{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:44:34Z","timestamp":1761007474040,"version":"build-2065373602"},"reference-count":60,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,5,17]],"date-time":"2016-05-17T00:00:00Z","timestamp":1463443200000},"content-version":"vor","delay-in-days":3758,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2006,2]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Labyrinthitis ossificans, the pathologic ossification of the otic capsule associated with profound deafness and loss of vestibular function occurs frequently as a sequella of bacterial meningitis and subsequent purulent labyrinthitis. Experimentally, in <jats:italic>Streptococcus pneumoniae<\/jats:italic> meningitis, it has been shown that a vigorous inflammatory response to teichoic acids in the bacterial cell wall contributes to cochlear damage and subsequent fibrosis and ossification. The hypothesis of this study is that a dilution of concentration of inflammatory mediators through cerebrospinal fluid (CSF) irrigation will lead to a reduction in both inner ear pathology and permanent hearing loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN AND SETTING<\/jats:title><jats:p>Auditory brainstem response testing was used to determine baseline hearing thresholds in 20\u00a0Mongolian gerbils (12 irrigated, 8 sham irrigated animals) at 32\u00a0kHz, 16\u00a0kHz, 8\u00a0kHz, and 4\u00a0kHz frequencies. Their thresholds at 14\u00a0days and 120\u00a0days post\u2010procedure were also obtained. <jats:italic>Streptococcus pneumoniae<\/jats:italic> meningitis was induced in both groups of animals by intrathecal (i.t.) injection of bacteria. Both groups received penicillin treatment. Forty\u2010eight hours after inoculation, both groups were implanted with i.t. inflow and outflow catheters. The irrigated group was infused continuously with artificial CSF over 36 hr at a rate of 70 \u03bcL\/hr and the outflow sampled. The tubing in the sham irrigated group was clamped (without sampling). They were sacrificed at 120\u00a0days post\u2010procedure and histomorphometric analysis carried out. The concentration of interleukin 1\u03b2 (IL\u20101\u03b2) for the CSF samples from the irrigated group were compared to samples collected from an additional control group of 8\u00a0non\u2010irrigated meningitic gerbils. IL\u20101\u03b2 was chosen to study because it is a potent pro\u2010inflammatory cytokines in bacterial meningitis that is unaffected by the neurosurgical trauma of the experimental protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty animals survived the meningitis (6 irrigation, 6 sham irrigation, 8\u00a0non\u2010irrigation meningitic controls). At Days 14 and 120 post\u2010infection, the irrigated animals manifested significantly less hearing loss with a mean loss of 28.82\u00a0dB compared to the sham irrigation group mean loss of 40.76\u00a0dB (<jats:italic>P<\/jats:italic> &lt; 0.03). The degree of hearing loss in both groups was frequency\u2010dependent with greater loss at higher frequencies (mean loss = 22.4\u00a0dB at 32\u00a0kHz, 23.0\u00a0dB at 16\u00a0kHz, 18.6\u00a0dB at 8\u00a0kHz, and 12.5\u00a0dB at 4\u00a0kHz). Histomorphometric analysis demonstrated a marked reduction in degeneration of the spiral ligament, spiral ganglion cells, and stria vascularis in experimental animals as compared to controls. Immunohistochemistry showed a significant reduction in IL\u2010\u03b21 concentrations in the irrigated animals compared to the non\u2010irrigated, infected controls (<jats:italic>P<\/jats:italic> &lt; 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Irrigation of CSF resulted in a significant reduction in post\u2010meningitic cochlear injury when compared to controls. This model for continuous cerebrospinal fluid irrigation provides a means to evaluate the effects of a dilution of inflammatory mediators on hearing loss and labyrinthitis ossificans after bacterial meningitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>SIGNIFICANCE<\/jats:title><jats:p>Despite advances in the prevention of meningitis and improved antibiotic treatment, bacterial meningitis continues to have significant associated morbidity. This study provides insight into some of the mechanisms responsible for post\u2010meningitic hearing loss and labyrinthitis ossificans and presents a novel approach to reduce these complications.<\/jats:p><jats:p>EBM rating: C\u20104<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.otohns.2005.09.022","type":"journal-article","created":{"date-parts":[[2006,2,8]],"date-time":"2006-02-08T13:25:05Z","timestamp":1139405105000},"page":"214-224","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Inhibition of Post\u2010Meningitic Cochlear Injury with Cerebrospinal Fluid Irrigation"],"prefix":"10.1002","volume":"134","author":[{"given":"A. H.","family":"Yeung","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California San Francisco CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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