Items: 35
1.
Endoscopic view of typical appearing tympanosclerosis in a right ear. Note the white plaque present within the substance of the eardrum. The middle ear is aerated (image courtesy of Dr. Abraham Jacob, MD).
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Mosaicking results for a TM with tympanosclerosis. A Video-otoscope image of the TM showing a chalky white patch with irregular boundaries, characteristic of tympanosclerosis. B Mosaicked image obtained over the region enclosed by orange dashed box in (A). C Thickness distribution map overlaid on the mosaicked image (thickness values in μm).
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Chronic middle ear inflammation. Axial CT in bone window demonstrates focal calcifications (arrow) in the tympanic cavity, close to ossicular chain. This is called tympanosclerosis
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In the control mice (A), the outer ear canal is clear without any discharge. The tympanic membrane appears to be transparent and malleus (blue asterisk) is clearly visible. In the age matched mutant mice (B), surrounding bone must be removed to expose the tympanic membrane, most of which is completely covered by discharge. White patches (inside black dashed lines) were observed on the tympanic membrane of the mutant mice (B). The ossicle bones of the age matched control and mutant mice appear to have similar morphology (C-D), but malleus and incus are fused in the mutant mice (D, red arrow). M: Malleus; I: Incus; S: Stapes. Alizarin red staining reveals extensive mineralization in the stapedial artery wall (green asterisk) in Enpp1as/asjj mice (F), but not in the control mice (E).
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Examples of power reflectance and umbo velocity for subjects with normal audiograms but with tympanometric or anatomical abnormalities: (a & c) hypermobile TM with static compliances of 4 cc (S002 Left) and 3.4 cc (S002 Right), plus 2 measurements from ; (b & d) Three ears with tympanosclerosis and normal hearing.
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(A) Right and left ears from one subject () (Reprinted with permission from Rosowski, J.J., et al., Ear and Hearing, 33, 19–34. Copyright (2012)) and 2 ears presented by (Reprinted with permission from Feeney, M.P., et al., Journal of Speech, Language and Hearing Research, 46, 901–911. Copyright (2003). These ears had normal audiograms but abnormally compliant tympanograms. (B) Three ears with tympanosclerosis and normal audiograms. In both plots, comparison is made to the shaded area representing one standard deviation above and below the mean PR of 58 normal ears. This figure was published in (Reprinted with permission from Rosowski, J.J., et al., Ear and Hearing, 33, 19–34. Copyright (2012).
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Round window (RW)-Coupler. The RW-Coupler was provided by MED-EL Co.
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Otoscopic findings of tympanic membrane. The right external auditory canal was expanded (A) and sclerotic lesion was found in the left tympanic membrane (B).
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Pure-tone audiogram. (A) Bilateral mixed hearing loss was present. (B) Left hearing level was not changed after the VSB surgery.
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(a) View of the right tympanic membrane and lesion (arrow) utilizing the operating microscope. (b) Intraoperative view of the lesion (long arrow) within the lifted tympanic membrane (asterisk) and the underlying malleus (short arrow) (images courtesy of Dr. Abraham Jacob, MD).
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Floating mass transducer (FMT) with round window (RW)-Coupler placement in the RW. The FMT attached with RW-Coupler was placed in the RW (A) after good fitting of the RW-Coupler (arrow) was confirmed (B). The FMT was wrapped in perichondrium (C).
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X-P finding of floating mass transducer (FMT) placement after VSB surgery. Good placement of the FMT with the round window (RW)-Coupler was confirmed. Scheme of X-P is shown. Lscc, lateral semicircular canal; Sscc, superior semicircular canal.
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CT scan of region of the round window (RW) in our case. (A) Right ear, (B) left ear, and (C) control case. The RW in our case was remarkably small compared with the control case. The diameter of the RW is shown as arrowheads in the schematic representation.
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L = ladder (100 bp), P = positive control, Lanes are numbered in the following order from 1 to 2: case H. Pylori-positive (286 bp), case H. Pylori-negative.
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L = ladder (100 bp), P = positive control, Lanes are numbered in the following order from 1 to 3: case H. Pylori-positive (630 bp), negative control, case H. Pylori-negative.
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Warble tone threshold level. Compared with the threshold level of the conventional hearing aid (A), the threshold level of the VSB at the first fitting was improved at the high frequencies (B). After refitting, amplification at the low frequencies was elevated (C).
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(a) Hematoxylin and eosin stained light microscopy obtained from the right ear mass (10x). Fibrous infiltrate, hyaline degeneration, and calcification (arrow) without presence of squamous epithelium are seen. (b) 20x view with black arrows demonstrating giant cell reaction (images courtesy of Sarah Tang, PSF).
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(a) Axial bone windowed temporal bone CT scan showing a 3-4 mm hyperdense lesion (arrow); the middle ear is aerated. (b) Coronal bone windowed temporal bone CT scan showing a 3-4 mm lesion lateral to the neck of the malleus (arrow). The scutum (lateral wall of epitympanum) is free of bone erosion (images courtesy of Banner University Medical Center).
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Diameter of the round window (RW) by radiologic evaluation of CT scan. The diameter was measured on the inferior edge of the RW in the transverse slice in the left ear. This case (black square) was remarkably small compared with control cases (black circles). Patients with sensorineural hearing loss were measured as control cases.
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Original magnification, ×400. No obvious calcium deposition is shown in the normal middle ear mucosa of guinea pigs (A) and rats (D). Calcium depositions are appeared as brown yellow granules in TS middle ear mucosa of guinea pigs (B) and rats (E). After captopril and losartan treated, calcium deposition is selodom displayed in guinea pigs (C) and in rats (F). Arrow: calcium deposition.
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Hematoxylin and eosin, original magnification, A, B, C: ×100 and D, E, F: ×400. Normal morphological structure of middle ear mucosa is shown in (A, D). (B, E): In TS group, significantly increased thickness, inflammatory cell infiltration, fibroblast proliferation and vascularization are illuminated. (C, F): In captopril and losartan treated group, the stroma is much thinner and vascularization is reduced than that in the TS group. Double-headed arrow: membrane thickness; arrow: vascularization.
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Compared with littermate controls (A), the middle ear epithelium in 1-month-old Enpp1asj mutant mice (B) shows an increased number of goblet cells (red asterisks). Scattered goblet cells (green asterisks) and cilia are seen in the mucociliary epithelia of control mice at 6-months of age (C); however, a layer of mucin obscures most cilia and goblet cells (arrows) in age-matched Enpp1asj mutant mice (D). Scale bars = 25μm.
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Original magnification, ×400. Few positive cells are observed in normal middle ear mucosa of the guinea pigs (A) and rats (D). Only some positive cells are seen in epithelial cells. In the TS group of the guinea pigs (B) and the rats (E), numerous positive cells are displayed in fibroblasts and inflammatory cells, and mainly locate in cytoplasm of fibroblasts and inflammatory cells. Only few positive cells could be seen in captopril and losartan treated group of guinea pigs (C) and rats (F). Arrow: positive cells.
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Hematoxylin and eosin, original magnification, A, B, C: ×100 and D, E, F: ×400 (A, D). Normal morphological structure is displayed in control group. (B, E) In TS group, inflammatory cell infiltration, fibroblast proliferation and vascularization can be seen, as well as significantly increased membrane thickness. (C, F) The two panels show that, in captopril and losartan treated group, not only inflammatory cells, neovascularization and collagen fibers are decreased, but also the stroma is much thinner than that of the TS group. Double-headed arrow: membrane thickness; arrow: vascularization.
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(A) In control group, normal hearing threshold can be seen at 10 dB. (B) The hearing threshold is evidently increased in TS group with strong response at 60 dB. (C) After captopril and losartan treated, obvious improvement of hearing threshold is displayed, as clear waveforms shown at 35 dB. (D) This graph shows ABR thresthold amplitudes in rats of three different groups. Each bar represents the mean ± SEM, n = 19 (each of the three groups). *p<0.05, **p<0.01 as conducted.
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Mayer's mucincarmine method was used to visualize goblet cells (stained red) in the epithelia lining the Eustachian tube (A, B) and middle ear cavity (C, D) of mutant and control mice. A, B: Few goblet cells are seen in the epithelia lining the Eustachian tube of littermate control mice (A, empty arrow points to Eustachian tube, insert shows higher magnification of the Eustachian tube epithelia). By contrast, goblet cells are present at high density in the epithelium lining the Eustachian tube of Enpp1asj mutant mice (B, empty arrow points to Eustachian tube, magnified inset shows goblet cells, marked by arrows, in the Eustachian tube epithelia). C, D: More goblet cells are present in the epithelia in the middle ear cavity (MEC) of the asj mutant mouse (arrows in D) than in the control (C). Scale bars: A, B = 200 μm, C, D = 50 μm, A and B inserts = 20 μm.
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Expression changes of TGF-β1 in protein level are obviously observed in all groups of guinea pig (A) and rat (B). (C) In guinea pig group, statistic analysis reveals that TGF-β1 is increased in TS group, decreased in captopril and losartan treated group but still higher than that of the control group. The same tendency also can be seen in rats group (D). (E) Expression of TGF-β1 in RNA level increases in TS group, and decreases in captopril and losartan treated group at the end of week 6. Each bar represents the mean percent ± SEM, n = 19 (each of the three groups). *p<0.05, **p<0.01 as conducted.
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The X-axis represents time in milliseconds and Y-axis represents amplitude of the action potentials in microvolts. Each waveform, at a declining dB level to examine response, is stacked onto the same graph. (A) ABR threshold from the control group recorded at week 6. This panel displays a much stronger response to the stimulus and clear waveforms at 10 dB. (B) In TS group, no strong response is shown even at 60 dB. (C) Obvious response can be seen at 30 dB in a guinea pig of the captopril and losartan treated group. The graph in (D) shows ABR thresthold amplitudes in guinea pigs of three different groups. Each bar represents the mean ± standard error of the mean (SEM), n = 19 (the control group), n = 17 (the TS group), n = 19 (the captopril and losartan treated group). *p<0.05, **p<0.01 as conducted.
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ABR threshold means are shown for Enpp1asj/asj mice and littermate control mice, tested at the ages of 3 (n = 6 mutant ears/8 control ears), 6 (n = 10/10), 8 (n = 6/6), 12 (n = 22/16), 18 (n = 8/6), 26 (n = 10/8), and 30 (n = 12/14) weeks. Starting from 6 weeks of age, the mutant mice exhibit significantly higher mean ABR threshold values at all the stimulus frequencies tested (click, 8 kHz, 16 kHz, 32 kHz) compared to those of the littermate controls. Thresholds of mutant mice continue to increase with age and by 18 weeks most of the Enpp1asj/asj mice are profoundly hearing impaired. The increase in 32 kHz ABR thresholds of the control mice is due to the B6 background, a strain known to exhibit age-related hearing loss starting at high frequencies. Error bars indicate standard errors of the mean.
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A, B: Representative images of pathological changes in the middle ears of Enpp1asj mutant mice (B) compared with controls (A) at the age of 5 months. The middle ear cavity (MEC) of Enpp1asj mutant mice is filled with effusions (black asterisk), fibroblastic and amorphous tissue masses (long arrows), and inflammatory cells (arrow head). Ectopic mineralization of the otic capsule is also evident in mutant mice (open arrow in B). Control mice show a clear middle ear cavity without fibroblastic proliferation (A). C, D: The thickness of the middle ear epithelium (double headed arrows) is greater in Enpp1asj mutant mice (D) than controls (C). E, F: The stapedial artery wall (arrows) is thicker in Enpp1asjmutant mice (F) than controls (E). G, H: Representative images of discharge in mutant mice (H) and littermate controls (G) at the age of 5 months. The external ear cavity of the mutant mice is filled with discharge (red asterisk), while control mice have a clear external ear canal and easily observable tympanic membrane (black asterisk). Scale bars: A, B = 200μm, C, D = 50μm, E, F = 80 μm.
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A-D: 6–12 week time course of middle ear pathology of Enpp1asj mutant mice (B, C, D) compared with a 12-week-old control (A). At 6 weeks of age (B), an aqueous effusion (black asterisk) and a slightly thickened epithelium (arrow) are observed in the middle ear cavity of the Enpp1asj mutant mice. At 8 weeks (C), the middle ear cavity of the Enpp1asjmutant mouse is filled with an aqueous effusion (black asterisk) and contains amorphous tissue masses (green asterisk). The middle ear epithelium is much thickened (arrow), and the otic capsule exhibits regions of ectopic mineralization (arrowhead) with adjacent fibroblastic proliferation. At 12 weeks (D), the middle ear cavity of mutant mice is filled with pus-like secretions (black asterisk), a thickened epithelium (arrows), and an amorphous tissue mass (green asterisk). E, F: Eustachian tube morphology of mutant (F) and control (E) mice at 12 weeks of age. In mutant mice, an amorphous tissue mass (green asterisk) is present near the orifice of the Eustachian tube (empty arrow), which may impede Eustachian tube function and lead to an accumulation of effusion in the middle ear cavity. G, H: Cochlear morphology and round window membranes of mutant (H) and control (G) mice. Cochlear morphology is grossly normal in Enpp1asjmutant mice compared with controls; however, the round window membrane (black arrow) of mutant mice is thicker. MEC: middle ear cavity. Scale bars: A, B, C, D, E, F = 200μm, G, H = 100μm.
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