Human endolymphatic duct: possible mechanisms of endolymph outflow.

The ultrastructure of the normal human endolymphatic duct (ED) was observed by transmission electron microscopy. The role of the epithelium, the various regions of the subepithelial space, and vasculature in the resorption of endolymph was morphologically studied in order to generate testable hypotheses of human ED function. These hypothetical mechanisms of endolymph outflow at the level of the ED are a passive transcellular movement of water across the epithelium, driven by an osmotic gradient created by a subepithelial organic matrix; an active transcellular ion exchange with a passive transepithelial outflow of water, which stresses the importance of the dilated lateral intercellular spaces; and an active transcellular vacuolar endolymph outflow, whereby high molecular weight substances are removed by the ED. These mechanisms may be useful in designing experimental studies of the ED and in interpretation of retrospective light microscopic and transmission electron microscopic studies of patients with Meniere's disease.