Radiological differences between HIV-positive and HIV-negative children with cholesteatoma.

INTRODUCTION: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. OBJECTIVES: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. METHODS: A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at our institute over a 6 year period. RESULTS: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to opacification of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. CONCLUSION: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.

[Identification of human papilloma viruses (HPV) in inflammatory states and ear neoplasms]. / Identyfikacja wirusów ludzkich brodawczaków (HPV) w stanach zapalnych i nowotworach uszu.

INTRODUCTION: Human Papilloma Virus has a strong relation to oropharyngeal mucosa and is considered to be responsible for a wide range of upper respiratory tract pathologies, like laryngeal papilloma. There's a hypothesis, that it plays a significant role in middle ear chronic inflammations and neoplasm's. MATERIAL AND METHODIC. The examination was carried on a group of 53 patients, 39 of which was suffering from granulation tissue chronic otitis media, 7-cholesteatomatous otitis media, 6--middle ear malignant neoplasm, and 1 middle and/or external ear benign neoplasm. The control group consisted of 5 patients operated on: otosclerosis--4 cases and post-traumatic tympanic membrane perforation--1 case. The material was postoperative tissue, like polyps, inflammatory granulation tissue, cholesteatoma masses and malignant neoplasm's tissue. RESULTS: In the whole group of 53 examined cases, HPV DNA was confirmed in 22 cases (41.5%), in that group oncogenic types 16 or 18 in 12 cases (22.6%), and in 14 cases (26.4%) types 6 or 11. In a group of chronic granulomatous otitis media DNA characteristic for Papilloma was identified in 12 cases (25.6%), in it in 9 cases DNA HPV type 6 or 11 was confirmed, and in 7 cases type 16 or 18. Among cholesteatomatous chronic otitis media HPV DNA types 6 or 11 was identified in 70%. In every case of middle ear malignant neoplasm a presence of high-risk DNA Papilloma types 16 or 18 was confirmed. In any case of control group HPV DNA was detected. CONCLUSIONS: The results has been compared with other authors examinations and it is claimed that they confirm the observation, that Human Papilloma Viruses may be a factor, that might play an important role in pathology of chronic otitis media and ear neoplasm's. It is concluded, that differences in percentages of HPV presence in chronic inflammations (70%) and ear neoplasm's may be explained by viral co-infection during bacterial c. o. m. Viral infection probably evolves carcinogenesis, which leads to a neoplastic growth.

Prevalence of human papillomavirus DNA in cholesteatomas.

Cholesteatomas show histomorphological features like papillary growth and koilocytosis, which are characteristic of lesions induced by human papillomaviruses (HPV). Two previous studies investigating the possible role of HPV in the development of cholesteatoma had detected HPV-6 and HPV-11 DNA with a prevalence differing from 3 to 36%. The aim of the presented study was to evaluate the prevalence of different HPV types in cholesteatomas using a sensitive detection system for HPV DNA. Twenty-nine biopsies from cholesteatomas were screened for HPV DNA with a 2-step broad-spectrum PCR (PCR and nested PCR). HPV-positive products were directly sequenced by means of a cycle sequencing approach. Sensitivity of the applied broad-spectrum PCR was 0.1 copy/genome. One out of 29 biopsies showed a positive signal on the nested PCR level. Considering the low prevalence (1/29 biopsies) of detected HPV DNA in cholesteatomas, infections with common HPV types are unlikely to be a causative factor.

Correlation of clinical and surgical findings to histological features (koilocytosis, papillary hyperplasia) suggesting papillomavirus involvement in the pathogenesis of cholesteatoma.

BACKGROUND: The clinical course of cholesteatoma is rather unpredictable, as some cases show aggressive development, while others have a mild, more 'benign' nature. The aim was to correlate the clinical course and surgical findings of cholesteatomas with histological features. MATERIAL/METHODS: The study included 45 patients with cholesteatoma, 29 of whom had surgically aggressive and 16 simple (not surgically aggressive) cholesteatoma. All patients underwent mastoid surgery and the cholesteatoma specimens were sent for histological examination. RESULTS: The clinical course of the cholesteatomas had a statistically significant association (p < 0.001) with the 'aggressiveness' found in surgery, suggesting that clinical history correlates well with surgical findings. All 29 specimens of patients with surgically aggressive cholesteatoma had characteristic papillary hyperplasia of the epithelium and marked koilocytosis, suggesting papillomavirus-incduced lesions. In contrast, none of the specimens of the 16 patients with simple (non-aggressive) cholesteatoma had papillary hyperplasia and there was no marked koilocytosis, as few koilocytes could occasionally be found. The difference was statistically significant (p < 0.001). In situ hybridization for human papillomnavirus (HPV) was performed in 14 specimens (7 each with aggressive and simple cholesteatomna). Positive staining was found in three aggressive cholesteatomas. All seven simple cholesteatomas were negative for HPV. CONCLUSIONS: The results of the present paper suggest that papillomaviruses may play an important role in the pathogenesis of cholesteatomas. Further studies with controls and the development of new methods to identify known and unknown types of papillomavirus are needed to explore their exact role.

Detection of human papillomavirus in cholesteatomas.

The presence of human papillomavirus DNA in cholesteatoma may have some role in the development of middle ear cholesteatoma as well as in papilloma. In the present study, polymerase chain reaction and in situ hybridization with human papillomavirus (HPV)-6 and -11 DNA probes were used to detect the presence of HPV DNA in 32 human middle ear cholesteatomas. Only one specimen contained HPV-6 DNA. Although its occurrence may have been coincidental, it is also possible that the hyperproliferative epithelium of cholesteatomas might have some relationship with HPV infections.

[Expression of human papillomavirus DNA in cholesteatoma of the middle ear].

OBJECTIVE: To reveal the role of HPV in the occurrence and development of cholesteatoma of the middle ear. METHOD: PCR and nuclear acid hybridization were applied in screening 44 cases of middle ear cholesteatoma for detection of HPV DNA, and a comparison analysis with the pathological results of 35 cases of middle ear cholesteatoma was made. RESULTS: Pathologically, the characteristics of HPV induced-lesions was found in 12 of 35 specimens (34.3%). 44 cases of middle ear cholesteatoma were examined with consensus primers PCR and digoxigenin labeled HPV general probes. HPV DNA positive rates were 29.5% (13/44) and 25.0% (11/44) respectively. HPV DNA positive rate was 58.3% (7/12) and 13.0% (3/23) respectively in 12 cases with pathological characteristics of HPV induced-lesions and in 23 cases without those characteristics. There was significant difference(chi 2 = 7.926, P < 0.005). CONCLUSIONS: HPV infection can arouse the cleavage and proliferation of cholesteatoma epithelium and may play certain role in the occurrence and development of middle ear cholesteatoma. Aggressive, papillomatous growth and koilocytes can be served as the initial proof of HPV infection in cholesteatoma of the middle ear.

[Detection of DNA of human papillomaviruses (HPV) in an "aggressively" growing cholesteatoma. Is cholesteatoma a virus-induced tumor?]. / Nachweis der DNS humaner Papillomviren (HPV) in einem "aggressiv" wachsenden Cholesteatom. Das Cholesteatom, ein virusinduzierter Tumor?

It is yet unknown why under certain circumstances the benign epithelium covering the outer ear canal in a protective role causes an erosion of bony structures after migration into the middle ear. Histologically, a papillomatous growth and clusters of koilocytes are typical features of the aggressively growing, bone-destructive areas of the cholesteatoma. Since these resemble the characteristics of a papilloma, biopsies originating from cholesteatomas were examined for the presence of human papillomavirus (HPV) DNA. Findings demonstrated that HPV-11-related DNA was present in one such lesion. In general, papilloma viruses need specific conditions to be able to replicate and induce a papillomatous growth. Retraction pockets of epithelium, junction lines between squamous epithelium and mucosa as well as inflammatory processes may stimulate this replication. Because these conditions are characteristic for cholesteatoma, we therefore suggest a possible papillomavirus etiology for the development of aggressive cholesteatoma.

Human-papillomavirus DNA in cholesteatomas.

Cholesteatoma of the middle ear is a relatively common disorder, often with severe consequences. Histologically, the aggressively growing, bone-destructing form shows papillary growth and koilocytosis, which are characteristic of papillomavirus-induced lesions. A PCR (polymerase chain reaction) method using degenerate primers for the detection of any known or as yet unknown HPV (human papillomavirus) type was applied in screening 51 biopsies from 42 patients. A resulting 36% (16/45) of the cholesteatomas were found to contain papillomavirus DNA, which hybridized under stringent conditions with an HPV-II DNA probe. In 3 cases the presence of HPV-II DNA could be confirmed by sequencing the PCR products. The mere presence of this HPV DNA does not prove an etiological role of this group of viruses in the induction of cholesteatomas. It does, however, identify another group of human proliferative lesions putatively linked to papillomavirus infections.