Vestibular Pathology in Meniere's Disease

描述(申请人提供)：建议项目的总体目标是描述梅尼埃病对个人内脏和前庭神经节的影响，以及病理与临床病史和前庭功能在常规测试中的关系。我们建议对梅尼埃病的前庭外周进行前瞻性研究，使用内耳消融手术标本和尸检标本。该项目将使用1)组织病理学分析、免疫组织化学和电子显微镜来研究前庭病理；2)无偏体视学以获得多个水平的形态测量：同一受试者的神经上皮、神经纤维和Scarpa神经节神经元3)临床病理相关性以及形态测量参数和标准化前庭测试之间的比较。拟研究的形态计量学参数包括：1)前庭5个内脏的I型、II型和支持细胞区域总数；2)前庭神经纤维计数和直径分布；3)Scarpa神经节神经元计数和体积分布。梅尼埃病患者的档案颞骨将用于斯卡帕神经节神经元计数。使用这一系统的前瞻性设计，我们希望回答一些重要的临床问题，如1)梅尼埃病对个体内脏的影响是否不同？2)神经上皮内脏损害的类型是否与临床病史相关？3)梅尼埃病是否影响前庭神经和神经节？4)梅尼埃病是否与斯卡帕神经节神经元萎缩有关？5)临床现象，如图玛金坠落、延迟性内淋巴积水和慢性平衡失调是否与神经上皮细胞或差异性内脏损害的特定类型有关？或者与神经元数量或大小的改变有关？6)形态测量学与传统前庭测试的异常有什么关系：卡路里麻痹，阶跃旋转测试的增益和时间常数降低？

DESCRIPTION (provided by applicant): The Overall goal of the proposed project is to describe the effects of Meniere's disease on the individual endorgans and vestibular ganglion, and how the pathology relates to the clinical history and vestibular function on routine testing. We propose a prospective study of the vestibular periphery in Meniere's disease using specimens obtained from ablative inner ear surgery and postmortem specimens. The project will use 1) histopathologic analysis, immunohistochemistry, and electron microscopy to study vestibular pathology 2) unbiased stereology to obtain morphometric measures at multiple levels: neuroepithelium, the nerve fibers, and Scarpa's ganglion neurons in the same subject 3) clinico-pathological correlations and comparisons between morphometric parameters and standarized vestibular testing. Morphometric parameters to be studied include 1) regional total type I, type II, and supporting cell counts in each of the five vestibular endorgans 2) vestibular nerve fiber counts and diameter distribution 3) Scarpa's ganglion neuronal counts and volume distribution. Archival temporal bones from patients with Meniere's disease will be used for Scarpa's ganglion neuronal counts. Using this systematic, prospective design we hope to answer important clinical questions such as 1) Does Meniere's disease affect the individual endorgans differently? 2) Can the patterns of neuroepithelial endorgan damage be correlated with clinical history? 3) Does Meniere's disease affect the vestibular nerve and ganglion? 4) Is Meniere's disease associated with an atrophy of the Scarpa's ganglion neurons? 5) Are clinical phenomenon such as Tumarkin falls, delayed endolymphatic hydrops, and chronic dysequilibrium associated with particular patterns of neuroepithelial or differential endorgan damage? or with alterations in neuronal number or size? 6) What are the morphometric correlates to abnormalities on traditional vestibular testing: caloric paresis, and decreased gain and time constant on step rotational testing?