The contralateral ear in cholesteatoma

Cholesteatoma of the middle ear is bilateral in 10% of cases. Depending upon the ethnical characteristics or socio-economic levels, the frequency of cholesteatoma for a normal population varies from 1 in a 1,000 to 1 in 10,000. So, it becomes evident that the controlateral ear of cholesteatoma has to be considered at risk. The chances of seeing a cholesteatoma develop and particularly of observing the evolutionary stages are multiplied by 100 or 1,000! This report concerns the results of systematic examination of controlateral ear of 200 consecutive cholesteatomas, using binocular microscope and routine otoscopic photography. Eardrum was normal for 1/3 cases only. Modifications of the aspect of the tympanum related with active or sequellar lesions chronic otitis have been observed in all other cases. This finding leads us to the conclusion that cholesteatoma of the middle ear is related in the great majority of cases with the chronicle ear disease. Tubal insufficiency is of prime importance if we consider the high incidence of retractions pockets. Papillary invagination at the level of Shrapnell membrane is induced by chronical inflam-mation. Epithelial migration from the edges of a perforation is rare and only accidental. Clinical evaluation of the condition of the controlateral ear may also give indications about the background, the eustachian tube function and help for the choice of surgical technique radical or conservative.     

The status of the contralateral ear in children with acquired cholesteatoma

Conclusion. Otoacoustic emissions generated by outer hair cells (OHCs) are influenced by stimulation of the contralateral ear via a neural pathway involving the olivo-cochlear efferent system. This is often referred to as a contralateral ‘suppression reflex’, but we suggest that such a term is inappropriate since distortion product otoacoustic emissions (DPOAEs) can be both enhanced and suppressed, and there is continuous modulation with no threshold effects. Objective. To characterize the continuous amplitude modulation of DPOAEs by contralateral sound stimulation. Materials and methods. In an animal model (chinchilla), DPOAEs were recorded in real time from one ear during presentation of acoustic stimuli to the opposite ear. Results. DPOAE amplitude is suppressed by an increase in contralateral stimulation, and enhanced by a decrease in same, i.e. the emissions are continuously modulated by activity in the opposite ear. The input-output function shows a linear relationship to this system over a 40–50 dB range of contralateral stimulus levels. After a neural delay time of approximately 25 ms, DPOAE amplitude closely follows contralateral amplitude signals up to modulation frequencies of approximately 20 Hz. Thus, stimuli to one ear continually modulate the OHC system (and therefore the biomechanical amplification) of the contralateral cochlea.     

A clinico-radiological study of the contralateral ear in acquired unilateral cholesteatoma

OBJECTIVE: Clinico-audiological and CT scan assessments of the contralateral ear in patients with unilateral cholesteatoma can be a good predictive method for the fate of these ears. MATERIAL AND METHODS: Fifty patients with unilateral cholesteatoma and 25 control subjects with bilateral normal ears were subjected to otomicroscopical and audiological assessment. Axial and coronal computed tomography (CT) for the mastoid bone at 1 mm slice thickness was done for all ears. A simplified method was used to find out the surface area (SA) of the air cells at each individual section and semi-automatically calculate the total volume of the matstoid air cells. RESULTS: Otomicroscopically, 72% of the contralateral ears showed signs of retraction pockets, granulation tissues and other signs of chronicity. Audiologically 20% of the control ears showed moderate to severe conductive hearing loss while 10% showed mixed hearing loss. As regards mastoid pneumatization, the mean air cell volumes were 6.1, 12.68 and 29.92 CC in cholesteatomatous, contralateral and control ears respectively. This indicates a highly significant difference in the mean air cell volume between the control ears and the other two groups. CONCLUSION: It can be concluded that continuous follow up of the contralateral ear in cholesteatomatous ears is mandatory to detect subtle pathological changes and manage them early. Volumetry of contralateral ear using the applied simple method can lead to a reduction in major surgery and can affect the choice of the surgical approach.     

Contralateral ear in cholesteatoma]

The authors examine 224 contralateral files of patients suffering from cholesteatoma. They record that the systematic study of the opposite ear can prove to be of interest, given the numerous anomalies found. One ear in two has a contralateral pathology. In 32% of the cases, there is a retraction pocket, and in 14% a cholesteatoma. The mean time for a cholesteatoma to appear from a retraction pocket varies by 24 months in 44% of the cases, thus demonstrating the necessity of examining the opposite ear, as a dynamic evolution exists. Of these pockets, 2% in fact evolved, these statistics, to a true cholesteatoma.     

External ear canal cholesteatoma

External ear canal cholesteatoma (EECC) is a rare otologic entity. Erosion of the inferior canal wall and accumulation of keratin debris are consistent findings. In the past there had been confusion between EECC and keratosis obturans, and they were thought to represent the same disease process. Currently, based on clinical and pathologic findings, it is believed that they are two different entities. In this article we present our experience in treating eight patients with EECC. For limited lesions, local debridement and curettage of necrotic bone is effective management. For more extensive lesions, canalplasty or tympanomastoidectomy is indicated.     

儿童中耳先天性胆脂瘤的诊断和预后

目的:探讨儿童中耳先天性胆脂瘤的临床症状、位置、影像学特征、治疗及预后.方法:回顾性分析9例中耳先天性胆脂瘤患儿的临床资料.结果:患儿均行手术治疗,5例有听小骨破坏,术后复发4例,复发率为44.4%.平均随访7.4年,术前平均听阈为28 dB,术后平均听阈为26 dB.结论:中耳先天性胆脂瘤临床少见,发病隐匿,单侧传导性聋为主要表现.术前诊断可根据Levenson诊断标准和CT检查结果.其预后和复发率与病变范围、手术方式、是否2次手术有关.     

Immunological problems in middle ear cholesteatoma

Regardless of the pathogenesis of congenital and acquired cholesteatoma two questions seem to be fundamental: what is the origin of the keratinizing squamous epithelium, and what influences invasive and hyperproliferative behavior of the epidermis. The authors of this paper advance a hypothesis that the similar mechanism of the skin infection could exist in psoriasis and atopic dermatitis as well as in cholesteatoma. The retraction pocket leads to the loss of the defense mechanisms and development of planctonic bacteria. Direct and indirect signalings of bacterial products, such as endotoxin stimulate the cytokine cascade and therefore the hyperproliferation of the epithelium keratynocytes. The mobilization of the immunological system may an important role in the perimatrix development.     

Colony-stimulating factor in middle ear cholesteatoma

Granulocyte-macrophage colony stimulating factor (GM-CSF) was found in human middle ear cholesteatoma tissues by immunohistochemical technique using mouse monoclonal anti-(human) GM-CSF IgG. Immunofluorescent staining showed the presence of GM-CSF in the peribasal area, in some suprabasal cells of the epithelium, and in the inflammatory connective tissue, especially in the monocytes and fibroblasts. These findings were confirmed by the immunoperoxidase method. Staining of the external ear canal epithelium, however, was significantly weaker than that of the cholesteatoma epithelium. The presence of GM-CSF in cholesteatoma appears to be a response to inflammation occurring in the middle ear cavity. Moreover, our in vitro study showed that GM-CSF induced the proliferation and protein synthesis of basal keratinocytes. This study suggests that GM-CSF is involved in the development and destructive effects of middle ear cholesteatoma.     

Micronucleus frequency in acquired middle ear cholesteatoma

OBJECTIVE: To determine the micronucleus (MN) frequency of acquired cholesteatoma tissue using an MN assay. MATERIAL AND METHODS: Eighteen patients were diagnosed as having chronic otitis media with acquired cholesteatoma and were divided into primary and secondary acquired cholesteatoma groups. Cholesteatoma tissue and normal tissue specimens from the external ear canal skin were taken from the patients during surgical operations. MN frequencies of cholesteatoma and control samples were determined according to standard criteria. RESULTS: The MN frequencies of the cholesteatoma and control tissues were 0.54%+/-0.31% and 0.24%+/-0.11%, respectively (p<0.01). MN frequencies for the primary and secondary acquired cholesteatoma groups were 0.63%+/-0.36% and 0.46%+/-0.26%, respectively (p>0.05). MN frequencies in cholesteatoma patients without and with complications were 0.42%+/-0.19% and 0.85%+/-0.37%, respectively (p<0.05). CONCLUSION: MN frequencies were found to be increased in cholesteatoma tissues when compared with external ear canal skin. The MN frequency in five cases with complications was higher than in cases without complications. These results indicate that there could be associations between MN frequency and acquired cholesteatoma and between MN frequency and complications.     

The contralateral ear in acoustic tumors and hearing conservation

Hearing conservation in acoustic tumor surgery is an admirable goal and a logical extension of micro neurotologic surgery, but ideal candidates for conservation are few, and attempts to preserve hearing in those few fail in about half of all cases. Conserved hearing most often falls far beyond a range that will provide binaural function and is, therefore, of questionable use. The problem of hearing conservation in acoustic tumor surgery is rationally approached based upon the implications of the total presurgical overview, particularly with reference to age, general health, tumor size, and especially hearing in the tumor ear, the contralateral ear, and interaural relationships. Technical considerations, the morbidity and mortality, and, finally, probability factors are reviewed from the literature. The patient's consideration regarding potentials for hearing conservation, his need for conservation, and alternative options are discussed. Rehabilitative options for unilateral hearing impairment are discussed. A review of the amplification requirements of 45 acoustic tumor patients — S or more years postoperative — indicated that three-quarters had normal hearing in the contralateral ear, 24% of whom required CROS amplification; 67% of the remaining quarter had mild to moderate hearing losses and were effectively wearing BiCROS aids. None were rehabilitated with monaural aids; 20% of the entire group studied had demonstrated some degree of additional hearing loss in the non-tumor ear since surgery.     

中耳胆脂瘤一例

患者 男，19岁。因左耳流脓反复发作10年，眩晕、恶心反复发作2年入院。发病以来，伴左耳耳鸣及听力下降，无头痛呕吐，无口角歪斜及闭眼障碍。查体：一般情况好，心肺腹无阳性体征。左外耳道后上壁下塌破溃。左耳纯音测听（听力级）骨导平均听阈20dB，气导平均听阈60dB。颞骨CT：左侧颞骨示溶骨性骨质破坏，正常鼓室、鼓窦及乳突结构消失，听小骨显示不清，     

中耳乳突珍珠型胆脂瘤新生血管的观察

目的了解珍珠型中耳乳突胆脂瘤微血管的组织病理学特点,探讨微血管在胆脂瘤形成中的作用。方法对6例珍珠型中耳胆脂瘤微血管的病理学特点进行观察,并应用免疫组化法对其血管内皮细胞中Ⅷ因子相关抗原和CD341的表达进行观察。结果在胆脂瘤的囊壁及其蒂部含丰富薄壁微血管,Ⅷ因子相关抗原和CD34在血管内皮细胞内有明显表达。结论珍珠型胆脂瘤微血管的形成可能是胆脂瘤生长扩张的重要前提之一。     

中耳胆脂瘤上皮中白介素-1α的表达

目的研究白介素-1α(interleukin-1α,IL-1α)在中耳胆脂瘤上皮的表达,并分析与基质金属蛋白酶-9(metalloproteinase-9,MMP-9)以及增殖细胞核抗原(proliferatingcellnuclearantigen,PCNA)表达的关系。方法采用免疫组织化学SP法检测了IL-1α、MMP-9及PCNA在21例继发性胆脂瘤上皮标本与10例胆脂瘤患者外耳道皮肤表皮中的表达。结果IL-1α、MMP-9及PCNA在胆脂瘤上皮的表达,与外耳道皮肤上皮相比明显增强,差异均具显著性(P<0.01,P<0.01,P<0.01)。IL-1α与MMP-9表达存在正相关性(P<0.05),IL-1α与PCNA表达无显著相关性。结论IL-1α与MMP-9表达密切相关,表明IL-1α可通过上调MMP-9的表达在介导胆脂瘤骨质破坏行为中扮演着重要角色。在体内IL-1α可能不是影响胆脂瘤上皮增殖的主要因素。     

Micronucleus frequency in acquired middle ear cholesteatoma

Objective—To determine the micronucleus (MN) frequency of acquired cholesteatoma tissue using an MN assay.

Material and Methods—Eighteen patients were diagnosed as having chronic otitis media with acquired cholesteatoma and were divided into primary and secondary acquired cholesteatoma groups. Cholesteatoma tissue and normal tissue specimens from the external ear canal skin were taken from the patients during surgical operations. MN frequencies of cholesteatoma and control samples were determined according to standard criteria.

Results—The MN frequencies of the cholesteatoma and control tissues were 0.54%±0.31% and 0.24%±0.11%, respectively (p<0.01). MN frequencies for the primary and secondary acquired cholesteatoma groups were 0.63%±0.36% and 0.46%±0.26%, respectively (p>0.05). MN frequencies in cholesteatoma patients without and with complications were 0.42%±0.19% and 0.85%±0.37%, respectively (p<0.05).

Conclusion—MN frequencies were found to be increased in cholesteatoma tissues when compared with external ear canal skin. The MN frequency in five cases with complications was higher than in cases without complications. These results indicate that there could be associations between MN frequency and acquired cholesteatoma and between MN frequency and complications.     

Sialomucin in middle ear cholesteatoma perimatrix.

Mucosubstance histochemistry of human middle ear cholesteatoma revealed that sialomucins are abundant and sulfomucins present in small amounts in the glandlike structures of the cholesteatoma perimatrix. Based on the study, various glycoproteins were injected into the dermis of the external ear canal and infiltrated into the tympanic membranes of guinea pigs. Tympanic membranes were obtained 7 days later and light- and electron-microscopically studied. Injection of a sialomucin from bovine submaxillary gland resulted in marked proliferation of epidermis and degeneration of the lamina propria. Asialomucin prepared from sialomucin by hydrolysis produced mild thickening of the epidermis but the lamina propria was not degenerated. Fetuin and bovine serum albumin did not cause proliferation of the epidermis. Cholesterol granuloma formed in some of the specimens injected with sialomucin. The presence of sialomucin in cholesteatoma perimatrix and these experimental studies using tympanic membranes of guinea pigs suggests that sialomucins participate in the proliferation of epidermis and degeneration of subepidermal connective tissue in human middle ear cholesteatoma.     

罕见中耳巨大胆脂瘤1例

中耳胆脂瘤是一种常见的慢性中耳疾病,特征是中耳腔、乳突腔及岩尖存在高度增殖的角化鳞状上皮和邻近骨质的破坏吸收,上皮细胞脱落、上皮碎屑堆积而形成胆脂瘤[1].现将我科收治的1例罕见巨大胆脂瘤病历资料报告如下.