A guide to managing disorders of the ear pinna and canal.

This review will help you troubleshoot everything from infections and foreign bodies to trauma and neoplasm.

Bisphosphonate-induced osteonecrosis of the external ear canal: a retrospective study.

In 2003, osteonecrosis of the jaw was described as an intraoral complication of bisphosphonate therapy. More recently, cases of avascular necrosis of the hip were reported in patients with long-lasting bisphosphonate therapy. Thus, it was the aim of the present study to analyze cases of benign osteonecrosis of the external ear canal and to retrospectively identify a possible relationship to long-lasting bisphosphonate therapy. 13 patients with osteonecrosis of the external ear canal operated on between 2005 and 2009 were included. Patient histories were reviewed for possible previous or current bisphosphonate therapy. Three patients with osteonecrosis of the external ear canal and long-term bisphosphonate therapy could be identified. They had been treated either for breast cancer or multiple myeloma. Certainly, the jaw is an area of increased risk for developing osteonecrosis with its high mechanical stress and intraoral bacterial flora. However, osteonecrosis of the hips and the external ear canal in patients receiving long-term bisphosphonate therapy necessitate further investigation of a possible systemic, bisphosphonate-related phenomenon.

External auditory canal and middle ear relapse of acute promyelocytic leukemia treated with arsenic trioxide: case report and review of the literature.

Extramedullary involvement occurs infrequently in acute promyelocytic leukemia and is said to be more common after treatment with all-trans retinoic acid. We describe a 9-year-old girl who had an isolated external auditory canal and middle ear relapse after treatment with all-trans retinoic acid and chemotherapy. A patient with cytogenetically and molecularly confirmed acute promyelocytic leukemia developed isolated extramedullary relapse in the auditory canal and middle ear 4 years and 9 months after initial diagnosis, while in hematologic and molecular remission, successfully treated with arsenic trioxide alone.

Regression of Kaposi's sarcoma lesions following highly active antiretroviral therapy in an HIV-infected patient.

This case report documents that highly active antiretroviral therapy (HAART) can lead to the regression of Kaposi's sarcoma (KS) lesions in the auditory canal of an HIV-infected male from Chennai, India. In resource-limited settings where administering anti-KS chemotherapeutic agents may not be feasible, HAART alone can be an option in HIV-infected individuals with KS.

Dissociation between distortion-product and click-evoked otoacoustic emissions in sheep (Ovis aries).

Distortion-product otoacoustic emissions (DPOAEs) were weak or absent in about one-third of sheep (Ovis aries) of both sexes tested for otoacoustic emissions (OAEs) even though their click-evoked OAEs (CEOAEs) seemingly were typical of other sheep of the same sex. Various pieces of evidence suggest that the absence of measurable DPOAEs was unlikely to be attributable to anesthetic effects, a poorly located probe tip, a pressure differential between middle and outer ears, season of the year, body position during testing, temperature effects, or previous medical history. Sheep apparently can exhibit a marked dissociation between DPOAEs and CEOAEs. In those sheep having measurable DPOAEs, the DPOAEs were stronger in males than in females, which is the opposite direction of effect from the CEOAEs measured in these same sheep and in humans. In female sheep exposed to higher-than-normal levels of androgens during gestation, the measurable DPOAEs were stronger than in untreated females. Although this also was the opposite direction of effect from expected, it still was a shift in the male direction, in accord with past findings about the masculinizing effects of androgens on OAEs. In sheep, androgen exposure appears to have different effects on the mechanisms underlying DPOAEs from those underlying CEOAEs.

Intraoperative use of mitomycin C in fibrous atresia of the external auditory canal.

The ability of mitomycin C to inhibit fibroblasts in vitro has prompted its use during standard surgical procedures as a means of preventing the development of adhesions and stenosis. We conducted a prospective study to evaluate the effectiveness of topical mitomycin C in maintaining an open external auditory canal in 6 ears of 4 patients with aural fibrotic atresia who were undergoing meatoplasty. During the procedure, we applied 1 ml of mitomycin C (0.4 mg/ml) for 4 minutes to the external auditory canal (in 1 case, mitomycin C was reapplied to an ear 1 month later). Between 3 and 14 months postoperatively, the patency of the ear canal was assessed visually and hearing was evaluated audiometrically. Adequate patency was achieved in 5 of the 6 ears (83.3%), and the air-bone gap in these 5 ears had improved to 10 dB or less. No postoperative complications or sensorineural hearing loss was observed. In this very limited number of cases, we found that the intraoperative use of mitomycin C appeared to have been helpful in preventing scarring in both congenital and secondary fibrotic atresias of the external auditory canal. These preliminary results are encouraging, and a prospective, placebo-controlled study appears to be warranted.

Hepatocyte growth factor/scatter factor induces VEGF in human external auditory canal cholesteatoma cell culture.

Human external auditory canal cholesteatoma (EACC) is not often seen in otolaryngology. Some authors have noted circulatory disorders of the local blood vessels as the etiologic factor for establishing EACC. Diminished oxygen supply results in the attempt to establish angiogenesis. Hepatocyte growth factor/scatter factor (HGF/SF) and vascular endothelial growth factor (VEGF) are the most important angiogenic factors in this process. In a recent study we described strong expression of VEGF and HGF in EACC. All EACC and normal AMS cell cultures were obtained from 5 patients undergoing surgery and used at passage 3. After 16 to 72 h of incubation with 20 ng/ml HGF/SF, the expression of the VEGF protein in the supernants of the HGF/SF-treated and untreated culture was analyzed. EACC-culture cells showed a stronger baseline expression of VEGF. After 72 h of incubation with 20 ng/ml HGF/SF of HGF/SF, the expression of VEGF in normal keratinocytes was 173.4 pg/ml. The expression level of VEGF in the EACC culture was 275.73 pg/ml. We observed a 2.5-fold induction of VEGF in EACC after 72 h, which started with 1.5-fold baseline VEGF concentrations of normal keratinocytes. Our analysis showed that, in the EACC culture, VEGF was elevated after treatment with HGF/SF. HGF/SF appears to activate cellular pathways inducing release of VEGF. After purification, no fibroblasts were present in our EACC culture so as to exclude possible paracrine effects by fibroblasts.

Effect of 17 beta-estradiol on diastrophic dysplasia sulfate transporter activity in otosclerotic bone cell cultures and SaOS-2 cells.

OBJECTIVE: Diastrophic dysplasia sulfate transporter (DTDST) is involved in the regulation of bone turnover, and its activity in otosclerosis has been shown to be abnormally high. Taking into account the role of estrogens in the progression of otosclerosis, the possible effect of estrogens on DTDST was investigated in otosclerotic bone cell cultures and in SaOS-2, a human osteoblastic cell line. MATERIAL AND METHODS: Primary bone cell cultures of stapes and external auditory canal (EAC) bone were obtained from 33 patients with otosclerosis and 18 control patients undergoing cerebellopontine angle tumor surgery. These cultures were assessed in parallel with SaOS-2 cells. Estrogen receptors (ERs) were detected using reverse transcriptase polymerase chain reaction. DTDST activity was assessed by sulfate uptake at baseline and after 24 h of incubation with 17 beta-estradiol at concentrations ranging from 10(-12) to 10(-6) M. RESULTS: Stapes and EAC cultures predominantly expressed mRNA of ER alpha, while ER beta expression was predominant in SaOS-2 cells. In stapes and EAC cultures no modification of DTDST activity was observed with 10(-8) M 17 beta-estradiol. In SaOS-2 cells, DTDST activity was inhibited by 17 beta-estradiol (93.5+/-9.21 vs 83.6+/-8.83 pmol/mg protein/5 min, n=29; mean of differences=10.0+/-3.22, paired t-test, p<0.01). CONCLUSION: DTDST activity is regulated by estrogens in SaOS-2 cells, but not in primary cell cultures from stapes and EAC. This difference in the regulation mechanisms may be related to the type of estrogen receptor expressed.

Avaliaçäo terapêutica do oticerim em pacientes portadores de cerumen rígido e otites média e externa / Therapeutic evaluation of oticerim in patients in ear tract

Trinta e seis pacientes portadores de cerumen rígido foram avaliados em um estudo aberto, näo comparativo, no Estado do Rio de Janeiro, visando avaliar a eficácia do produto na remoçäo do cerumen do conduto auditivo e como coadjuvante no tratamento das otites média e externa, comprovando uma eficácia de 91,66 por cento

Experimental cholesteatoma in the rat.

The etiology of cholesteatoma is still enigmatic. Of the current theories, none has been confirmed with adequately convincing evidence. A completely suitable animal model has not hitherto been available and there is still a need for further experimental studies of this entity. As a possible experimental model we suggest dimethyl-benzanthracene induced cholesteatoma in the rat.

Avaliacao pre-operatoria na cirurgia da otite media cronica / Chronic suppurative otitis media: preoperative evaluation

A otite media cronica supurativa (OMCSup), infeccao do ouvido medio acompanhada de perfuracao timpanica e otorreia ou suas sequelas, e enfermidade frequente, particularmente na populacao mais carente, na qual o tratamento clinico primario pode ser deficiente. Diversas bacterias aerobias e anaerobias participam da infeccao do ouvido medio, principalmente Pseudomonas aeruginosa, Staphylococcus aureus e Bacterioides fragilis. Na OMCSup ativa (com otorreia), nosso tratamento inicial envolve limpeza metodica do conduto auditivo e a associacao de sulfametoxazol 800 mg+ trimetropin 160 mg po bid l4d com gotas otologicas de cloranfenicol e polimixina B. Embora empirica, essa terapeutica permite, com baixo custo, atacar os principais microrganismos, com risco inexpressivo de ototoxicidade. Cultura e antibiogramas da secrecao sao feitos apenas na falencia dessa medicacao, quando a escolha do antibiotico e baseada na bacteria (aerobia) isolada, adicionando-se metronidazol 400 mg po tid l4d, para combater presumiveis anaerobios associados. Apos, o paciente e avaliado quanto a sequelas e necessidade de tratamento cirurgico visando: 1) combater a infeccao e suas recrudescencias; 2) restaurar ou manter a audicao. Rotineiramente, sao feitos testes audiologicos e radiografias de ouvido nas posicoes de Schuller, Stenvers ou Guillen, e transorbitaria antero-posterior. Em casos especiais, podem ser necessarias tomografias lineares, e mesmo computadorizadas axiais-coronais de ouvidos, com janela ossea e para partes moles.

The effect of butyl 2-cyanoacrylate on the middle and inner ear of the chinchilla.

Butyl 2-cyanoacrylate was placed on the oval and round window of the ear of the chinchilla and was also used as an adhesive for myringoplasty with autogenous muscle fascia. Butyl 2-cyanoacrylate was found to be difficult to manipulate and moderately toxic to the middle ear; there were occasional significant reactions in the inner ear.

[Experimentally produced cholesteatoma (author's transl)]. / Tierexperimentelle Untersuchungen zur Erzeugung von Cholesteatomen.

Application of various mildly irritant substances to the posterosuperior and anteroinferior aspects of the external auditory canal of the rabbit, with intact ear drum and middle ear, produced cholesteatomas in the skin of the auditory canal, and the tympanic membrane particularly in the pars flaccida. At the anteroinferior insertion of the tympanic membrane, however, cholesteatoma growth could not be induced in these animal experiments. In severe diffuse otitis externa, secondary to the operative closure of the external auditory canal, cholesteatomas also preferably develop in the pars flaccida, the relatively thick, loose intermediate layer of connective tissue allows a rapid expansion of epithelial ridges thus favouring the formation of cholesteatoma in this region.