Management of ear lobule keloids using 980-nm diode laser.

The objective of the study was to evaluate the 980-nm diode laser in conjunction with corticosteroids in the treatment of ear lobule keloids. Several methods have been described for the treatment of keloid scars, but none of them have been 100% successful. Advances in laser techniques have enabled surgeons to define the most appropriate lasers for use in the treatment of different scar types. The diode laser pulses are delivered interstitially in a single repeated mode in non-overlapping sites using a bare optical fiber, followed by intralesional triamcinolone acetonide injection. The number of sessions varies between two to five for the management of more than 75% of keloid size, with a total success rate of 75% and no recurrence in the follow-up of 12 months. The technique used proved to be effective in the treatment of ear lobule keloids.

Mast cell degranulation and vascular endothelial growth factor expression in mouse skin following ionizing irradiation.

The present study aimed to identify the mechanisms underlying the increase in vascular permeability in mouse skin following irradiation. The left ears of C3H mice were subjected to 2 and 15 Gy of radiation in a single exposure. At 24 h after irradiation, the ears were excised and tissue sections were stained with toluidine blue to assess mast cell degranulation. Vascular endothelial growth factor (VEGF) expression was assessed via immunohistochemistry and western blotting. Approximately 5% (3%-14%) (mean [95% CI]) of mast cells in the skin of control mice were degranulated; moreover, at 24 h after 2 Gy irradiation, this value increased to approximately 20% (17%-28%). Mast cell degranulation by 15 Gy irradiation (32% [24%-40%]) was greater than that by 2 Gy irradiation. Significant differences were observed in mast cell degranulation among the control, 2 Gy and 15 Gy groups (p = 0.012). Furthermore, VEGF-positive reactions were observed in the cytoplasm of scattered fibroblasts in the dermis. In immunohistochemistry tests, VEGF expression at 24 h after irradiation increased slightly in the 2 Gy group compared to that in the control group, whereas no difference in VEGF expression was observed in the 15 Gy group compared to that in the control group. Expression of VEGF in western blots was consistent with that in immunohistochemistry. In conclusion, mast cell degranulation was increased in mouse skin at 24 h after irradiation in a dose-dependent manner. In contrast, VEGF expression was slightly increased following only low-dose (2 Gy) irradiation.

Auditory cortical activity elicited by infrared laser irradiation from the outer ear in Mongolian gerbils.

Infrared neural stimulation has been studied for its potential to replace an electrical stimulation of a cochlear implant. No studies, however, revealed how the technic reliably evoke auditory cortical activities. This research investigated the effects of cochlear laser stimulation from the outer ear on auditory cortex using brain imaging of activity-dependent changes in mitochondrial flavoprotein fluorescence signal. An optic fiber was inserted into the gerbil's ear canal to stimulate the lateral side of the cochlea with an infrared laser. Laser stimulation was found to activate the identified primary auditory cortex. In addition, the temporal profile of the laser-evoked responses was comparable to that of the auditory responses. Our results indicate that infrared laser irradiation from the outer ear has the capacity to evoke, and possibly manipulate, the neural activities of the auditory cortex and may substitute for the present cochlear implants in future.

Effectiveness of chemoradiotherapy for radiation-induced bilateral external auditory canal cancer: A case report and literature review.

BACKGROUND: Radiation-induced bilateral external auditory canal cancer is an extremely rare disease that has yet to be fully characterized in the clinical literature. METHODS: Herein, we present a case study of a 75-year-old man with radiation-induced bilateral external auditory canal cancer. The patient's medical history included left maxillary cancer that had been treated with chemoradiation 19 years earlier and local recurrence with total maxillectomy 10 years earlier. Intracavitary radiation was delivered to the site of postoperative recurrence 8 years before the current presentation. The patient declined radical surgery for the external auditory canal cancer at this time, and a customized combined modality regimen was thus administered. RESULTS: There was no recurrence of cancer for 22 months, to date, after completing chemoradiotherapy. CONCLUSIONS: Our finding that radiotherapy can be successfully used for radiation-induced cancer indicates that chemoradiotherapy may be a useful strategy for treating this type of malignancy.

[T cell non-Hodgkin's lymphoma of the external auditory canal]. / Linfoma no hodgkiniano de célula T del conducto auditivo externo.

Developing of primary lymphoma of the external auditory canal is excepcional. We describe a 53 years old woman who developed a T cell non-Hodgkin's lymphoma and review literature. She was treated with surgery and chemotherapy and remains disease-free 10 months after the treatment.

Ototoxicity after radiotherapy for head and neck tumors.

PURPOSE: To investigate the incidence of radiation-induced ototoxicity according to the total dose delivered to specific parts of the auditory system, fractionation, and chemotherapy. METHODS AND MATERIALS: Records of 325 patients treated for primary extracranial head and neck tumors with curative intent who received radiotherapy between 1964 and 2000 (median follow-up, 5.4 years) were retrospectively reviewed. Reconstructions of the treatment plans were generated to estimate the doses received by components of the auditory system. RESULTS: Radiotherapy-induced morbidity developed in 41.8% of patients (external ear, 33.2%; middle ear, 28.6%; and inner ear, 26.8%). Univariate/multivariate analyses indicate that total dose received by parts of the auditory system seem to be significant, though fractionation and chemoradiation may contribute to the incidence of ototoxicities. Sensorineural hearing loss (SNHL) was observed in 49 patients (15.1%). Univariate and multivariate analyses indicated that age (p = 0.0177 and p = 0.005) and dose to cochlea (p < 0.0001 and p < 0.0001) were significant, and chemoradiation (p = 0.0281 and p = 0.006) may increase the incidence of SNHL. Five-year and 10-year actuarial risk of clinically overt SNHL increased to 37% (p > 0.0001) above doses of 60.5 Gy compared to 3% at doses below 60.5 Gy. For patients treated with adjuvant chemotherapy, clinically overt SNHL increased to 30% compared to 18% in the no-chemotherapy group at 10 years (p = 0.0281). CONCLUSION: Radiotherapy toxicity was observed in all parts of the auditory system with median doses for incidence varying between 60 Gy to 66 Gy. Total dose to organ seems to be a significant factor though fractionation and chemo-radiation may contribute to ototoxicities.

Postoperative radiotherapy with high dose rate iridium 192 mould for prevention of earlobe keloids.

BACKGROUND: A 50% to 80% recurrence rate of earlobe keloids can occur following a simple excision. Many modalities, including radiotherapy, have been suggested to reduce the postoperation recurrence. OBJECTIVE: The aim of the present study was to determine the efficacy of postoperative radiotherapy by a high dose rate Iridium 192 mould in the prevention of earlobe keloids recurrence. MATERIAL AND METHOD: Between March 1999 and March 2003, 22 patients with 24 earlobe keloids were treated by radiotherapy immediately following surgical excision. A dose of 15 Gray in 3 fractions was delivered at a point placed 5 mm from the axis of the Iridium sources. RESULTS: From the 22 patients with 24 keloids who were treated, 15 patients with 16 keloids were followed for a minimum of 6 months. Recurrence occurred in two keloids (12.5%). There were no severe adverse effects. CONCLUSION: Postoperative radiotherapy by high dose rate Iridium 192 mould was an effective prevention of earlobe keloids recurrence. It was well tolerated and did not present any significant side effects.

Effects of microcurrent therapy on excisional elastic cartilage defects in young rats.

The effects of microcurrent application on the elastic cartilage defects in the outer ear of young animals were analyzed. Sixty male Wistar rats were divided into a control (CG) and a treated group (TG). An excisional lesion was created in the right outer ear of each animal. Daily treatment was started after 24h and consisted of the application of a low-intensity (20µA) continuous electrical current to the site of injury for 5min. The animals were euthanized after 7, 14 and 28 days of injury and the samples were submitted to analyses. In CG, areas of newly formed cartilage and intense basophilia were seen at 28 days, while in TG the same observations were made already at 14 days. The percentage of birefringent collagen fibers was higher in CG at 28 days. The number of connective tissue cells and granulocytes was significantly higher in TG. Ultrastructural analysis revealed the presence of chondrocytes in TG at 14 days, while these cells were observed in CG only at 28 days. Cuprolinic blue staining and the amount of glycosaminoglycans were significantly higher in TG at 14 days and 28 days. The amount of hydroxyproline was significantly higher in TG at all time points studied. The active isoform of MMP-2 was higher activity in TG at 14 days. Immunoblotting for type II collagen and decorin was positive in both groups and at all time points. The treatment stimulated the proliferation and differentiation of connective tissue cells, the deposition of glycosaminoglycans and collagen, and the structural reorganization of these elements during elastic cartilage repair.

Age and Gender Effects on Wideband Absorbance in Adults With Normal Outer and Middle Ear Function.

PURPOSE: This study examined the effects of age and gender on wideband energy absorbance in adults with normal middle ear function. METHOD: Forty young adults (14 men, 26 women, aged 20-38 years), 31 middle-aged adults (16 men, 15 women, aged 42-64 years), and 30 older adults (20 men, 10 women, aged 65-82 years) were assessed. Energy absorbance (EA) data were collected at 30 frequencies using a prototype commercial instrument developed by Interacoustics. RESULTS: Results showed that the young adult group had significantly lower EA (between 400 and 560 Hz) than the middle-aged group. However, the middle-aged group showed significantly lower EA (between 2240 and 5040 Hz) than the young adult group. In addition, the older adult group had significantly lower EA than the young adult group (between 2520 and 5040 Hz). No significant difference in EA was found at any frequency between middle-aged and older adults. Across age groups, gender differences were found with men having significantly higher EA values than women at lower frequencies, whereas women had significantly higher EA at higher frequencies. CONCLUSIONS: This study provides evidence of the influence of gender and age on EA in adults with normal outer and middle ear function. These findings support the importance of establishing age- and gender-specific EA norms for the adult population.

Radiotherapy-induced ear toxicity.

Despite their particular functional consequences, radiotherapy-induced ear injuries remain under-evaluated and under-reported. These reactions may have acute or late character, may affect all structures of the hearing organ, and result in conductive, sensorineural or mixed hearing loss. Up to 40% of patients have acute middle ear side effects during radical irradiation including acoustic structures and about one-third of patients develop late sensorineural hearing loss (SNHL). Total radiotherapy dose and tumour site seem to be among the most important factors associated with the risk of hearing impairment. Thus, reduction in radiation dose to the auditory structures should be attempted whenever possible. New radiotherapy techniques (3-dimensional conformal irradiation, intensity modulated radiotherapy, proton therapy) allow better dose distribution with lower dose to the non-target organs. Treatment of acute and late external otitis is mainly conservative and includes the anti-inflammatory agents (applied topically and systematically). Post-radiation chronic otitis media and the eustachian tube pathology may be managed with tympanic membrane incision with insertion of a tympanostomy tube (grommet), although the benefit of such approach is controversial and some authors advocate a more conservative approach. In these patients the functional deficit can be alleviated by application of bone conduction hearing aids such as, e.g., the bone anchored hearing aid (BAHA). There is no standard therapy for post-irradiation sudden or progressive SNHL yet corticosteroid therapy, rheologic medications, hyperbaric oxygen or carbogen therapy are usually employed (as for idiopathic SNHL), although controversial data on the efficacy of these treatment modalities have been published. In selected cases with bilateral profound hearing loss or total deafness, cochlear implants may prove effective. Further improvements in radiotherapy techniques and progress in otologic diagnostics and therapy may allow better prevention and management of radiation-related acoustic injury.

Some effects of radiation on the healing of transected mouse ear.

Both histological assessments and measurements of epidermal and dermal components are used to describe some effects of radiation on wound healing in mouse ear. A pattern of early wound closure followed by wound reopening was seen after doses of about 20 Gy and above. After 10 Gy X rays wound closure was comparable with that in unirradiated wounds but the nature of the tissue repair was different. The results suggested that the severity of radiation damage to epidermis is relatively unaffected by wounding but that the time course of expression of the radiation damage is appreciably accelerated. The observations are discussed in terms of their clinical relevance and of current radiobiological hypotheses.

The effect of prior heat treatment on the thermal enhancement of radiation damage in the mouse ear.

The effects of prior heat treatment on the skin reaction produced by a subsequent treatment with combined heat and X-rays were investigated in the mouse ear. Ears were heated by immersion in hot water. The priming heat treatment was always 43.5 degrees C for 40 minutes. Its effect was transient, beginning between 24 and 48 hours after the priming treatment and reaching a maximum at 48 to 96 hours when there was a reduction in the skin response to combined heat and X rays, i.e. it caused a reduction in the thermal enhancement ratio (TER). The effect was lost by 192 hours. At 96 hours after the priming treatment the TER for 30 minutes at 42.5 degrees C or at 43.5 degrees C was reduced by a value equivalent to decreasing the temperature by about 0.4 degrees C. This was equivalent to increasing the heating at 43.5 degrees C required to produce a given enhancement of radiation damage by a factor of 1.4 relative to that required without prior heating. The effect was smaller than induced resistance to damage caused by severe heat treatment alone (i.e. necrosis) and it occurred later. These differences support the concept that two separate mechanisms underlie direct heat necrosis and thermal enhancement of radiation damage.

Long-term thermal sensitivity of previously irradiated skin.

The response of the mouse ear to hyperthermia was investigated at 7-64 weeks after irradiation with X rays. Thermal sensitivity was increased by 12 weeks after single doses of 18 to 20 Gy but showed no further changes up to 64 weeks after exposure. It is suggested that the increase in sensitivity to retreatment by hyperthermia several months after the initial course of radiation may be related to the turnover time of the tissue. Although there are reports which suggest that prior irradiation, given more than two months earlier, does not affect the response of human skin or superficial tumours to the mild hyperthermic treatment in current clinical use, more aggressive heat therapy may produce unexpectedly severe responses in previously irradiated sites.

Ear lobe keloids, surgical excision followed by radiation therapy: a 10-year experience.

This retrospective study was conducted to analyze the recurrence of ear lobe keloids in 36 patients after surgical excision followed by radiation therapy. In all the cases keloids were excised and the surgical wound closed primarily. Following surgery, patients underwent 1800 cGy of radiation therapy in three equally divided doses over five to seven days. Most of our patients were young black females who developed keloids secondary to ear lobe piercing. Of the 36 patients followed for a mean period of 5.6 years, we noted only one (2.8%) recurrence. All the patients were followed for a minimum of two years. No serious complications were observed in our series. However, one patient developed radiation dermatitis followed by patchy hypopigmentation. We conclude that surgical excision followed by radiation therapy is a safe and effective method to control keloid recurrence in the ear lobe region.

[Angiosarcoma of the outer ear. A case report]. / Angiosarcoma de pabellón auricular. A propósito de un caso.

Angiosarcoma (AS) is one of the rarest forms of soft tissue neoplasm. They are considered highly aggressive tumors with a poor prognosis. They range from highly differentiated tumors resembling hemangiomas to anaplastic tumors that are difficult to distinguish from carcinomas. Clinically, the appearance of these lesions varies, so confusion may arise from an initially benign appearance. AS comprise less than 1% of all sarcomas. In these patients, tumor size is an important predictor of survival. In our case, the tumor was located in the outer ear and the patient was treated with surgery, radiotherapy (65 Gy), and chemotherapy (adriamycin). A recurrence one year later was treated with salvage surgery and external carotid artery ligature to control abundant hemorrhage.

[Possibilities of the use of surgical laser irradiation in spontaneous formation of cartilage tissue in ENT plastic surgery]. / Vozmozhnosti primeneniia izlucheniia khirurgicheskikh lazerov s tsel'iu proizvol'nogo formirovaniia khriashchevoi tkani v plasticheskoi LOR-khirurgii.

The experiments were made to study CO2-laser ability to promote spontaneous formation of nasal septum cartilage. Laser-induced changes in physical and histological characteristics of the cartilage tissue were followed up. Optimal regimens of radiation were selected which allowed to modify cartilage shape without impairment of its morphological and histological structure. In vivo tests were performed on rabbit auricular floor cartilage. The present shape of the cartilage remained stable. It is inferred that laser energy may be a promising tool in plastic ENT surgery.

Ex vivo decrease in uranium diffusion through intact and excoriated pig ear skin by a calixarene nanoemulsion.

Cutaneous contamination by radionuclides is a major concern in the nuclear industry. In case of skin exposure to uranium, no efficient emergency treatment is available to remove the actinide from the skin. For this purpose, we developed a nanoemulsion containing calixarene molecules displaying good chelating properties towards uranium. In this paper, we describe the ability of this formulation to trap uranium and limit its transfer from the cutaneous contaminated site into the blood. Uranium percutaneous diffusion kinetics was assessed with Franz cells over 24 h through intact and excoriated pig ear skin biopsies, after or without application of the nanoemulsion. Uranium distribution in the skin layers was analysed by SIMS microscopy. The results showed that prompt application of the calixarene nanoemulsion allows a 94% and 98% reduction of the amount of uranium diffused respectively through intact and excoriated skin. The formulation is still efficient in case of delayed application up to 30 minutes since the 24 h-uranium transfer through excoriated skin is reduced by 71%. Besides, no accumulation of uranium or uranium-calixarene chelate was observed in the different skin layers. In conclusion, this study demonstrated the efficiency of the calixarene nanoemulsion, which can be regarded as a promising treatment for uranium cutaneous contamination.