Bone resorption in chronic otitis media. The role of cholesteatoma,a must or an adjunct?*

The paper contains the results of light microscopical, electron microscopical and histochemical examinations of chronic otitis media, with and without cholesteatoma, with special focus on the problems regarding bone resorption. It is demonstrated that bone resorption takes place without the presence of cholesteatoma itself, even though the magnitude of resorption is higher in the cases with cholesteatoma. It is demonstrated that there is always a layer of subepithelial granulation tissue between the cholesteatoma membrane and the underlying bone. The picture in the resorbing zone is dominated by mononuclear histiocyte like cells, containing dense cytoplasmatic bodies, called lysosomes, and it is demonstrated that the marker enzyme for acid hydrolases, the acid phosphatase, is present in large quantities, both in the histiocytes, as well as spread along the bony surface. It is concluded that a possible mechanism for bone resorption is performed by the acid hydrolases, contained in the histiocytes, working at acid pH. It is noteworthy that the multinucleated osteoclast is not demonstrated in the resorbing margin of bone and that the picture is dominated by capillary proliferation, indicating that ischemia does not play a role in bone resorption. On the contrary, this is in the author's opinion caused by inflammation and hyperemia. The various factors influencing bone resorption in general and in chronic otitis media are discussed and a new model for studying cholesteatoma pathology in the middle ear is presented.     

The head shaking nystagmus

The head shaking nystagmus is a sign of vestibular assymmetry. Its detection is simple office test useful for screening the patients with vertigo and dysequilibrium. Its nature defies its recording with electro-oculography and is simply observed under Frenzel’s glasses. The direction of nystagmus is persistently directed away from the site of lesion and is not influenced by the compensatory adjustments. It is transient, rotatory and repeatable in nature. Its reliability is limited in face of the difficulty in its recognition. In presence of strong spontaneous nystagmus in the same face, it is not recognised easily. In the present study, its validity in peripheral disorders was 49.27% and 14% in central cases. There are limitations In earring out this test in situations of railed intracranial the tension, hence, its use in the latter cases is limited.     

Fibrous dysplasia of the temporal bone.

Fibrous dysplasia is characterized by a progressive replacement of normal bone elements by fibrous tissue. It is seen in the two first decades of life and is equally distributed in relation to the sex of patients. The temporal bone is involved in 18% of the cases. Fibrous dysplasia of the temporal bone is more commonly manifested in the external auditory canal (80%) and the inner and medium ear can also be involved. Sarcomatous alterations are rare. Diagnosis is based on radiological images. Treatment is conservative and surgery is reserved for preserving function and preventing complications. The case of a male patient, 16 years old, who presented with progressive hearing loss over a 1-year period is reported.     

Otological problems of the Alaskan native population

The Alaskan Otological Fellowship of the New York Eye and Ear Infirmary operates at the Alaskan Native Health Facility in Mt. Edgecumbe, Sitka, Alaska. It is a division of the Health Education and Welfare Program. The Fellowship is now in its fourth year. The area we service is approximately 35,000 square miles. All villages and schools in the area have been screened for otological care and for possible hearing aids. The incidence of otitis media and its complications is 13 percent in the Eskimo and 9.1 percent in the Indian. These percentages are those reported in the Southwest Native. There is no ready explanation of the preponderance of otologic disease in this group. In the first three years, 360 procedures were performed on 310 chronically diseased ears. Following is a breakdown of these procedures: Myringoplastys 165 Simple Mastoidectomies 25 Simple Mastoidectomy with Myringoplasty 66 Mastoidectomy with Type III Tympanoplasty 17 Modified Radical Mastoidectomy 26 Radical Mastoidectomies 36 Miscellaneous Procedures 25 It is the opinion of the authors that the choice of procedure is much more limited in this group than in an urban community. It must be remembered that aftercare and follow-up is more difficult in these areas. It has been our policy to use conservative procedures. Elimination of the disease is the first consideration, and conservation of hearing is secondary. A dry ear is of the utmost importance, and for this reason, modified radical and classical radical mastoidectomies are more frequently performed. Types IV and V tympanoplastys are not considered feasible.     

An electromyographic study of recurrent laryngeal nerve conduction and its clinical applications

Electromyographic techniques were used to study laryngeal nerve conduction in dogs and in man. The data obtained confirmed that there is a 2–5 msec difference in latency between the left and right recurrent laryngeal nerve. Conduction velocities were determined by actual measurement in dogs and calculated from known anatomic data in humans. Conduction velocity in both species was the same bilaterally. The actual value varied, depending upon the site of stimulation. It is slower the more distal the stimulating cathode is placed. Proximal conduction velocity is approximately 65 M/sec. Distal conduction velocity approximately 30 M/sec. Study of bilateral activity indicated that the onset of electrical activity is simultaneous ± 5 msec. Following simultaneous bilateral vagus nerve stimulation there is a time lag of 3 msec, in the onset of electrical activity in the right and left recurrent laryngeal muscles. Since vocalization does not occur until 350–400 msec after onset of electrical activity in the laryngeal muscle, it is felt that, in comparison, 3 msec is an insignificant difference in symmetry. In addition phonation is a function of subglottic pressure and tension in the vocal cord and not muscular vibration; therefore, there is no physiologic reason for nerve impulses to arrive simultaneously in the adductor muscles. Electromyography and nerve conduction studies can lead to greater precision in diagnosis and treatment of laryngeal disorders. The study can be done with little or no morbidity and the equipment is easily available. It is recommended for studying patients with disorders of voice that could have a neurologic basis.     

Management of the ear canal seborrhea with cerumen

For the past 20 years, the author has been treating recurrent chronic seborrheic dermatitis with a suspension of human cerumen in glycerine. The cerumen is obtained from healthy children and young adults in which there is an over-production which requires removal. If the cerumen contains debris it is not used. The collected cerumen is suspended in 50% glycerine and left for several weeks to sterilize. It is then strained through a fine filter having been heated so that its is workable. The material is dispensed to the patient in a small dropper bottle and the patient is instructed to place two drops in the external ear canal once a week. The chronicity of seborrheic dermatitis must be explained carefully to the patient and the necessity for avoiding water, cosmetics and other materials must be stressed. The patient must be made aware that the cause of the condition is unknown and that periodic inspection of the ear canal is necessary in addition to the topical application of the cerumen suspension.     

Human papillomavirus in larynx

OBJECTIVES: The core of the present clinical and basic research knowledge of laryngeal human papillomavirus (HPV) infection is described. STUDY DESIGN: Review. METHODS: A computer-aided search of MEDLINE database supplemented by hand searches of key journals was conducted. RESULTS: One of the tumor-promoting factors in the larynx is the HPV found both in normal laryngeal epithelium and in laryngeal tumors. The most important manifestation of laryngeal HPV infection is laryngeal papillomatosis, a rare disease caused by HPV types 6 and 11. In laryngeal carcinogenesis, the role of HPV remains uncertain. The means of transmission of HPV are partly unknown, and the course of laryngeal HPV infection is unpredictable and variable. Treatment of laryngeal papillomatosis is based on surgery, especially on CO2 laser and shaver. Alpha-interferon is the drug of choice in patients whose response to surgery is poor. However, neither interferon nor other antiviral drugs are able to eradicate the virus from laryngeal mucosa. Little is known about immunological mechanisms involved in laryngeal HPV infection, but in defense against HPV cellular immunity is considered a more important mechanism than humoral immunity. A good experimental model of HPV infection is lacking in which the entire viral life cycle can take place. Organotypic cell cultures (collagen rafts) are useful, but the rate-limiting step in this method is the difficulties in culturing HPV-positive epithelial cells. CONCLUSIONS: Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.     

Tympanosclerosis

Tympanosclerosis is a pathological condition which results in deposits of dense hyaline tissue or even bone in the lamina propria of the middle ear mucous membrane. It is induced by chronic inflammation in the middle ear, and is likely a Type III immune complex disease. Clinical tympanosclerosis results in decreased sound conduction by fixing ossicles or the tympanic membrane, or by obstruction to ventilation of the middle ear or mastoid. Management is dictated by the location and extent of the tympanosclerotic involvement. Ossicular problems are met by removal of the tympanosclerosis and reconstruction of the chain. The exception to this is in involvement of the stapes and oval window where stapedectomy is usually necessary. Tympanosclerosis is not expected to recur, but in the oval window fibrous scarring usually refixes a mobilized stapes. A greater incidence in recent years is due to an increased awareness and interest.     

Integrated development and maturation of the hearing system. A critical review article

The understanding of development and maturation of the auditory system is essential for many reasons, including the practical aspects of auditory behaviour, testing, and teaching a hearing-impaired child to communicate effectively. The study of maturation of the auditory system is gaining increasing importance also because it should help us to interpret correctly certain aspects of auditory behaviour in infants. When studying the auditory system we should not be concerned solely with development of function in isolation; the emphasis is on integrated development. Understanding a process of integrated development enables us to understand the peculiarities of auditory behaviour in infants. Sound became the raw material of human language for good reasons. It is the only medium which made it possible to transmit efficiently complex information encoded in human language. Phylogenetically, hearing in vertebrates is a late development, and because of this, in certain unfavourable circumstances the hearing system is more vulnerable than other phylogenetically older systems. Within the auditory system, high-frequency hearing is also phylogenetically a late development, and therefore more vulnerable to certain unfavourable metabolic influences. In all species there is a 'best frequency' range, usually the one which is most vital for communication. In humans the best frequency range is the one which is most important for transmitting speech sounds. This is already noticeable in newborn and very young infants, that is, we can obtain the best reactions in the frequencies which are important for speech. Higher sensitivity for perception of patterns is already developed in newborn and young infants (and acquires a special significance). Direction detection and localisation of sound source develops gradually. It is fully developed only when the auditory pathway matures and when the function is well integrated with the maturing motor system. The ears of the young are more vulnerable to noise damage and therefore a variety of protective mechanisms exist. The quality of the sound environment of the infant is important and can be decisive for further development. It is highly desirable to detect hearing impairment as soon as possible after birth. Lack of stimulation of the auditory system, even when it functions only partially, or along a very narrow channel of communication, may lead to permanent complete loss of function of the auditory centre. But this could be prevented by early stimulation, even when it is possible only via the narrow channel of communication which fortunately is present in the great majority of cases of even severely hearing-impaired children.     

立复汀喷雾剂治疗小儿变应性鼻炎的疗效观察

目的 :观察立复汀喷雾剂治疗小儿变应性鼻炎的效果 ,并探讨其机制。方法 :对 113例小儿变应性鼻炎患者 ,分别用立复汀喷雾剂 (立复汀组 )和生理盐水喷鼻剂 (生理盐水组 )进行治疗和疗效对比。结果 :立复汀组的总有效率为 95 .1% ,生理盐水组为 2 5 .0 % ;立复汀组起效时间 72 .1%在 1min以内 ,维持时间 72 .1%在 5 h以上 ;而生理盐水组起效时间 2 3.1%在 3m in以内 ,维持时间 30 .8%在 3h以内。 2周后 ,立复汀组所查鼻分泌物中嗜酸性粒细胞明显减少或消失 (P <0 .0 5 )。结论 :立复汀喷雾剂缓解症状迅速 ,维持时间长 ,疗效显著 ,安全性好 ,是治疗小儿变应性鼻炎的有效药物。     

关于儿童阻塞性睡眠呼吸暂停低通气综合征我们面临的问题

儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)为耳鼻喉科常见病,其发病率高,且严重危害儿童生长发育。儿童OSAHS的发病与多种因素有关,其中最常见的原因是扁桃体肥大及腺样体肥大。扁桃体腺样体切除术是治疗儿童OSAHS的首选方法,但是仍然有一些问题需要面对,现就儿童OSAHS的术前评估、术后对生活质量的影响、术后继续干预等问题进行述评。     

Pleomorphic adenoma of the nose

Pleomorphic adenoma is the most frequent tumor of the major salivary glands. It is rarely located in the lacrymal glands and is unusual in the nasal cavity. A rare case of a pleomorphic adenoma of the nose is presented along with a review of the literature. The use of nasal endoscopy in removing tumors of the nose and paranasal sinuses is discussed.     

Plasmacytoma of the larynx

Plasmacytoma of the larynx is rare; thirty-one cases are reported in the literature and in this paper a further case is presented. The difficulty in diagnosing plasmacytoma is mentioned. Investigations to exclude multiple myeloma are mandatory to be sure that the disease is a localized lesion. Treatment of a localized lesion is essentially by radiotherapy but in the case of widespread or systemic disease, chemotherapy is recommended. A scoring system utilizing different parameters is suggested to decide whether the case has passed the borderline between local and systemic disease, a line which is invariably difficult to define.     

Phase-locking in the cochlear nerve of the guinea-pig and its relation to the receptor potential of inner hair-cells

The high-frequency limit of phase-locking has been measured in fibres of the auditory nerve in the guinea-pig. It is shown that phase-locking begins to decline at about 600 Hz and is no longer detectable above 3.5 kHz which is about 1 octave lower than in the cat, squirrel monkey and some birds. Direct measurements of the cochlear afferent fibre synaptic delay are consistent with indirect estimates from phase-locking, both giving values of 0.7-0.8 ms. Measurements of the receptor potentials of inner hair-cells in the guinea pig cochlea indicate that as the stimulus frequency is increased there is a progressive decrease in the a.c. component compared to the steady depolarization. The cause of this decline is the low-pass filtering of the a.c. component by the hair-cell membrane. The cut-off and slope of the decline in the a.c. component is consistent with the suggestion that this process is the limiting factor in cochlear nerve fibre phase-locking. The implications of these findings for interspecies variation in phase-locking cut-off, for cochlear mechanisms and for the encoding of complex sounds are discussed.     

Revision of the immobile ciliary syndrome on the ENT speciality's point of view

Primary ciliary dyskinesia is a disorder characterized by the presence of recurrent infections of the superior and inferior respiratory tract. It is caused by a recessive autosomic genetic disorder. Its diagnosis is often given late, because other diagnostic possibilities are thought of first. It is common to find many previous visits to the ENT specialist in a medical record. The final diagnosis is given by electronic microscopy observing the ciliary defect, which is frequently due to the absence or anomalies of dineine in the arms and in the structures of the microtubule pairs responsible of movement. The mucus to study is usually obtained from the inferior nasal concha. In the rest of cases the mucus of the tracheobronchial apparatus is only studied if a fibrobronchoscopy is necesary in order to evaluate bronchial compromise or when the nasal sample is not sufficient. The ENT specialist must be alert in order to be able to think of this entity. The genetic advice is the best way to prevent it.     

Inflammatory myofibroblastic tumor of the thyroid in its sclerosing subtype: the first case report

Inflammatory myofibroblastic tumor (IMT) is a rare entity. It is usually found in the lung and upper respiratory tract. Its location in the thyroid is exceedingly rare. Only seven cases of IMT of the thyroid were reported in the literature, mostly after the age of 50 years. The predominant histological pattern in all previously reported cases is that of marked plasma cell infiltrate. We report the detailed clinico-pathological and immunophenotypical features of a case of IMT of the thyroid in an 18-year-old girl with a family history of goiter. Our case is unique because it is the first and only known case of IMT of the thyroid in its alternative sclerosing subtype.     

Giant cell reparative granuloma originating from the ethmoid sinus

Giant cell granuloma is a reactive osseous proliferation and is histologically benign despite its aggressive clinical course. It usually involves the maxilla and the mandible in the region of the head and neck. It is rare in the ethmoid region. In this paper, an aggressive and recurrent giant cell reparative granuloma, which is recurred in a very short time period, originating from the ethmoid sinus is presented and the criteria for the differential diagnosis are noted in the light of the histological, clinical and biochemical parameters and the literature is reviewed.     

Salivary disease in childhood

Salivary disease in childhood is uncommon. Clinical features are much the same as in adult disease, however, congenital, inflammation, and functional disease is more common. Management is governed by the same general principles in all age groups. Congenital abnormalities are rare. Inflammation, either bacterial or viral, is the most common disease. Chronic sialadenitis usually resolves at puberty. Neoplasia is rare, and the majority of tumors are benign and occur in the parotid gland. Malignancy is suggested by rapid growth, pain, skin fixation, and lymphadenopathy. Surgical treatment of sialorrhea should only be considered after careful assessment. Relocation of the submandibular ducts is the treatment of choice.     

Ceruminoma

A unique case of adenoid cystic carcinoma arising in a ceruminous gland, with widespread pulmonary metastases, is presented. This is the first case in the English literature in which the diagnosis was made from material obtained by needle aspiration from a pulmonary metastasis. The literature is reviewed and the histological features and clinical course are discussed in the paper. Adenoid cystic carcinoma is the most common tumor of ceruminous gland origin, and is the only one which produces widespread metastases in the lungs. Tumors arising from ceruminous glands are slightly more prevalent in females, and pulmonary metastases occur almost three times as often in females as in males. Suggested treatment is wide local excision of the primary tumor and of local recurrences, and excision of distant metastases when possible. Irradiation is useful only for palliation. All patients, but especially females, should be followed carefully for the detection of possible pulmonary metastases.     

慢性鼻窦炎动物模型应用现状及评价指标

目的慢性鼻窦炎（chrohic rhinosinusitis,CRS）是上呼吸道常见的慢性炎症性疾病,已经成为严重影响公众健康的慢性疾病之一,根据目前国内外指南的治疗方法难以根治,主要原因是该疾病病因复杂呈异质性、发病机制尚不完全清楚,而基础研究缺乏成熟稳定的动物模型是重要原因。目前建立的CRS动物模型还存在各种争议,未形成成熟稳定公认的动物模型。本文就近十年来国内外建立CRS动物模型的现状进行简要综述,分析各种动物模型的优缺点,以期对未来研究CRS选择正确的模型起指导作用。