Ear canal cholesteatoma

Expression von Zell-Zell-Adhäsionsproteinen im Gehörgangscholesteatom

BACKGROUND

External auditory canal cholesteatoma (EACC) is a rare entity in otolaryngology, which is histomorphologically identical with middle ear cholesteatoma. The cause of EACCt is, however, still not clear. The aim of this study was to describe the expression of beta-catenin, MMP-2, and MMP-9 in EACC matrix compared to the normal auditory meatal skin (AMS).

METHODS

Thirteen specimens were obtained during surgical procedure. EACC and AMS specimens were immunostained with antibodies for beta-catenin, MMP-2, and MMP-9.

RESULTS

Only the basal layers of the EACC specimens were positive for beta-catenin. The suprabasal layers showed diminished or negative immunostaining for beta-catenin. In all layers, AMS was homogeneously positive for beta-catenin. In contrast, the immunostaining for the gelatinases was equally increased in all layers of EACC, whereas AMS was weekly positive.

CONCLUSION

The reduced immunoreactivity for beta-catenin may have been present because of the lessened cell-cell adhesion in the suprabasal layers of EACC. The increased expression of the metalloproteinases might point at an increased lack of integrity of EACC matrix. Recent studies revealed a balance between disintegrating and stabilising factors in normal tissue, which is disturbed in inflamed and neoplastic tissue. In EACC matrix, an imbalance of these factors, represented by reduced beta-catenin and increased gelatinase expression, is possible. Increased desquamation, the accumulation of keratin debris, and loss of tissue-stability support our findings.

Co-expression of different angiogenic factors in external auditory canal cholesteatoma

OBJECTIVE

Although external auditory canal cholesteatoma (EACC) was first described in 1850, its cause remains surprisingly unclear. Angiogenesis, the formation of new blood vessels, is essential to normal development and wound healing in adults. Abnormal regulation of angiogenesis has been implicated in the pathogenesis of several disorders. The aim of this study was to analyse angiogenesis regulator expression in EACC.

MATERIALS AND METHODS

Cryostat sections of 13 investigated EACC tissue samples and normal control tissue were immunostained for angiogenic hepatocyte growth factor (HGF)/scatter factor (SF), its c-Met receptor and vascular endothelial growth factor (VEGF) using a standard streptavidin-biotin complex procedure. Staining against von Willebrand factor (vWF) served as an endothelial marker. Statistical analysis was performed semiquantitatively.

RESULTS

The assayed angiogenic factors were all present in the EACC tissue, and partly overexpressed. vWF was detected in the apical layers of the matrix epithelium. Positive immunoreactivity for c-Met and VEGF was detectable in all layers of the EACC epithelium; however, adjacent tissue did not express c-Met and VEGE. HGF/SF was predominantly expressed in the adjacent perimatrix tissue and fibroblasts in particular were stained positive.

CONCLUSIONS

The presence of vWF in the apical part of the matrix depicted the attempt at angiogenesis in this part of the EACC. The detection of VEGF and c-Met in the epithelial part of the EACC implied that their origin may be epithelial, while HGF/SF may be secreted or stored in the adjacent mesenchymal EACC tissue. The angiogenic factors investigated seem to play an important role in establishing that EACC occurs by modulation of angiogenesis.

Immunohistochemical Investigations on External Auditory Canal Cholesteatomas

OBJECTIVE

The aim of the study was to analyze the biological behavior of external auditory canal cholesteatoma (EACC). The expression and distribution of relevant markers such as transforming growth factor-alpha (TGF-alpha), epidermal growth factor-receptor (EGFR), and the proliferation marker MIB 1 were studied in comparison with normal auditory meatal skin.

BACKGROUND

EACC are uncommon and knowledge concerning etiology and pathogenesis is limited. Whether this is a unique entity remains controversially discussed.

MATERIALS AND METHODS

Immunohistochemical methods were used to study the expression and distribution TGF-alpha, EGFR, and the proliferation marker MIB 1 on 15 tissues samples. Only the spontaneous form of EACC was included in this study.

RESULTS

Positive immunoreactivity for the proliferation marker MIB 1 could be demonstrated in keratinocytes in the basal and suprabasal layers of the epithelium. The number of MIB 1-positive proliferating cells in cholesteatoma was significantly higher than in normal external auditory skin. Cholesteatoma epithelium also showed an enhanced expression of TGF-alpha and EGFR. Inflammatory infiltrate was observed in the perimatrix to various degrees.

CONCLUSION

These results suggest that similar to the middle ear cholesteatoma, a chronic inflammatory process underlies the EACC, and the inflammatory stimuli may alter keratinocyte proliferation.

Spontaneous external auditory canal cholesteatoma complicated by rheumatoid arthritis--case report and review of the literature

A 63-year-old woman with rheumatoid arthritis sought medical assistance for dull and chronic pain in her left ear two and half years after her initial diagnostic examination. Otoscopic examination revealed that the posteroinferior wall of the bony external ear canal was eroded and that the small cavity was filled with squamous debris. The condition was diagnosed as external auditory canal cholesteatoma (EACC). The existence of EACC might suggest complications of bone disease, aging cerumen gland, or a low migratory rate of the epithelium.

Multifocal cholesteatoma of the external auditory canal following blast injury

Posttraumatic cholesteatoma of the external auditory canal is a rare condition that may present years after the original injury. A unique case of multifocal cholesteatoma of the external auditory canal following blast injury is presented and discussed.

Silent intratympanic membrane cholesteatoma

OBJECTIVE

To detect the presence of intratympanic membrane cholesteatoma in cases of chronic otitis media.

DESIGN

Two hundred forty-three temporal bones from patients with chronic otitis media were studied for the presence of intratympanic membrane cholesteatoma.

METHODS

Specimens had been previously removed at autopsy, fixed in 10% buffered formalin, decalcified in trichloroacetic acid, dehydrated in a graded series of ethanol, and embedded in celloidin. Sections were cut at a thickness of 20 microm, stained with hematoxylin eosin, and examined using light microscopy.

RESULTS

Intratympanic membrane cholesteatomas were found in five of the 243 temporal bones with chronic otitis media. All temporal bones with intratympanic membrane cholesteatomas were from adult patients. Two patients had bilateral intratympanic cholesteatomas in symmetric quadrants of the tympanic membrane, and the remaining patients with unilateral intratympanic membrane cholesteatoma had been operated on previously for a cholesteatoma of the opposite ear. Other common findings included chronic granulation tissue in the middle ears and mastoids, ossicular pathologic conditions, and in four of the five ears, fluid in the middle ears and/or mastoids.

CONCLUSION

When a white area is observed on the tympanic membrane of patients (especially those with "silent" chronic otitis media), differential diagnosis should include not only tympanosclerosis, but also intratympanic membrane cholesteatoma.

Osteoma with cholesteatoma in the external auditory canal

We report an unusual case of a 13-year-old girl with a benign osteoma associated with a cholesteatoma in the external auditory canal and serous otitis media. The osteoma was located in the antero-inferior wall of the right external auditory canal. A cholesteatoma was present between the osteoma and the tympanic membrane. Computed tomography revealed a soft tissue density within the external auditory canal and in the middle ear cleft. The shadow in the middle ear cleft was considered to represent the serous otitis media. Surgical removal of the osteoma and cholesteatoma proved successful, and no recurrences or complications have occurred in the first year postoperatively.

CT appearances of external ear canal cholesteatoma

External ear canal cholesteatoma (EECC) is rare in ear, nose and throat (ENT) practice. Two cases, one bilateral, are described. Computed tomography demonstrates the extent of bony involvement. Erosion of the external canal should not be overlooked when reviewing CT of the petrous bone in cases of discharge from the ear. EECC may necessitate surgery and delay in the diagnosis of EECC can result in progressive bony destruction.

Giant cholesteatoma of the external auditory canal

Cholesteatomas are found almost exclusively in the middle ear and mastoid. Occasionally this disease is seen in the external auditory canal. Cholesteatoma of the external auditory canal is a rare condition. Severe pain and profuse discharge associated with a normal eardrum and normal hearing are essential clinical features. In addition, we found facial paresis and conductive hearing loss in our case. Smaller cholesteatomas can be managed by frequent debridement in the office; larger lesions require surgical intervention. Surgery is successful in resolving otorrhea and relieving pain. In addition, our own experience has shown that surgery is successful in relieving facial paresis.

External auditory canal wall cholesteatoma: a complication of ear surgery

Primary external auditory canal wall cholesteatomas are usually present in the inferior portion of the canal lateral to the tympanic membrane. Small inclusion cysts are a common finding along incision lines after ear surgery. This report details 5 cases of large canal wall cholesteatomas after prior ear surgery. The middle ear or mastoid was not directly involved in any of the cases. The largest of these presented 8 years after the initial procedure and eroded in the middle and temporal fossae. A common feature among these patients was an extended period in which the patient was lost to follow-up after surgery. This experience reinforces the need for vigilant long term follow up even in the asymptomatic postoperative patient.

Pathologic conditions of the external ear and auditory canal

Primary care physicians are influential in diagnosing and initiating treatment of most pathologic conditions in patients with a history of hearing loss, chronic ear infection, diabetes, immunosuppression, or otologic symptoms with excessive exposure to sunlight. Lesions of the external ear and the external auditory canal (external acoustic meatus) are significant and common. Patients with such a history should have a thorough basic examination, which can be done with simple tools. Symptoms of hearing loss, otalgia, otorrhea, tinnitus, aural fullness, vertigo, and facial weakness may warrant referral of the patient to an otolaryngologist. The crux of preventing worsening otologic sequelae is early detection and treatment.

External ear canal cholesteatoma. Case report

External ear canal cholesteatoma is a rare condition in otologic practice. A case in a 43-year-old woman is presented in which despite the extensive nature of the lesion, minimal symptoms and absence of signs delayed diagnosis. The cause of the lesion and its treatment are discussed.