RESUMO
OBJECTIVE: Mesna (i.e. sodium 2-mercaptoethanesulfonate; C2H5NaO3S2) has been used in otological surgery such as cholesteatoma dissection and tympanic membrane lateralisation in atelectatic ears. However, this study aimed to investigate its effect on cholesteatoma formation. METHODS: A total of 20 Wistar rats were divided into two groups of 10 animals. The right and left ears of control animals were treated with saline (saline control group; n = 10 ears) and propylene glycol plus saline (propylene glycol control group; n = 10 ears), respectively. In the mesna group, both ears were treated with propylene glycol plus mesna (n = 20 ears). On days 1, 8 and 15, the saline control group had intratympanic injections of 0.2 ml saline and the propylene glycol control and mesna groups had intratympanic injections of 0.2 ml 100 per cent propylene glycol. On day 22, the propylene glycol control group had a single intratympanic injection of 0.2 ml saline and the mesna group had a single intratympanic injection of 10 per cent mesna. Animals were killed 12 weeks after the last injection and the temporal bones were sent for histopathological evaluation. RESULTS: The cholesteatoma formation rate was 88 per cent in the propylene glycol control group, but was significantly lower in the mesna group (p = 0.01). There were no significant differences in granulation tissue formation (p = 0.498), cyst formation in the bulla (p = 0.381), fibrosis (p = 0.072) and epithelial hyperplasia (p = 0.081) among experimental groups. CONCLUSION: Intratympanic propylene glycol administration is an effective method of promoting experimental cholesteatoma formation. Administration of a single dose of intratympanic mesna inhibited cholesteatoma formation in an animal model.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Mesna/administração & dosagem , Substâncias Protetoras/administração & dosagem , Animais , Colesteatoma da Orelha Média/induzido quimicamente , Colesteatoma da Orelha Média/patologia , Fibrose , Tecido de Granulação/patologia , Hiperplasia , Injeção Intratimpânica , Masculino , Propilenoglicol , Ratos , Ratos Wistar , Solventes , Osso Temporal/patologia , Resultado do TratamentoRESUMO
CONCLUSION: We demonstrated that repression of keratinocyte growth factor (KGF) receptor (KGFR) could be a potentially useful strategy in the conservative treatment of middle ear cholesteatoma. OBJECTIVES: Recently, the use of a selective inhibitor of the KGFR, SU5402, in an in vitro experiment resulted in the inhibition of the differentiation and proliferation of epithelial cells through KGF secretion by fibroblasts isolated from the cholesteatoma. In this study, we investigated the effects of the KGFR inhibitor during middle ear cholesteatoma formation in vivo. METHODS: Based on the role of KGF in the development of cholesteatoma, Flag-hKGF cDNA driven by CMV14 promoter was transfected through electroporation into the external auditory canal of rats five times on every fourth day. Ears transfected with empty vector were used as controls. KGFR selective inhibitor (SU5402) or MEK inhibitor (PD0325901) was administered in the right ear of five rats after vector transfection. In the control, 2% DMSO in PBS was administered in the other ears after vector transfection. RESULTS: The use of a selective KGFR inhibitor, SU5402, completely prevented middle ear cholesteatoma formation in the rats.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Pirróis/uso terapêutico , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/antagonistas & inibidores , Animais , Benzamidas , Colesteatoma da Orelha Média/metabolismo , Difenilamina/análogos & derivados , Avaliação Pré-Clínica de Medicamentos , Meato Acústico Externo/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Vetores Genéticos , Masculino , Ratos Sprague-Dawley , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/metabolismo , TransfecçãoRESUMO
Cochlear implant candidates with mastoid cavity present a significant challenge to safe cochlear implantation because of possible spread of infection to the inner ear as well as an increased risk of electrode array extrusion. Closure of the external auditory canal is one of the several surgical techniques utilized to block the potential entry routes for infection and to protect the implanted device. The main concern after external auditory canal closure is the risk of developing a cholesteatoma, which can lead to an asymptomatic erosion of the temporal bone and/or cochlear implant failure. In this study we present the results of very long-term (mean 12 years) clinical and radiological follow-up in 12 patients who underwent external auditory canal closure associated with mastoid and Eustachian tube obliteration to facilitate cochlear implantation. To date, with a mean ± SD follow-up of 12 ± 4.7 years (range 5-21 years), the only complication experienced was the breakdown of the EAC closure in one patient, successfully treated by performing a rotation skin flap. The results of this study confirmed that external auditory canal closure is a reliable technique in cochlear implantation after radical mastoidectomy provided that a rigorous surgical technique is performed. A right balance between the need to reduce costs and to avoid unnecessary doses of radiation to patients and the task of a radiological surveillance may be represented by performing computed tomography 12-18 months postoperatively and then, only if clinically warranted.
Assuntos
Implante Coclear , Meato Acústico Externo , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Colesteatoma da Orelha Média/etiologia , Colesteatoma da Orelha Média/prevenção & controle , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Meato Acústico Externo/fisiopatologia , Meato Acústico Externo/cirurgia , Orelha Interna/diagnóstico por imagem , Orelha Interna/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , Tempo , Tomografia Computadorizada por Raios X/métodos , Timpanoplastia/efeitos adversos , Timpanoplastia/métodosRESUMO
OBJECTIVE: To determine whether the administration of mitomycin C prevents propylene glycol exposure from inducing middle-ear cholesteatoma and otitis media, in a rat model. METHODS: Twenty-four Wistar rats underwent intratympanic injections on days 1, 8 and 15, via the tympanic membrane pars tensa, in both the right and left ears. The right ear injection solution contained 50 per cent propylene glycol, gentamicin and saline (0.9 per cent), while the left ear solution contained 50 per cent propylene glycol, gentamicin and mitomycin C. Animals were sacrificed and examined. RESULTS: There were statistically significant differences between the control and experimental groups for tympanic bulla mucosal thickness (p = 0.004) but not for tympanic membrane thickness (p = 0.371), otomicroscopic findings (p = 0.262), or the presence of exudate (p = 0.125), fibrosis (p = 1.000) or cholesteatoma (p = 0.687). CONCLUSION: Intratympanic mitomycin C was ineffective in preventing middle-ear cholesteatoma and otitis media in this rat model.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Mitomicina/farmacologia , Otite Média/prevenção & controle , Membrana Timpânica/efeitos dos fármacos , Animais , Masculino , Análise por Pareamento , Propilenoglicol/farmacologia , Ratos , Ratos WistarRESUMO
BACKGROUND: Recurrent cholesteatoma after surgical excision occurs frequently in children. Until recently, a surgical second look was mandatory and considered as standard reference. MRI including a delayed T1 sequence after gadolinium injection and diffusion-weighted imaging (DWI) has proved its efficiency but has been evaluated mainly in adults. OBJECTIVE: Our purpose was to evaluate the accuracy of DWI to diagnose recurrence of cholesteatoma in children. MATERIALS AND METHODS: We evaluated prospectively with MRI 20 ears in 18 children who had had surgery for cholesteatoma. We compared DWI and delayed T1-weighted images following gadolinium administration with intraoperative or follow-up findings. We calculated the sensitivity and specificity of each sequence for the diagnosis of recurrent cholesteatoma. RESULTS: Sensitivity to diagnose recurrent cholesteatoma was 87% for both DWI and delayed post-gadolinium sequences, specificity was 71% and 83%, respectively. Adding both sequences, the sensitivity was 87%, the specificity 100%. There was one false negative probably due to small size recurrence. CONCLUSION: In our series, DWI was reliable to diagnose recurrent cholesteatoma in children and allows avoiding surgery when negative. However, because small recurrences less than 5 mm may be missed, follow-up must be prolonged (5 years).
Assuntos
Colesteatoma da Orelha Média/patologia , Colesteatoma da Orelha Média/cirurgia , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Adolescente , Criança , Colesteatoma da Orelha Média/prevenção & controle , Feminino , Humanos , Masculino , Projetos Piloto , Reprodutibilidade dos Testes , Prevenção Secundária , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
OBJECTIVE: To compare anatomical and audiological outcomes of ring versus 'Mercedes-Benz' cartilage-perichondrium graft tympanoplasty in patients with pars tensa cholesteatoma. STUDY DESIGN: Prospective clinical study. SETTING: Otolaryngology department, Tanta University Hospital, Egypt. PATIENTS AND METHODS: Over three years, 60 ears in 60 patients underwent surgery for either sinus or tensa retraction cholesteatoma, reconstructed using either a ring-shaped (30 ears) or Mercedes-Benz symbol shaped (30 ears) cartilage-perichondrium graft, with at least two years' follow up. Post-operative drum perforation and retraction, cholesteatoma residue and recurrence, middle-ear effusion, and hearing acuity were monitored. RESULTS: Anatomical outcomes were equivalent in both groups, but slightly better in the Mercedes group. Hearing improved significantly in both groups (pre- vs post-operative results), but significantly more so in the ring group. Within-group hearing outcomes were unaffected by cholesteatoma type or tympanoplasty type. CONCLUSION: The Mercedes-Benz technique may be superior to the ring technique in preventing neodrum retraction. However, the ring graft technique had better hearing outcomes, perhaps due to its more physiological design.
Assuntos
Colesteatoma da Orelha Média/cirurgia , Cartilagem da Orelha/transplante , Timpanoplastia/métodos , Adolescente , Audiometria , Criança , Colesteatoma da Orelha Média/prevenção & controle , Audição/fisiologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Otite Média com Derrame/epidemiologia , Estudos Prospectivos , Reoperação , Prevenção Secundária , Resultado do Tratamento , Perfuração da Membrana Timpânica/prevenção & controle , Timpanoplastia/instrumentação , Adulto JovemRESUMO
OBJECTIVE: The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma. PATIENTS: Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8-113.6 months). INTERVENTION: All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging). RESULTS: Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids. CONCLUSION: Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.
Assuntos
Colesteatoma da Orelha Média , Processo Mastoide , Procedimentos Cirúrgicos Otológicos/métodos , Adolescente , Adulto , Idoso , Criança , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/prevenção & controle , Colesteatoma da Orelha Média/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Neoplasia Residual , Prevenção Secundária , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
UNLABELLED: Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM: this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD: this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were produced from both coronal and axial planes. Two radiologists assessed the images and decided consensually that the presence of hyperintensive signal in DWI on T2, iso/hypointensive signal on T1, and absence of contrast uptake were indicative of relapsing cholesteatoma. Surgical review findings were compared to DWI scans. RESULTS: eleven of the twelve cases of recurring cholesteatoma presented hyperintensive signal in the DWI scans. None of the patients with granulation tissue in the surgical wound presented hyperintensive signal in the DWI scans. A patient with an abscess in the internal acoustic meatus also presented a hyperintensive signal in the DWI scans. Sensibility, specificity, positive predictive value and negative predictive value were 91.6%, 60.0%, 84.6%, and 75.0%, respectively. CONCLUSION: DWI combined with delayed post-contrast T1 SE sequence proved to be useful in the differential diagnosis of granulation tissue and recurring cholesteatoma.
Assuntos
Colesteatoma da Orelha Média/patologia , Colesteatoma da Orelha Média/prevenção & controle , Imagem de Difusão por Ressonância Magnética , Processo Mastoide/cirurgia , Complicações Pós-Operatórias/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Meios de Contraste , Estudos Transversais , Feminino , Humanos , Masculino , Processo Mastoide/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Tomografia Computadorizada por Raios XAssuntos
Colesteatoma da Orelha Média/prevenção & controle , Ventilação da Orelha Média/métodos , Membrana Timpânica/patologia , Membrana Timpânica/cirurgia , Criança , Pré-Escolar , Intervenção Educacional Precoce , Feminino , Seguimentos , Humanos , Masculino , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do Tratamento , Membrana Timpânica/fisiopatologiaRESUMO
A tomografia computadorizada e ressonância magnética (RM) com seqüências convencionais têm baixa especificidade para a diferenciação entre tecido de granulação e recidiva de colesteatoma. OBJETIVO: Avaliar a aplicação da RM com sequência de difusão e pós-contraste T1 tardio na detecção de recidiva de colesteatoma. MATERIAL E MÉTODO: Realizado estudo transversal prospectivo de dezessete pacientes estudados no pós-operatório de colesteatoma utilizando RM de 1.5 T com seqüência difusão, T1, T2 e pós-contraste T1 tardio nos planos coronal e axial. Dois radiologistas avaliaram e decidiram em consenso a presença de foco de hipersinal na difusão e T2, iso/hipossinal em T1 e ausência de impregnação pelo contraste como suspeitos de recidiva de colesteatoma. Os achados da revisão cirúrgica foram comparados com o resultado da RM. RESULTADOS: Onze dos doze casos de recidiva de colesteatoma apresentaram hipersinal na difusão. Todos os pacientes com tecido de granulação na cavidade cirúrgica não apresentaram alteração de sinal na difusão. Um paciente com abscesso no conduto auditivo interno também apresentou hipersinal na difusão. A sensibilidade, especificidade, valor preditivo positivo e negativo foram respectivamente 91,6 por cento, 60 por cento, 84,6 por cento e 75 por cento. CONCLUSÃO: A seqüência de difusão combinada com pós-contraste tardio pode ser útil na diferenciação entre tecido de granulação e recidiva de colesteatoma.
Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM: this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD: this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were produced from both coronal and axial planes. Two radiologists assessed the images and decided consensually that the presence of hyperintensive signal in DWI on T2, iso/hypointensive signal on T1, and absence of contrast uptake were indicative of relapsing cholesteatoma. Surgical review findings were compared to DWI scans. RESULTS: eleven of the twelve cases of recurring cholesteatoma presented hyperintensive signal in the DWI scans. None of the patients with granulation tissue in the surgical wound presented hyperintensive signal in the DWI scans. A patient with an abscess in the internal acoustic meatus also presented a hyperintensive signal in the DWI scans. Sensibility, specificity, positive predictive value and negative predictive value were 91.6 percent, 60.0 percent, 84.6 percent, and 75.0 percent, respectively. CONCLUSION: DWI combined with delayed post-contrast T1 SE sequence proved to be useful in the differential diagnosis of granulation tissue and recurring cholesteatoma.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colesteatoma da Orelha Média/patologia , Colesteatoma da Orelha Média/prevenção & controle , Imagem de Difusão por Ressonância Magnética , Processo Mastoide/cirurgia , Complicações Pós-Operatórias/diagnóstico , Meios de Contraste , Estudos Transversais , Colesteatoma da Orelha Média/cirurgia , Processo Mastoide/patologia , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: Middle ear cholesteatoma affected more than 5 million people until the 80;s. Many animal models were used, unsuccessfully, to study an alternative therapy to cholesteatoma. AIM: observe the effect of the trans-retinoic acid in the inhibition of middle ear cholesteatomas induced by propylene glycol. STUDY DESIGN: Clinical and Experimental. METHODS: 25 guinea pigs were submitted to the application of a 100% propylene glycol solution in their bulla bilaterally and a solution of trans-retinoic acid was applied locally in the external right ear, while in the left ear saline solution was applied (control ear). The guinea pigs were slaughtered and their temporal bones were prepared for macroscopic and histological analysis. RESULTS: The macroscopic findings had evidenced the presence of cholesteatoma in 25% of the right ears and 85% of the left ears (P=0.0003 *). The histological study had evidenced the presence of cholesteatoma in 30% of right ears and 75% of the left ears (P=0.0104*). CONCLUSION: The local use of the trans-retinoic acid is effective in inhibiting the induced formation of cholesteatomas in guinea pigs.
Assuntos
Antineoplásicos/uso terapêutico , Colesteatoma da Orelha Média/prevenção & controle , Propilenoglicol , Tretinoína/uso terapêutico , Administração Cutânea , Animais , Colesteatoma da Orelha Média/induzido quimicamente , Colesteatoma da Orelha Média/patologia , Modelos Animais de Doenças , Feminino , Cobaias , Masculino , Estudos ProspectivosRESUMO
O colesteatoma de orelha média atingia mais de 5 milhões de pessoas até a década de 80. Vários modelos animais já foram utilizados para alternativas de tratamento do colesteatoma sem sucesso. OBJETIVO: Estudar os efeitos do ácido trans-retinóico, uso tópico na orelha externa em cobaias, na inibição da formação do colesteatoma de orelha média induzido pelo propilenoglicol. Estudo experimental prospectivo. MATERIAL E MÉTODOS: 25 cobaias foram submetidas à aplicação de propilenoglicol a 100 por cento na bula timpânica bilateralmente e uma solução de ácido trans-retinóico foi aplicada topicamente (total de 5 aplicações) na orelha externa, região justa-timpânica, na orelha direita, enquanto na orelha esquerda aplicou-se solução fisiológica (orelha controle). As cobaias foram sacrificadas após 6 semanas do procedimento inicial e os ossos temporais foram separados, fixados e descalcificados, para análise macroscópica e histológica. RESULTADOS: Os achados macroscópicos evidenciaram a presença e suspeita de colesteatoma em 25 por cento das orelhas direitas e 85 por cento das orelhas esquerdas (P=0,0003*). Os achados histológicos dos 40 ossos temporais evidenciaram a presença de colesteatoma em 30 por cento das orelhas direitas e 75 por cento das orelhas esquerdas (P=0,0104*). CONCLUSÃO: O uso tópico do ácido trans-retinóico é efetivo na inibição da formação de colesteatoma induzido pelo propilenoglicol em cobaias.
Middle ear cholesteatoma affected more than 5 million people until the 80`s. Many animal models were used, unsuccessfully, to study an alternative therapy to cholesteatoma. AIM: observe the effect of the trans-retinoic acid in the inhibition of middle ear cholesteatomas induced by propylene glycol. STUDY DESIGN: Clinical and Experimental. METHODS: 25 guinea pigs were submitted to the application of a 100 percent propylene glycol solution in their bulla bilaterally and a solution of trans-retinoic acid was applied locally in the external right ear, while in the left ear saline solution was applied (control ear). The guinea pigs were slaughtered and their temporal bones were prepared for macroscopic and histological analysis. RESULTS: The macroscopic findings had evidenced the presence of cholesteatoma in 25 percent of the right ears and 85 percent of the left ears (P=0.0003 *). The histological study had evidenced the presence of cholesteatoma in 30 percent of right ears and 75 percent of the left ears (P=0.0104*). CONCLUSION: The local use of the trans-retinoic acid is effective in inhibiting the induced formation of cholesteatomas in guinea pigs.
Assuntos
Animais , Feminino , Cobaias , Masculino , Antineoplásicos/uso terapêutico , Colesteatoma da Orelha Média/prevenção & controle , Propilenoglicol , Tretinoína/uso terapêutico , Administração Cutânea , Colesteatoma da Orelha Média/induzido quimicamente , Colesteatoma da Orelha Média/patologia , Modelos Animais de Doenças , Estudos ProspectivosRESUMO
Retraction pockets can lead to hearing loss and cholesteatoma. Distinguishing stable from progressive disease is challenging to any otologist. The management of retraction pockets is a contentious issue with present treatment options often plagued with recurrence. The purpose of this article is to summarize recent developments in the aetiology of retraction pockets of the pars tensa, its diagnostic and management problems and to define possible future therapeutic options.
Assuntos
Otopatias/patologia , Membrana Timpânica/patologia , Adulto , Criança , Pré-Escolar , Colesteatoma da Orelha Média/fisiopatologia , Colesteatoma da Orelha Média/prevenção & controle , Otopatias/cirurgia , Tuba Auditiva/patologia , Tuba Auditiva/fisiopatologia , Feminino , Humanos , Masculino , Otite Média/etiologia , Otite Média/fisiopatologia , Recidiva , Índice de Gravidade de Doença , Membrana Timpânica/cirurgiaRESUMO
OBJECTIVE: To determine the effectiveness of the Z-meatoplasty technique for enlargement of the external auditory meatus of children undergoing modified radical mastoidectomy. DESIGN: Case series. SETTING: Pediatric otolaryngology practice in an academic setting. PATIENTS: Consecutive sample of children (< or =18 years old) who had undergone modified radical mastoidectomy performed by the author from 1995 to 2005. INTERVENTION: Z-meatoplasty technique used as part of modified radical mastoidectomy. MAIN OUTCOME MEASURE: Development of postoperative stenosis of the external auditory meatus that required additional surgery. RESULTS: A total of 28 children and 29 ears were treated with modified radical mastoidectomy during the study period. The Z-meatoplasty was used in 24 ears, and 3 (12.5%) required revision meatoplasty for meatal stenosis. Twenty-one ears (87.5%) treated with Z-meatoplasty had excellent healing and cosmesis without stenosis, during a mean follow-up period of 40 months. CONCLUSION: The Z-meatoplasty is an effective technique for use during modified radical mastoidectomy to treat children with cholesteatoma.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Meato Acústico Externo/cirurgia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Stable, self-cleansing retraction pockets of the pars tensa are common incidental findings and require no treatment. In other cases, recurrent discharge occurs and there may also be associated conductive hearing loss. In a minority of cases, cholesteatoma may develop. This paper presents the results of surgery using a graft composed of cartilage and perichondrium for retraction pockets involving the posterior half of the tympanic membrane, as well as early results using a larger graft designed to manage retraction of the entire tympanic membrane. Data on 51 patients with posterior retraction pockets are presented. Forty-two (82 per cent) patients had no aural discharge one year following surgery and the tympanic membrane was not retracted in 43 (84 per cent). The larger 'Mercedes-Benz' graft was used in four patients and the results obtained suggested that it may prove a successful technique for extensive retraction pockets.
Assuntos
Cartilagem da Orelha/transplante , Membrana Timpânica/anormalidades , Timpanoplastia/métodos , Colesteatoma da Orelha Média/prevenção & controle , Seguimentos , Humanos , Estudos Prospectivos , Resultado do TratamentoAssuntos
Colesteatoma da Orelha Média/etiologia , Colesteatoma da Orelha Média/prevenção & controle , Orelha Média/patologia , Otite Média/complicações , Adulto , Movimento Celular , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Epitélio/patologia , Humanos , Masculino , Otoscopia , Perfuração da Membrana Timpânica/complicaçõesRESUMO
The major drawback of combined approach tympanoplasty (CAT) is a relatively high rate of cholesteatoma recurrence compared to open-cavity techniques, which is thought to occur primarily by recurrence of retraction pockets. In this series of 63 CATs carried out by one surgeon, scutum reconstruction to prevent recurrent attic retraction was carried out in 43 cases. Repair with bone pate proved much more successful in achieving this (20.7%; 6/29 recurrent retraction pockets) compared to tragal cartilage (57.1%; 8/14) (Fisher's exact test, P = 0.0205) and was found to be a result of the greater incidence of cartilage resorption. Recurrence of retraction in pars tensa defects was more common as the only material used was a simple temporalis fascia graft. The mean time to development of recurrences was 21.1 months and that has important implications for follow-up. We conclude that the use of bone pate for scutum reconstructions reduces the incidence of attic retraction pockets, and therefore the risk of cholesteatoma recurrence following CAT.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Timpanoplastia/métodos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Criança , Colesteatoma da Orelha Média/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
Objetivo : Estudar os efeitos do ácido trans-retinóico, uso tópico na orelha externa e região justa à membrana timpânica em cobaias, na inibição da formação do colesteatoma de orelha média induzido pelo propilenoglicol a 100 por cento. Métodos : 25 cobaias foram submetidas à aplicação de propilenoglicol a 100 por cento na bula timpânica bilateralmente e uma solução de ácido trans-retinóico foi aplicada topicamente (total de 5 aplicações) na orelha externa, região justa-timpânica, na orelha direita, enquanto na orelha esquerda aplicou-se solução fisiológica (orelha controle). As cobaias foram sacrificadas após 6 semanas do procedimento inicial e os ossos temporais foram separados, fixados e descalcificados, para análise macroscópica e histológica. Resultados: Das 25 cobaias, 20 terminaram o estudo. As alterações otoscópicas mais comuns foram a opacidade da membrana timpânica e a formação de cerume no meato acústico externo. Os achados macroscópicos evidenciaram a presença de colesteatoma e suspeita de colesteatoma em 25 por cento das orelhas direitas e 85 por cento das orelhas esquerdas (P=0,0003*). Os achados histológicos dos 40 ossos temporais evidenciaram a presença de colesteatoma em 30 por cento das orelhas direitas e 75 por cento das orelhas esquerdas (P=0,0104*)...
Assuntos
Colesteatoma da Orelha Média/induzido quimicamente , Colesteatoma da Orelha Média/prevenção & controle , Tratamento FarmacológicoRESUMO
OBJECTIVES: This study was conducted to examine the role of matrix metalloproteinases (MMPs) and the impact of a topical MMP inhibitor, ilomostat, on the development of tympanic membrane (TM) atelectasis in the gerbil model. METHODS: Eustachian tubes were cauterized bilaterally in 19 gerbils. Thereafter, both TMs received once-daily topical treatment for 8 weeks with ilomostat or vehicle or no treatment (n = 6 or 7 per group). TM atelectasis was serially graded, and TMs were harvested at 8 weeks. Gelatin zymograms were performed to determine MMP activity. RESULTS: The mean activity levels of proenzyme and active MMP-9 and MMP-2 and degree of atelectasis did not differ between groups. TM atelectasis did not correlate to levels of enzymes across individual samples. CONCLUSIONS: Topical application of an MMP inhibitor did not significantly prevent the development of TM atelectasis. It remains to be determined whether the use of MMP inhibitors may prevent the progression of atelectasis in humans.
Assuntos
Colesteatoma da Orelha Média/prevenção & controle , Dipeptídeos/uso terapêutico , Inibidores de Metaloproteinases de Matriz , Metaloproteinases da Matriz/fisiologia , Inibidores de Proteases/uso terapêutico , Animais , Gerbillinae , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Membrana Timpânica/efeitos dos fármacosRESUMO
HYPOTHESIS: In view of the proven effectiveness of vitamin A for the treatment of hyperkeratosis, it was hypothesized that vitamin A may also be a feasible therapeutic option for cholesteatoma, which has similar histologic features. BACKGROUND: Cholesteatoma is a major cause of chronic ear disease, often requiring surgery. The recurrence rate may exceed 20%. Hyperkeratosis is a major sequela of tympanomastoid surgery, causing chronic ear hygiene problems. METHODS: The external auditory canals of 40 Mongolian gerbils were ligated to induce cholesteatomas. The ears were divided into three groups by type of treatment: group I, vitamin A drops (n = 40); group II, Cortisporin drops (n = 20); group III, no treatment (control subjects) (n = 20). Examination for the development and grade of cholesteatomas was performed after 9 months. RESULTS: Cholesteatomas developed in 26 ears (65%) of group I, 12 ears (60%) of group II, and 20 ears (100%) of group III. The differences were significant between groups I and III and groups II and III for both rate of cholesteatomas and severity of grade. There were no significant differences between groups I and II. CONCLUSION: Local treatment reduces the risk of cholesteatomas in ligated gerbilline ears. Cortisporin and vitamin A are equally effective as local treatments.