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.     

Giant cell reparative granuloma of maxilla

Giant Cell Reparative Granuloma is a reparative process in mandible. A case of Giant Cell Reparative Granuloma of Maxilla in a 15 years old female is reported. Tumour is very rare in maxilla and more often is diagnosed as a giant cell tumour. The case is reported on account of its rarity in maxilla and dilemma in differentiating it from other giant cell lesions. Differentiation is only based on the clinical test histopathological examination.     

Impact of evolution on the eustachian tube

I posit that humans appear to be the only species that develops otitis media. If animals in the wild had developed middle‐ear disease to any significant degree, they would have been selected out during evolution because they would not have survived their predators given the associated hearing loss. Why do humans have otitis media? Evolution has had a significant impact. It is well known that humans are born 12 months too early, which is the result of adaptations to bipedalism and our big brain that, over time, resulted in a relatively small female pelvic outlet compared with nonhuman primates. As a consequence of too early a birth, not only is our immune system immature, but the eustachian tube is too short and floppy in the first year of life. But why is otitis media still common in older individuals? What other adaptation is uniquely human? We developed speech that was associated with descent of the larynx and hyoid bone, which, along with a decrease in prognathism (i.e., facial flattening), resulted in a change in palatal morphology as compared with other primates. Comparative anatomic and physiologic studies have demonstrated significant differences between humans and monkeys, especially in the muscles of the eustachian tube. Paradoxic constriction, as apposed to dilation, on swallowing is a common tubal dysfunction in humans and certain monkey models with chronic middle‐ear effusion. My hypothesis is that chronic otitis media with effusion in patients with tubal constriction is a consequence of adaptation for speech and that, most likely, the levator veli palatini muscle is the cause.     

Rhino sinusal bilateral hamartoma: a case report

The hamartoma is a benign rare tumor constituted by a mixture of tissue. It is very unusual in the nasal cavity.The objective of the study is to describe an unusual case of bilateral nasal hamartoma. We report a 52-year-old male patient with a bilateral paranasal hamartoma of the ethmoid and maxillary sinus. Functional endoscopic sinus surgery was performed to completely remove the masses.The reported localization is unusual because the most common site in the nose is the posterior septum. Although hamartoma arising from the rhino sinusal region is very rare, head and neck surgeons must know this entity in order to differentiate it from inverted papilloma and adenocarcinoma. Misinterpretation of this lesion may result in aggressive surgery for a benign lesion.     

Velopharyngeal sequels in labial-alveolar-velopalatine clefts. Analysis, conclusions and speech therapy management

The association of voice and speech defines phonation. Phonation depends on various organs: the lungs for air, the larynx as a vibration generator, and cavities of resonance modeling articulation and tone. The role of the soft palate is important in French and for everyday conversation. Velopharyngeal incompetence is defined as a voice and articulation disruption by anatomic and/or functional deficiency between the soft palate and pharynx. Hypernasality is studied on an acoustic, phonetic, and vocal level and graded in various degrees of hypernasality. The various clinical and perceptive tests of velopharyngeal incompetence are described according to age. The difficulty to modelize hypernasality is discussed based on a recent study published in 2007. The differential diagnosis with hyper-closed nasality is discussed. The treatment for this condition is essentially speech therapy associated with pharyngoplasty in some cases. The assessment of children born with a labial-alveolar-velopalatine cleft is mainly clinical and perceptive. Therapeutic management is necessary for the child and his family. The follow-up requires a multidisciplinary approach.     

Use of zoledronic acid in the treatment of Gorham's disease

Gorham's disease (Gorham-Stout syndrome) is a rare condition of unknown etiology involving a localized endothelial proliferation of lymph vessels resulting in destruction with bone resorption. The syndrome is rarely seen in the facial skeleton and has a large variety of prognoses and treatments. A case of this syndrome in a 9-year-old boy is presented. The clinical aspects are described, together with the treatment involving zoledronic acid. Other treatments described in the literature are reviewed. The authors believe that this report is one of the first cases in which a child afflicted in the first decade of life survives.     

Evaluating the Perceptual and Pathophysiological Consequences of Auditory Deprivation in Early Postnatal Life: A Comparison of Basic and Clinical Studies

Decades of clinical and basic research in visual system development have shown that degraded or imbalanced visual inputs can induce a long-lasting visual impairment called amblyopia. In the auditory domain, it is well established that inducing a conductive hearing loss (CHL) in young laboratory animals is associated with a panoply of central auditory system irregularities, ranging from cellular morphology to behavior. Human auditory deprivation, in the form of otitis media (OM), is tremendously common in young children, yet the evidence linking a history of OM to long-lasting auditory processing impairments has been equivocal for decades. Here, we review the apparent discrepancies in the clinical and basic auditory literature and provide a meta-analysis to show that the evidence for human amblyaudia, the auditory analog of amblyopia, is considerably more compelling than is generally believed. We argue that a major cause for this discrepancy is the fact that most clinical studies attempt to link central auditory deficits to a history of middle ear pathology, when the primary risk factor for brain-based developmental impairments such as amblyopia and amblyaudia is whether the afferent sensory signal is degraded during critical periods of brain development. Accordingly, clinical studies that target the subset of children with a history of OM that is also accompanied by elevated hearing thresholds consistently identify perceptual and physiological deficits that can endure for years after peripheral hearing is audiometrically normal, in keeping with the animal studies on CHL. These studies suggest that infants with OM severe enough to cause degraded afferent signal transmission (e.g., CHL) are particularly at risk to develop lasting central auditory impairments. We propose some practical guidelines to identify at-risk infants and test for the positive expression of amblyaudia in older children.     

Short-wave world revisited: Resonance in a two-dimensional cochlear model

According to the type of wave motion occurring, the length of the cochlea can be divided into three parts: in the first part there is a travelling wave with location-dependent propagation velocity, in the second the motion is dominated by resonance and in the third the wave is rapidly attenuated. This paper investigates two-dimensional aspects of wave motion in the second region for a simple cochlear model. The partition impedance is approximated by a linear function of the location χ and the integral equation for two-dimensional fluid motion is solved analytically. It is shown that for the commonly used cochlear parameters the fluid wave motion in the resonance region is predominantly two-dimensional, i.e., characterized as occurring in a short-wave world. Several physical aspects of this type of fluid motion are discussed.     

腺苷受体对视网膜疾病的作用及相关中药研究进展

腺苷被认为是一种神经调节剂,它通过激活腺苷受体(Adenosine receptor,ADOR)等多种机制参与机体的生理病理。ADOR被腺苷激活后控制神经递质的释放,促进视网膜神经调节。在视网膜中,从发育的早期阶段就开始存在ADOR的表达,ADOR是调节发育和成熟中视网膜组织多种功能的关键参与者。然而由于ADOR不同亚型的调控作用具有复杂性、多样性,因此本文就ADOR在视网膜疾病中的作用机制进行系统梳理,并总结目前中药干预ADOR缓解视网膜疾病的研究进展,以期为视网膜疾病的防治提供参考。     

Deep temporal fascial-periosteal flap for canal wall down mastoidectomy

It is very important to make a safe, dry, trouble-free ear for the canal wall down mastoidectomy. Although fascia graft is the most common material used for the repair of the perforated tympanic membrane, it is usually too small to cover the whole mastoid cavity in canal wall down mastoidectomy. The presence of exposed bone delays the epithelialization and results in prolonged otorrhea. We present a new simple technique that uses a postauricular, inferiorly based pedicled flap. Although our deep temporalis fascial-periosteal flap is not bulky, it is large enough to obliterate a sclerotic mastoid cavity without the need for additional flaps. It shrinks much less than a muscular flap during the healing period. In addition to reducing the cavity volume, this flap promotes the epithelialization over the bone and the shortening of the healing time. Although only a small number of patients were included in this study, coverage of a canal wall down mastoid cavity by a deep temporalis fascial-periosteal flap is expected to be a reliable and effective technique that results in a dry, trouble-free mastoid cavity.     

Sinonasal haemangiopericytoma: a case report

Haemangiopericytoma (HPC) is a rare vascular tumour that is thought to originate from the vascular pericytes of Zimmerman. HPC may arise in any part of the body, and from 15 to 30% of these tumours are found in the head and neck, with a rare involvement of the sinonasal region The main symptoms of nasal HPC, epistaxis and nasal obstruction, are not typical. The final diagnosis is based on the histopathology and immunochemistry, and whether the tumour is benign or malignant is defined on the basis of the clinical history. HPC located in the sinonasal area is generally benign. We report the case of a young woman with a sinonasal mass histologically proven to be haemangiopericytoma. The patient underwent surgical treatment by means of mid-facial degloving after embolisation of the maxillary artery. After a careful 3-year follow-up, the patient is disease free and healthy.     

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.     

Desmoplastic fibroma of the mandible associated with pathological fracture in a pediatric patient

Desmoplastic fibroma (DF) is a benign, locally aggressive, bone tumor that rarely presents in the facial bones. It is considered an intraosseous counterpart of the soft tissue fibromatoses. It is very rare in children. The present report describes the clinico-pathological and radiographic features of a desmoplastic fibroma of the mandible in a 12-year-old female who presented with a few months history of an expanding, painless mass along the left inferior border of the mandible. The patient underwent a resection with wide margins of the inferior border of the mandible that was followed by a pathological fracture. The fracture was reduced and the mandible was reconstructed by a vascularized free fibula flap.Conservative surgical approach and long term follow up is an effective treatment modality for mandibular DF in children.     

Bell's palsy: prognostic accuracy of case history,sialometry and taste impairment

A prognostic test in cases of Bell's palsy must be accurate and applicable early in the course of the disease. The case history is examined in 239 patients with Bell's palsy. The prognostic value of the case history, taste impairment and sialometry is investigated in a series of untreated patients who were followed up for 12 months. Sialometry is advocated as a reliable prognostic indicator in the individual patient if a strong stimulant is used. None of the other examined parameters discrimates between good and poor outcome with reasonable accuracy. A follow-up time of 12 months is advocated in determining the ultimate outcome of a Bell's palsy.     

Tibial bone harvesting technique for filling maxillary bone gaps in implantology

We present an easy and quick technique of tibial bone grafting that can be used in maxillary bone losses, specially in implantology. The surgical technique is performed under general anaesthesia. A 1.5 cm skin incision is made on the anteromedial side of the tibia. Then the bone marrow can be approached through a cortical window drilled with a motorized trephine. At this stage, a disposable bone aspirator is used to collect the cancellous bone. At the end of the procedure, the periosteum, the subcutaneous tissues and the skin are sutured in three layers. The quantity of harvested cancellous bone varies from 18 to 30 cc. The procedure duration is about twenty minutes. The complication rate is low and the patients are able to walk a few hours after the procedure. They leave the hospital on the day after. Tibial bone harvesting is an alternative technique that can be chosen in cases with large bone defects. This tibial graft can be recommended because of its low morbidity, the quality of the bone and the short time duration of the procedure. Some details must be pointed out. A medial tibial surgical approach is for us better than a lateral approach because of its lower morbidity and because the bone is more superficial. The use of a motorized trephine is important to lift precisely the cortical bone window and because it is less traumatic than the hand trephine. The disposable bone aspirator is an excellent option to pick-up bone marrow with a minimum loss of bone material and in a shorter time.     

Protein energy malnutrition revealing an esophageal foreign body

It is not unusual for a foreign body to be swallowed and be lodged in the esophagus. It is however, very unusual for such a foreign body to remain lodged for a period of 8 months. This particular case, a 15-month-old male infant, is under focus because of the time length the foreign body remained in the esophagus without local complications, what is unusual is a protein energy malnutrition complication. The neck and chest X-ray permitted the foreign body identification. The management of esophageal foreign body requires a multidisciplinary approach among otorhinolaryngologist, radiologist and pediatrician.     

A Simple Model of Cochlear Micromechanics in the Mammal and Lizard

A model is presented which is a simple representation of cochlear micromechanics in the lizard and mammal. The model is a linear, time-invariant mechanical system, consisting of two coupled mechanical filters. It is capable of a sharply tuned first and second filter, consistent with the sharply tuned basilar membrane and auditory nerve fibers in the mammal. When parameters are adjusted for the alligator lizard (Gerrhonotus multicarinatus), the model generates a sharply tuned second filter without a sharply tuned first filter. In the alligator lizard, the auditory nerve fibers are sharply tuned but the basilar membrane is not. The model supports the hypothesis that cochlear transduction is not fundamentally different in the mammal and the alligator lizard.     

A protocol for otolaryngology-head and neck resident training in pneumatic otoscopy

Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OME. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentially performs pneumatic otoscopy, otomicroscopy, and myringotomy on each patient scheduled for a myringotomy and tube placement the morning of surgery. After each task the trainee is required to state if an effusion is present or not, and the accuracy of the diagnosis is immediately reinforced at the time of myringotomy. The trainee's sensitivity and specificity in diagnosing OME is then calculated for the first and second half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the trainee is validated in otomicroscopy if the sensitivity and specificity is > 90% and > 80% respectively. Four residents completed the protocol, and a total of 275 ears were examined. Four residents were validated in pneumatic otoscopy, and three residents were validated in otomicroscopy. We conclude that this protocol allows for accurate documentation of the resident's skill progression and enhances resident education.     

Isolated palate ulcer due to mucormycosis

Mucormycosis is a rare but serious fungal infection that rapidly attacks and kills its untreated victims, who are often immunocompromised. It is one of the most fulminant and often fatal mycotic infections known to human beings. Rhinocerebral mucormycosis is the commonest presentation and its extension to the orbit and brain is quite usual but the palatal involvement is a rare and late occurrence. Isolated location of mucormycosis on the palate in an immunocompetent host is an unusual clinical entity. Here we report a case of deep hard palate ulcer due to mucormycosis in a 56-year-old man without any predisposing factor. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks. By presenting this case report we would like to emphasis that mucormycosis should be included in the differential diagnosis of the hard palate ulcers even in immunocompetent patient.