Acta Oto-Laryngologica
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Tympanic Muscle Reflex Elicited by Electric Stimulation of the Tongue in Normal and Pathological Subjects A. Bosatra, M. Russolo & A. Semeraro To cite this article: A. Bosatra, M. Russolo & A. Semeraro (1975) Tympanic Muscle Reflex Elicited by Electric Stimulation of the Tongue in Normal and Pathological Subjects, Acta OtoLaryngologica, 79:3-6, 334-338, DOI: 10.3109/00016487509124695 To link to this article: http://dx.doi.org/10.3109/00016487509124695
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 4
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California, San Diego]
Date: 10 April 2016, At: 05:05
Acta Otolaryngol 79: 334-338, 1975
TYMPANIC MUSCLE REFLEX ELICITED BY ELECTRIC STIMULATION
OF THE TONGUE I N NORMAL A N D PATHOLOGICAL SUBJECTS
A. Bosatra, M. Russolo and A . Semeraro From the Department of Otolaryngology, University of Trieste, Trieste, Italy
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
(Received April 22, 1974)
Abstract. A bilateral reflex contraction of the tensor tympani muscle has been obtained in man by electric stimulation of the tongue (1-2 mA). The stimulus is well tolerated and always effective. The advantage is stressed of eliciting a contraction of this muscle without involvement of the stapedius, as occurs with other methods. An analysis has been subsequently conducted in normal subjects and in patients affected by pathology of the tympano-ossicular system: tympanosclerosis, otosclerosis, suprastapedial facial paralysis; in cases of interruption of the afferent arch: section of the homolateral lingual nerve; in cases of involvement of itscentral portion: cerebello-pontine-angle tumours; and in cases of section of chotda tympani. A chiasm-like central neIvous pattern is suggested.
An increasing number of data demonstrate that the reflex contraction of the tensor tympani muscle can be elicited by tactile stimulation of some facial areas: puff of air against the orbit (Klockhoff & Anderson, 1960); eyelid lifting (Djupesland, 1964); or by strong sound stimuli (LidCn et al., 1970). It can also be observed during the motor activity of some muscular groups of the face, of the neck and of the phonatory muscles (Salomon & Starr, 1963). In all these conditions, however, the contraction of this muscle is not isolated but is associated with that of the stapedius, being a sort of startle reaction to sudden stimuli, or correlated with the cnntraction of a more general nuscular system (Kato, 1913; Klockhoff, 1960; Lindstrom & LidCn, 1964). However, the advantage of obtaining an isolated tensor tympani muscle contraction is obvious when studying the physiopathological conditions of its nervous reflex arc or of the Acta Otolnryngnl 79
middle ear structures, as is currently done with the stapedius muscle reflex. To this end we have investigated the possibility of eliciting an isolated tensor tympani muscle reflex (t.t.m.r.) contraction by electric stimulation of the tongue, which is an organ furnished of a rich, sensitive innervation by the trigeminal nerve.
MATERIAL AND METHOD The stimulus was given by a positive and/or negative electrode (28 mm2) applied to one side of the tongue slightly protruded by the subject himself. The organ was slightly moistened by saliva during the brief duration of the test. The stimulus was of an intensity of 1-2 mA and about 1 sec in duration. During the stimulation the subject was pressing one wide-open hand on the ground plate. To our experience, the large surface of this plate allows the application of these rather intense stimuli without unpleasant sensations or reactions from the subject. Electrogustometry, indeed, is performed by applying electric stimuli in the range from 3 to 300 PA. The reflex was recorded by an Impedance Meter (Madsen ZO 70) connected to a graphic recorder (Minigor R E 501) and to an Bscilloscope (Tektronix 5103N/D13) with the probe inserted into the homolateral or contralateral ear canal. The test was carried out in a quiet room.
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
Tympanic muscle reflex elicited by tongue stimulation
335
explanation of this phenomenon is not easy at the moment: the positive spikes are due to an increase in intensity of the sound wave emitted by the probe of the impedance meter, and this increase is due to a reduction in size of the meatal chamber because of an outward displacement of the tympanic membrane. The opposite is true for the negative spikes. Thus, the opposite directions of the spikes may be due to the opposite mechanical effect at the level of the tympanic membrane of the very short and small contractions of this muscle which exerts a traction at nearly right angles to the chain, with a rotatory component. Fig. 1. Graphic records of tensor tympani muscle reflex contraction in a normal subject. Some of the contractions are indicated by an arrow.
RESULTS
Normal Subjects In a preliminary investigation (Bosatra & Russolo, 1973) 150 normal individuals, from 20 to 56 years old, were tested. In all subjects the application of the stimulus provoked a bilateral reflex contraction of the t.t.m. at the opening; but often also at the closure of the electric circuit, so that the response was characterized by a double spike with an interval as long as the duration of the stimulus (about 1 sec). The spikes were at random, positive or negative, relative to the base-line (Figs. 1 and 2). The
Fig. 2. Oscilloscopic tracing of single tensor tympani muscle reflex contraction. First spike at the closure, second spike at the opening of the electric circuit.
Pathological Subjects In the present study, in addition to many more normal individuals, pathological ears have also been tested.
(A) Pathology of tympano-ossicular system and related structures (i) 12 cases of otosclerosis were tested: the traces obtained appeared to be normal or slightly reduced. (ii) 15 subjects showing a typical picture of tympanosclerosis with scarred and retracted drum, but with normal tuba1 function and presence of the stapedius reflex elicited by contralateral acustic stimulus, showed very reduced or no responses. (iii) 1 subject with complete bilateral velar paralysis, with atrophy of this organ due to previous diphtheria, showed slower responses (Fig. 3). 18 subjects with unilateral paresis of the VII nerve showed normal responses on the affected side. 3 subjects with unilateral complete suprastapedial paralysis of the VII nerve showed greater than normal responses on the affected side (Fig. 4). Pathology of nervous arc 2 cases were tested in which a unilateral surgical section of the lingual nerve at the level of the submandibular gland was Acta Otolavyngol 79
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
336 A . Bosatra et al.
Fig. 3. Graphic record of tensor tympani muscle reflex contraction in a case of complete velar paralysis. Arrows indicate some of the contractions.
plete and strictly limited interruption of performed during radical neck dissection: the electric stimulation of the homolateral the motor portion of the V nerve. side of the tongue provoked no t.t.m.r. (iv) 13 cases have been examined in which a contraction, bilaterally. The response was unilateral section of chorda tympani was present with the stimulus applied on the performed for the treatment of facial palsy opposite side of the tongue, as it was or during myringoplasty or stapedectomy. present bilaterally previous to the operaIn these cases the homolateral stimulation tion. showed normal responses in the contralateral ear and also in the homolateral one (ii) 4 cases were tested showing the clinical in all cases in which the anatomical conpicture of a unilateral ponto-cerebellar ditions of the tympano-ossicular system angle tumour, subsequently confirmed surgically and provoked by an acoustic rendered it possible. neuroma. In 3 cases the t.t.m.r. reflex was absent homolaterally to the side of the lesion CONCLUSIONS for a stimulus applied homolaterally, whereas, the contralateral reflex was present. We believe that unilateral electric stimulation With a contralateral stimulus, the t.t.m.r. of the tongue with intensities of 1-2 mA is an was present bilaterally. In these subjects adequate stimulus to elicit an isolated bilateral the neurological picture also showed homo- t.t.m.r. contraction, without involvement of lateral severe perceptive deafness, no or very the stapedius. Indeed it is possible to observe the reduced vestibular responses, spontaneous t.t.rn.r. contraction elicited by this method nystagmus to the homolateral and contra- superimposed on the maximal stapedial contraclateral side, homolateral severe hypogeusia tion elicited by sound stimuli. to electrogustometry, no other signs of V In our experience this method is always nerve involvement. In the 4th patient, effective, whereas a puff of air directed towards showing more severe clinical signs of brain- the eye sometimes gives no response. Moreover stem involvement, with vertical nystagmus, it is ol'ten unpleasant and when effective it is reduced corneal reflex and facial palsy, usually associated with a contraction of the the t.t.m.r. was bilaterally absent for an stapedius muscle. homolateral stimulus whereas the contraBy considering its shape, the t.t.m.r. contraclateral stimulus elicited a bilateral con- tion does not seem to be involved with the contraction of other muscular groups of the traction. (iii) We have not yet met with subjects with com- face and oropharynx as demonstrated especially Acta Otolaryngol 79
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
Tympanic muscle reflex elicited by tongue stimulation
Fig. 4. Graphic record of single tensor tympani muscle reflex contraction in a case of suprastapedial facial paralysis. Arrows indicate the spikes at the closure and at the opening of the circuit.
337
ossicular system is small, as a consequence, we believe, of the small intensity of the stimulus and of the physiological mode of action of this muscle. Obviously the size of the response is related to the conditions of the mechanical effector: it is greater in cases of complete facial paralysis or interruption of the ossicular chain. It is smaller or abolished in cases of stapes anchylosis or tympanoscleiosis. The t.t.m.r. is absent when the stimulus is homolaterally applied to the section of the lingual nerve. It is not affected by the section of chorda tympani. The bilateral distribution of the reflex seems to follow a chiasm-like nervous pattern, as demonstrated in cases of brainstem involvement due to unilateral pontocerebellar angle tumour (Fig. 5).
RCSUME by the cases of unilateral central block of the reflex arch. The recording of this contraction by an impedance meter demonstrates that its mechanical effect at the level oi the tympanoT T M
T M.
Une contraction rtflexe bilatCrale du muscle tensor tympani a etk obtenue sur I’homme par stimulation electrique de la langue (1-2 mA). Le stimulus est bien tolere et toujours efficace. L’avantage est que I’on obtient une contraction de ce muscle sans celle du stapedius, comme il arrivait avec d’autres niethodes. Ensuite une analyse a ete effectuee sur des sujets normaux et sur des patients atteints de lesions du systeme tympanoossiculaire: Tympanosclerose, otospongiose, paralysie faciale suprastapedienne; en cas d’interruption de l’arc afferent: section du nerf lingual homolateral; en cas d’atteinte dans sa portion centrale : tumeurs de l’angle pontockrebelleux; et en cas de section de la chorda tympani. On envisage un croisement des voies nerveuses centrales.
ZUSAMMENFASSUNG
Fig. 5. Schematic pattern of nervous arch of tensor tympani muscle (T.T.M.) reflex. T - tongue. Triangle marked c.p.a.t. represents various sizes of cerebellopontine-angle tumours, surgically confirmed, interfering with reflex pathway.
Durch die elektrische Reizung der Zunge (1-2 mA) ist in der Paukenhohle des Menschen eine Reflexe, beidseitige Kontraktion des Musculus Tensor Tympani erzielt worden. Dieser Reiz ist gut vertraglich und ausreichend. Der Vorteil der Methode liegt darin, dass eine Kontraktion dieses Muskels hervorgerufen wird, ohne dass der Steigbugel daran teilnimmt, wie dies bei anderen Methoden der Fall ist. Es ist daher eine Versuchsreihe durchgefiirt worden, sowohl an gesunden als auch an Patienten, die am knochernen-tympanischen System erkrankt waren, und zwar an Tympanussklerose, Gehorsklerosen, Lahmung des Nervus Facialis oberhalb des Stapes; in einigen Fallen an Unterbrechung des zufuhrenden Bogens: Durchtrennung des Nervus Lingualis der gleichen Seite; in einigen Fallen an Verletzung des zentralen Teiles des Nerven; in einigen Fallen an Unter-
Acta Otolaryngol 79
338 A . BoJatra et al. brechung der Corda Tympani: Tumoren a n der Brucke zum Gehirn. Bei diesen Fallen ist a n ein Uberschneiden der zentralen Nervenbahnen zu denken.
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
REFERENCES Bosatra, A. & Russolo, M. 1973. Studio del riflesso del muscolo tensore del timpano mediante stimolazione elettrica della lingua. Boll Aud Fon 1-2, 137. Djupesland, G. 1964. Middle ear muscle reflexes elicited by acoustic and nonacoustic stimulation. Acta Otolaryngol (Stockh), Suppl. 188. Kato, T. 1913. Zur Physiologie der Binnenmuskeln des Ohrens. Pfluegers Arch 150, 569. Klockhoff, I. 1960. Discussion about acoustic reflexes of the human muscle tensor tympani. see Terkildsen, Acta Otolaryngol (Stockh), Suppl. 158. Klockhoff, I. & Anderson, H. 1960. Reflex activity in the
Acta Otolaryngol 79
tensor tympani muscle in man. lcta Otolaryngol (Stockh) 51, 184. LidCn, G., Peterson, J. L. & Harford E. R. 1970. Simultaneous recording of changes in relative impedance and air pressure during acoustic and nonacoustic elicitation of the middle ear reflexes. Acta Otolaryngol (Stockh), Suppl. 263. Lindstrom, D. & LidCn, G. 1964. The tensor-tympani reflex in operative treatment of trigeminal neuralgia. Acta Otolaryngol (Stockh), Suppl. 188. Salomon, G. & Starr, A. 1963. Electromyogiaphy of middle ear muscles in man during motor activities. Acta Neurol Scand 39, 161. A . Bosatra, M.D. Dept. of Otolaryngology University of Trieste Trieste Italy
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Tympanic Muscle Reflex Elicited by Electric Stimulation of the Tongue in Normal and Pathological Subjects A. Bosatra, M. Russolo & A. Semeraro To cite this article: A. Bosatra, M. Russolo & A. Semeraro (1975) Tympanic Muscle Reflex Elicited by Electric Stimulation of the Tongue in Normal and Pathological Subjects, Acta OtoLaryngologica, 79:3-6, 334-338, DOI: 10.3109/00016487509124695 To link to this article: http://dx.doi.org/10.3109/00016487509124695
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 4
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California, San Diego]
Date: 10 April 2016, At: 05:05
Acta Otolaryngol 79: 334-338, 1975
TYMPANIC MUSCLE REFLEX ELICITED BY ELECTRIC STIMULATION
OF THE TONGUE I N NORMAL A N D PATHOLOGICAL SUBJECTS
A. Bosatra, M. Russolo and A . Semeraro From the Department of Otolaryngology, University of Trieste, Trieste, Italy
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
(Received April 22, 1974)
Abstract. A bilateral reflex contraction of the tensor tympani muscle has been obtained in man by electric stimulation of the tongue (1-2 mA). The stimulus is well tolerated and always effective. The advantage is stressed of eliciting a contraction of this muscle without involvement of the stapedius, as occurs with other methods. An analysis has been subsequently conducted in normal subjects and in patients affected by pathology of the tympano-ossicular system: tympanosclerosis, otosclerosis, suprastapedial facial paralysis; in cases of interruption of the afferent arch: section of the homolateral lingual nerve; in cases of involvement of itscentral portion: cerebello-pontine-angle tumours; and in cases of section of chotda tympani. A chiasm-like central neIvous pattern is suggested.
An increasing number of data demonstrate that the reflex contraction of the tensor tympani muscle can be elicited by tactile stimulation of some facial areas: puff of air against the orbit (Klockhoff & Anderson, 1960); eyelid lifting (Djupesland, 1964); or by strong sound stimuli (LidCn et al., 1970). It can also be observed during the motor activity of some muscular groups of the face, of the neck and of the phonatory muscles (Salomon & Starr, 1963). In all these conditions, however, the contraction of this muscle is not isolated but is associated with that of the stapedius, being a sort of startle reaction to sudden stimuli, or correlated with the cnntraction of a more general nuscular system (Kato, 1913; Klockhoff, 1960; Lindstrom & LidCn, 1964). However, the advantage of obtaining an isolated tensor tympani muscle contraction is obvious when studying the physiopathological conditions of its nervous reflex arc or of the Acta Otolnryngnl 79
middle ear structures, as is currently done with the stapedius muscle reflex. To this end we have investigated the possibility of eliciting an isolated tensor tympani muscle reflex (t.t.m.r.) contraction by electric stimulation of the tongue, which is an organ furnished of a rich, sensitive innervation by the trigeminal nerve.
MATERIAL AND METHOD The stimulus was given by a positive and/or negative electrode (28 mm2) applied to one side of the tongue slightly protruded by the subject himself. The organ was slightly moistened by saliva during the brief duration of the test. The stimulus was of an intensity of 1-2 mA and about 1 sec in duration. During the stimulation the subject was pressing one wide-open hand on the ground plate. To our experience, the large surface of this plate allows the application of these rather intense stimuli without unpleasant sensations or reactions from the subject. Electrogustometry, indeed, is performed by applying electric stimuli in the range from 3 to 300 PA. The reflex was recorded by an Impedance Meter (Madsen ZO 70) connected to a graphic recorder (Minigor R E 501) and to an Bscilloscope (Tektronix 5103N/D13) with the probe inserted into the homolateral or contralateral ear canal. The test was carried out in a quiet room.
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
Tympanic muscle reflex elicited by tongue stimulation
335
explanation of this phenomenon is not easy at the moment: the positive spikes are due to an increase in intensity of the sound wave emitted by the probe of the impedance meter, and this increase is due to a reduction in size of the meatal chamber because of an outward displacement of the tympanic membrane. The opposite is true for the negative spikes. Thus, the opposite directions of the spikes may be due to the opposite mechanical effect at the level of the tympanic membrane of the very short and small contractions of this muscle which exerts a traction at nearly right angles to the chain, with a rotatory component. Fig. 1. Graphic records of tensor tympani muscle reflex contraction in a normal subject. Some of the contractions are indicated by an arrow.
RESULTS
Normal Subjects In a preliminary investigation (Bosatra & Russolo, 1973) 150 normal individuals, from 20 to 56 years old, were tested. In all subjects the application of the stimulus provoked a bilateral reflex contraction of the t.t.m. at the opening; but often also at the closure of the electric circuit, so that the response was characterized by a double spike with an interval as long as the duration of the stimulus (about 1 sec). The spikes were at random, positive or negative, relative to the base-line (Figs. 1 and 2). The
Fig. 2. Oscilloscopic tracing of single tensor tympani muscle reflex contraction. First spike at the closure, second spike at the opening of the electric circuit.
Pathological Subjects In the present study, in addition to many more normal individuals, pathological ears have also been tested.
(A) Pathology of tympano-ossicular system and related structures (i) 12 cases of otosclerosis were tested: the traces obtained appeared to be normal or slightly reduced. (ii) 15 subjects showing a typical picture of tympanosclerosis with scarred and retracted drum, but with normal tuba1 function and presence of the stapedius reflex elicited by contralateral acustic stimulus, showed very reduced or no responses. (iii) 1 subject with complete bilateral velar paralysis, with atrophy of this organ due to previous diphtheria, showed slower responses (Fig. 3). 18 subjects with unilateral paresis of the VII nerve showed normal responses on the affected side. 3 subjects with unilateral complete suprastapedial paralysis of the VII nerve showed greater than normal responses on the affected side (Fig. 4). Pathology of nervous arc 2 cases were tested in which a unilateral surgical section of the lingual nerve at the level of the submandibular gland was Acta Otolavyngol 79
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
336 A . Bosatra et al.
Fig. 3. Graphic record of tensor tympani muscle reflex contraction in a case of complete velar paralysis. Arrows indicate some of the contractions.
plete and strictly limited interruption of performed during radical neck dissection: the electric stimulation of the homolateral the motor portion of the V nerve. side of the tongue provoked no t.t.m.r. (iv) 13 cases have been examined in which a contraction, bilaterally. The response was unilateral section of chorda tympani was present with the stimulus applied on the performed for the treatment of facial palsy opposite side of the tongue, as it was or during myringoplasty or stapedectomy. present bilaterally previous to the operaIn these cases the homolateral stimulation tion. showed normal responses in the contralateral ear and also in the homolateral one (ii) 4 cases were tested showing the clinical in all cases in which the anatomical conpicture of a unilateral ponto-cerebellar ditions of the tympano-ossicular system angle tumour, subsequently confirmed surgically and provoked by an acoustic rendered it possible. neuroma. In 3 cases the t.t.m.r. reflex was absent homolaterally to the side of the lesion CONCLUSIONS for a stimulus applied homolaterally, whereas, the contralateral reflex was present. We believe that unilateral electric stimulation With a contralateral stimulus, the t.t.m.r. of the tongue with intensities of 1-2 mA is an was present bilaterally. In these subjects adequate stimulus to elicit an isolated bilateral the neurological picture also showed homo- t.t.m.r. contraction, without involvement of lateral severe perceptive deafness, no or very the stapedius. Indeed it is possible to observe the reduced vestibular responses, spontaneous t.t.rn.r. contraction elicited by this method nystagmus to the homolateral and contra- superimposed on the maximal stapedial contraclateral side, homolateral severe hypogeusia tion elicited by sound stimuli. to electrogustometry, no other signs of V In our experience this method is always nerve involvement. In the 4th patient, effective, whereas a puff of air directed towards showing more severe clinical signs of brain- the eye sometimes gives no response. Moreover stem involvement, with vertical nystagmus, it is ol'ten unpleasant and when effective it is reduced corneal reflex and facial palsy, usually associated with a contraction of the the t.t.m.r. was bilaterally absent for an stapedius muscle. homolateral stimulus whereas the contraBy considering its shape, the t.t.m.r. contraclateral stimulus elicited a bilateral con- tion does not seem to be involved with the contraction of other muscular groups of the traction. (iii) We have not yet met with subjects with com- face and oropharynx as demonstrated especially Acta Otolaryngol 79
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
Tympanic muscle reflex elicited by tongue stimulation
Fig. 4. Graphic record of single tensor tympani muscle reflex contraction in a case of suprastapedial facial paralysis. Arrows indicate the spikes at the closure and at the opening of the circuit.
337
ossicular system is small, as a consequence, we believe, of the small intensity of the stimulus and of the physiological mode of action of this muscle. Obviously the size of the response is related to the conditions of the mechanical effector: it is greater in cases of complete facial paralysis or interruption of the ossicular chain. It is smaller or abolished in cases of stapes anchylosis or tympanoscleiosis. The t.t.m.r. is absent when the stimulus is homolaterally applied to the section of the lingual nerve. It is not affected by the section of chorda tympani. The bilateral distribution of the reflex seems to follow a chiasm-like nervous pattern, as demonstrated in cases of brainstem involvement due to unilateral pontocerebellar angle tumour (Fig. 5).
RCSUME by the cases of unilateral central block of the reflex arch. The recording of this contraction by an impedance meter demonstrates that its mechanical effect at the level oi the tympanoT T M
T M.
Une contraction rtflexe bilatCrale du muscle tensor tympani a etk obtenue sur I’homme par stimulation electrique de la langue (1-2 mA). Le stimulus est bien tolere et toujours efficace. L’avantage est que I’on obtient une contraction de ce muscle sans celle du stapedius, comme il arrivait avec d’autres niethodes. Ensuite une analyse a ete effectuee sur des sujets normaux et sur des patients atteints de lesions du systeme tympanoossiculaire: Tympanosclerose, otospongiose, paralysie faciale suprastapedienne; en cas d’interruption de l’arc afferent: section du nerf lingual homolateral; en cas d’atteinte dans sa portion centrale : tumeurs de l’angle pontockrebelleux; et en cas de section de la chorda tympani. On envisage un croisement des voies nerveuses centrales.
ZUSAMMENFASSUNG
Fig. 5. Schematic pattern of nervous arch of tensor tympani muscle (T.T.M.) reflex. T - tongue. Triangle marked c.p.a.t. represents various sizes of cerebellopontine-angle tumours, surgically confirmed, interfering with reflex pathway.
Durch die elektrische Reizung der Zunge (1-2 mA) ist in der Paukenhohle des Menschen eine Reflexe, beidseitige Kontraktion des Musculus Tensor Tympani erzielt worden. Dieser Reiz ist gut vertraglich und ausreichend. Der Vorteil der Methode liegt darin, dass eine Kontraktion dieses Muskels hervorgerufen wird, ohne dass der Steigbugel daran teilnimmt, wie dies bei anderen Methoden der Fall ist. Es ist daher eine Versuchsreihe durchgefiirt worden, sowohl an gesunden als auch an Patienten, die am knochernen-tympanischen System erkrankt waren, und zwar an Tympanussklerose, Gehorsklerosen, Lahmung des Nervus Facialis oberhalb des Stapes; in einigen Fallen an Unterbrechung des zufuhrenden Bogens: Durchtrennung des Nervus Lingualis der gleichen Seite; in einigen Fallen an Verletzung des zentralen Teiles des Nerven; in einigen Fallen an Unter-
Acta Otolaryngol 79
338 A . BoJatra et al. brechung der Corda Tympani: Tumoren a n der Brucke zum Gehirn. Bei diesen Fallen ist a n ein Uberschneiden der zentralen Nervenbahnen zu denken.
Downloaded by [University of California, San Diego] at 05:05 10 April 2016
REFERENCES Bosatra, A. & Russolo, M. 1973. Studio del riflesso del muscolo tensore del timpano mediante stimolazione elettrica della lingua. Boll Aud Fon 1-2, 137. Djupesland, G. 1964. Middle ear muscle reflexes elicited by acoustic and nonacoustic stimulation. Acta Otolaryngol (Stockh), Suppl. 188. Kato, T. 1913. Zur Physiologie der Binnenmuskeln des Ohrens. Pfluegers Arch 150, 569. Klockhoff, I. 1960. Discussion about acoustic reflexes of the human muscle tensor tympani. see Terkildsen, Acta Otolaryngol (Stockh), Suppl. 158. Klockhoff, I. & Anderson, H. 1960. Reflex activity in the
Acta Otolaryngol 79
tensor tympani muscle in man. lcta Otolaryngol (Stockh) 51, 184. LidCn, G., Peterson, J. L. & Harford E. R. 1970. Simultaneous recording of changes in relative impedance and air pressure during acoustic and nonacoustic elicitation of the middle ear reflexes. Acta Otolaryngol (Stockh), Suppl. 263. Lindstrom, D. & LidCn, G. 1964. The tensor-tympani reflex in operative treatment of trigeminal neuralgia. Acta Otolaryngol (Stockh), Suppl. 188. Salomon, G. & Starr, A. 1963. Electromyogiaphy of middle ear muscles in man during motor activities. Acta Neurol Scand 39, 161. A . Bosatra, M.D. Dept. of Otolaryngology University of Trieste Trieste Italy
