Clinical characteristics of pediatric external auditory canal cholesteatoma.

BACKGROUND & OBJECTIVE: External auditory canal cholesteatoma (EACC) is caused by an invasion of squamous tissue into a localized area of periosteitis in the bony canal wall. The clinical characteristics of pediatric EACC are still unknown because of its rare occurrence. To date, only a single paper has reported that pediatric EACC has a less aggressive growth pattern compared to adult EACC. Further studies are required to understand the clinical behavior of EACC, i.e., its aggressiveness. The purpose of this study was to evaluate the clinical characteristics of pediatric EACC. MATERIALS AND METHODS: The clinical records of all patients diagnosed with EACC in our department from January 1, 2012 to February 29, 2016 were retrospectively reviewed, focusing on the extension of bone erosion, symptoms, and clinical findings. RESULTS: Seven patients had primary pediatric EACC (age range, 5-17 years). All patients showed unilateral EACC. Otalgia and intermittent otorrhea were common symptoms. Bacterial cultures were performed for four patients with otorrhea, which was controlled by diluted vinegar irrigation with a topical antibiotic solution. The most common bone destruction sites were the inferior and posterior walls. All patients required surgical treatment. Four patients (patient nos. 1, 3, 4, and 5) were treated via a postauricular transcanal approach. Three patients (patient nos. 2, 6, and 7) required mastoidectomy. CONCLUSION: Pediatric EACC is not less aggressive than adult EACC. Therefore, early diagnosis and adequate treatment are necessary. Further studies are required to elucidate the clinical features of pediatric spontaneous EACC.

Bacterial Infections and Osteoclastogenesis Regulators in Men and Women with Cholesteatoma.

One of the most distinct features of middle ear cholesteatoma is bone destruction. Aetiology of cholesteatoma is thought to be multifactorial. Endotoxins produced by bacteria are thought to initiate the inflammation process in the middle ear leading to cholesteatoma. There are physiological differences in bone metabolism between men and women. The aim of our study was the immunohistochemical evaluation of the contents of two key components of the OPG/RANK/RANKL triad-RANKL and OPG in cholesteatoma, to analyse if there are any differences between the sexes and to evaluate the bacteria species isolated from cholesteatoma just before surgical treatment and to evaluate their plausible influence on the expression of OPG and RANKL in cholesteatoma. Twenty-one adult patients with acquired cholesteatoma who underwent surgery were analysed. There were no statistically significant differences in the expression of both regulators of osteoclastogenesis between the sexes. In 38.1 % patients cholesteatoma was not infected, whereas in 61.9 % patients various bacterial infections or mycosis were found. The most frequently isolated species was Pseudomonas aeruginosa (14.29 % infections) followed by Staphylococcus aureus (9.52 % infections). There were no statistically significant differences in expression of both OPG and RANKL between uninfected and infected cholesteatomas.

Brain abscess due to Trueperella bernardiae.

We present the case of a brain abscess caused by a combination of rare organisms (Trueperella bernardiae and Peptoniphilus harei) in a patient with chronic suppurative otitis media that had been complicated by the presence of a cholesteatoma. The authors believe this is the first report published in the literature.

Infectious causes of cholesteatoma and treatment of infected ossicles prior to reimplantation by hydrostatic high-pressure inactivation.

Chronic inflammation, which is caused by recurrent infections, is one of the factors contributing to the pathogenesis of cholesteatoma. If reimplantation of autologous ossicles after a surgical intervention is intended, inactivation of planktonic bacteria and biofilms is desirable. High hydrostatic pressure treatment is a procedure, which has been used to inactivate cholesteatoma cells on ossicles. Here we discuss the potential inactivating effect of high hydrostatic pressure on microbial pathogens including biofilms. Recent experimental data suggest an incomplete inactivation at a pressure level, which is tolerable for the bone substance of ossicles and results at least in a considerable reduction of pathogen load. Further studies are necessary to access how far this quantitative reduction of pathogens is sufficient to prevent ongoing chronic infections, for example, due to forming of biofilms.

Biofilms en otorrinolaringología / Biofilms in otolaryngology

Según el Instituto de Salud de los Estados Unidos de Norteamérica «un porcentaje superior al 60% de todas las infecciones microbianas están originadas por biofilms», afirmación que puede parecernos sorprendente, pero basta que consideremos que infecciones tan comunes como las del tracto genitourinario, las producidas por el catéter, las del oído medio en los niños, la formación de la placa dental y la gingivitis son originadas por biofilms, para que esta afirmación parezca más realista. Los biofilms son conglomerados de células que viven inmersas en una matriz propia de exopolisacárido con una organización estructural y funcional compleja, resultado de una comunicación continua entre ellas. La estructura de dicha biopelícula les confiere protección contra los antibióticos y las defensas del organismo, por lo que son los responsables de innumerables infecciones recalcitrantes en todo el cuerpo humano y particularmente en oídos, senos paranasales, amígdalas y adenoides. Actualmente se investigan nuevos tratamientos que puedan ser eficaces para erradicarlos (AU)

According to the National Institute of Health of the USA, "more than 60% of all microbial infections are caused by biofilms". This can surprise us, but it is enough to consider that common infections like those of the genito-urinary tract, infections produced by catheters, middle ear infections in children, the formation of dental plaque and gingivitis are caused by biofilms, for this statement to seem more realistic. At present this is one of the subjects of great interest within medicine, particularly in otolaryngology. Bacteria have traditionally been considered to be in a free state without evident organisation, partly perhaps by the ease of studying them in this form. Nevertheless, the reality is that, in nature, the great majority of these germs form complex colonies adhered to surfaces, colonies that have received the name of biofilms. These biofilms are more common than previously thought and almost all of the people have been in contact with them in the form of infections in the teeth or humid, slippery areas. New treatments that can eradicate them are currently being investigated (AU)

Biofilm formation by otopathogenic strains of Pseudomonas aeruginosa is not consistently inhibited by ethylenediaminetetraacetic acid.

HYPOTHESIS: Biofilm formation in otopathogenic of Pseudomonas aeruginosa (OPPA) strains is inhibited by ethylenediaminetetraacetic acid (EDTA). BACKGROUND: EDTA, a widely used chelating agent, has been shown to inhibit biofilm formation in a number of bacteria. Because EDTA may be a well-tolerated reagent to inhibit biofilm formation in cases of suppurative otitis media, we asked if it might be effective in all OPPA strains isolated from chronically infected cholesteatomas. METHODS: OPPA strains were isolated from patients with infected cholesteatomas. These strains were grown into log phase then were placed in minimal media with varying concentrations of EDTA and incubated for varying periods. Biofilm production was measured colorimetrically by staining with crystal violet. RESULTS: Without added EDTA, most otopathogenic PA exhibited a distinct, but varying, time course of biofilm formation and dissolution with peak production at 12 to 18 hours. Addition of 1 mM EDTA resulted in a delay in the time to peak biofilm formation for most strains, although the amount of biofilm was not decreased. In contrast, some strains showed greater biofilm production with 1 mM EDTA compared with the untreated bacteria. Addition of 10 mM EDTA resulted in a similar effect. Some strains increased biofilm production over controls. Moreover, EDTA inhibited planktonic growth of all OPPA strains at the concentrations studied. CONCLUSION: Our hypothesis was disproven: EDTA tends to delay biofilm development, although it consistently inhibits planktonic growth. Because EDTA does not cause suppression of biofilm production in all isolates of OPPA, usefulness as an antimicrobial is questioned.

Otopathogenic Pseudomonas aeruginosa strains as competent biofilm formers.

OBJECTIVE: To determine whether Pseudomonas aeruginosa, a common cholesteatoma pathogen, known to form biofilms in other chronic infections, is capable of contributing to biofilm formation in cholesteatoma. DESIGN: We tested 12 OPPA isolates for several aspects of biofilm formation, including adherence to human keratinocytes, expression of quorum-sensing genes, twitching motility, and production of extracellular matrix as determined by both crystal violet staining and carbazole reaction. RESULTS: Ten OPPA strains demonstrated increased adherence (1.5- to 12-fold) to human keratinocytes relative to PAO1, a laboratory strain. Expression of las and rhl quorum-sensing products were detected in 11 OPPA strains. By crystal violet staining, we found biofilm formation in all OPPA strains equal to or greater than that found in PAO1 (2- to 18-fold). In addition, OPPA strains demonstrated mucoid characteristics, including down-regulation of twitching motility and increased alginate production. CONCLUSIONS: Strains of OPPA isolated from cholesteatoma are strongly adherent to keratinocytes and capable of forming biofilm. In addition, OPPA strains have mucoid characteristics in vitro. When these bacteria assume a biofilm phenotype, they are highly resistant to antibiotics and host defenses. These data suggest that OPPA can contribute to biofilm formation in cholesteatoma, leading to the persistence of this infection.

Evidence for microbial biofilms in cholesteatomas.

BACKGROUND: Sessile bacteria within biofilms are highly resistant to eradication by antimicrobial agents. Previously, we have shown that the most common organisms cultured from experimentally induced cholesteatomas are biofilm formers. Additionally, the keratin "matrix" of a cholesteatoma is an ideal environment for the support of biofilm formation. OBJECTIVE: To determine if microbial biofilms occur within the keratin matrix of infected cholesteatomas. DESIGN: We evaluated the histomorphologic characteristics of 24 human and 22 experimental cholesteatomas for evidence of biofilm formation using light and transmission electron microscopy. SUBJECTS: Human tissues were collected during surgical eradication of existing cholesteatomas. Twenty-two gerbil cholesteatomas were either spontaneously occurring or induced by external auditory canal ligation and harvested several months later. RESULTS: Gram-positive and gram-negative bacteria were seen within acellular deposits among the keratin accumulations in 21 of 22 gerbil and 16 of 24 human cholesteatomas. Regions of accumulated bacteria possessed the ultrastructural appearance of typical amorphous polysaccharide biofilm matrix. CONCLUSIONS: There is strong anatomic evidence for the presence of bacterial biofilms in experimental and human cholesteatomas. The existence of bacterial biofilms within cholesteatomas may explain the clinical characteristics of infected cholesteatomas, that is, persistence and recurrence of infection, with surgical eradication being the only effective treatment.

[Congenital cholesteatoma of temporal bone]. / Perlak wrodzony kosci skroniowej.

On the basis of 72 reports in the literature and own case, the authors described new theories on the pathogenesis of congenital cholesteatoma. They present differentiation of congenital and acquired cholesteatoma by cyto-, histochemical and immunohistochemical methods. They discuss methods of diagnosis and therapy. Attention has been called to diagnosis by CT and MR examinations.

[Cerebral abscess of otogenic origin located simultaneously in the temporal and cerebellar regions]. / Absceso cerebral de origen otógeno. Localización simultánea temporal y cerebelosa.

A 28-year-old male was seen for chronic left ear disease. A brain abscess appeared in the left temporal lobe and later spread to the cerebellum. Diagnosis was clinical and radiological. Intravenous antibiotic treatment resulted in resolution of the temporal abscess on CT. However, a new abscess that appeared in the left cerebellar hemisphere required neurosurgical debridement. The patient's microbiological cultures and history suggested an otological origin. Brain abscess is a serious complication of ear disease that requires early diagnosis and treatment.

Bilophila wadsworthia clinical isolates compared by polymerase chain reaction fingerprinting.

Bilophila wadsworthia isolates recovered from a right-ear cholesteatoma and brain abscess of the same patient were analyzed by means of polymerase chain reaction (PCR) fingerprinting with single primers (T3B and M13 core) to ascertain if they originated from the same clone. Their PCR fingerprint profiles were compared with those of three additional B. wadsworthia clinical isolates and the type strain (ATCC 49260). The two isolates from the same patient produced PCR fingerprint profiles identical to each other, regardless of which primer was used. All isolates' PCR fingerprint profiles, with use of either the T3B or M13 core primer, shared some major and minor bands. However, differences in additional major and minor bands distinguished each of the additional isolates, suggesting that there are different subgroups of B. wadsworthia.

Bacterial flora in the external ear canal and in induced cholesteatoma in the Mongolian gerbil.

We report on the bacterial flora of the external ear canal and of induced aural cholesteatoma in 14 Mongolian gerbils (Meriones unguiculatus). In the control, nonmanipulated external ear canal, gram-positive and gram-negative organisms were isolated. In the contents of the cholesteatoma sac, only monomicrobial, gram-negative isolates were found; in each animal they were different from the isolates from the nonmanipulated external ear canal. Obligate anaerobes were absent in all cases. Ligation of the external ear canal in the left ear provoked cholesteatoma in all cases.

Concentrations of ofloxacin in ear and nasal tissues.

The results of two kinetic studies examining soft tissue, cartilage and bone after uptake of oral ofloxacin [administered as 200 mg twice daily (study I/nose) or 400 mg once daily (study II/ear)] show that antibiotic concentrations lie within the therapeutic range. Findings demonstrate that 400 mg ofloxacin daily is a compliance-enhancing and effective approach to the treatment of ENT-related infections, in particular those caused by problem organisms such as Pseudomonas aeruginosa.

Cochlear hair cell loss in ears with cholesteatomas. Scanning electron microscopy study.

Cochleas from 16 Mongolian gerbils with spontaneous aural cholesteatomas, and four of similar age without cholesteatomas, were examined by scanning electron microscopy to quantify cochlear hair cell loss. Loss of hair cell stereocilia was found in all ears with cholesteatomas and was significantly increased when compared with uninvolved ears from animals of similar age. The hair cell loss associated with gerbilline cholesteatomas appeared to be most marked in the middle turn of the cochlea and increased in severity with increasing size of the cholesteatomas. Outer hair cells were affected more than inner hair cells. Inner and outer hair cell loss was not significantly different in infected cholesteatomas versus sterile cholesteatomas. The greater damage to hair cells at the middle turn compared to the basal turn suggests that these losses may be the result of some agent acting through the cochlear wall rather than through the round window.