Clinical implications of experiments on alteration of the labyrinthine fluid pressures

Hearing is affected by changes in hydrostatic pressure of the perilymph, but very high pressures are required to produce a significant loss. Among the observed findings in cats are a rapidly reversible decrease in the sensitivity of the cochlear microphonic that is greater for low frequencies, harmonic distortion and reduction of dynamic range as measured by the input-output function for the cochlear microphonic, and a change in the summating potential from negative to positive. These changes are attributed to a temporary reduction in the size of the cochlear duct due to a shift of water molecules out of the cochlear duct into the blood until the resulting increase in osmotic pressure balances the increase in hydrostatic pressure. Consequently, the organ of Corti is biased "upward" away from the scala tympani. Increasing the hydrostatic pressure of the endolymph produces a "downward" biasing of the organ of Corti and has an opposite effect upon the summating potential. Presumably this is what happens in Meniere's disease. Because of the presence of the perilymphatic canaliculi, the locus of the hydrostatic pressure effect is assumed to be in the region of the reticular lamina. A theory has been developed to explain why cochlear function is very sensitive to relative differences between the hydrostatic pressures of the perilymph and the endolymph but is resistant to large variations in the absolute magnitudes of those pressures. Some of the clinical implications of this theory are discussed.