The ciliary beat frequency of middle ear mucosa in children with chronic secretory otitis media.

The chronic secretory otitis media (CSOM) is a common disease in children. Its cardinal symptoms are recurrent middle ear effusions and conductive hearing loss. Until today, the pathophysiological mechanism of this disease remains unknown. The correlation with adenoids and tubal dysfunction during childhood seems to be obvious, but the origin of middle ear effusions still has to be clarified. It is known that the CSOM affects the mucociliary system in several ways. In order to find out more about these correlations, the ciliary beat frequency was examined in 123 samples of infantile middle ear mucosa suffering from CSOM. Samples were surveyed using a stroboscopic microscopy method. The results of this study showed a significant decrease of ciliary beat frequency (CBF) to an average of 7.4 s(-1) in children with a CSOM. The healthy group of control showed a frequency of 10.1 s(-1). The measured CBF dataset was correlated with microbiological findings. We found a typical bacterial profile in nearly all the cases that were examined but were unable to find a specific bacterium decreasing CBF. This study provides evidence for the diminution of CBF in cases of CSOM in comparison to a healthy control group. Our findings emphasize the importance of stopping the vicious circle of recurrent effusions by paracentesis or grommet insertion.

[Bilateral cochlea implantation in varying duration of deafness]. / Bilaterale Cochlea-Implantation bei unterschiedlicher Ertaubungsdauer.

The effectiveness of cochlear implants in profoundly deaf patients could be demonstrated in the last years. One of the problems of these patients is the decreased speech understanding in noise. Therefore bilateral cochlear implantation seems to be obvious. Another problem of unilateral cochlear implantation is to predict the better side for implantation concerning speech understanding. Only a few factors seem to help for the choice of the side for implantation. One of these is duration of deafness. In other studies short duration of deafness is a significant predictor of good word recognition. We present a case of a deaf patient with a time gap of 23 years for deafness between both ears. The patient underwent bilateral cochlear implantation (Med-el Combi 40+) as one stage procedure. After activation of the speech processor he shows better speech understanding on that ear, which is deaf for more than 25 years. In addition he has further improvement of speech understanding in noise by using both implants compared to one. In unilateral cochlear implantation selection of the side might still be difficult. In bilateral cochlear implantation the better side is always implanted, which is an other advantage of bilateral cochlear implantation.

[Alterations of the basal membrane in middle ear cholesteatoma]. / Alteraciones de la membrana basal en el colesteatoma de oído medio.

Cholesteatoma epithelium is characterized by a keratinocyte disregulation accompanied by destruction of the ossicles and other bony parts of the temporal bone. Immunohistochemical methods using antibodies to fibronectin, tenascin and metalloproteinases were used to assess the alterations of the instrinsic and extrinsic components of the basement membrane. Spatial orientation of the basement membrane was preserved in histological sections. Collagen type IV, tenascin, fibronectin, basic fibroblastic growth factor (bFGF), and matrix metalloproteinases (MMPs) are related to the matrix, perimatrix of normal or pathological tissues. They were studied immunohistologically in twenty cholesteatomas, eight samples of normal auditory canal skin, and six specimens of normal middle ear mucosa. Cholesteatomas displayed alterations of the basal membrane, with presence of MMPs and a linear immunoreactivity for collagen type IV and laminin, disrupted in areas with intense inflammation. The electronic microscope revealed protrusions, duplications, thickening and disruptions of the lamina densa of the basement membrane. Thus, we conclude, that MMPs and bFGF could play an important role maintaining the proliferative activity and the aggressive behaviour of cholesteatoma in the middle ear.

Alteraciones de la membrana basal en el colesteatoma de oído medio / Alterations of the basal membrana in middle ear cholesteatoma

El epitelio del colesteatoma se caracteriza por una disregulación de los queratinocitos acompañada de una destrucción de la cadena osicular y de otras partes óseas del hueso temporal. Los métodos inmunohistoquímicos con anticuerpos a la fibronectina, la tenascina y a las metaloproteinasas pueden emplearse para evaluar las alteraciones de los componentes intrínsecos y extrínsecos de la membrana basal. La orientación espacial queda preservada en los cortes histológicos. El colágeno tipo IV, la tenascina, la fibronectina, el factor básico de crecimiento fibroblástico (bFGF) y las metaloproteinasas de la matriz (MMP) están relacionadas con la matriz y perimatriz de tejido normal y alterado, por los que se estudian inmunohistoquímicamente, en 20 colesteatomas, 8 muestras de piel normal de CAE y 6 biopsias de mucosa normal de oídomedio. Los colesteatomas presentaron alteraciones de la membrana basal con la presencia anormal de MMP y una inmunorreactividad linear para el colágeno tipo IV y la laminina, interrumpida en zonas con una inflamación intensa. El microscopio electrónico evidenció protrusiones, duplicaciones, engrosamientos y rupturas de la lámina densa de la membrana basal. Se concluye, que las MMPs y el bFGF podrían tenerr un papel importante en el mantenimiento de la actividad proliferativa y del comportamiento agresivo del colesteatoma de oído medio (AU)

Cholesteatoma epithelium is characterized by a keratinocyte disregulation accompanied by destruction of the ossicles and other bony parts of the temporal bone. Immunohistochemical methods using antibodies to fibronectin, tenascin and metalloproteinases were used to assess the alterations of the instrinsic and extrinsic components of the basement membrane. Spatial orientation of the basement membrane was preserved in histological sections. Collagen type IV, tenascin, fibronectin, basic fibroblastic growth factor (bFGF), and matrix metalloproteinases (MMPs) are related to the matrix, perimatrix of normal or pathological tissues. They were studied immunohistologically in twenty cholesteatomas, eight samples of normal auditory canal skin, and six specimens of normal middle ear mucosa. Cholesteatomas displayed alterations of the basal membrane, with presence of MMPs and a linear immunoreactivity for collagen type IV and laminin, disrupted in areas with intense inflammation. The electronic microscope revealed protrusions, duplications, thickening and disruptions of the lamina densa of the basement membrane. Thus, we conclude, that MMPs and bFGF could play an important role maintaining the proliferative activity and the aggressive behaviour of cholesteatoma in the middle ear (AU)

Angiogenesis and angiogenic growth factors in middle ear cholesteatoma.

HYPOTHESIS: This study aimed to analyze the localization and distribution of vessels and of these angiogenic growth factors: basic fibroblast growth factor (FGF-2), transforming growth factor-alpha (TGF-alpha), transforming growth factor-beta1 (TGF-beta1), and vascular endothelial growth factor (VEGF) in middle ear cholesteatoma in comparison with normal middle ear mucosa and auditory meatal skin. BACKGROUND: Angiogenesis is particularly important in many normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for the expansion of cholesteatoma. METHODS: The expression of FGF-2, TGF-alpha, TGF-beta1, and VEGF was studied by immunohistochemistry. The amount of vessels (collagen type IV staining) was determined by an automatic imaging analyzing system. RESULTS: The results showed an altered expression and distribution of VEGF, FGF-2, TGF-alpha, and TGF-beta1 in cholesteatoma in relation to middle ear mucosa and auditory meatal skin. The results were consistent with rapidly growing, activated keratinocytes and stromal cells. Vascularization within the perimatrix of cholesteatoma showed a 4.3-fold increase compared with middle ear mucosa and a twofold increase compared with ear canal skin. An increase of 3.2- to 4-fold in the number of vessels was observed. A close relationship was seen between the density of capillaries, degree of inflammation, and expression of the angiogenic factors investigated, and an increased number of microvessels in cholesteatoma tissue. CONCLUSIONS: Angiogenesis enables and supports the sustained migration of keratinocytes into the middle ear cavity. Therefore, it is a pivotal factor in the destructive behavior of middle ear cholesteatoma.

Massive epistaxis after rupture of intracavernous carotid artery aneurysm. Case report.

We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.

[Functional and morphological defects of the mucociliary system in secretory otitis media]. / Funktionelle und morphologische Störungen des mukoziliären Systems bei der sekretorischen Otitis media.

BACKGROUND: One of the main functions of the ciliated cells of the middle ear mucosa is the continuous drainage of fluids from the middle ear cavity to the Eustachian tube. Impaired mucociliary clearance is related to disturbed clearance of middle ear secretions and results in otitis media with effusion. The aim of this study was to evaluate the ciliary beat frequency (CBF) and the ultrastructure of cilia in young patients suffering from otitis media with effusion (OME). METHODS: CBF and ciliary ultrastructure were studied in 36 patients with OME and 10 normal subjects without any history of middle ear effusion. RESULTS: The CBF was significantly decreased in the study group (6.59 Hz, +/- 1.83) compared to the controls (10.68 Hz, +/- 1.87) and the incidence of ultrastructural defects was higher than in controls. The most common defect were compound cilia, random orientation of the ciliary axes, and defects of the central microtubules. Defects of the dynein arms were not observed.

Cirugía de las malformacions mayores de oído / Surgery of the ear over malformacions

En el presente trabajo quiere informar al otolaringólogo de los pasos funfamentales de la cirugía de las atresias. Por razones embriológicas la articulación temporomandibular es retroplazada y se apoya a la pared anterior de la mastoides por falta de desarrollo del anillo timpánico. En consecuencia una parte de la caja se esconde detrás de la articulación y el neoconducto no puede ser formado en la posición normal. En muchos pacientes la situación anatómica no permite la cirugía reconstructiva. La selección cuidadosa de los casos favorables a base de la tomografía computarizada evita operaciones inútiles.

This paper intends to give a general information to the otolaryngologist on the basic steps in atresia surgery. In most cases the tympanic ring which in embryologic development eventually forms the outer ear canal is missing. Therefore the temporomandibular joint is placed backward towards the anterior wall of the mastoid. In consequence the middle ear space is partially hidden behind the articulation and cannot be reached by direct drilling in the normal position. The surgeon has to form the new canal through the mastoid. A considerable number of cases cannot be operated for anatomical reasons. A careful selection of the favorable cases based on computerized tomography avoids unessceessary surgery.

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children.

The hallmark of gastroesophageal reflux disease (GERD) is an increased exposure of esophageal and laryngeal mucosa to gastric juice. This exposure can cause complications such as chronic laryngitis or chronic respiratory diseases. We report our experience in managing three pediatric patients with severe recurrent juvenile laryngeal papillomatosis (JLP) associated with GERD. All patients showed a high rate of recurrence requiring multiple laser surgeries. Systemic alpha interferon therapy over a period of more than 1 year and photodynamic therapy with dihematoporphyrin produced no improvement. However, after therapy for GERD, the rate of recurrence of JLP decreased significantly. Although the course of respiratory papillomatosis is known to fluctuate, our findings suggest that gastroesophageal reflux may have a role in aggravating papillomatosis.

Transplantes e implantes en la cirugía del oído medio / Transplant and you implants in the middle ear

El autor muestra en el presente trabajo las diferentes opciones que hay de manejo de la cadena osicular del oído medio por alteraciones de esta en diferentes circunstancias. Se hace mensión de las posibilidades de utilización de diferentes elementos para la reconstrucción de la cadena osicular como pueden ser (hueso, diente, cartilago, metales, cerámicas, polietileno, cemento dental, etc.) muestra en el presente artículo la s estadísticas en este tipo de reconstrucción.

The author shows different options in the ossicular chain management because in different circumstances. He describes some possibilities about using a variety of elements for the ossicular chain reconstruction such as bone, teeth, polythelene, metals, ceramic, cartilage, dental clay, etc. Finally statistics abut tis kind of reconstruction is also detailed.

[Epidermoid formation in the pathogenesis of congenital cholesteatoma--a current review]. / Zur Rolle der "Epidermoid Formations" in der Pathogenese des kongenitalen Cholesteatoms--eine aktuelle Ubersicht.

BACKGROUND: Many theories have been suggested regarding the origin, pathogenesis, diagnosis, and incidence of congenital cholesteatoma. REVIEW OF LITERATURE: An overview on the current literature on congenital cholesteatoma of the middle ear is presented. It comprises the possible etiology and pathogenesis of congenital cholesteatoma. Among other theories, germ scattering, metaplasia, ingrowth of meatal epidermis, and reflux of amniotic fluid have been proposed. Special emphasis is put on the epidermoid formation theory, which has been described by Michaels and others. CONCLUSIONS: It is widely accepted that congenital cholesteatomas may originate from the postpartum persistence of epidermoid formations. Nevertheless, a clear transition from epidermoid formation to congenital cholesteatoma has yet to be confirmed.

[Autologous perichondrium-cartilage graft in the treatment of total or subtotal perforations of the tympanic membrane]. / Autologer Knorpel-Perichondrium-"Spannring" bei subtotalen oder totalen Trommelfelldefekten.

BACKGROUND: In myringoplasty or tympanoplasty, fascia of the temporalis muscle and perichondrium or cartilage-perichondrium composite grafts are most commonly used to reconstruct the tympanic membrane (TM). Primary failures or recurrent perforations in the anterior part of the TM frequently occur in cases of eustachian tube dysfunction or total perforations of the TM. The purpose of this paper is to introduce a perichondrium-cartilage composite graft for closure of total perforations of the TM. Twenty-one patients (17 adults, 4 children) were included in this study, all of whom had a total perforation of the TM. METHODS: An oval shaped piece of cartilage with perichondrium on one side was harvested from the cavum conchae. The cartilage was cut in the shape of a U without removing the inner layer of perichondrium. The inner diameter of the cartilage ring should be nearly the same as the diameter of the tympanic ring. This cartilage framework stabilizes and fixes the perichondrium and prevents the perichondrium from subsiding into the middle ear cavity. Shrinking of the perichondrium is also reduced by the cartilage ring. In all patients introduced in this study, the TM was closed and no residual perforation occurred. The hearing results in tympanoplasty were the same as in other techniques with a residual air-bone gap of about 20 dB. CONCLUSIONS: This technique seems to be a valuable method for the closure of total perforations of the TM. Especially in perforations near the anterior anular region the underlay technique with fascia or perichondrium is an uncertain method. The soft material which is only fixed by adhesion can easily be displaced during wound healing. The hearing results are comparable to that achieved in other techniques. Further studies with greater number of patients are necessary to assess long term results.

[Ototoxicity of cisplatin in children]. / Cisplatinototoxizität im Kindesalter.

BACKGROUND: The ototoxicity of cisplatin has long been well known for its damage to hair cells. However, the results of published studies vary widely with respect to the intensity and frequency of auditory damage. METHODS: We analyzed the data of 13 young children that have been treated with cisplatin for varying tumor diseases in established combination chemotherapy. The study focused on these major questions: How high is the rate of cisplatin-related incidents of hearing loss in relation to age, sex, nature of tumor, and total dosage of the administered cisplatin? How much does the supplementary application of further ototoxic medications affect the ototoxicity itself? RESULTS: Eight of 13 children examined showed regular hearing capacities in conformity with their age-group, 3 showed a bilateral, and one child showed an one-sided loss of auditory capacity. Deterioration of preexisting auditory damage was observed in one child. No relation to age, sex, nature of tumor, or dosage of administered cisplatin was established. Bilateral hearing loss occurred in three of these children, which indicates that possible synergy of aminoglycoside antibiotics and cisplatin should be investigated with respect to ototoxicity. CONCLUSION: The results indicate that cisplatin, especially in combination with other ototoxic drugs, can lead to severe hearing loss in young children. Since factors other than the possible synergy discusses above favorable to the development of auditory damage cannot be specified, every child under cisplatin therapy should undergo auditory checkups at brief intervals.

[Immunohistochemical studies with middle ear mucosal remnants in cholesteatoma]. / Immunhistochemische Untersuchungen von Mittelohrschleimhautresten im Cholesteatom.

The development of a middle ear cholesteatoma is usually associated with chronic inflammation and displacement of the mucosa present by the invading squamous epithelium. To analyze the clinically different behaviors of both epithelia, we used immunohistochemical methods to study the distribution and expression of interleukin-1 (Il-1), transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), epidermal growth factor-receptor (EGF-R), the proliferation marker MIB 1, c-myc proto-oncogene product and activation marker 4F2. Results stromal that keratinocytes in a cholesteatoma exhibited a much higher activation and proliferation rate when compared to middle ear mucosa cells. Middle ear epithelial cells showed no immunoreactivity for TGF-alpha, EGF-R, Il-1 and c-myc in contrast to the markedly positive immunoreactivity found in cholesteatoma matrix. The local release of cytokines and growth factors, such as TGF-alpha, EGF and Il-1 by inflammatory cells seems to be an important factor for the hyper-proliferative behavior of cholesteatoma epithelium. Our findings could contribute to the pathogenesis of middle ear cholesteatoma and give a possible explanation for the sustained progression of its growth leading to displacement of the middle ear mucosa.

A possible role of Helicobacter pylori infection in the etiology of chronic laryngitis.

In order to study a possible role of Helicobacter pylori infection in chronic laryngitis, we performed endoscopic and histological assessments in addition to a urease test for the bacterium in 35 patients with chronic hoarseness. Six of the patients investigated (17.1%) revealed a positive urease test of the laryngeal biopsy (four male and two female patients). These H. pylori-positive patients were treated with omeprazole and an antibiotic regimen using clarithromycin and metronidazole. This led to an eradication of the H. pylori and resolution of clinical signs and symptoms. These findings show a possible role of H. pylori infection in the etiology of chronic laryngitis in certain patients and can be important for clinical diagnosis and treatment.

Argyrophilic nucleolar organizer regions in auditory meatal skin and middle ear cholesteatoma.

Comparative silver-staining of argyrophilic nuclear organizer regions (AgNORs) was performed to study the proliferative activity of auditory meatal skin and middle ear cholesteatoma. AgNOR expression patterns were counted by standardized methods in two centres, Bochum and London, and mean numbers of dots per nucleus were calculated. Specimens of normal auditory meatal skin showed 1.54 dots/nucleus (n = 12) in the Bochum study, whereas cholesteatoma had 3.71 dots/nucleus (n = 21). In the London study normal meatal skin showed two dots/nucleus (n = 4), whereas acquired cholesteatoma (n = 8) gave a mean of 4.90 dots/nucleus and congenital cholesteatoma a mean of 4.70 dots/nucleus (n = 2). Our findings confirm the hyperproliferative state of middle ear cholesteatoma, suggest that the congenital variety of cholesteatoma may have a similar activity and indicate that AgNOR staining is a useful technique for assessing cellular proliferation in cholesteatoma and objectifying and quantifying its aggressive behaviour.

The effects of group housing on the research use of the laboratory rabbit.

This project evaluated the influence of group housing on common aspects of research use of female laboratory rabbits (Oryctolagus cuniculus). Eight rabbits housed individually in conventional cages were compared to a second group of 8 housed as a social group in a proportionately larger enclosure. The group housing method provided increased opportunities for exercise, social contact, and a more novel environment. As a function of housing style, the 2 experimental groups were compared on humoral and delayed hypersensitivity response, feed intake, growth rate, and selected physiological parameters that are considered to reflect stress in most species. Single and group housed rabbits did not significantly differ in physiological and immunological measurements, indicating that the practical research performance (immune response, stress level, growth rates etc.) of these rabbits was not significantly affected by group housing compared with the more traditional single housing. Analysis of group social behaviour indicated that the rabbits preferred small social groups, had preferences for microenvironments within the enclosure, and exhibited behaviours that are not possible when housed singly. Group housing appeared to be a successful method for enriching the environment of female rabbits and aspects of it should be considered in the approach to housing rabbits used in research.

Obturator mononeuropathy caused by pelvic cancer: six cases.

OBJECTIVE: To report the clinical and pelvic CT findings in six patients with obturator mononeuropathy caused by cancer. DESIGN: A clinical case series of six patients followed for 2 months to 10 years (one patient lost to follow-up). SETTING: Three referral centers. PATIENTS: Three men and three women, ages 52 to 81 years. Three patients had transitional cell carcinoma of the bladder, and one patient each had pelvic papillary carcinoma, carcinoma of unknown origin, and lymphoma. MAIN RESULTS: In each patient, symptoms of obturator mononeuropathy were the sole presenting sign of new or recurrent pelvic cancer. Three patients had ipsilateral leg edema in addition to the typical sensory and motor findings of obturator mononeuropathy. Tumor sites detected on pelvic CT that correlated with obturator nerve compression or infiltration, singly or in combination, included the posterolateral wall of the upper pelvis or midpelvis, the anterior wall of the lower pelvis, and the external obturator and pectineus muscles extrinsic to the bony pelvis. Antineoplastic treatment provided symptomatic relief in four patients. CONCLUSIONS: Pelvic CT or MRI should be performed to exclude pelvic tumor in patients with obturator mononeuropathy if there is no temporal association with pelvic trauma or intra-abdominal, pelvic, or hip surgery.