Correlation Between Sensorineural Hearing Loss and Chronic Otorrhea.

Many studies have been trying to correlate chronic otorrhea, both in children and in adults, with the sensorineural hearing loss in the affected ear, but have been obtaining contradictory results. This loss might be due to the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All the studies evaluated up to the present date compared the affected ear with the normal contralateral ear. From the digitized archive of otological surgery files of the Department of Otorhinolaryngology, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared to ears with dry tympanic perforation of other patients. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was taken into account. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1000, 2000, and 4000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. From a statistical study, a correlation between sensorineural hearing loss and the chronic otorrhea was observed, in comparison both with contralateral normal ears and with dry perforated ears of other patients. There was no relationship with the duration of suppuration or with whether this was due to cholesteatoma. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss. The great majority of otorrhea cases begin during childhood.

Correlation between sensorineural hearing loss and chronic otorrhea.

Many studies have attempted to correlate chronic otorrhea in children and in adults with the sensorineural hearing loss in the affected ear, with contradictory results. This loss might be the result of the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All studies evaluated to date compared the affected ear with the normal contralateral ear. From the digitized archive of otologic surgery files of the Department of Otorhinolaryngology at Santa Casa de São Paulo School of Medical Sciences, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared with ears of other patients with dry tympanic perforation. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was considered. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1,000, 2,000, and 4,000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. A correlation between sensorineural hearing loss and chronic otorrhea was observed when compared with both contralateral normal ears and dry perforated ears of other patients. No relationship between hearing loss and the duration of suppuration or cholesteatoma was found. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss.

Benign Inclusions in Lymph Nodes / Inclusiones Benignas en Linfonodos

Benign inclusions are foci of non-neoplastic ectopic tissue in lymph nodes. They are classified into three types: epithelial, nevomelanocytic and decidual. It is important to identify them for the differential diagnosis with lymph node metastases, particularly among patients who present proliferative benign lesions. In general, epithelial inclusions are presented inside lymph nodes as epithelial cysts or as numerous structures resembling ducts. The cells of these structures may originate from the cells of paramesonephricus ducts, salivary glands, breast tissue, thyroid follicles, squamous epithelium or mesothelium. Paramesonephricus -type inclusions are almost exclusively found in pelvic lymph nodes and, in appearance, they resemble the epithelium of the uterine tube. Inclusions of breast tissue are composed predominantly of ectopic mammary glands and ducts that present diverse morphological characteristics that still have obscure etiology. Thyroid-type inclusions are frequently found in cervical and axillary lymph nodes, and it is believed that, embryologically, they arise from the mixing of tissues from which lymph nodes and the thyroid gland originate. Mesothelial inclusions occur preferentially in the mediastinal lymph nodes of patients who are affected by pleural or pericardial effusions. Aggregates of melanocytic cells are generally found in the lymph node capsule. The explanation for this occurrence is uncertain, but it is believed to be a consequence of incorrect migration of neural crest cells, or because of "benign metastases" of nevi present in the skin. Studies on benign inclusions in lymph nodes take on importance through assisting in correctly diagnosing the presence of metastases.

Las inclusiones benignas son focos de tejido ectópico no neoplásico en los linfonodos. Ellos son clasificados en tres grupos: epitelial, nevomelanocítico y decidual. Es importante identificarlos para el diagnóstico diferencial con metástasis de linfonodos, particularmente en aquellos pacientes que presentan lesiones proliferativas benignas. En general, las inclusiones epiteliales se presentan dentro de los linfonodos como quistes epiteliales o como numerosas estructuras que parecen conductos. Las células de estas estructuras se pueden originar a partir de las células del conducto paramesonéfrico, glándulas salivales, tejido mamario, folículos tiroideos, epitelio escamoso o mesotelio. Las inclusiones tipo paramesonéfrico son exclusivamente encontradas en los linfonodos pélvicos y su apariencia recuerda el epitelio de la tuba uterina. Las inclusiones del tejido mamario están compuestas predominantemente de tejido mamario glandular ectópico y los ductos presentan diversas características morfológicas las que no tienen una clara etiología. Las inclusiones del tipo tiroideas son frecuentemente encontradas en los linfonodos cervicales y axilares y se cree que embriológicamene, se originan de una mezcla de tejidos de que origina linfonodos y tejido glandular tiroideo. Las inclusiones mesoteliales ocurren preferentemente en los linfonodos mediastínicos de pacientes que son afectados por dilataciones pleurales y pericárdicas. Los agregados de células melanocíticas son generalmente encontrados en la cápsula de los linfonodos. La explicación para este hecho es incierta, pero se cree que es una consecuencia incorrecta de la migración de células de la cresta neural o por metástasis benignas de nevos presentes en la piel. Los estudios de las inclusiones benignas en linfonodos toma importancia ya que a través de ellos se puede ayudar a un correcto diagnóstico de la presencia de metástasis.