[Investigation of clinical pathology and treatments on the auricle pseudocyst]

OBJECTIVE

To study the clinical pathology and treatments on the pseudocyst of auricle.

METHODS

Sixty cases of auricular pseudocyst were treated by surgery from 1993 to 2008 in our hospital. Their operation effects and the clinic pathological features were analyzed.

RESULTS

The clinic pathological data showed that the source of serous effusion of auricular pseudocyst origin from cartilage membrane in the top wall. In the early stage of the cyst, the top wall of auricular pseudocyst was the cartilage membrane. With the course progresses, the cartilage membrane in the top wall of auricular pseudocyst was proliferating, thickened and generated new cartilage. The new cartilage was formed from small piece to the big one, and eventually became an entire new cartilage on the top wall of auricular pseudocyst. Serous effusion at this time was terminated, and this cyst became intra-cartilaginous effusion of auricle. Finally the fluid between cartilages was absorbed and organized. In the cyst, the new cartilage and auricle cartilage were organized and adhered together each other. The auricle became thickened and deformed. The observation of capsule wall under light microscope showed that there were a few fibrous desmoplasia, anapetia and lymphocyte infiltrating in the fibrous tissue, as well as that there were cartilage cell layers from firmness to thicker. The cartilage cells and their lacunes were small, and the cartilage capsule and the basilaris substantia was showed as eosin. This data indicated that the cartilage was neogenesis but not degenerating. Sixty patients were followed up from 3 months to 1 year. The effect of surgical treatment for the auricular pseudocyst was satisfactory. There was no auricular deformation in these patients with the operation.

CONCLUSIONS

Auricular pseudocyst can be divided into the early period (acute exudative period), the medium period (cartilage formation period) and the late period (proliferative and organized period). The treatment should be based on the pathological findings of auricular pseudocyst. The operation is easy, safe and reliable. The key of the operation is the complete removal of perichondrium and cartilage at the top of auricular pseudocyst.

[The morphology and differential diagnosis of neuroglial heterotopias and related tumors]

The paper reviews the data available in the literature and a clinicomorphological analysis of 15 cases of neuroglial heteropias and related tumors retrieved from the joint databases of Sikl's Department of Pathology, Pilsen, Czech Republic, and the Department of Pathology, Petrov Oncology Institute, with emphasis on the histological, immunohistochemical and ultrastructural features, as well as differential diagnosis.

[Expression and localization of macrophages and BMP2 in mucosa of tympanosclerosis]

OBJECTIVE

To detect the expression and localization of macrophages and BMP2 (bone morphogenetic protein 2) in the middle ear mucosa of TS, to explore its role in the pathogenesis of TS.

METHOD

Seventeen patients with TS were studied and 17 matching cases with simple chronic suppurative otitis media (COM) were enrolled as control. Immunohistochemistry was performed to detect the expression and localization of CD68 (the symbol of macrophage) and BMP2 in the middle ear mucosa. And the expression difference in the TS and COM were analyzed.

RESULT

Positive cells of CD68 was mainly localized in the submucosa layer. Each group had 12 cases with positive expression of CD68 (70.59%) and had no difference in the number of positive cells (TS: 6.94 +/- 6.08; COM: 7.59 +/- 7.84; P=0.79). All the specimens had positive expression of BMP2 and BMP2 protein was expressed in the mucosa layer and submucosa layer. There was statistical difference in the number of BMP2 expression between TS and COM group. In TS group, all the sclerotic plaques were surrounded with macrophages and BMP2 positive cells. The cells surrounding sclerotic plaques were synchronously expressing CD68 positive and BMP2 positive.

CONCLUSION

Macrophages should take part in the pathogenesis of TS. BMP2 secreted by macrophage was important in formation of TS.

Huge cholesterol granuloma of the middle ear extending to middle cranial fossa

Cholesterol granuloma (CG) may erode into the middle ear, the mastoid bone and the petrous apex. However, aggressive erosion into the cranial cavity is extremely rare. Here we report a case of huge CG extending to the middle cranial fossa. Temporal bone computerized tomography showed a soft tissue mass which destroyed the bony plate of the posterior and middle cranial fossa. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2-weighted images. The mass compressed the middle cranial fossa without invasion into the brain. The CG was removed by extended cortical mastoidectomy. The postoperative course was uneventful and there were no neurological complications.

Granuloma possibly induced by palladium after ear piercing

A case of sarcoidal-type allergic contact granuloma due to palladium is presented. The patient developed papulonodular lesions at the right earlobe after ear piercing, which after 3 to 4 years became more granulomatous and very resistant to treatment. Repeated intralesional injections with corticosteroids produced only a temporary regression of the lesions. Patch testing revealed a strong positive reaction to palladium (and nickel). Biopsy specimens taken from the persistent granulomatous lesion in the nodule at the earlobe, as well as from the site of the positive test reaction to palladium several weeks after patch testing, indicated epithelioid granulomas with some multinucleate histiocytes surrounded by a lymphocytic-histiocytic infiltrate. Similar cases (also with other metals) have been reported in the literature.

Foreign body in ENT--general practitioner's duty

Foreign body in ENT region is an age-old problem. Introduction of foreign body in ear, nose and throat is specially seen in children. There are many types of foreign body seen in the ear, nose and throat. They can aspirate into larynx, trachea and bronchus. How to manage the removal of foreign body in ear, nose and throat had been discussed in a nutshell. General practitioners should be skilled enough to remove foreign body with their limited resources and they should know when to send the cases to an ENT specialist or to a hospital.

Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

CONCLUSION

The expression profile of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase-2 (TIMP-2) was specific to the type of middle ear effusion. Further studies are necessary for elucidating its correlation with the sequelae of otitis media with effusion (OME) and idiopathic hemotympanum.

OBJECTIVES

We aimed to investigate the relative activities of gelatinases (MMP-2 and -9), stromelysin-1 (MMP-3), and matrilysin-1 (MMP-7), as well as measuring TIMP-2 levels in the serous and mucous effusions of OME and hemorrhagic effusion of the idiopathic hemotympanum.

MATERIALS AND METHODS

Middle ear effusions were collected from patients with OME and idiopathic hemotympanum, and were classified as mucoid, serous, or hemorrhagic. MMP activity in the effusion samples was examined by gelatin and casein zymography. Levels of TIMP-2 were measured by ELISA. Human temporal bone sections, with and without otitis media (OM), were examined histologically.

RESULTS

One case showed tympanic membrane thinning in the OM group, but none in the control group. While MMP-2 was present in all effusions, the active form of MMP-2 was found only in mucous effusions. MMP-3 and MMP-7 activity was detected only in the mucous effusions. MMP-9 exhibited activity in all effusions, with the highest levels in mucous effusions. TIMP-2 levels were markedly elevated in serous effusions.

The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis

BACKGROUND

Chondrodermatitis nodularis helicis (CDNH) is a painful inflammatory condition affecting the helix of the ear. Several surgical treatments are described in the literature, with different cure rates and cosmetic outcomes.

OBJECTIVES

To determine the cure rate of a novel method of surgical treatment, the 'punch and graft' technique, for CDNH and to compare this with reported techniques.

METHODS

Twenty-three lesions in 22 patients over a period of 7 years and 4 months were treated with the punch and graft technique, which is described.

RESULTS

A cure rate of 83% was obtained. The patients were followed up for a period of 1-86 months and cosmetic results were good.

CONCLUSIONS

The punch and graft technique is a novel method for surgical treatment of CDNH, with results comparable with those of existing methods.

Treatment of anterior semi-circular canalithiasis by a sedimentation procedure in a vertical rotatory chair

OBJECTIVES

To describe the video-nystagmographic characteristics, treatment, and results of a specific canalith repositioning procedure (CRP) on patients with canalolithiasis of the anterior semicircular canal (ASC).

MATERIAL AND METHODS

This was a retrospective study conducted from January 2005 to March 2006 on 16 patients treated for a benign paroxysmal positional vertigo (BPPV) of the ASC. Each patient after analysis and diagnosis using two-dimensional video-nystagmography (2DVNG) was treated with a specific CRP in a specific vertical rotatory chair with control of pulse and blood pressure. The effect of this procedure was determined after 1 week with video-nystagmoscopic (VNS) positional control. A 2DVNG bithermic caloric test, an impulse rotatory test, and a vibratory test were performed. Patients were contacted in May 2006 to measure the long-term effect of the CRP results.

RESULTS

In this retrospective study of 16 anterior BPPVs (a BPPV), the sex ratio, the average age, and the symptoms were comparable to those in patients with posterior BPPV (p BPPV). The sedimentation CRP proved to be effective, with all patients cured after 8 days, even though the length of illness before treatment was 11.68 weeks on average. At the time of the study, 13 patients were already cured, 8.07 months on average after the CRP. Three patients relapsed (one in an anterior form, two in a posterior form).

CONCLUSIONS

ASC BPPV is rare, possibly because the DIX HALLPIKE (DH) test does not sufficiently provoke the condition. The hyperextension with the head in the 45-degree upper position, especially in a rotatory chair, is probably more effective. It seems that the prolonged sedimentation in this position is the key to the treatment.

Echinococcosis presenting as an otogenic brain abscess: an unusual lesion of the middle ear cleft and temporal lobe

This paper presents a case of a 28-year-old male with a seizure episode and a 4-year history of intermittent tinnitus on the left ear. On computed tomography and magnetic resonance imaging, a density with rim enhancement was found at the temporal lobe, associated with mastoid tegmen destruction and middle ear mass, indicating cholesteatoma with complicating brain abscess. Evacuation of the brain abscess was performed with a combined otolaryngologic and neurosurgical procedures (canal wall-down mastoidectomy and temporal craniotomy). The pathology turned out to be infestation with Echinococcus granulosus.

Ear, nose and throat manifestations in pemphigus vulgaris

BACKGROUND

Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are two clinical forms: mucosal (MPV) and mucocutaneous (MCPV). The frequency of ear, nose and throat (ENT) involvement in PV is not clearly defined. Only a few isolated individual cases have been reported.

OBJECTIVES

The objective of our study was to determine the incidence of ENT involvement in patients with PV.

PATIENTS

We studied prospectively all 16 patients diagnosed with PV and treated in the Department of Dermatology of the University Clinic of Navarra between 2001 and 2005. They were 10 cases of MPV and six cases of MCPV. All patients were evaluated for ENT manifestations by endoscopic examination.

RESULTS

Of the 16 patients, 13 presented with throat symptoms (81%), 12 pharyngeal (75%) and seven laryngeal symptoms (44%). Fourteen patients (88%) had active PV lesions on endoscopic evaluation (eight patients had active lesions on both pharyngeal and laryngeal mucosa, four had PV lesions only on laryngeal mucosa and two had PV lesions on pharyngeal mucosa). Laryngeal lesions were most commonly present in MPV patients. The frequency of nasal symptoms (38%) was lower than active PV lesions (62%) found on ENT examination. Oral symptoms and oral active PV lesions were the most frequent findings (94%). Only three patients with MCPV showed erosions on the external auditory canal.

CONCLUSIONS

As ENT endoscopy allows more extensive areas of mucosa to be examined than simple visual inspection, we recommend that it be included in the examination of all patients with PV. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved.

Histological evaluation of novel ossicular chain replacement prostheses: an animal study in rabbits

CONCLUSION

The improved biocompatibility of Bioverit II coated with a nanostructured surface shows promising qualities for use in human reconstructive middle ear surgery. In the case of chitosan-hydroxyapatite composite prostheses, further investigations regarding composition of the material, degree of purity and design are necessary before clinical application.

OBJECTIVE

The selection of optimal materials for reconstructive middle ear surgery continues to be a problem. In the present study novel materials were tested as total ossicular replacement prostheses (TORPs) in an animal model.

MATERIALS AND METHODS

Bioverit II coated with a nanostructured surface and chitosan-hydroxyapatite composites were placed in the middle ear of 40 rabbits. Uncoated Bioverit II was used as control. After an implantation period of 28, 84 or 300 days petrous bones were extracted, embedded in epoxy resin and examined by light microscopy.

RESULTS

Uncoated and coated Bioverit prostheses revealed a mucosal coverage and a little osseogenic response after 28 days. The results of the coated Bioverit prostheses slightly surpassed those of the plain prostheses. Chitosan-hydroxyapatite composite prostheses were mostly found to be dislocated after 28 days. Formations of granulation tissue and fibrotic capsules were observed around these implants. This reaction could be caused by the instability of the composite material or may be due to impurities present in the chitosan.