Abstract

ABSTRACTDefects in ear canal development can cause severe hearing loss as sound waves fail to reach the middle ear. Here, we reveal new mechanisms that control human canal development and highlight for the first time the complex system of canal closure and reopening. These processes can be perturbed in mutant mice and in explant culture, mimicking the defects associated with canal atresia. The more superficial part of the canal forms from an open primary canal that closes and then reopens. In contrast, the deeper part of the canal forms from an extending solid meatal plate that opens later. Closure and fusion of the primary canal was linked to loss of periderm, with failure in periderm formation in Grhl3 mutant mice associated with premature closure of the canal. Conversely, inhibition of cell death in the periderm resulted in an arrest of closure. Once closed, re-opening of the canal occurred in a wave, triggered by terminal differentiation of the epithelium. Understanding these complex processes involved in canal development sheds light on the underlying causes of canal atresia.

Highlights

  • The external ear canal funnels sound towards the ear-drum and middle ear

  • The deeper part is formed by a solid meatal plug that extends as a thin sheet of epithelial cells which opens up (Figure 7)

  • Proliferation in the meatal plug was fairly uniform throughout the structure but it is possible that orientated cell division may play a role in extension of this tissue towards the middle ear

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Summary

Introduction

The external ear canal funnels sound towards the ear-drum and middle ear. Defects in initiation, extension or opening of the canal cause canal aplasia (absence) or atresia/stenosis (malformation/narrowing), leading to deafness and hearing loss (Schuknecht, 1975). In cases of aplasia/atresia (1 in 10,000-15,000 births) canal reconstruction is sometimes attempted (atresiaplasty), such surgery has a fairly poor history of success, hampered by the fact that the surgically constructed epithelium often collapses, fuses and becomes infected (Edfeld and Stromback, 2015). Such operative management of congenital aural atresia is one of the most challenging surgeries faced by otologists as the operation is hindered by the unpredictability and variability of deformities of the canal (Abdel-Aziz, 2013). In this paper we have investigated how the ear canal forms in human and mouse embryos, using mutant mice and explant culture to understand the mechanisms behind canal defects

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