Expression of Toll-like receptors on peripheral blood white cells in acute otitis media.

OBJECTIVE: From 10 to 15% of children suffer from recurrent acute otitis media (AOM). An association between polymorphism in TLRs and their co-receptor CD14 with otitis media proneness has been described in children. Moreover, the experiments on animal models have shown that TLRs and their signaling molecules are critical for timely resolution of bacterial otitis. AIM: The aim of this study was to determine the expression of TLR1, TLR2 and TLR4 on lymphocytes, monocytes and granulocytes in peripheral blood in children with recurrent or persistent AOM. METHODS: The study was performed on a group of 25 children hospitalized for recurrent AOM, failures of previous treatments and/or acute mastoiditis. The results were compared to the control group of healthy children at the same age. The expression of TLRs on peripheral blood white cells was measured by flow cytometric analysis. The results were expressed as mean fluorescence intensity (MFI). The statistical analysis was performed using the Mann-Whitney U test. RESULTS: The highest expression of TLR was found on monocytes, the lowest on lymphocytes in both groups of children (AOM and the control one). The expression of TLR1 was the lowest and expression of TLR4 was the highest on all examined cells. The expression of all examined TLRs on monocytes was significantly higher in the AOM group. CONCLUSIONS: Peripheral blood monocytes are characterized by increased expression of TLRs in the course of recurrent AOM.

[Keratinocyte growth factor and its receptor in middle-ear cholesteatoma]. / Czynnik wzrostu komórek rogowaciejacych i jego receptor w perlaku ucha srodkowego.

AIM: Etiology of middle ear cholesteatoma is far from beeing elicidated. Current concepts postulate that cholesteatoma is the result of disturbed wound healing process. Keratinocyte growth factor (KGF) plays important role in wound healing, so it seemed interesting to assess the expression of KGF and its receptor in the cholesteatoma. MATERIAL AND METHODS: 25 cholesteatoma and 7 retraction pockets specimens were obtained from the patients during middle ear surgery. The expression of KGF and FGFR2 was evaluated by immunohistochemical staining using polyclonal antibodies. The results were analyzed depending on clinical features such as: localization, number of anatomic sites involved and presence of purulent discharge. RESULTS: KGF expression was detected in the cells of subepithelial tissue. It was observed in 4/7 (57%) of the specimens of retraction pockets and 11/25 (44%) of cholesteatoma specimens. FGFR2 expression was observed mainly in the cells of spinous layer of epithelium in 4/7 (57%) specimens of retraction pockets and 19/25 (76%) of specimens of cholesteatoma. Statistically significant (p=0.011) relationship between the presence of KGF expression in the subepithelial tissue and the presence of FGFR2 expression in the epithelium was found. There were no differences in the expression of KGF and FGFR2 between retraction pocket and cholesteatoma specimens. Also, no differences in the expression, depending on localization, extend of the cholesteatoma and presence of purulent discharge were observed. CONCLUSION: KGF and its receptor seem to play an important role in paracrine regulation of cholesteatoma growth.

The status of the contralateral ear in children with acquired cholesteatoma.

CONCLUSION: The high prevalence of pathological changes in the contralateral ear (CLE) among children treated because of middle ear cholesteatoma (MEC) was observed. Evolution of many retraction pockets into cholesteatoma points to the need for early intervention in those patients, especially those with concomitant attic retraction pockets and secretory otitis media (SOM). OBJECTIVES: The aim of the study was to assess the frequency of pathological changes in the CLE of children operated because of MEC, and to determine their clinical evolution. METHODS: Retrospective analysis was performed on the basis of medical records of 202 patients treated surgically for MEC in the years 1998-2011. The mean age of included patients was 11 years and the mean observation period was 54 months. Otoscopic findings before surgery were compared with the latest examination. RESULTS: At the time of surgery for MEC, 54.5% of CLEs presented with abnormalities. The most frequent findings were retraction of the tympanic membrane (30%) and SOM, 22.4%. Also, 7% of patients presented with bilateral MEC. Thirty-four percent (20 cases) of retraction pockets diagnosed at the beginning of the observation period required surgical intervention. During the intervention in 20% of cases (12/59 cases) diagnosis of cholesteatoma was confirmed. At the end of the observation period bilateral cholesteatoma was diagnosed in 12.9% of children.

[The status of contralateral ear in children with cholesteatoma]. / Stan ucha konralateralnego u dzieci z przewleklym zapaleniem ucha z perlakiem.

INTRODUCTION: Recently published data indicate that over 60% of patients with middle ear cholesteatoma (MEC) have concomitant changes in the contralateral ear (CE). Studies concerning the condition of the CE are few and rarely present the situation in the pediatric population. THE AIM OF THIS STUDY: was to assess the frequency of pathological changes occurring in the CE in children operated on MEC, as well as to determine their clinical evolution. MATERIAL AND METHOD: Retrospective analysis was performed on basis of medical records of 193 patients treated surgically for MEC in 1998-2008 at the Department of Pediatric Otolaryngology in Bialystok. The comparison of otoscopic evaluation before first operation with the latest examination was undertaken. The evolution of abnormalities was analyzed and the effect of age and type of cholesteatoma was assessed. RESULTS: The opposite ears were abnormal in 46.1% of patients. Most frequently observed changes in the CE were retraction pockets (23%). Cholesteatoma was found in 8 of 45 identified cases of retraction pocket. The incidence of abnormalities in the CE was not correlated with patients age or type of cholesteatoma. Cholesteatoma occurred on both sides in 9,3% of children. In these cases, the attic cholesteatoma was presented in 66.67%, tensa cholesteatoma in 16.67%. CONCLUSIONS: In patients with MEC contralateral ear should be systematically examined to detect early any abnormality, or to assess their evolution and take appropriate treatment.