Is There A System Inflammatory Effect of Cholesteatoma?

Abstract Introduction Inflammation causes squamous epithelial transformation of the mucosa in the middle ear cavity and plays a role in the onset, growth, spread, and recurrence of cholesteatoma. Objectives The objective of this study is to investigate the systemic inflammatory effect in chronic otitis with cholesteatoma. Methods The study included a total of 311 patients comprising 156 patients with a pathology diagnosis of cholesteatoma and a control group of 155 with no active inflammation. The Neutrophil-to-lymphocyte Ratio (NLR) was calculated by dividing the neutrophil value by the lymphocyte value. Results The mean NLR was 1.94 ± 0.91 in the patients with cholesteatoma and 1.94 ± 0.85 in the control group. We determined no statistically significant difference between the groups in respect of NLR (p = 0.983). We calculated the NLR as 2.01 ± 1.00 in patients with ossicle erosion and 1.82 ± 0.69 in those without ossicle erosion, 1.86 ± 0.85 in patients with bone erosion and 1.98 ± 0.95 in those without bone erosion. We determined no statistical difference between these values (p = 0.175). Conclusion The results of this study showed that NLR had no predictive value in respect of bone erosions and associated complications in patients with cholesteatoma. The inflammatory effect of cholesteatoma is not systemic but remains more local.

Perda auditiva induzida por ruído ou complicação da otite média crônica? / Noise-induced hearing loss or result of chronic otitis media?

Contexto: Quando há exposição ao ruído ocupacional acima do nível de ação recomendado ou dos limites de tolerância determinados pela NR-15, podem ocorrer alterações estruturais na orelha interna que podem evoluir para a perda auditiva induzida pelo ruído (PAIR). Objetivo: Relatar um caso de perícia judicial trabalhista por suposta PAIR. Métodos: Revisão integrativa com busca de artigos nas bases de dados da Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO). Resultados: Não houve nexo entre a perda auditiva apresentada pelo periciando e a exposição ocupacional ao ruído. Conclusão: Concluiu-se pela perda auditiva decorrente de otite média crônica supurativa, não induzida por ruído.

Context: When exposure to occupational noise reaches levels that are higher than the recommended action or tolerance thresholds determined by NR-15, there may be structural changes in the inner ear, which can evolve to noise-induced hearing loss (NIHL). Objective: To report a judicial labor investigation due to alleged NIHL. Methods: Integrative review including searches in Biblioteca Virtual em Saúde (BVS) and Scientific Electronic Library Online (SciELO) databases. Results: There was no connection between hearing loss presented by the investigated party and occupational exposure to noise. Conclusion: The investigation concluded that hearing loss was a result of chronic suppurative otitis media, not induced by noise.

Erratum: Optical Coherence Tomography for the Diagnosis and Evaluation of Human Otitis Media

We made two mistakes in our recently published article. We are correcting the authorship and funding information.

Avaliação tomográfica das orelhas contralaterais de pacientes com otite média crônica grave / Tomographic evaluation of the contralateral ear in patients with severe chronic otitis media

Alguns estudos indicam uma tendência à bilateralidade da otite média crônica. Acredita-se que a orelha contralateral possa fornecer evidências da via de formação da doença da orelha mais afetada, ser um parâmetro da função da tuba auditiva e predizer o sucesso do tratamento. A tomografia computadorizada é um excelente teste para avaliar as estruturas do osso temporal e as alterações decorrentes da da otite média. OBJETIVO: Avaliar tomografias computadorizadas (TC) de osso temporal de pacientes com otite média crônica e descrever anormalidades na orelha contralateral. MÉTODO: Estudo de Prevalências (transversal). Avaliação das TC de 75 pacientes com otite média crônica de um hospital terciário de referência no Brasil por um neurorradiologista. RESULTADOS: A população foi constituída por 50,6% do sexo masculino, com idade média de 36 anos. Encontramos 54,7% de alterações na orelha contralateral claramente relacionadas com otite média crônica. DISCUSSÃO: A prevalência de alterações radiográficas nas orelhas contralaterais de pacientes com otite média crônica corrobora com estudos clínicos, histopatológicos e funcionais desenvolvidos pelo mesmo grupo de pesquisa e sugere que esta doença tem uma característica bilateral.

Some studies indicate a bilateral tendency of chronic otitis media. It is believed that the contralateral ear can provide evidences of the route of formation of ear disease in the most affected, be a parameter of Eustachian tube function and predict successful treatment. The CT scan is an excellent test to evaluate the structures of the temporal bone and the changes resulting from otitis media. OBJECTIVE: To evaluate Temporal Bone Computed Tomography of patients with chronic otitis media and describe abnormalities in the contralateral ear. METHOD: Cross-sectional study. Evaluation of CT scans of 75 patients with chronic otitis media from a tertiary referral hospital in Brazil by a neuroradiologist. RESULTS: Population was consisted of 50.6% males with a mean age of 36 years. We found 54.7% of changes in contralateral ear clearly associated with chronic otitis media. CONCLUSION: The prevalence of radiographic changes in the contralateral ears of patients with chronic otitis media corroborates with clinical, histopathological and functional resources developed by the same group that this disease has a bilateral feature.

Frequência de manifestações otorrinolaringológicas em pacientes portadores de tuberculose pulmonar / Frequency of otorhinolaryngologies' manifestations in patients with pulmonary tuberculosis

Introdução: A tuberculose continua sendo um problema mundial e nos últimos anos teve um aumento na sua incidência principalmente pelo número crescente de pacientes com HIV. A tuberculose possui como agente etiológico o Mycobacterium tuberculosis que possui um período de latência geralmente prolongado entre a infecção inicial e a doença. Essa doença pode afetar diversos órgãos e sistemas. Objetivo: O objetivo principal do estudo era estimar a prevalência de manifestações otorrinolaringológicas em pacientes portadores de tuberculose e descrever as frequências das diferentes manifestações. Método: O estudo em questão é descritivo, transversal e prospectivo. Nele, pacientes diagnosticados com tuberculose pulmonar pelo serviço de pneumologia do ambulatório Araújo Lima da Universidade Federal do Amazonas (UFAM), em Manaus, entre o período de Julho de 2005 e Maio de 2006 foram submetidos a exame otorrinolaringológico em busca de manifestações da doença. Resultados: Foram analisados 15 casos de tuberculose pulmonar confirmada pela baciloscopia, sendo 7 do sexo feminino e 8 do sexo masculino. A maioria dos pacientes eram adultos jovens entre a terceira e quarta década de vida (46,7%). Apenas um dos pacientes possuía co-infecção com o vírus HIV. Conclusão: O acometimento otorrinolaringológico pela tuberculose foi observado em 2 pacientes correspondendo a 13,33% da amostra, sendo um paciente com otite média tuberculosa e um paciente com linfoadenopatia cervical.

Introduction: The tuberculosis continues being a world problem and in the last years had an increase in his incidence mainly by the growing number of patients with HIV. The tuberculosis has like an etiologic agent the Mycobacterium tuberculosis that possesses a period of latency generally prolonged between the initial infection and the illness. That illness can affect diverse organs and systems. M Method: This study is descriptive, transversal and prospective. Within, patients diagnosed with pulmonary tuberculosis by the service of pneumologia of the outpatient clinic Araújo Lima of the Federal University of the Amazon (UFAM), in Manaus, between the period of July of 2005 and May of 2006 were submitted to otorhinolaryngological exam in search of manifestations of the illness. Objectives: The main objective of the study was estimate the predominance of otorhinolaryngological manifestations in patients with tuberculosis and to describe the frequencies of the different manifestations. Results: They were analyzed 15 cases of pulmonary tuberculosis confirmed by the baciloscopia, being 7 of the female sex and 8 of the male sex. The majority of the patients were young adults between the third and fourth decade of life (46,7%). Only one of the patients had co-infection with the HIV virus. Conclusion: The otorhinolaryngological affection by the tuberculosis was observed in 2 patients corresponding to 13.33% of the sample, being a patient with tubercular medium otitis and a patient with linfoadenopatia cervical.

Correlação da cadeia ossicular no transoperatório com achados histológicos de colesteatomas / Hystology findings' correlation between the ossicular chain in the transoperative and cholesteatomas

A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10 por cento e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P≤0,05. RESULTADOS: Havia algum envolvimento da cadeia ossicular em 65 casos. O ossículo mais freqüentemente afetado era a bigorna, seguida pelo estribo e pelo martelo. Ao aplicarmos o coeficiente de Spearman entre o grau de comprometimento da cadeia ossicular com a idade do paciente à cirurgia, a espessura da perimatriz e o grau histológico de inflamação não foram detectadas correlações. CONCLUSÃO: Os nossos achados indicam que é praticamente universal o acometimento da cadeia ossicular na presença de colesteatoma. Não foi encontrada correção entre a erosão ossicular e os achados histológicos.

Chronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change. AIM: to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix. STUDY DESGN: Cross-sectional study. METHODS: Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10 percent formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P≤0.05. RESULTS: the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of surgery, perimatrix thickness and histological degree of inflammation, correlations were not established. CONCLUSION: Our findings indicate that ossicular chain changes are practically universal when a cholesteatoma is present. We didn't find correlations related with bone erosion and cholesteatoma's histological findings.

Disquinesia ciliar: diagnóstico ultraestructural, evolución clínica y alternativas de tratamiento / Clinical and ultrastructural features of ciliary dyskinesia

Background: Ciliary dyskinesia (CD) is a low incidence genetic illness, that presents with a wide clinical spectrum. Also, there are transitory conditions that present with ciliary anomalies, secondary to infectious diseases of the airways. Aim: To descube clinical and ultrastructural findings and clinical and therapeutic evolution of these patients. Patients and Methods: Retrospective review of medical records and electron microscopy findings of 33 patients (aged 1 to 21 years, 14 females) with ultrastructural diagnosis of CD. To obtain follow up information, a telephone survey was done. Results: In 30 patients (90 percent) the inner dynein arm (IDA) was absent in 50 or more percent of the cilia. Twenty two (66 percent) had absence of the outer dynein arm. Before diagnosis of CD, 19 patients (57 percent) presented recurrent otitis media, 25 patients (77 percent), three or more episodes of rhinosinusitis and 18 patients (56 percent) had recurrent pneumonia. Middle ear ventilation tubes were placed in 19 patients (57 percent), and during its use, 12 (68 percent) remained without othorrea. Sixteen patients (48 percent) with recurrent episodes of rhinosinusitis required adenoidectomy Seven (21 percent) required a functional endoscopic sinus surgery (FESS), and 6 (86 percent) improved after FESS. Conclusions: Our patients with CD presented recurrent infections in different airway locations. In those with a diagnosis of CD and recurrent otol¢gica! and rhinosinusal infections, IDA was absent in a high percentage of cilia. FESS and the use of ventilation tubes may have a beneficial role in a subgroup of patients with CD.

Descrição histológica de colesteatomas adquiridos: comparação entre amostras de crianças e de adultos / Histologic description of acquired cholesteatomas: comparison between children and adults

O colesteatoma é constituído de matriz, perimatriz e conteúdo cístico. Alguns autores afirmam que, em crianças, seu comportamento clínico é mais agressivo do que em adultos. OBJETIVOS: Comparar histologicamente colesteatomas de crianças e adultos. METODOLOGIA: Foram analisados 74 colesteatomas, sendo 35 de pacientes pediátricos (<18 anos) e 39 de adultos (>18 anos). Foram avaliados o número de camadas celulares e hiperplasia na matriz; espessura, epitélio delimitante, fibrose, inflamação e granuloma na perimatriz. A análise estatística foi realizada com o programa SPSS 10.0, utilizando os coeficientes de Pearson e de Spearman, testes t e de qui-quadrado. O número de camadas celulares na matriz foi de 8,2±4,2. A hiperplasia aparece em 17 por cento, a fibrose em 65 por cento, o granuloma em 12 por cento e o epitélio delimitante em 21 por cento. A perimatriz apresentou uma mediana de 80 micrômetros (37 a 232), valor mínimo zero e valor máximo 1.926. O grau histológico de inflamação foi considerado de moderado a acentuado em 60 por cento. Ao aplicarmos o coeficiente de Spearman entre o grau de inflamação e média de camadas celulares da matriz com as variáveis sumarizadoras da medida de espessura da perimatriz encontramos correlações, significativas, com magnitudes de moderadas a grandes (rs=0,5 e P<0,0001). CONCLUSÃO: Não foram identificadas diferenças morfológicas entre os colesteatomas de adultos e crianças. Encontramos correlação entre a intensidade da inflamação e da média de camadas celulares da matriz com a espessura da perimatriz, o que pode predizer sua agressividade, mais estudos são necessários para definir o papel deste achado na patogênese do colesteatoma.

Cholesteatoma is constituted of matrix, perimatrix and cystic content. Some authors affirm that, in children, its clinical behavior is more aggressive of the than in adults. AIMS: Histologic compared cholesteatomas of children and adults. METHODOLOGY: 74 cholesteatomas been analyzed, being 35 of pediatrics patients (<18 years). The average number of cellular layers and hyperplasia in the matrix had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and granuloma in the perimatrix. The analysis statistics was carried through with program SPSS 10,0, using the coefficients of Pearson and Spearman, test of qui-square and t test. The number of cellular layers in the matrix was of 8,2±4,2. The hyperplasia appears in 17 percent, fibrosis in 65 percent, granuloma in 12 percent and the delimitante epithelium in 21 percent. The perimatrix presented a medium one of 80 micrometers (37 the 232), minimum value zero and maximum value 1.926. The histological degree of inflammation was considered of moderate the accented one in 60 percent. When applying the coefficient of Spearman enters the inflammation degree and average of cellular layers of the matrix with the variables of the measure of thickness of the perimatrix we find correlations, significant, with moderate magnitudes of the great ones (rs=0,5 and P<0,0001). CONCLUSION: Adults colesteatomas of and child had not been identified to morphologic differences between. We find correlation enters the intensity of the inflammation and of the average of cellular layers of the matrix with the thickness of the perimatrix, what it can predict its aggressiveness, more studies are necessary to define the paper of this finding in pathogenesis of cholesteatoma.

Study of anatomical and functional results of myringoplasty in children

Opinions about the timing and surgical techniques of myringoplasty in children with chronic supportive otitis media have been conflicting for many years. The aim of this study was to evaluate surgical and functional results of myringoplasty in selected children with tympanic membrane perforation and assess factors potentially influencing their outcome. The study included 82 patients aged from 7 to 14 years. Forty two were females and forty were males. All of the children underwent myringoplasty using underlay technique. Higher rate of anatomical failure was observed in cases with wet middle ear mucosa and with longer duration of discharge. The relation was statistically significant. One year postoperatively, the hearing level changes in patients with take11 grafts [66 patients] were as follows, in eleven cases the air bone gaps were closed to within 10 dB or less [mean preoperative gap was 21.5 dB and mean post-operative gap was 6.2dB]. In 51 cases the gaps were improved [the mean preoperative gap was 30.3 dB and mean postoperative gap was 18.15dB]. In three cases there were no changes and in one patient the hearing deteriorated. In cases with broken graft [12 cases] one year postoperatively there was seven cases of deterioration of hearing [mean preoperative ABG was 28 dB and mean postoperative gap was 47dB]. In five cases, there were no changes between pre and post-operative ABG. The overall clinical success rate after one year was 80.5% [66/82]. The overall audiological success rate after one year was 79.5% [62/78]. These cases included 11 cases with closed gap and 55 cases with azndioZogica1 improvement. Based on our study findings, we recommend pediatric myringoplasty to preserve and restore hearing, prevent recurrent attach of chronic otitis media and leave the child to bath and participate in water activities without restriction. The operation gives the child a safe, dry and functioning ear. We also recommend proper management of the ear to get a dry ear at the time of surgery; this will increase the success rate of the operation

Comparação da espessura da perimatriz, de colesteatomas adquiridos, entre pacientes pediátricos e adultos / Correlation of cholesteatomas perimatrix thickness with patient's age

Os colesteatomas podem ocorrer tanto em crianças como em adultos, porém nas crianças apresentam um crescimento mais agressivo e extenso. Objetivo: Comparar a espessura da perimatriz, em µm, entre colesteatomas adquiridos de crianças com o de adultos. Forma de estudo: coorte transversal. Material e Método: Estudamos 74 colesteatomas, 35 pediátricos, coletados em cirurgias otológicas, fixados em formol 10% e preparadas uma lâmina em Hematoxilina-Eosina (HE) e outra em Picrossírios, para análise ao microscópio óptico. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P.

Cholesteatoma may occur either in children as in adults; in children, however, they have a more aggressive and extensive growth. Objective: To compare the thickness of the perimatrix, in µm, between adults (>18 years old) and children cholesteatomas. Study design: transversal cohort. Material and Method: 74 cholesteatomas (35 of children) obtained from othologic surgeries were included, fixed in formol 10%. It was made laminas with HE and Picrossisius, with were studied at the optic microscope. We obtained digital images of the laminas at the Image Pro-Plus and we used Spearman's coefficient for data analysis. Differences were considered statistically significant if P.

Achados otomicroscópicos e histológicos da miringoesclerose induzida em ratos: estudo crítico de um modelo experimental / Otomicroscopic and histologic findings of induced myringosclerosis in rats: a critical study of an experimental model

A miringoesclerose é caracterizada por hialinização da lâmina própria da membrana timpânica. Trabalhos experimentais têm utilizado a otomicroscopia ou a histologia para estudar a miringoesclerose em animais, porém sem correlacionar precisamente estes dois métodos de avaliação. OBJETIVO: Este estudo procura avaliar a acurácia da otomicroscopia no diagnóstico de miringoesclerose em modelo experimental com ratos. FORMA DE ESTUDO: experimental. MATERIAL E MÉTODO: Foi induzida miringoesclerose por inoculação transtimpânica de Streptococcus pneumoniae em 25 ratos Wistar, que foram examinados quinzenalmente por otomicroscopia e sacrificados após oito semanas, tendo suas membranas timpânicas examinadas por histologia. RESULTADOS: Da confrontação das alterações otomicroscópicas com os achados histológicos, houve uma sensibilidade de 80 por cento e especificidade de 75 por cento. CONCLUSÃO: Pelos resultados obtidos neste estudo, a otomicroscopia não representou um bom método para avaliar a miringoesclerose neste modelo experimental.

Otite média aguda recorrente / Acute otitis Media

Os autores fazem uma revisão bibliográfica sobre a otite média recorrente (OMR), visto que a mesma é a doença mais comum na infância, depois do resfriado. Além disso, é uma das principais causas de atendimento em pediatria, causando muita dor e sofrimento às crianças e aos seus pais

Ultrastructural Characteristics of the Round Window Membrane During Pneumococcal Otitis Media in Rat

To understand better the pathogenesis of inner ear (IE) damage caused by otitis media (OM), the round window membrane(RWM) structure was investigated in a rat model for pneumococcal otitis media (POM). The RWM of 25 rats were evaluated light and electron microscopically on 1 day, 3 days, 6 days, 10 days, and 20 days after the unilateral inoculation of type 3 pneumococcus suspension into their middle ear cavities. The thickness of the RWM increased in various stages of the pneumococcus-evoked otitis media, compared with that of the normal. The thickening was most pronounced on day 1, being about 4 to 5 times greater than that of the normal RWM. All layers of the RWM were affected by the pneumococcal infection, but the major changes were confined to the subepithelial space close to the basement membrane (BM). Together with alterations to the BM, the most distinct pathological features were characterized by an increase and hypertrophy of fibroblasts in association with abundant collagen fibers. Elastic fibers observed close to the inner mesothelial layer under a high power magnification also increased during the experiment. These results will be relevant to a better understanding of the histologic implication of RWM in stages of acute otitis media involving pneumococcus-evoked otitis media.

Eficacia comparativa de la claritromicina y la amoxicilina en el tratamiento de niños venezolanos con otitis media aguda / Comparative efficacy of clarithromycin and amoxicillin in the treatment of venezuelan children with acute otitis media

Como parte de un estudio prospectivo, comparativo, investigador-ciego, 63 niños venezolanos (Rango de Edad: 1-12 años) con otitis media aguda (OMA), fueron distribuidos de manera aleatoria en dos grupos para recibir claritromicina (Clar) oral 7,5 mg/kg TID (n=32) o amoxicilina (Amox) 14 mg/kg TID (n=31), durante 10 días. Se realizaron evaluaciones clínicas que incluían pneumo-timpanoscopía y timpanometría, inmediatamente antes del incio de cada tratamiento a las 48 horas, 4 días y 10 días durante el tratamiento, así como a los 21 días post-tratamiento, respectivamente. En todos los pacientes se practicó timpanocentesis empleando un catéter protegido, con el fin de obtener una muestra microbiológica pre-tratamiento y en las visitas subsiguientes, si estaba clínicamente indicado. En 49 (77,7 por ciento) casos, un patógeno bacteriano potencial fue identificado. Los microorganismos más frecuentemente aislados fueron: S pneumoniae (11), H. influenzae (10), S. aureus (4), S. pyogenes (4), M. catarrhalis (4), y S. epidermidis (4). Se confirmó resistencia a Amox más no a Clar en 3 de 10 cepas de H. influenzae, y en 3 de 4 de cepas de M. catarrhalis aisladas (p<0,05). La tasa de cura post-tratamiento fue 96,8 por ciento para Clar y 87,0 por ciento para Amox, respectivamente (NS). No se observaron ningunas diferencias importantes con respecto a las tasas de recaída clínica o de eventos adversos que condujeran a la suspensión del tratamiento. La Clar fue igualmente efectiva que la Amox en el tratamiento de pacientes pediátricos venezolanos con OMA, resultando tanto en una alta tasa de curación clínica como una baja tasa de eventos adversos. En países como Venezuela donde los microorganismos productores de Beta-lactamasas son frecuentes, la Clar representa una alternativa conveniente a la Amox u otros antimicrobianos menos efectivos.

Quiste dermoide mastoideo, reporte de un caso / Dermoid cyst in the mastoid process. case report

Se reporta el caso de paciente femenino de 34 años de edad, con historia de otitis media crónica y cirugía mastoidea en su infancia que en su vida adulta presenta hipoacusia conductiva unilateral progresiva, sintomatología vestibular, acúfeno y otalgia ipsilateral de un año de evolución. Los hallazgos tanto en estudios de imagen como trans operatorio fueron de una neoformación que ocupaba y ampliaba antro y mastoides con un defecto óseo hacia fosa posterior. La lesión fue resecada vía transmastoidea. El reporte histopatológico señalaba quiste dermoide mastoideo

Otitis media / Middle otitis

La Otitis Media, es uno de los motivos de consulta más frecuentes en pediatría. Por eso es necesario que manejemos muy bien los aspectos más importantes de esta enfermedad. Realizamos una revisión bibliográfica de este tema, haciendo énfasis en la etiopatogenia, métodos diagnósticos y tratamiento, esperando que esta sirva para el manejo óptimo de dicha patología

Secretory otitis media in relation to cow's milk allergy in infants and children

This study included 30 infants and children aged 7 months to 2 years suffering from secretory otitis media [SOM] either alone or in combination with allergic rhinitis [6 cases], wheezy chest [9 cases] and skin allergy [4 cases]. All cases where chosen from the ENT Clinics of Al-Azhar University Hospitals. They were 17 males and 13 females. SOM was proved through clinical examination and routine laboratory investigations, cow's milk and its products were excluded from their diet for one month, then tempanogram was performed, which proved an improvement in 12 [40%] of cases. On the other hand, improvement was observed in 2 [50%] of skin allergy, 2 [33.3%] of allergic rhinitis and only one case [11.1%] of wheezy chest. After challenge test recurrence of SOM occurred in 6 cases, allergic rhinitis in 2 cases and wheezing of chest in one case which represented 20%, 6.6% and 3.3% of all cases, respectively

Toxic labyrinthine reaction: a human temporal bone study

The study material included 240 temporal bones with various pathological conditions involving the middle ear, internal auditory meatus and otic capsule in addition to 40 normal temporal bones to serve as controls. The bones were examined for histomorphologic changes in the inner ear and its fluid content. A significant correlation has been shown between the intralabyrinthine eosinophillic reaction and many of the pathological categories included in the study. It was concluded that speculation were inferred relating the toxic labyrinthine reaction to the immune mechanisms of the inner ear, to the development of secondary endolymphatic hydrops and to the modalities of hearing loss in otitic and meningitic conditions. The pathogenesis of intralabyrinthine eosinophilic exudate was hypothesized and pathophysiology of the consequent hearing loss was discussed