Immunobiological peculiarities of cholesteatoma in children: quantification of epithelial proliferation by MIB1.

Cholesteatoma in children is characterized by a more extensive and rapid growth in the middle ear and mastoid cavities. The growth characteristics of the cholesteatoma in 20 children were studied using the monoclonal antibody MIB 1, which recognizes a nuclear antigen expressed by cells in the G1, S, and G2/M phases. Specimens of normal adult auditory meatal skin (n = 15) and adult cholesteatoma (n = 15) served as controls. The tissue specimens were prepared for immunohistochemical examination using the alkaline phosphatase-antialkaline phosphatase method and an automatic image analyzer. Specimens of normal skin revealed an average MIB 1 score of 9.2 +/- 3.10%. Child and adult cholesteatomas showed higher values. The average MIB 1 score was higher in child cholesteatoma (42 +/- 9.4%) than in adult cholesteatoma (28.2 +/- 6%). This difference was statistically significant (P<.01). Our results confirm a significant increase of the proliferative rate of cholesteatoma keratinocytes in children, giving an explanation for the more aggressive clinical behavior observed in these patients.

Transvestibular approach to the internal auditory canal.

Summary--A surgical approach to the internal auditory canal is presented which as proved useful in the following circumstances: 1) as a destructive procedure in Ménière's disease, 2) as a diagnostic procedure in patients in whom an acoustic neurinoma is suspected and a labrinthectomy is indicated. In this situation the tumor may be removed during the same operative procedure, 3) for the removal of small, mobile, intracanalicular neurionomas, and 4) for complete facial nerve decompression in patients with no vestibular response and no serviceable hearing.

Histopathological observations on the cochlear changes in otosclerosis.

Alterations in the dimensions of the basilar membrane and spiral ligament have been implicated in the pathogenesis of sensorineural hearing loss in otosclerosis. The histopathological findings in nineteen temporal bones with otosclerotic involvement of the cochlear endosteum are reviewed. Hyalinization and decrease in the width of the spiral ligament are the only consistent findings related to the otosclerotic focus in these temporal bones. The width of the basilar membrane is normal. The hair cell population and the stria vascularis are normal for the age group.

[Stapedotomy, stapedectomy and revision surgery performed with laser techniques. Revision of literature]. / Estapedotomía, estapedectomía y cirugía de revisión realizados con técnica láser. Análisis de la evolución de los sistemas.

The usefulness of laser in otologic surgery, and specifically the suitability of its use in stapes surgery, is still under discussion. We intend to support the use of this method in the surgical treatment of otosclerosis, as well as to elucidate which type of laser is the most advisable one, establishing also in which stages of surgery it should be used. For this, we carry out a revision of the main opinions published in this regard in the international literature, commenting on the results and observations gathered in it. We end by setting out a number of conclusions which are the result of the analysis of the criteria put forward in the bibliography.

[Auditory neuropathy in childhood]. / Neuropatía auditiva en la infancia.

The combination of transient otoacoustic emissions (TOAE) and auditory brainstem responses (ABR) permits us to identify a group of patients with auditory neuropathy. The clinical and therapeutic aspects of these patients are a challenge for otological practice. The patients underwent ENT, neurological, and otological examination using audiometry, tympanometry, stapedial reflex, OAE, or ABR, depending on the patient. TOAE and tympanograms were normal in all cases. The stapedial reflex and ABR were absent in all cases. Logoaudiometry showed a disproportionate decrease in speech comprehension in relation to each patient's audiogram. These audiograms revealed mild-to-moderate hearing loss. These findings suggest that the lesion is sensorineural with normal function of the external hair cells. However, we could not determine if the lesion lay in the internal hair cells, the eighth cranial nerves, or both sites. The causes of hearing loss were: hyperbilirubinemia, perinatal asphyxia, or idiopathic. All the patients were treated by a speech therapist: The results obtained with hearing aids vary. Successful speech rehabilitation depends on early treatment.

[Menière's disease: diagnostic criteria, criteria to establish stages, and standards for treatment evaluation. Bibliographic review and update]. / Enfermedad de menière: criterios diagnósticos, criterios para establecer estadios y normas para la evaluación de tratamientos. Revisión bibliográfica y actualización.

If all doctors would use the same concepts to define Meniere's Disease (MD) and the same scale to either establish the different steps of the disease or to evaluate a specific treatment, it would be easy to compare our results. This would be beneficial for patients because of the possibility of giving them a more accurate information about the follow-up of their disease and the advantages of the different possibilities of treatment. Since the introduction of informatic systems a new goal appeared: large databases could be achieved, as a result of being able to gather the different database that are independently used in each hospital, provided that rules to establish data would be previously standardized. The purpose of this paper is to evaluate the proposal of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology and those proposed by other authors according to the stated courses of action.

Identification of proliferating keratinocytes in middle ear cholesteatoma using the monoclonal antibody Ki-67.

Cholesteatoma epithelium is characterized by a keratinocyte dysregulation with aggressive growth subsequently destroying the middle ear mucosa. The monoclonal antibody Ki-67 recognizes a nuclear antigen expressed by cells in the G1, S, and G2/M phases being used to determine the growing cell fraction in tissue samples. Cryostat sections of skin and cholesteatoma biopsies were examined immunohistochemically for reactivity with Ki-67 using the alkaline phosphatase-anti-alkaline phosphatase method. Nuclear staining was seen in a small number of keratinocytes located in the basal cell layer of normal auditory meatal skin. In contrast, numerous cells of the basal and suprabasal layers in cholesteatoma were found to react with Ki-67. A cytoplasmic staining was also observed in both skin and cholesteatoma. In cholesteatoma, the cytoplasmic staining was stronger. These results clearly show that cholesteatoma epithelium proliferates at a higher rate than normal epidermis, confirming the hyperproliferative behavior of cholesteatoma.

Estapedotomía, estapedectomía y cirugía de revisión realizados con técnica láser. Análisis de la evolución de los sistemas / Stapedotomy, stapedectomy and revision surgery performed with laser technique. Revision of literature

Se sigue discutiendo la utilidad del láser en la cirugía otológica y concretamente la adecuación de su empleo a la cirugía del estribo. Pretendemos apoyar el uso de este medio en el tratamiento quirúrgico de la otosclerosis y además dilucidar qué tipo de láser es el más aconsejable, definiendo también en qué tiempos de la cirugía puede emplearse. Para ello efectuamos una revisión de las principales opiniones que al respecto han aparecido en la literatura internacional, comentando los resultados y observaciones que en ella se reúnen. Finalizamos exponiendo unas conclusiones que son fruto del análisis de los criterios expuestos en la bibliografía. (AU)

The usefulness of laser in otologic surgery, and specifically the suitability of its use in stapes surgery, is still under discussion. We intend to support the use of this method in the surgical treatment of otosclerosis, as well as to elucidate which type of laser is the most advisable one, establishing also in which stages of surgery it should be used. For this, we carry out a revision of the main opinions published in this regard in the international literature, commenting on the results and observations gathered in it. We end by setting out a number of conclusions which are the result of the analysis of the criteria put forward in the bibliography (AU)

Síndrome vestibular bilateral. Criterios diagnósticos / Bilateral vestibular syndrome. Diagnostic criteria

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