedures which served as controls: 1. sacculotomy alone, 2. sacculotomy and simultaneous obliteration of the endolymphatic duct, and 3. sacculotomy followed in 21/2 months by obliteration of the endolymphatic duct. Group four was considered to be the most clinically significant and consisted of those animals with obliteration of the endolymphatic duct 2 months prior to sacculotomy. Material and Methods
In each guinea pig only one ear was operated; the opposite ear remained as a control. In the first group of nine animals only the sacculotomy procedure was performed; this group served as a basis for evaluating the changes in groups two and three. In the second group of eleven animals, sacculotomy and obliteration of the endolymphatic duct were performed simultaneously. This experiment was expected to provide information as to whether a saccular fistula would remain open against a steadily increasing endolymph volume associated with blockage of the endolymphatic duct. In the third group of eight animals, sacculotomy was performed 21/2months before obliteration of the endolymphatic duct. In the fourth group of eleven guinea pigs, the duct was obliterated first, thus producing hydrops, and 2 months later sacculotomy was performed. This procedure is somewhat similar to that used in the treatment of M~ni6re's disease, but perhaps more traumatic since the macula sacculi was necessarily damaged in the process of assuring a tear in the membranous saccular wall.
3 3~ 3 3 3 3 3b 3 5
1 2 3 4 5 6 7 8 9
.
.
. --
. -. 1 -.
Cochlear Sens. C.
.
.
.
.
1, 2 1
1
1 1
.
.
Limbus spiralis
.
.
.
.
---
--
--
.
Spiral ganglia
.
. 1 --
--
--
Stria
-C
---
H, S
Re~ssner's membrane
D H , S, D D D D D D D D
Sac.
4 4a 3 3 3b 3 3 3 3 3 3
10 11 12 13 14 15 16 17 18 19 20
3, 4 1,2, 3,4 1 -1 1 1 1 -. . --
Cochlear Sens. C.
-1, 2 1 1, 4 -1 -1 . 1
Limbus spiralis
a F r a c t u r e o f the o s s e o u s spiral l a m i n a
Survival (mos.)
No.
. --
1, 4 1, 2, 3, 4 1 -4 1,4 -1 --
Stria
H, E C,T H , S, C H, E H, E H,E,T H, M H,E H,S,C H,S H,M,C
Reissner's " membrane
H , E, D C,D H , E, D H , E, D H , E, D H , E, T, D H, M, D H,E,D H,E,D H,E,D H,E,D
Sac.
.
. . . .
.
D
. --
.
. . . .
.
Sup.
.
Ampullae
H H H H
H -H H -C
Utr,
h
m
m
L
Sup.
Ampuliae
hydrops, E --extensive, M-
. . . . D .
. H, S
Utr.
.
. . . .
. .
-
Post.
m
L
Horiz.
L
m
Post.
moderate, S --slight, C-
D
.
Horiz.
u B a s i l a r m e m b r a n e p e r f o r a t i o n t h r o u g h the r o u n d w i n d o w in a d d i t i o n to s a c c u l o t o m y
--
4 1, 2, 3, 4 --1 -----
Spiral ganglia
T a b l e 2. S i m u l t a n e o u s s a c c u l o t o m y a n d o b f i t e r a t i o n o f the e n d o l y m p h a t i c d u c t (11 g u i n e a pigs)
a N o r e p l a c e m e n t m e m b r a n e at o v a l w i n d o w u Otitis m e d i a at r o u n d w i n d o w Areas showing degeneration: 1- basal turn, 2- second turn, 3- third turn, 4- apical turn, Itcollapse, T -- tear, D - s e n s o r y cell d e g e n e r a t i o n
Survival (mos.)
No.
T a b l e 1. S a c c u / o t o m y o n l y (9 g u i n e a pigs)
m
=N E"
~
