Clinical and histological evidence for the presence of the vomeronasal (Jacobson's) organ in adult humans

One hundred adult humans were examined specifically for the presence of the opening of the vomeronasal organ (VNO) on the antero-inferior part of the nasal septum. This was found in 39% of patients. Twenty-seven human septums were removed at post mortem, examined macroscopically, sectioned coronally and examined microscopically. In 70% of these specimens, vomeronasal structures were identified. Histological examination failed to reveal any evidence that these organs may be functional. The human embryology and comparative anatomy of the VNO are reviewed. The physiological function in different vertebrates is also considered, and the significance of the findings in this study is assessed in the light of this evidence.

Histopathology of the temporal bone in osteogenesis imperfecta congenita: a report of 5 cases

The histopathologic findings in 8 temporal bones from 5 patients with osteogenesis imperfecta congenita are reported. The otic capsule, bony walls of middle ear, and ossicles showed evidence of both deficient and abnormal ossification. Microfractures were found in the otic capsule and in the anterior process and handle of the malleus, in addition to their common location at the crura of the stapes. The cochlear and vestibular end-organs appeared normal. Pathologic changes compatible with otosclerosis were not seen. The possible implication of these changes on hearing and balance is discussed.

Paget's disease and the temporal bone--a clinical and histopathological review of six temporal bones

Paget's disease of bone occurs more commonly in the elderly and has been reported to involve the temporal bone in 30% of those afflicted. The clinical and histopathological features of six temporal bones from three patients with this disease are reported and the relevant literature reviewed. The effect of Paget's disease on the middle ear structures was more variable than its extension into the otic capsule. Pagetic involvement of the otic capsule was observed in five temporal bones. One patient had bilateral asymptomatic neurofibromas in the eighth cranial nerve. the potential mechanisms responsible for the conductive deafness, the sensorineural deafness and vestibular dysfunction associated with Paget's disease are discussed.

Mast cells in human middle ear mucosa in health and in disease

The distribution of mast cells was studied in normal human middle ear mucoperiosteal lining and in middle ear biopsies of patients with acute and chronic otitis media. The mast cells were identified on the basis of the metachromatic staining for their cytoplasmic granules with Giemsa and toluidine blue. Only a few mast cells located in proximity to blood vessels in the lamina propria underneath the epithelial layer were observed in normal middle ear mucoperiosteum. The number of mast cells in acute inflammatory reactions and in the normal middle ear lining was similar. By contrast, the mast cell count was significantly increased in chronic inflammatory reactions. The population density of the mast cells was the highest in the subepithelial layer of cholesteatoma, in regions where the lamina propria showed fibrosis and infiltration with chronic inflammatory cells, and around mucous glands. The presence of increased numbers of mast cells in chronic otitis media is consistent with our previous finding of high levels of histamine in middle ear effusions. It is postulated that mast cells play an important role in the pathogenesis of chronic otitis media through the release of their active biochemical mediators.

1984 Hodge memorial Award--surface wrinkles, cell ridges, and desquamation in the external auditory canal

The phenomenon of epithelial migration from the tympanic membrane laterally along the external auditory meatus has long been recognized, and the site of keratin desquamation observed. In this study, the surface features of deep canal epithelium have been studied in 14 human temporal bones, and skin removed from 21 human temporal bones has been sectioned and studied by light microscopy. The findings reveal the role of hairs and ceruminous glands in the desquamation of deep canal stratum corneum, and elucidate the migratory mechanism. The formation an distribution of keratin wrinkles and cellular ridges in the external canal are explained.

Histamine levels in middle ear effusions

The presence of histamine in 131 middle ear effusions was determined by the fluorometric assay technique. This potent mediator of inflammation was found in significant amounts in most of the samples, suggesting that it may play an important role in the pathogenesis of otitis media with effusion. It is postulated that mast cells located in the lamina propria of the tympanic mucoperiosteum are triggered to degranulate and release histamine by anaphylatoxin derived from activation of the complement system.

Clinical and microbiological features of otitis externa

A prospective study of 40 cases of acute otitis externa and 99 cases of chronic otitis externa in unselected patients revealed that otitis externa affects males and females with a similar frequency. The peak incidence occurs in the summer and early fall months of the year. Exposure to water, previous use of ear drops, and cotton-tipped applicators predisposed to both acute and chronic otitis externa. Hearing aid ear molds appear to be a predisposing factor in the development of chronic otitis externa. Pain, itching, discharge, and hearing loss were the most common presenting complaints in both acute and chronic otitis externa. The discharge in chronic otitis externa is more commonly purulent, whereas in acute otitis externa it is more commonly mucoid. The tympanic membrane is not frequently involved in acute otitis externa; however, in chronic otitis externa changes in the tympanic membrane were more often encountered. Most infections were of a pure bacterial origin, primarily Pseudomonas aeruginosa and Staphylococcus aureus. Fungi were the causative organisms more commonly in chronic otitis externa than in acute otitis externa (Figure 7). It was found that previous usage of ear drops was more often associated with otomycosis in acute otitis externa and yet was not related to a higher frequency of otomycosis in chronic otitis externa. The presence of a foreign material, such as an ear mold, was associated with a greater frequency of mixed infections (bacteria and fungi) in the group with chronic otitis externa. The presence of a greenish discharge or foul odor was not related to any particular organism.

The pathologic features of keratosis obturans and cholesteatoma of the external auditory canal

The presence of a keratin plug occluding the deep external auditory canal was first noted and documented in the 19th century. It has subsequently been proposed that two different diseases can be responsible for the presence of this type of obstruction within the deep meatus: keratosis obturans and external auditory canal cholesteatoma. Keratosis obturans is characterized by a dense plug of keratin debris located primarily within the deep meatus. There is an associated hyperplasia of the underlying epithelium and evidence of chronic inflammation within the subepithelial tissue. There is no evidence of erosion or necrosis of the underlying bone. In external auditory canal cholesteatoma the significant finding is extensive erosion of the bony external auditory canal by a wide-mouthed sac, lined with stratified squamous keratinizing epithelium, that arises lateral to the tympanic membrane and is located in the inferior portion of the bony external canal. There is frequently evidence of sequestration of the underlying bone.

Sudden deafness and vertigo due to inner ear hemorrhage--a temporal bone case report

A case of sudden deafness with vertigo shortly before death is reported in a patient with disseminated adenocarcinoma of the breast. Examination of the temporal bones revealed extensive perilymphatic hemorrhage as the probable cause of the deafness. The pathophysiology of deafness due to inner ear hemorrhage is discussed.

The role of histamine in secretory otitis media

Secretory otitis media is the most common cause of hearing loss in children. Although allergy has been suggested as a possible cause, its role as an etiologic factor in the formation of secretory otitis media is controversial. The presence of histamine in most middle ear effusions is thought to be generated from inflammatory and not allergic provocation. This potent mediator of inflammation may contribute to the chronicity of secretory otitis media.

Thickness of the migratory epithelium of the external auditory canal

The migratory epithelium of the external ear has been the object of much study, and it has long been presumed to thicken in abnormal conditions of the external ear. In this study, normal values have been established for the thickness of the epithelium at various sites on horizontally sectioned normal temporal bones. Three sites, the umbo, the anterior annulus, and the posterior annulus are shown to have statistically significant thickening when compared with other contiguous sites on the same section. A study of temporal bones with various abnormalities of both external and middle ear showed a statistically significant thickening of the epithelium when compared with the normal bones. This difference was particularly marked at the umbo, anterior annulus, and posterior annulus. This would imply that these thickened areas may represent growth centers in the epithelium of the external ear.

The anterior process of the malleus

The anterior process of the malleus has been recognized and its unique embryological development described for some time. However, most authorities, while describing it in the fetus and the child, claim that it atrophies with age and offer no theory as to its function. This study examined the horizontal serial sections of whole temporal bones of 50 ears, from donors of various ages from a 24 week fetus to extreme old age. Measurements indicate that, while the anterior process of the malleus seems to get smaller with increasing age, its anatomical consistency would indicate a physiological function. It is proposed that the anterior malleal process, in conjunction with the anterior malleal ligament, acts as the fulcrum of the axis of rotation of the malleus/incus complex and also acts as a damper to resonant oscillations of the complex at low frequencies.

The cytopathology of middle ear effusions (a new technique)

This article describes a simple technique for the dissolution of the mucus elements within middle ear effusions and the subsequent separation of the cells contained. After the mucus and mucopolysaccharides within middle ear effusions have been dissolved, the cells can be separated allowing for absolute cell counts with automated counters, smears for examination with light microscopy and differential cell counts, and transmission electron microscopic examination of the cell population. Transmission electron microscopy was utilized in this study to evaluate the amount of cellular distortion and artifact that resulted from the separation of these cells from the middle ear effusions and to evaluate the relative status of preservation of these cells. The ability to preserve, count, and identify the cellular component of middle ear effusions will be of value in attempting to understand the pathogenesis of otitis media with effusion.

The natural history of otosclerosis. A correlation of the volume and activity of the otosclerotic lesion with age

Two-hundred and fifty years after Valsalva's discovery that fixation of the stapes could be a cause of deafness, there is still a lack of knowledge about the etiology and pathogenesis of otosclerosis. The purpose of this study was to obtain more information about the natural history of this disease by correlating the volumes and activity of otosclerotic lesions within the temporal bone to the patient's age and sex. Fifty temporal bones from 33 patients (19 females and 14 males) with otosclerotic lesions were reviewed microscopically. The degrees of activity of these foci were assessed and, using a computer based technique known as "digitizing", the volumes of each otosclerotic lesion were calculated. The results of this study indicate that there is no statistical difference in volumes between males and females. From the results obtained, it is suggested that there appear to be two growth patterns of the otosclerotic lesion: one pattern grows for a very short period and then becomes dormant or inactive. The other type of otosclerosis shows a continuing growth and progression throughout life.

The Ontario Temporal Bone Bank program and the University of Toronto Temporal Bone Histopathology Laboratory

The first temporal bone histopathology laboratory in Canada was established at the University of Toronto in 1966. Its organization is outlined. More than 600 bones have been processed and more than 45 publications produced. These are broadly classified as new discoveries, new techniques of temporal bone processing, clinical pathological case reports, and papers on clinical entities. The laboratory has a major teaching role for the trainee in otolaryngology. The history of the temporal bone bank program in North America and of the Ontario Temporal Bone Bank is outlined.

Histopathological findings in clinical gentamicin ototoxicity

The temporal bone histopathological findings in a case of gentamicin sulfate-induced hearing loss and vertigo in an anephric patient undergoing hemodialysis are presented. A study of the sensory neuroepithelium of the cristae and maculae disclosed the presence of vacuoles with clubbing of the sensory cells. In the cochlea, loss of the innermost row of outer hair cells in the basal turn was the most prominent feature. These findings are discussed in light of reports of similar morphological changes in laboratory studies of gentamicin ototoxicity.

Telescopic otoscopy and photography of the tympanic membrane

High resolution wide field photographs of the external canal, tympanic membrane, and middle ear can now be readily taken using a Hopkin's Lens Fiberoptic Tele-otoscope with a high intensity flash generator and light source. The equipment required and the technique used are described and sample photographs presented. The old adage that one picture is worth a thousand words holds true for illustrating tympanic membrane and middle ear pathology. The pictures taken have proved to be extremely valuable in following the course of disease within an ear. When ears are examined for photographic purposes the examiner tends to look at the ears in greater detail and develops an appreciation of the subtle departures from normal which occur.

Artificial eustachian tube-induced keratin foreign-body granuloma

The pathogenesis of granulation tissue that arises periodically around artificial Eustachian tubes was elucidated by histologic examination of 15 cases of tube granuloma. All cases showed the presence of a keratin foreign-body granuloma. The implanted squames incited a foreign-body type of granulomatous reaction and produced a friable vascular exuberant mass that surrounded the artificial Eustachian tube. Histologically, the tube granuloma was characterized by the presence of irregular ovoid slit-like spaces that contained keratin squames, and it was surrounded by foreign-body giant cells.

Occult intralabyrinthine schwannoma

Report of a case of an intralabynrinthine schwannoma discovered unexpectedly during a labyrinthectomy for intractable vertigo, and description of the light and electron microscopic appearances. Although only 18 of these tumors have been previously reported, it is possible that some cases which are categorized as peripheral vertigo of unknown origin, may be due to an occult Schwannoma. All material removed during surgical procedures on the inner ear should therefore be submitted for histopathological examination.

Pathogenesis and detection of aminoglycoside ototoxicity

Aminoglycoside antibiotics are widely prescribed in the treatment of serious gram negative sepsis. The more recently developed members of this group, although purporting to be less ototoxic, are also capable of producing inner ear damage in sufficiently high doses. This paper reviews the morphological, histochemical, and electrophysiological evidence concerning the mode of action of aminoglycosides on the auditory and vestibular systems and discusses the available methods for the detection of possible clinical ototoxicity. Guidelines are proposed to assist the otolaryngologist when advising about the prevention of ototoxicity and the management of patients with established auditory or vestibular dysfunction.

Osteopetrosis of the temporal bone

Osteopetrosis is a rare hereditary disorder of bone development. We examined the right temporal bone of a 17-year-old boy with recessive osteopetrosis and a conductive hearing loss and describe the histopathologic characteristics. The conductive deafness in this case was caused primarily by recurrent otitis media.

Epstein-Barr virus RNA. V. Viral RNA in a restringently infected, growth-transformed cell line

A continuous lymphoblastoid cell line, IB-4, was established by infection and growth transformation of normal neonatal B lymphocytes with the B95-8 isolate of Epstein-Barr virus (EBV). The IB-4 cells contained the intranuclear antigen, EBNA, but not early antigen, EA. The fragments produced by the digestion of intracellular episomal viral DNA (density, 1.700 to 1.720 g/cm3) with EcoRI restriction endonuclease were identical in size to the A, B, C, E, F, G, and H fragments of virion DNA. As expected from the previous observation that episomal intracellular DNA is circular, the fragment containing the rightward terminal sequences of EBV DNA in IB-4 cells was larger than the corresponding fragment of linear viral DNA, probably as a consequence of covalent linkage to the leftward terminal fragment. Also, two fragments, EcoRI-I and -J, which were adjacent to each other in the virion DNA, were absent from the intracellular DNA. The labeled EcoRI-J of viral DNA hybridized instead to a new fragment equal in size to EcoRI-I and -J combined. Analysis of viral RNA in IB-4 cells showed that RNAs encoded by more than 30% of the viral DNA comprised approximately 0.06% of the nuclear RNA, whereas RNAs encoded by 20% and 10% of the viral DNA comprised approximately 0.06% and 0.003% of the polyadenylated and polyribosomal RNAs, respectively. Viral mRNA (polyribosomal RNA) was encoded by DNA which mapped at 0.05 x 10(8) to 0.36 x 10(8) daltons and to a lesser extent by DNAs which mapped at 0.62 x 10(8) to 0.67 x 10(8), 0.70 x 10(8) to 0.73 x 10(8), and 1.13 x 10(8) to 1.15 x 10(8) daltons in the B95-8 genome. The most agundant nuclear viral RNAs were encoded primarily by DNA which mapped at the same loci; but RNAs encoded by many other fragments of viral DNA could also be detected among nuclear RNAs. Viral mRNA(s) (polyribosomal) was encoded by about 40% of the internal reiteration and by 25% of the BamHI-H fragments which mapped from 0.32 x 10(8) to 0.36 x 10(8) daltons, nuclear RNAs were encoded by at least 57% of the internal reiteration and 40% of BamHI-H. These data indicate that there is selective accumulation of some viral RNAs within the nucleus of IB-4 cells and that there is selective post-transcriptional processing of these RNAs. Finer mapping of the DNA which encodes mRNA (polyribosomal) in IB-4 cells indicated that some of this DNA is deleted in the DNA of the P3 HR-1 virus, the only isolate of EBV which cannot initiate growth transformation. These data, therefore, support the hypothesis that expression of this region of EBV genome is important for growth transformation or for the maintenance of restrigent infection.

Peripheral facial paralysis secondary to metastatic malignant melanoma. A clinicopathologic report

We report a case of disseminated malignant melanoma in which the initial sign was an isolated peripheral facial palsy on the left side. The cause of the palsy was established five months later, with the appearance of metastatic axillary nodes. The temporal bones demonstrated tumor infiltration within the marrow spaces of the petrous apices bilaterally. The left facial nerve was also extensively involved with melanoma to the level of the geniculate ganglion.

Otitis externa: a rationale for treatment

Acute diffuse otitis externa due to Pseudomonas (swimmer's ear) is a common summer problem which may be empirically (and inadequately) treated. Rational treatment is based upon accurate diagnosis of the etiology of the inflammation, and meticulous treatment of the ear canal. The type of ear drop seems less important than the technique of its application and physical management of the inflamed canal itself. A rational regime of therapy is outlined and side effects of drops discussed with complications of the disease itself.

Surgery and histopathology of the stapes in osteogenesis imperfecta tarda

Fourteen stapedectomies were performed on ten patients with osteogenesis imperfecta tarda. Clinically, the footplates were softer and more tenuously fixed than in otosclerosis and floating footplates seemed more common. Stapes and stapes fragments from all 14 operations were examined microscopically. The histopathology of osteogenesis imperfecta was contrasted to that of otosclerosis. We believe that the greater degree of structural disorganization and greater area occupied by resorption spaces clearly distinguish the new bone formed in osteogenesis imperfecta from otosclerosis.

Hearing without hair cells? A case report

Audiograms from a five year old accident victim with a profound hearing loss are compared to temporal bone and brain stem histological findings. One temporal bone was evaluated using surface preparation and transmission electron microscope techniques. The other temporal bone was evaluated using serial section procedures. No sensory cells were present in either cochlea. This unusual finding is discussed. Evaluation of ventral cochlear nuclei showed a 50 per cent loss of neurons on both sides.

Histologic processing and examination of a 4,000-year-old human temporal bone

We believe this is the first report of a mummy temporal bone successfully processed by decalcification and serial sectioning. The condition of the bone required modifications of standard processing technique. Examination of the sections revealed evidence of antemortem otitis media and mastoiditis. The technique described should prove useful in otopathological studies of other paleontological specimens.

Foreign body granulomas of the ear

Foreign body granulomas of the ear are seldom looked for, but probably common occurrences. They may be due to exogenous or endogenous material which became implanted in the course of trauma or treatment in the external or middle ear. They provoke inflammation which may be subclinical, clinical, or masked by concurrent infection. They can aggravate chronic infection, initiate acute local inflammation, or jeopardize surgical success. Histologically, the foreign material is seen lying freely or partially encapsulated within chronic inflammatory tissue, in close proximity to foreign body giant cells. Medical treatment can only succeed when the offending agent is surgically removed.

Bone formation in the normal human otic capsule

Postmoretem examination of undecaicified temporal bones from five patients treated with tetracycline during adult life for unrelated disease showed the uptake of tetracycline label within the endochondral bone the otic capsule. Adult endochondral bone is histologically woven (nonlamellar) in character, and has been assumed to be metabolically inert in the healthy state. The strong perlvascular labelling seen suggests that new bone is normally deposited in the otic capsule and that this new bone is lamellar in character. Continuous new bone formation in the presence of a constant net volume of bone implies that resorption must also occur normally within the otic capsule.

Nonlamellar new bone formation in the anterior attic recess

An area of nonlamellar new bone formation was observed in the anterior epitympanic region of 27 randomly chosen human temporal bones. The donors ranged in age from 9 to 80 years and had no evidence of ear disease or systemic skeletal or metabolic abnormalities. The frequency of this finding suggests that it is a normal feather of the human anterior attic recess.