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Histopathologic Evaluation of Vascular Findings

in The Cochlea in Patients with Presbycusis

Natsuka Kurata, MD; Patricia A. Schachern, BS; Michael M. Paparella, MD;


Sebahattin Cureoglu, MD

Pembimbing:
dr. Arief Tjatur P, Sp. THT-KL

Rizki Widya Kirana


03012236
Fakultas Kedokteran Universitas Trisakti
Kepaniteraan Klinik Ilmu THT RSAL Mintohardjo
More than 25% of
Presbycusis or age- related
people 50 years or
hearing loss
older affected

Difficulty with sound localization


and speech discrimination

Result of cumulative
Causes ? intrinsic and extrinsic
Unclear factor
Intrinsic Factor Extrinsic Factor

•Mitochondrial DNA mutation • Bising

•Genetic disorders • Ototoxic drugs

•Hypertension • diet

•DM
•Metabolic disease
•Other systemic disease

The pathologic changes associated as


degeneration of hair cells, spiral ganglion cells, and
stria vascularis
Stria Vaskularis Maintenance of inner ear
fluid homeostasis

Quantitative
Hypotesized
Analysis

Age-related histopathologic changes Patients with presbycusis, the strial


capillaries will have an increased
of the stria vascularis and vessel walls
vessel wall thickness and the area of
in the cochlea using a sample of
the stria vascularis will be decreased
human temporal bones
compared with patients with normal
hearing
• Screened the autopsy reports of 1024 patients from the temporal bone collection at the University of Minnesota to
select cases with presbycusis

• Inclusion criteria for the presbycusis group included age of at least 60 years, a diagnosis of sensorineural hearing
loss characterized by insidious onset, bilateral symmetry, and progression of hearing loss into old age. Control
individuals were selected using medical records and otologic interview sheets. Inclusion criteria for the control
group consisted of age of at least 60 years, no clinical evidence of other ear disorders, and no description of
hearing loss in the medical record. Pure-tone audiometry had been performed between 5 months and 18 years
before death for all participants.

• We excluded individuals from both groups if they had a history of otologic diseases, such as otosclerosis or otitis
media; ototoxic drug use; head or acoustic trauma; or systemic diseases, such as diabetes mellitus or neurologic
disease

• A diagnosis of atherosclerosis was noted

• A total of 19 temporal bones from 11 patients with presbycusis and 24 temporal bones from 15 agematched
controls met the inclusion criteria

• All temporal bones had been removed at autopsy and fixed in formalin solution. Each bone was decalcified,
embedded in celloidin, and serially sectioned in the horizontal plane at a thickness of 20 μm. Every 10th section was
stained with hematoxylin-eosin and mounted on a glass slide for assessment with light microscopy.
Spiral Modiolar Artery and Vessels in Stria Vascularis

• Morphometric measurement of the wall of the spiral modiolar artery, a main end
artery providing cochlear blood flow, was performed in perpendicular cross
sections
Statistical Analysis

Data were analyzed from October 1 to December 15, 2014. Statistical


evaluation was performed with the nonparametric Mann-Whitney test. The
level of significance was set at P < .05. Correlations were calculated with
the Spearman rank correlation coefficient.
Eleven patients with presbycusis (7 men
and 4 women; age range, 67-88 years;
mean [SD] age, 78 [7] years) and 15 age
matched controls (7 men and 8 women ;
age range, 67-94 years; mean [SD] age,
79 [8] years) were included in the
analysis. Clinical records were positive for
atherosclerosis in 10 of the 11 case
patients with presbycusis and in 14 of the
15 controls.
•Thickening of capillary basal membrane has been reported to occur in
several organs with aging
•In the present study, we showed a significant increase in thickness of the walls
of the spiral modiolar arteries and the capillaries of the stria vascularis in
patients with presbycusis.
•The cochlea is supplied by the spiral modiolar artery and the cochlear branch
of the vestibulocochlear artery, which are the terminal branches of the inner
ear artery.18 Circulatory disturbance induced by microvascular problems
may be a main factor underlying sensorineural hearing loss in patients with
presbycusis because it occurs, for example, in individuals with diabetes
mellitus
•The blood-labyrinth barrier is thought to be an important homeostatic
mechanism that protects the delicate ionic balance within the labyrinth. Like
other barrier systems, tight junctions within capillaries of the stria vascularis
form the morphologic site of the blood labyrinth barrier and prevent the
passage of substances from blood into the fluid of the inner ear
•.
•Thickened vessel walls in patients with presbycusis may
compromise the function of this barrier.
•The present study showed that the number of vessels in the
stria vascularis of case patients with presbycusis was
significantly decreased compared with those of control
•Our present findings demonstrate that the area of the stria
vascularis in patients with presbycusis was significantly
decreased compared with that in controls. Degeneration of
the stria vascularis as the most common morphologic
characteristic of age-related hearing loss.
•The stria vascularis is essential for generating positive
endocochlear potential, which is necessary for auditory hair
cell function. Strial atrophy causes degeneration of hair cells
by alteration of endolymph composition
•We found a significant loss of area in the capillaries of the
stria vascularis in the presbycusis group compared with the
control group in the lower basal turn of the cochlea. The
narrowing of the vessel lumen area may cause failure of
blood flow. The disorder of blood flow may be the cause of
the atrophy.
The thickness of the cochlear vessel wall and capillaries in the stria
vascularis were increased in case patients with presbycusis. The present
study also showed that atrophy of the stria vascularis, which decreased the
area of the vessels, and the smaller number of vessels in the stria vascularis
aremore common in case patients with presbycusis than in controls. Further
studies with a larger patient population are necessary to confirm these
results. Based on the findings of our study, we can speculate that
deficiency in the circulation and perfusion of the cochlea might be one of
the factors leading to hearing impairment with aging
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