Intracranial cholesteatoma - case report and critical review.

OBJECTIVE: Chronic otitis media is a potentially serious disease because of its complications, most of which are common in conjunction with cholesteatomas. There is variance in the terminology used by neurosurgeons, otorhinolaryngologists and neuropathologists. Synonyms for cholesteatoma found in the literature include epidermoid tumor, epidermoid cysts and epithelial inclusion cyst. Intracranial extension of an acquired cholesteatoma is a rarely documented occurrence. PATIENTS/MATERIAL AND METHODS: A 47-year-old woman who had undergone a right tympanomastoidectomy 20 years previously, presented with a long history of mild headaches that had become progressively more severe over the last 3 years. Clinical and radiological evaluation of the patient raised the suspicion of an intracranial cholesteatoma. RESULTS: A right temporal craniotomy was performed. The mass was completely excised and histopathological study revealed the tumor to be a cholesteatoma. The patient's post-operative recovery was uneventful. CONCLUSIONS: Cholesteatomas possess the capacity for eroding bone and can have an insidious onset, but once established, grows relentlessly and destroys neighboring structures. Since a gradual intracranial involvement does not usually cause acute symptoms of increased intracranial pressure, the correct diagnosis may be difficult. Detailed clinical and radiographic studies in particular are diagnostically helpful. Because of the high incidence of delayed recurrence, life-long follow-up is required. The inconsistency in the histopathological classification of intracranial cholesteatomas should be clarified.

Gastroesophageal reflux disease and tympanoplasty surgical outcome: is there a relationship?

OBJECTIVE: To investigate the possible clinical relationship between gastroesophageal reflux disease and the type one tympanoplasty surgical outcomes of adults with chronic otitis media, by using a simple, cost-effective, reliable questionnaire and physical findings. METHODS: Fifty-two of 147 patients undergoing type one tympanoplasty were studied. Gastroesophageal reflux disease symptoms were evaluated using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease questionnaire. Laryngoscopic physical findings of laryngopharyngeal reflux were evaluated using the Reflux Finding Score. A successful outcome was defined as an intact tympanic membrane. Correlations between the two assessment tool results and the patient's surgical success were calculated. RESULTS: The gastroesophageal reflux disease questionnaire score was significantly higher in patients with unsuccessful tympanic membrane closure (group one) than in patients with successful closure (group two) (p < 0.05). The Reflux Finding Score was also significantly higher in group one than group two (p < 0.05). There was a significant positive relationship between the gastroesophageal reflux disease questionnaire score and the Reflux Finding Score (p < 0.01). CONCLUSION: Gastroesophageal reflux disease may be a significant prognostic factor for tympanoplasty failure. Therefore, reflux investigation may be important during the treatment of chronic otitis media, and positive cases may need reflux treatment as well as ear disease treatment.

Effect of nasolacrimal duct obstruction on nasal mucociliary transport.

BACKGROUND: Most patients with nasolacrimal duct obstruction have dry, crusty nasal mucosa. Mucociliary clearance is modulated by the amount and biochemical composition of nasal mucus. Nasolacrimal duct obstruction disturbs the drainage of tears into the nasal cavity. OBJECTIVE: We examined the effect of nasolacrimal duct obstruction on the mucociliary transport of nasal mucosa, by comparing saccharine test results for epiphora patients versus healthy volunteers. STUDY DESIGN: Prospective, randomised, clinical trial. METHODS: Eight patients with bilateral epiphora and 10 patients with unilateral epiphora were included in the study group. Complete nasolacrimal duct obstruction was demonstrated by studying irrigation of the nasolacrimal system, and by fluorescein dye study. The control group comprised 20 healthy volunteers. Mucociliary transport was assessed by the saccharine test in both the study and control groups. The saccharine transit times of 26 impaired nasal cavities were compared with those of 20 healthy nasal cavities of controls. Also, the saccharine transit times of the healthy nasal cavities of the 10 patients with unilateral epiphora were compared with those of their diseased sides, and also with those of healthy volunteers. RESULTS: The saccharine transit times of the epiphora patients were statistically significantly greater than those of the control group. Also, there was a statistically significant difference in saccharine transit times, comparing the healthy and impaired nasal cavities of patients with unilateral epiphora. CONCLUSION: Nasolacrimal duct obstruction has a negative effect on nasal mucociliary clearance. This may be related to changes in the amount and biochemical composition of nasal mucus.