Cochlear implant and congenital cholesteatoma.

BACKGROUND: The occurence of cholesteatoma and cochlear implant is rare. Secondary cholesteatomas may develop as a result of cochlear implant surgery. Primarily acquired cholesteatoma is not typically associated with congenital sensorineural hearing loss or cochlear implant in children. The occurrence of congenital cholesteatoma during cochlear implant surgery has never been reported before, partly because all patients are preoperatively submitted to imaging studies which can theoretically exclude the disease. CASE PRESENTATION: We have reported a rare case of congenital cholesteatoma, found during sequential second side cochlear implantation in a 3-year-old child. The child underwent a computed tomography (CT) scan and magnetic resonance imaging (MRI) at 12 months of age, before the first cochlear implant surgery, which excluded middle ear pathology. The mass was removed as an intact pearl, without visible or microscopic violation of the cholesteatoma capsule. All the areas where middle ear structures were touching the cholesteatoma were vaporized with a laser and the cochlear implant was inserted uneventfully. Further follow-up excluded residual disease. CONCLUSION: We believe that primary, single stage placement of a cochlear implant (CI) with simultaneous removal of the congenital cholesteatoma can be performed safely. However, to prevent recurrence, the capsule of the cholesteatoma must not be damaged and complete laser ablation of the surface, where suspicious epithelial cells could remain, is recommended. In our opinion, cholesteatoma removal and cochlear implantation should be staged if these conditions are not met, and/or the disease is at a more advanced stage. It is suspected, that the incidence of congenital cholesteatoma in pediatric CI candidates is much higher that in average pediatric population.

The effect of betahistine on vestibular habituation: comparison of rotatory and sway habituation training.

This study was designed to investigate the effect of histaminergic agonists and antagonists on the acquisition of vestibular habituation. The experimental animals, pigeons, were subjected to unilateral rotatory and sway habituation training sessions. The habituation of postural reflexes and post-rotatory head nystagmus was assessed. Vestibular habituation in the control group was achieved by adopting the kinetic reflex posture after approximately 9 training sessions, and after 10 and 14 training sessions, respectively for 50% reduction of the total number of beats (TNB) and the duration of post-rotatory head nystagmus. In the sway adaptation test control pigeons needed nearly 15 training sessions while pigeons receiving betahistine adapted after approximately 8 sessions. Administration of histamine and, most notably, betahistine accelerated the process, while both H1 and H2 antagonists (clemastine, cimetidine) tended to retard it, indicating a less significant contribution of H2 receptors. The cholinergic agent physostigmine strongly retarded habituation while the anticholinergic agent scopolamine markedly accelerated it. In addition the adrenomimetic agent ephedrine also accelerated habituation while the adrenolytic agent droperidol retarded reduction of nystagmus beats. The results indicate that histaminergic receptors play a significant role in the vestibular habituation mechanism but are intricately involved with other types of receptors. Betahistine is clearly the agent of choice for attenuating vestibular effects.

[Congenital cholesteatoma in children--case reports]. / Perlaki wrodzone ucha srodkowego u dzieci--obserwacje wlasne.

The authors present three cases of congenital cholesteatoma in children. In two cases primary surgery was curative, in third patient one year after first surgery the residual cholesteatoma was diagnosed, and second surgery was performed. Finally in all cases good anatomical and functional effect was obtained. The natural history of congenital cholesteatoma, as well as surgical techniques which can be applied depending on type and location of congenital cholesteatoma are discussed. The authors emphasise the importance of early recognition of the disease. Exploratory tympanotomy, or CT scan should be applied in all cases where suspected changes are observed during otoscopy.

[Isolated sphenoiditis treated with endoscopic surgery in a child]. / Izolowane zapalenie zatoki klinowej u dziecka leczone metoda endoskopowa.

Isolated sphenoiditis in childhood is a rare entity which is often very difficult to diagnose with conventional techniques. The authors present a case of sphenoiditis in nine years old boy, where chronic rhinitis and persistent cephalqia where the main symptoms. The diagnosis was made on the base of computed tomography and nasal endoscopy. Because of lack of effect after pharmacological treatment the child was submitted to endoscopic surgery--sphenoethmoidectomy, which resulted it total recovery. The diagnosis, indications to computed tomography of paranasal sinuses in children, options of both conservative and surgical treatment and possible complications of the diseases are discussed.

[The vestibular system and migraine in children]. / Uklad przedsionkowy a migrena u dzieci.

Migraine in childhood is relatively common disease. Although clinical practice and scientific publications recognize frequent association of migraine and vestibular disorders, relationships have yet to be well defined. In present study the vestibular function was extensively tested in 20 children suffering from migraine. All the patients underwent complete neurootological examination including tonal threshold audiometry, testing of vestibulo-spinal reflexes--Romberg and Unterberger-Fukuda tests, Dix-Halpike test for BPPV, videonystagmography. On videonystagmography each patient was evaluated regarding: calibration, spontaneous nystagmus, gaze nystagmus, eye tracking test, optokinetic and positional nystagmus, and caloric testing. The same procedure have been performed regarding control group comprised of 15 healthy. All the patients with migraine presented abnormalities in vestibular testing. Analysis of the results showed that: functional state of structures forming both visuo-ocular and vestibulo-ocular structures was altered in all the migraine patients evaluated in the study, pathological findings suggest mainly central localisation of vestibular dysfunction in children suffering from migraine, the number of pathological VNG findings seems not to be correlated with the type of migraine.

[The role of the histaminergic receptor in the vestibular habituation: an experimental study]. / Znaczenie receptora histaminergicznego w habituacji przedsionkowej--badania doswiadczalne.

The aim of the study was to determine the role of histaminergic H1, H2 and H3 transmission on the acquisition of vestibular habituation in pigeons. Rotatory training was used and the intraperitoneal injections of the agonists and antagonists of receptors described above were performed before each training. The results showed that agonists of H1 and H2, and H3 antagonist facilitate vestibular habituation. On the other hand, H1 and H2 antagonists restrain this process.

[The role of neurotransmitters in the vestibular habituation: an experimental study]. / Rola przekazników synaptycznych w mechanizmie habituacji przedsionkowej--badania doswiadczalne.

The aim of the study was an evaluation of the influence that agonists and antagonists of the cholinergic and adrenergic transmission have on the acquisition and retention of habituation in a pigeon. Habituation training was performed by a rotatory test, under specific drugs influencing cholinergic and adrenergic transmission. The results show that after injection of a cholinergic antagonist or adrenergic agonist the acquisition of habituation is quicker; on the contrary, cholinergic agonists or adrenergic antagonists make this process slower. These drugs do not have any influence on the retention of habituation.

Vestibular habituation--the effect of cholinergic, adrenergic and histaminergic agents on the process.

Vestibular habituation-the effect of cholinergic, adrenergic and histaminergic agents on the process. The role of cholinergic, adrenergic and histaminergic transmission on the acquisition of vestibular habituation in pigeons is reported. 1. Cholinolytic, adrenomimetic and histaminergic agents probably clear the way for vestibular habituation in pigeons. 2. The cholinomimetic, adrenolytic and antihistaminergic effects probably inhibit the acquisition of habituation in these animals.