[Carcinoma of the skin of the external auditory meatus]. / Karcinom koze spoljasnjeg slusnog hodnika.

Carcinoma of the external meatus is a rare disease and a challenge to treat. Demographic and clinical characteristics of this disease are discussed for 14 patients treated in the Institute of Otorhinolaryngonlogy and Maxillofacial Surgery during the period 1993-2003. using four different clasification of the disease. All patients were treated surgically with postoperative radiotherapy. Five years survival is 100% for the II and II stage of the disease for all clasifications, and 75% for the III stage according to Pitsburg clasiffication. Reccurence of the disease in the first year after treatment is 66.6% and, 84% in the second year. The diagnostic protocol is clinical examination, computed tomography of the temporal bone, nuclear magnetic resonance of the temporal bone and endocranium, ultrasound examination of the neck and parotid region and tumor biopsy. The surgical approach could be less radical, through mastoid, with postoperative

[Mastoiditis in adults: diagnostic and therapeutic aspects]. / Mastoiditis u odraslih--dijagnosticki i terapijski aspekti.

The purpose of the present study is to report our experience in the diagnosis and treatment of mastoiditis in adults. Five patients with an active chronic otitis and mastoiditis were presented. All of them had a history of chronic ear discharge for long period of time and have been diagnozed and treated sufficiently. All relevant data were analyzed from the medical records. The most common symptoms of the disease were otalgia, otorrhea and hearing loss, but the physical signs of mastoiditis (swelling, erithema and tenderness of the retroauricular region) were presented in all cases. Localization and enlargement of the pathological process within the middle ear spaces was determined by CT. All patients were treated surgically and with intravenous antibiotics. In one patient the other treatment was applied due to a specific (TBC) process in the ear. Early diagnosis and adequate treatment (surgery combined with an effective antibiotics therapy) is most important to prevent a serious complications of mastoiditis (extracranial and/or intracranial).

Facial neuroma in the internal auditory canal.

Authors presented two cases of facial neuromas in the internal auditory canal, one without facial palsy and the other with facial palsy. In both cases neuromas were occult and undiagnosed. Although in the first case neuroma was greater than the other, facial palsy was not developed. The mechanism of the facial palsy due to neuromas could not be clearly clarified.

Congenital malformations of middle and inner ears of parabiotic twins.

We describe herein the congenital malformations of the middle and inner ears in temporal bones of parabiotic, monozygotic twins. Temporal bones were removed from twin B, who had no fetal cardiac activity and was born dead at 23-4/7 weeks, and twin A, the donor or "pump" twin in intrauterine life, who died shortly after birth at 20-6/7 weeks. The temporal bones were processed routinely in celoidin, stained with hematoxylin and eosin, and examined by light microscopy. We found that twin B had Mondini's dysplasia with associated deformities of the middle ear and in general showed more developmental anomalies than twin A, and we conclude that Mondini's dysplasia with anomalies of the middle ear may occur in the parabiotic twin syndrome, and the abnormalities may be explainable as the result of vascular disturbance, which also causes other lesions in these unusual cases.

Fibrous dysplasia of the temporal bone and maxillofacial region associated with cholesteatoma of the middle ear.

Fibrous dysplasia of the temporal bone is a rare disease which may lead to progressive stenosis of the external auditory canal and the development of cholesteatoma. We present a case in which minimal symptoms were present despite a massive temporal bone fibrous dysplasia. Cholesteatoma resulted most probably secondary to external auditory canal stenosis. Retroauricular fistula developed as a result of destructive effect of cholesteatoma, that influenced previous diagnosis and treatment of this clinically silent disease.

Otitis media (silent): a potential cause of childhood meningitis.

Sixteen temporal bones from 8 infants with otitis media, who died of meningitis, and 6 controls from infants with only otitis media, were studied histologically. All bones contained middle ear effusion and residual mesenchyme, but, unlike the controls, the meningitic cases showed considerable histopathological tissue changes of chronic and acute otitis media and chronic inflammatory cells in the round window membrane and within the perilymph, the modiolus, and the cochlear aqueduct, suggesting the latter as likely portals from the inner ear to the meninges. Since all tympanic membranes were intact and 3 were histologically normal, this silent route of infection warrants medical vigilance.

Altered immunoregulation in otitis media with effusion in children: presence of serum immuno-inhibitory factors.

In the present study serum immuno-inhibitory factors in children with otitis media with effusion (OME) were evaluated. The study included 23 children with OME and 23 healthy age-and-sex-matched controls. Serum inhibitory activity (SIA) was expressed as the inhibition index of proliferative response to T-cells lectins. In almost all the children with OME the indices reflecting T-cell proliferation were below the range of those in the control group. The results suggest that the activity of the factor(s) which affect T-cell proliferation may be included in mechanisms contributing to the persistence of OME in children. Further studies are needed in order to establish the cellular and molecular aspects of serum inhibitory activity, as well as its significance in the pathogenesis of OME.

[Pathological changes of the pyramidal eminence in chronic suppurative otitis media]. / Les changements pathologiques de l'éminence pyramidale en cas d'otite chronique suppurée.

Temporal bones of patients with chronic suppurative otitis media were used for evaluation of possibility of penetration of the infection from the cavum tympani into the facial nerve via the pyramidal eminence. The infection can spread to the facial nerve in two ways: via the natural opening on the pyramidal eminence through which tendon of the musculus stapedius is passing, without bone lesions of the eminence and via the sites of bone destruction on the eminence.

[Labyrinth fistula in chronic otitis with cholesteatoma]. / Fistules labyrinthiques en cas d'otite chronique avec cholestéatome.

The authors studied 116 surgically treated patients with labyrinthine fistulae due to cholesteatoma. The fistulae were most commonly localized on the lateral semicircular canal (75%) and much less frequently involved only the oval window area (7%) and the promontory (4%). The multiple fistulae were found in 14% patients. The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. The cholesteatoma matrix was not removed from the fistula of the oval window area or the promontory or in the cases of multiple fistulae and large fistulae of the lateral semicircular canal if the cholesteatoma matrix had penetrated into the labyrinth. The fistulae on the lateral semicircular canal were covered by a piece of fascia. Postoperatively deafness occurred only very exceptionally.

[Complications of stapedectomy involving the middle ear structures]. / Komplikacije na sastivnim delovima srednjeg uva pri stapedektomiji.

On the basis of personal experience and data from literature, the authors enumerate possible complications of the middle-ear structures during stapedectomy: perforation of the eardrum, disturbed function of the chorda tympani, peripheric paralysis of the facial nerve, incus luxation, haematotympanon, inflammatory complications, late improvement of the hearing, reoperative granuloma, cholesteatoma and sudden damage of the hearing.

[Indications for surgical treatment of fractures of the pyramid of the temporal bone]. / Indikacije za hirursko lecenje fraktura piramide temporalne kosti.

On the basis of data from literature and personal experience, the authors precise indications for surgery of the fractured temporal bone. They suggest that after appeasement of neurosurgical phase of the disease operation should only be carried out if peripheric paralysis of the facial nerve, conductive deafness and otoliquorrheoa, are evident. In addition to these indications they also suggest operation in patients with chronic otitis due to injury or if this process preceded the injury.

Malignant tumours of the middle ear.

The authors present 15 patients with middle ear malignant tumours, of which 13 were squamous cell carcinomas, one was a rhabdomyosarcoma and one a malignant lymphoma. In 11 of 13 patients with squamous cell carcinoma, long-standing chronic otitis media preceded the malignant process and only in 2 patients did the tumour develop without previous chronic infection. Most of the patients presented at an advanced stage of the disease: in 6 the tumour had destroyed surrounding bone, commonly involving the endocranium; in 7 the facial nerve was paralysed and in 8 patients there was total hearing loss. The diagnosis of malignant tumour was established before surgery in 5 patients, but 8 patients were operated upon for suspected chronic otitis. Three patients died without treatment and 10 were treated: 3 with radiotherapy because the tumour was inoperable, 3 had surgery only and 4 patients had surgery and received radiotherapy post-operatively. Of 7 operated patients only 2 are alive without signs of tumour. Our findings suggest that otologists should bear in mind this disease in patients with chronic suppurative otitis and accompanying suspected symptoms. In 2 patients with rare types of sarcoma of the middle ear the diagnosis of tumour was established at an advanced stage and they could not be treated.

Indications for the surgical treatment of osteomas of the frontal and ethmoid sinuses.

Sixty-one patients with an osteoma of the frontal or ethmoid sinuses have been studied. The following indications for surgical removal of these osteomas are suggested: osteomas extending beyond the boundaries of the frontal sinus, if enlarging, if localized in the region adjacent to the nasofrontal duct, if signs of chronic sinusitis are present, osteomas of the ethmoid sinuses, irrespective of their size and if patients with osteomas complain of headache and other causes of headache have been excluded. The operation of choice is the osteoplastic flap operation.

[Errors in the diagnosis of Bell's facial nerve paralysis]. / Greske u dijagnostici Belovih paraliza nervusa facijalisa.

On the basis of personal experience, the authors present errors in the diagnosis of Bell's paralysis of the facial nerve. The commentary concerns the causes of these errors and possibilities of avoiding them.

[Intra-temporal bone paralysis of the facial nerve]. / Intratemporalne paralize facijalnog zivica.

On the basis of personal experience and data from literature, the authors enumerate causes of peripheric paralysis of the facial nerve due to diseases and injuries of the temporal bone. They made the aetiological classification of these paralyses and described some pathophysiological mechanisms of their onset.

Cholesteatoma in the oval window niche.

The histopathological changes in the oval window niche into which a cholesteatoma is spreading are described in 14 temporal bones. Extension of the matrix into the niche was found commonly. In some cases the matrix passed from the facial canal to the promontory but failed to reach the niche. The perimatrix of the cholesteatoma was composed of inflamed and vascularized granulation tissue or fibrocystic tissue. A matrix covering the walls of the niche and the footplate of the stapes or the oval window was rarely found. It was surrounded by a thin layer of non-inflamed fibrous or fibrocystic tissue which covered the niche. Bone destruction of the superstructures of the stapes was observed in 12 of the 14 cases examined. The footplate of the stapes was partially or totally destroyed in 4 cases. Bone destruction of the tympanic portion of the facial canal adjacent to the oval window niche was present in all cases. Our present studies further suggest that surgical removal of a cholesteatoma from the niche may be difficult, even when done very carefully.

Otogenic facial paralysis. A histopathological study.

The histopathological changes of the facial canal and nerve in facial paralysis due to chronic suppurative otitis madia are described in six temporal bones. Bony destruction of the facial canal was found in its tympanic segment and in its upper mastoid part in all cases, but it was particularly notable in the labyrinthine segment as well. The pathological process, cholesteatoma or granulation tissue surrounding the exposed facial nerve was inflamed in all cases. The affected facial nerve showed degenerative and inflammatory changes throughout its tympanic segment in all cases, but its mastoid segment appeared to be relatively normal. Our findings suggest that facial paralysis occurs us chronic suppurative otitis when the inflammatory process specifically involves the facial nerve trunk.