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Xie M, Tang Q, Wang S, Huang X, Wu Z, Han Z, Li C, Wang B, Shang Y, Yang H. Identification of miRNA expression profile in middle ear cholesteatoma using small RNA-sequencing. BMC Med Genomics 2024; 17:162. [PMID: 38890701 PMCID: PMC11186090 DOI: 10.1186/s12920-024-01932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The present study aims to identify the differential miRNA expression profile in middle ear cholesteatoma and explore their potential roles in its pathogenesis. METHODS Cholesteatoma and matched normal retroauricular skin tissue samples were collected from patients diagnosed with acquired middle ear cholesteatoma. The miRNA expression profiling was performed using small RNA sequencing, which further validated by quantitative real-time PCR (qRT-PCR). Target genes of differentially expressed miRNAs in cholesteatoma were predicted. The interaction network of 5 most significantly differentially expressed miRNAs was visualized using Cytoscape. Further Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analyses were processed to investigate the biological functions of miRNAs in cholesteatoma. RESULTS The miRNA expression profile revealed 121 significantly differentially expressed miRNAs in cholesteatoma compared to normal skin tissues, with 56 upregulated and 65 downregulated. GO and KEGG pathway enrichment analyses suggested their significant roles in the pathogenesis of cholesteatoma. The interaction network of the the 2 most upregulated (hsa-miR-21-5p and hsa-miR-142-5p) and 3 most downregulated (hsa-miR-508-3p, hsa-miR-509-3p and hsa-miR-211-5p) miRNAs identified TGFBR2, MBNL1, and NFAT5 as potential key target genes in middle ear cholesteatoma. CONCLUSIONS This study provides a comprehensive miRNA expression profile in middle ear cholesteatoma, which may aid in identifying therapeutic targets for its management.
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Affiliation(s)
- Mengyao Xie
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Qi Tang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Shu Wang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Xiaowu Huang
- Department of Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 518100, P.R. China
| | - Zhiyuan Wu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P.R. China
| | - Zhijin Han
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Chen Li
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Bin Wang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Yingying Shang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China
| | - Hua Yang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, P.R. China.
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Uğurlu BN, Aktar Uğurlu G. Exploring trends and developments in cholesteatoma research: a bibliometric analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08749-z. [PMID: 38809268 DOI: 10.1007/s00405-024-08749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Examination of the scientific literature on cholesteatoma from past to present using bibliometric methods. METHODS A total of 2353 articles on cholesteatoma between 1980 and 2023 were obtained from the Web of Science database and statistically analysed using bibliometric techniques. RESULTS The journals with the highest number of contributions to the literature were Otology & Neurotology (n = 192), Acta Oto-Laryngologica (156) and Laryngoscope (149). The most impactful journals based on h-index and total citation (TC) counts were Laryngoscope (h:36, TC: 4241), Otology & Neurotology (29, 3141), and American Journal of Otology (26, 2071) respectively. The most prolific author was Kojima H. (n = 49). According to the findings of the Reference Publication Year Spectroscopy (RPYS) analysis, there has been a significant increase in academic interest in Cholesteatoma since its first description in 1959, particularly following the expansion of its definition in 1977. Subsequently, the trend of increased interest has risen rapidly in later years, with notable peaks in research intensity observed in 1989, 2006, and 2011. The highest academic trend occurred in 2006. In recent years, trending topics have included innovative approaches such as diagnostic and imaging methods particularly alongside technological developments, endoscopic surgery, recurrence and complications, prognosis and quality of life, artificial intelligence, and obliteration. CONCLUSION In conclusion, the evolution of cholesteatoma and its research priorities reveal temporal shifts and emerging areas of interest over time. Primarily, diagnosis, treatment, and surgical approaches remain central. Additionally, research has expanded to encompass developments in surgical techniques, imaging modalities, cellular biology, pathology, and molecular mechanisms.
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Affiliation(s)
- Burak Numan Uğurlu
- Private Practitioner, Otolaryngology, Çorum, Turkey.
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey.
| | - Gülay Aktar Uğurlu
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey
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Chen N, Xu L, Bi Z, Wu J. Hypoxia-inducible factor-1α contributes to the proliferation of cholesteatoma keratinocytes through regulating endothelin converting enzyme 1 expression. Laryngoscope Investig Otolaryngol 2024; 9:e1233. [PMID: 38525120 PMCID: PMC10960243 DOI: 10.1002/lio2.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/11/2024] [Accepted: 02/25/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Cholesteatoma is a hyperproliferative, pseudoneoplastic lesion of the middle ear characterized by aggressive growth and bone destruction. Hypoxia-inducible factor-1α (HIF-1α, also known as HIF1A) is a key transcription factor that enters the nucleus and upregulates many genes involved in cancer progression in the oxygen-free environment. This study is designed to explore the role and mechanism of HIF1A in the progression of cholesteatoma. Methods HIF1A and endothelin converting enzyme 1 (ECE1) levels were determined using real-time quantitative polymerase chain reaction. The protein levels of HIF1A, Cyclin D1, proliferating cell nuclear antigen, and ECE1 were measured using western blot. Cell viability, proliferation, and cell cycle progression were analyzed using cell counting kit-8, Colony formation, 5-ethynyl-2'-deoxyuridine, and flow cytometry assays. Binding between HIF-1α and ECE1 promoter was predicted by Jaspar and verified using Chromatin immunoprecipitation and dual-luciferase reporter assays. Results HIF1A and ECE1 were highly expressed in cholesteatoma patients and keratinocytes. Moreover, HIF1A knockdown might suppress the cell viability, proliferation, and cycle progression of cholesteatoma keratinocytes. Furthermore, HIF1A upregulated the transcription of ECE1 through binding to its promoter region. Conclusion HIF1A might expedite cholesteatoma keratinocyte proliferation partly by increasing ECE1 expression, providing a possible therapeutic target for the cholesteatoma treatment.
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Affiliation(s)
- Nie Chen
- Department of OtolaryngologyChangzhou No. 2 People's Hospital affiliated to Nanjing Medical UniversityChangzhouChina
| | - Lei Xu
- Department of OtolaryngologyChangzhou No. 2 People's Hospital affiliated to Nanjing Medical UniversityChangzhouChina
| | - Zhi Bi
- Department of OtolaryngologyChangzhou No. 2 People's Hospital affiliated to Nanjing Medical UniversityChangzhouChina
| | - Jian Wu
- Department of OtolaryngologyChangzhou No. 2 People's Hospital affiliated to Nanjing Medical UniversityChangzhouChina
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Modée Borgström A, Mogensen H, Engmér Berglin C, Knutsson J, Bonnard Å. Occurrence of mucosa-affecting diseases of the upper airways in middle ear cholesteatoma patients: a nationwide case-control study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08567-3. [PMID: 38517544 DOI: 10.1007/s00405-024-08567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Exploring a possible link between upper airway inflammation and the development of cholesteatoma by studying the association between mucosa-affecting diseases of the upper airways and cholesteatoma surgery. METHODS This is a nationwide case-control study of 10,618 patients who underwent surgery for cholesteatoma in Sweden between 1987 and 2018. The cases were identified in the National Patient Register and 21,235 controls matched by age, sex and place of residency were included from national population registers. Odds ratios (OR) and corresponding 95% confidence intervals were used to assess the association between six types of mucosa-affecting diseases of the upper airways and cholesteatoma surgery. RESULTS Chronic rhinitis, chronic sinusitis and nasal polyposis were more common in cholesteatoma patients than in controls (OR 1.5 to 2.5) as were both adenoid and tonsil surgery (OR > 4) where the strongest association was seen for adenoid surgery. No association was seen between allergic rhinitis and cholesteatoma. CONCLUSION This study supports an association between mucosa-affecting diseases of the upper airways and cholesteatoma. Future studies should aim to investigate the mechanisms connecting mucosa-affecting diseases of the upper airways and cholesteatoma formation regarding genetic, anatomical, inflammatory and mucosa properties.
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Affiliation(s)
- Agnes Modée Borgström
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Engmér Berglin
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Knutsson
- Department of Otolaryngology, Västerås Hospital, Västerås, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Region Västmanland, Centre for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Åsa Bonnard
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
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Zeng L, Xie L, Hu J, He C, Liu A, Lu X, Zhou W. Osteopontin-driven partial epithelial-mesenchymal transition governs the development of middle ear cholesteatoma. Cell Cycle 2024; 23:537-554. [PMID: 38662954 PMCID: PMC11135870 DOI: 10.1080/15384101.2024.2345481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/28/2024] Open
Abstract
Cholesteatoma is a common disease of the middle ear. Currently, surgical removal is the only treatment option and patients face a high risk of relapse. The molecular basis of cholesteatoma remains largely unknown. Here, we show that Osteopontin (OPN), a predominantly secreted protein, plays a crucial role in the development of middle ear cholesteatoma. Global transcriptome analysis revealed the loss of epithelial features and an enhanced immune response in human cholesteatoma tissues. Quantitative RT-PCR and immunohistochemical staining of middle ear cholesteatoma validated the reduced expression of epithelial markers, as well as the elevated expression of mesenchymal markers including Vimentin and Fibronectin, but not N-Cadherin, α-smooth muscle actin (α-SMA) or ferroptosis suppressor protein 1 (FSP1), indicating a partial epithelial-mesenchymal transition (EMT) state. Besides, the expression of OPN was significantly elevated in human cholesteatoma tissues. Treatment with OPN promoted cell proliferation, survival and migration and led to a partial EMT in immortalized human keratinocyte cells. Importantly, blockade of OPN signaling could remarkably improve the cholesteatoma-like symptoms in SD rats. Our mechanistic study demonstrated that the AKT-zinc finger E-box binding homeobox 2 (ZEB2) axis mediated the effects of OPN. Overall, these findings suggest that targeting the OPN signaling represents a promising strategy for the treatment of middle ear cholesteatoma.
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Affiliation(s)
- Lingling Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xie
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jin Hu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao He
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aiguo Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Lu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Zhou
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Satoh C, Yoshiura KI, Mishima H, Yoshida H, Takahashi H, Kumai Y. Proto-oncogene mutations in middle ear cholesteatoma contribute to its pathogenesis. BMC Med Genomics 2023; 16:288. [PMID: 37968650 PMCID: PMC10647096 DOI: 10.1186/s12920-023-01640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/22/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Chronic inflammation causes bone destruction in middle ear cholesteatomas (MECs). However, the causes of their neoplastic features remain unknown. The present study demonstrated for the first time that neoplastic features of MEC are based on proto-oncogene mutations. RESULTS DNA was extracted from MEC and blood samples of five patients to detect somatic mutations using depth-depth exome sequencing. Exons with somatic variants were analyzed using an additional 17 MEC/blood test pairs. Variants detected in MECs but not in blood were considered pathogenic variant candidates. We analyzed the correlation between proto-oncogene (NOTCH1 and MYC) variants and the presence of bone destruction and granulation tissue formation. MYC and NOTCH1 variants were detected in two and five of the 22 samples, respectively. Two of the NOTCH1 variants were located in its specific functional domain, one was truncating and the other was a splice donor site variant. Mutations of the two genes in attic cholesteatomas (n = 14) were significantly related with bone destruction (p = 0.0148) but not with granulation tissue formation (p = 0.399). CONCLUSIONS This is the first study to demonstrate a relationship between neoplastic features of MEC and proto-oncogene mutations.
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Affiliation(s)
- Chisei Satoh
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Mishima
- Department of Human Genetics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruo Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Semiz-Oysu A, Oysu C, Kulali F, Bukte Y. PROPELLER diffusion weighted imaging for diagnosis of cholesteatoma in comparison with surgical and histopathological results: emphasis on false positivity and false negativity. Eur Arch Otorhinolaryngol 2023; 280:4845-4850. [PMID: 37149831 DOI: 10.1007/s00405-023-08001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To investigate the role of non-echo planar diffusion weighted imaging (DWI) using "periodically rotated overlapping parallel lines with enhanced reconstruction" (PROPELLER) sequence for the diagnosis of cholesteatoma compared to surgical and histopathological results in an attempt to determine the factors causing false negative and false positive diagnoses. METHODS Patients who had PROPELLER DWI before ear surgery were retrospectively reviewed. The presence of a lesion with diffusion restriction on PROPELLER DWI was accepted as positive for cholesteatoma, and the results were compared to the intraoperative and histopathological findings. RESULTS A total of 112 ears in 109 patients were reviewed. On PROPELLER DWI, a lesion with diffusion restriction was found in 101 (90.2%) ears, while in 11 (9.8%) of the patients, no diffusion restriction was found. Surgery and histopathological analysis revealed a cholesteatoma in 100 (89.3%) ears, while in 12 (10.7%) ears, no cholesteatoma was found surgically. There were 96 (85.7%) true positives, 7 (6.2%) true negatives, 5 (4.5%) false positives and 4 (3.6%) false negatives. The accuracy, sensitivity, specificity, positive predictive and negative predictive values of non-echo planar DWI were calculated to be 91.96%, 96%, 58.33%, 95.05%, and 63.64%, respectively. CONCLUSION Non-echo planar DWI using PROPELLER sequence has high accuracy, sensitivity and positive predictive value and can be used for the detection of cholesteatoma. The external auditory canal, postoperative ears and small lesions should be evaluated with caution to avoid false results.
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Affiliation(s)
- Aslihan Semiz-Oysu
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagatay Oysu
- Department of Otorhinolaryngology and Head and Neck Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Kulali
- Department of Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yasar Bukte
- Department of Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
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Li QC, Wang SQ, Cao ZZ, Zhou SH. Enhanced Mitophagy in Cholesteatoma Epithelial Cells. Otol Neurotol 2023; 44:e688-e694. [PMID: 37590884 DOI: 10.1097/mao.0000000000003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
HYPOTHESIS Mitophagy may have a potential role in the pathogenesis of acquired cholesteatoma. BACKGROUND Enhanced mitophagy has been proven to be involved in various cancers. However, its role in the pathogenesis of cholesteatoma, which shares some common features with cancer, is controversial. This study investigated mitophagy in cholesteatoma epithelial cells. METHODS The autophagy protein markers LC3-II and p62 and mitophagy proteins BNIP3, Parkin, and PINK1 were analyzed in cholesteatoma epithelial cells and external auditory canal epithelium cells by immunoblotting. The results were confirmed by immunohistochemistry. Adenovirus Ad-mCherry-GFP-LC3B and Ad-GFP-LC3B were used to evaluate autophagic activity. Transmission electron microscopy was used to observe and analyze autophagosomes. RESULTS LC3-II expression was increased in cholesteatoma cells, whereas soluble and insoluble p62 levels were decreased. The expressions of BNIP3, Parkin, and PINK1 were higher in total protein and mitochondrial protein of cholesteatoma cells compared with normal external auditory canal epithelium cells. Autophagic activity was increased in cholesteatoma cells compared with normal external auditory canal epithelium cells. CONCLUSION Mitophagy was enhanced in cholesteatoma epithelial cells and may have a potential role in the pathogenesis of acquired cholesteatoma.
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Affiliation(s)
- Quan-Cheng Li
- Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Gao M, Xiao H, Liang Y, Cai H, Guo X, Lin J, Zhuang S, Xu J, Ye S. The Hyperproliferation Mechanism of Cholesteatoma Based on Proteomics: SNCA Promotes Autophagy-Mediated Cell Proliferation Through the PI3K/AKT/CyclinD1 Signaling Pathway. Mol Cell Proteomics 2023; 22:100628. [PMID: 37532176 PMCID: PMC10495652 DOI: 10.1016/j.mcpro.2023.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023] Open
Abstract
Cholesteatoma is a chronic inflammatory ear disease with abnormal keratinized epithelium proliferation and tissue damage. However, the mechanism of keratinized epithelium hyperproliferation in cholesteatoma remains unknown. Hence, our study sought to shed light on mechanisms affecting the pathology and development of cholesteatoma, which could help develop adjunctive treatments. To investigate molecular changes in cholesteatoma pathogenesis, we analyzed clinical cholesteatoma specimens and paired ear canal skin with mass spectrometry-based proteomics and bioinformatics. From our screen, alpha-synuclein (SNCA) was overexpressed in middle ear cholesteatoma and might be a key hub protein associated with inflammation, proliferation, and autophagy in cholesteatoma. SNCA was more sensitive to lipopolysaccharide-induced inflammation, and autophagy marker increase was accompanied by autophagy activation in middle ear cholesteatoma tissues. Overexpression of SNCA activated autophagy and promoted cell proliferation and migration, especially under lipopolysaccharide inflammatory stimulation. Moreover, inhibiting autophagy impaired SNCA-mediated keratinocyte proliferation and corresponded with inhibition of the PI3K/AKT/CyclinD1 pathways. Also, 740Y-P, a PI3K activator reversed the suppression of autophagy and PI3K signaling by siATG5 in SNCA-overexpressing cells, which restored proliferative activity. Besides, knockdown of SNCA in RHEK-1 and HaCaT cells or knockdown of PI3K in RHEK-1 and HaCaT cells overexpressing SNCA both resulted in attenuated cell proliferation. Our studies indicated that SNCA overexpression in cholesteatoma might maintain the proliferative ability of cholesteatoma keratinocytes by promoting autophagy under inflammatory conditions. This suggests that dual inhibition of SNCA and autophagy may be a promising new target for treating cholesteatoma.
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Affiliation(s)
- Miao Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Heng Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yonglan Liang
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Huimin Cai
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaojing Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianwei Lin
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Suling Zhuang
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianhua Xu
- Department of Pharmacology, School of Pharmacy, Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, Fujian Medical University, Fuzhou, China.
| | - Shengnan Ye
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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Xie S, Jin L, He J, Fu J, Yin T, Ren J, Liu W. Analysis of mRNA m 6A modification and mRNA expression profiles in middle ear cholesteatoma. Front Genet 2023; 14:1188048. [PMID: 37609036 PMCID: PMC10441234 DOI: 10.3389/fgene.2023.1188048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction: Middle ear cholesteatoma is characterized by the hyperproliferation of keratinocytes. In recent decades, N6-methyladenosine (m6A) modification has been shown to play an essential role in the pathogenesis of many proliferative diseases. However, neither the m6A modification profile nor its potential role in the pathogenesis of middle ear cholesteatoma has currently been investigated. Therefore, this study aimed to explore m6A modification patterns in middle ear cholesteatoma. Materials and methods: An m6A mRNA epitranscriptomic microarray analysis was performed to analyze m6A modification patterns in middle ear cholesteatoma tissue (n = 5) and normal post-auricular skin samples (n = 5). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to predict the potential biological functions and signaling pathways underlying the pathogenesis of middle ear cholesteatoma. Subsequently, m6A modification levels were verified by methylated RNA immunoprecipitation-qPCR (MeRIP-qPCR) in middle ear cholesteatoma tissue and normal skin samples, respectively. Results: A total of 6,865 distinctive m6A-modified mRNAs were identified, including 4,620 hypermethylated and 2,245 hypomethylated mRNAs, as well as 9,162 differentially expressed mRNAs, including 4,891 upregulated and 4,271 downregulated mRNAs, in the middle ear cholesteatoma group relative to the normal skin group. An association analysis between methylation and gene expression demonstrated that expression of 1,926 hypermethylated mRNAs was upregulated, while expression of 2,187 hypomethylated mRNAs and 38 hypermethylated mRNAs was downregulated. Moreover, GO analysis suggested that differentially methylated mRNAs might influence cellular processes and biological behaviors, such as cell differentiation, biosynthetic processes, regulation of molecular functions, and keratinization. KEGG pathway analysis demonstrated that the hypermethylated transcripts were involved in 26 pathways, including the Hippo signaling pathway, the p53 signaling pathway, and the inflammatory mediator regulation of transient receptor potential (TRP) channels, while the hypomethylated transcripts were involved in 13 pathways, including bacterial invasion of epithelial cells, steroid biosynthesis, and the Hippo signaling pathway. Conclusion: Our study presents m6A modification patterns in middle ear cholesteatoma, which may exert regulatory roles in middle ear cholesteatoma. The present study provides directions for mRNA m6A modification-based research on the epigenetic etiology and pathogenesis of middle ear cholesteatoma.
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Affiliation(s)
- Shumin Xie
- Hunan Provincial Key Lab, Department of Otolaryngology-Head and Neck Surgery, The Xiangya Hospital, Otolaryngology Institute of Major Diseases, Central South University, Changsha, Hunan, China
| | - Li Jin
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun He
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinfeng Fu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuanfang Yin
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jihao Ren
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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11
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Dżaman K, Czerwaty K, Reichert TE, Szczepański MJ, Ludwig N. Expression and Regulatory Mechanisms of MicroRNA in Cholesteatoma: A Systematic Review. Int J Mol Sci 2023; 24:12277. [PMID: 37569652 PMCID: PMC10418341 DOI: 10.3390/ijms241512277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Cholesteatoma is a temporal bone disease characterized by dysfunctions of keratinocytes. MicroRNAs (miRNAs) are evolutionary conserved noncoding RNAs that regulate mRNA expression. They can be packaged into exosomes and transported to target cells that can be used in the future therapy of cholesteatoma. This study aimed to collect knowledge on the role of miRNAs and exosomal miRNAs in cholesteatoma and was conducted according to the PRISMA guidelines for systematic reviews. Four databases were screened: Pubmed/MEDLINE, Web of Science, Scopus, and the Cochrane Library. The last search was run on the 6th of June 2023. We included full-text original studies written in English, which examined miRNAs in cholesteatoma. The risk of bias was assessed using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool, modified for the needs of this review. We identified 118 records and included 18 articles. Analyses revealed the downregulation of exosomal miR-17 as well as miR-10a-5p, miR-125b, miR-142-5p, miR34a, miR-203a, and miR-152-5p and the overexpression of exosomal miR-106b-5p as well as miR-1297, miR-26a-5p, miR-199a, miR-508-3p, miR-21-3p, miR-584-5p, and miR-16-1-3p in cholesteatoma. The role of differentially expressed miRNAs in cholesteatoma, including cell proliferation, apoptosis, the cell cycle, differentiation, bone resorption, and the remodeling process, was confirmed, making them a potential therapeutic target in this disease.
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Affiliation(s)
- Karolina Dżaman
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
| | - Katarzyna Czerwaty
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
| | - Torsten E. Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
| | - Mirosław J. Szczepański
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
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12
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Rolesi R, Paciello F, Paludetti G, De Corso E, Sergi B, Fetoni AR. Study of Angiogenic, Pro-Apoptotic, and Pro-Inflammatory Factors in Congenital and Acquired Cholesteatomas. J Pers Med 2023; 13:1189. [PMID: 37623440 PMCID: PMC10455083 DOI: 10.3390/jpm13081189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES Despite recent advances in biomolecular research that have improved our knowledge of cholesteatoma pathogenesis, the reasons behind its highly variable clinical course are still not clarified. It has been proposed that biological signaling between peri-matrix and matrix cells could play a critical role in disease homeostasis. The aim of our study was to analyze the expression of inflammatory (IL-1β), hyper-proliferative (STAT-3, TGF-β), and angiogenic (VEGF-C, PDGFr) factors in congenital and acquired cholesteatomas (both in adults and children), which might correlate with the clinical features observed. We performed an experimental study on 37 patients (29 males and 8 females, ranging from 4 to 66 years of age) who were diagnosed with cholesteatoma between 2020 and 2021 in our institution. All patients underwent clinical, audiologic, and radiologic assessments. Bone erosion grading and staging of cholesteatoma growth were assessed through preoperative evaluation and intraoperative middle ear findings, according to the PTAM System proposed by the Japan Otological Society (2016). Retro-auricular skin specimens were intraoperatively collected in all patients. Skin and cholesteatoma samples were analyzed through histopathological, western blot, and immunohistochemical evaluations. The expression rate was measured to find out the differences between congenital and acquired cholesteatomas as well as between the adult and pediatric populations. Expression of angiogenic, inflammatory, and proliferative biomarkers is significantly increased in acquired cholesteatomas in children as compared to congenital and acquired forms in adults, in accordance with the higher stage of disease shown by imaging, surgical, and histological features. Our data suggest that pathways already supposed to be involved in the pathogenesis of cholesteatomas could be differently activated in more destructive forms, typically found in children. The identification of potential biomarkers of cholesteatoma aggressiveness could lead to more personalized management (timing of intervention, recurrence prevention) and the future identification of anti-growth/anti-proliferative agents as non-surgery therapeutic options.
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Affiliation(s)
- Rolando Rolesi
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Fabiola Paciello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gaetano Paludetti
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Eugenio De Corso
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Bruno Sergi
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, 80131 Naples, Italy;
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Xun M, Liu X, Sha Y, Zhang X, Liu JP. The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis. Laryngoscope Investig Otolaryngol 2023; 8:627-635. [PMID: 37342121 PMCID: PMC10278117 DOI: 10.1002/lio2.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The purpose of this meta-analysis was to compare the efficiency of high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (DWI) in guiding the diagnosis of middle ear cholesteatoma in clinical practice. Materials and methods Cochrane Library, Medline, Embase, PubMed, and Web of Science were searched for studies that evaluated the sensitivity and specificity of HRCT or DWI in detecting middle ear cholesteatoma. A random-effects model was used to calculate and summarize the pooled estimates of sensitivity, specificity, and diagnostic odds ratios. Postoperative pathological results were considered as the diagnostic gold standard for middle ear cholesteatoma. Results Fourteen published articles (860 patients) met the inclusion criteria. The sensitivity and specificity of DWI when diagnosing cholesteatoma (regardless of type) were 0.88 (95% confidence interval [CI], 0.80-0.93) and 0.93 (95% CI, 0.86-0.97), respectively, while those of HRCT were 0.68 (95% CI, 0.57-0.77) and 0.78 (95% CI, 0.60-0.90), respectively. Notably, the sensitivity and specificity levels of DWI were similar to those of HRCT (p = .1178 for sensitivity, p = .2144 for specificity; pair-sampled t tests). The sensitivity and specificity of DWI or HRCT for the diagnosis of primary cholesteatoma were 0.78 (95% CI, 0.65-0.88) and 0.84 (95% CI, 0.69-0.93), respectively, while that for recurrent cholesteatoma were 0.93 (95% CI, 0.61-0.99) and 0.94 (95% CI, 0.82-0.98), respectively. Conclusion DWI and HRCT have similar levels of high sensitivity and specificity in detecting various cholesteatomas. Also, the diagnostic efficiency of HRCT or DWI for recurrent cholesteatoma is identical to that of primary cholesteatoma. Therefore, HRCT may be used in clinical settings to reduce the use of DWI and save clinical resources. Lay summary Data on the use of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography in the diagnosis of cholesteatoma were obtained through a literature search. They were analyzed to guide the clinical diagnosis and treatment of cholesteatoma. Level of evidence NA.
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Affiliation(s)
- Mengzhao Xun
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xu Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Yongfang Sha
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xin Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Jian Ping Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
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14
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Kotowski M, Adamczyk P, Szydlowski J. Micro RNAs and Circular RNAs in Different Forms of Otitis Media. Int J Mol Sci 2023; 24:ijms24076752. [PMID: 37047725 PMCID: PMC10095330 DOI: 10.3390/ijms24076752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this comprehensive review was to present the current knowledge on the role of microRNAs (miRNAs) in acute, recurrent, and chronic forms of otitis media. Special attention was focused on cholesteatoma of the middle ear. MicroRNAs modulate gene expression, which, in turn, influences the development and likelihood of the recurrence of acute and aggressive chronic middle ear inflammatory processes. Moreover, this study discusses the modulating role of a specific subgroup of noncoding RNA, circular RNA (circRNA). Recognizing the precise potential pathways and the mechanisms of their function may contribute to a better understanding of the molecular bases of middle ear diseases and identifying novel methods for treating this demanding pathology. Articles published between 2009 and 2022 were used in this analysis. In this review, we provide a complete overview of the latest progress in identifying the role and mechanisms of particular miRNAs and circRNAs in acute, recurrent and chronic forms of otitis media.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Paulina Adamczyk
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Jaroslaw Szydlowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
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15
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Yamamoto-Fukuda T, Akiyama N, Hirabayashi M, Shimmura H, Kojima H. Epigenetic Regulation as a New Therapeutic Target for Middle Ear Cholesteatoma. Otol Neurotol 2023; 44:273-280. [PMID: 36593557 DOI: 10.1097/mao.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
HYPOTHESIS To evaluate the effectiveness of the menin-MLL inhibitor, MI503, as a conservative treatment of middle ear cholesteatoma (cholesteatoma) in a mouse model and to confirm its safety profile regarding auditory function in vivo. BACKGROUND Cholesteatoma is a mass formed by the keratinizing squamous epithelium in the tympanic cavity and/or mastoid and subepithelial connective tissue and by the progressive accumulation of keratin debris with/without a surrounding inflammatory reaction. Although the main treatment is surgical therapy, the techniques to prevent recurrence remain a critical area of research. Recently, the use of MI503 in experiments resulted in the inhibition of the growth of cholesteatoma in vivo under histone modification. METHODS After cholesteatoma was induced in ICR mice (n = 7) by keratinocyte growth factor expression vector transfection, MI503 (50 μM) or phosphate-buffered saline was topically injected for 14 days. The effects of MI503 against cholesteatoma were analyzed by micro-computed tomography images. For the in vivo ototoxicity study, a single intratympanic injection of MI503 (50 or 500 μM) or phosphate-buffered saline (n = 4 each) was done in the ICR mice. An auditory brainstem response was performed at days 0, 1, and 14. For morphological analysis, immunostaining for Phalloidin/F-actin and Myo7a was performed. RESULTS MI503 reduced keratinocyte growth factor-induced cholesteatoma in vivo (4 of 4 [100%]). No difference was found in the mean variation of the average of the auditory brainstem response thresholds between the three groups in the in vivo ototoxicity study, thus confirming its safety profile regarding auditory function. MI503 does not demonstrate any deleterious effects on murine hair cells when assessed by immunostaining. CONCLUSION These findings demonstrate an encouraging safety profile for the use of menin-MLL inhibitor for the conservative treatment of cholesteatoma.
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Affiliation(s)
| | - Naotaro Akiyama
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | | | - Hajime Shimmura
- Department of Otorhinolaryngology, Jikei University School of Medicine
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine
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16
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Costa JR, Rego ÂR, Soares T, Sousa CAE, Coutinho MB. Changes in Coagulation Study and Risk of Developing Cholesteatoma: Is There a Link? J Audiol Otol 2023; 27:30-36. [PMID: 36710417 PMCID: PMC9884986 DOI: 10.7874/jao.2022.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/27/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The etiopathogenesis of acquired pediatric cholesteatoma has not yet been fully clarified. Recent studies and modern technologies have led researchers to look for explanations at a molecular level. This study aims to understand if the origins of cholesteatoma could be related to dysfunctions in coagulation factors, thereby emphasizing its role in angiogenesis. Subjects and. METHODS This was a retrospective case-control study carried out at a tertiary hospital center between January 2010 and December 2020. The study included 92 children. The variables of the summary coagulation study (partial thromboplastin time, prothrombin time, and international normalized ratio) were compared among children with and without development of chronic otitis media with cholesteatoma. RESULTS The cases and controls were comparable in terms of age, type, and number of times that ventilation tubes were placed. Partial thromboplastin times tended to be higher in children who developed cholesteatoma, with a statistically significant difference between the two groups in terms of normal and abnormal partial thromboplastin times (p=0.029). CONCLUSIONS The results of this case control study indicate that slight extension of partial thromboplastin times in the coagulation study may not meet the criteria for diagnosis of certain hematological pathologies or clinical significance, but at a molecular level may already have implications for activation of angiogenesis and other growth factors involved in the onset, growth, and expansion of acquired pediatric cholesteatoma.
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Affiliation(s)
- Joana Raquel Costa
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal,Address for correspondence Joana Raquel Costa, MD Department of Otorhinolaryngology- Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Largo do Prof, Abel Salazar, 4099-001 Porto, Portugal Tel +351918109458 Fax +351223320318 E-mail
| | - Ângela Reis Rego
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Teresa Soares
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cecília Almeida e Sousa
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Bebiano Coutinho
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Vanhamäki L, Seppänen R, Candido M, Anttila M, Reunanen V. Long‐term non‐surgical management of canine aural tympanokeratoma with repeated removal of middle ear keratinous debris and CT follow‐up. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Riitta Seppänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine University of Helsinki Helsinki Finland
| | - Marcus Candido
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine University of Helsinki Helsinki Finland
| | - Marjukka Anttila
- Veterinary Bacteriology and Pathology Research Unit Finnish Food Authority Helsinki Finland
| | - Vilma Reunanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine University of Helsinki Helsinki Finland
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Maddineni S, Ahmad I. Updates in Eustachian Tube Dysfunction. Otolaryngol Clin North Am 2022; 55:1151-1164. [DOI: 10.1016/j.otc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yamamoto-Fukuda T, Akiyama N, Tatsumi N, Okabe M, Kojima H. Keratinocyte Growth Factor Stimulates Growth of p75 + Neural Crest Lineage Cells During Middle Ear Cholesteatoma Formation in Mice. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1573-1591. [PMID: 36210210 DOI: 10.1016/j.ajpath.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/20/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
During development, cranial neural crest (NC) cells display a striking transition from collective to single-cell migration and undergo a mesenchymal-to-epithelial transformation to form a part of the middle ear epithelial cells (MEECs). While MEECs derived from NC are known to control homeostasis of the epithelium and repair from otitis media, paracrine action of keratinocyte growth factor (KGF) promotes the growth of MEECs and induces middle ear cholesteatoma (cholesteatoma). The animal model of cholesteatoma was previously established by transfecting a human KGF-expression vector. Herein, KGF-inducing cholesteatoma was studied in Wnt1-Cre/Floxed-enhanced green fluorescent protein (EGFP) mice that conditionally express EGFP in the NC lineages. The cytokeratin 14-positive NC lineage expanded into the middle ear and formed cholesteatoma. Moreover, the green fluorescent protein-positive NC lineages comprising the cholesteatoma tissue expressed p75, an NC marker, with high proliferative activity. Similarly, a large number of p75-positive cells were observed in human cholesteatoma tissues. Injections of the immunotoxin murine p75-saporin induced depletion of the p75-positive NC lineages, resulting in the reduction of cholesteatoma in vivo. The p75 knockout in the MEECs had low proliferative activity with or without KGF protein in vitro. Controlling p75 signaling may reduce the proliferation of NC lineages and may represent a new therapeutic target for cholesteatoma.
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Affiliation(s)
- Tomomi Yamamoto-Fukuda
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan; Department of Anatomy, Jikei University School of Medicine, Tokyo, Japan.
| | - Naotaro Akiyama
- Department of Anatomy, Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Norifumi Tatsumi
- Department of Anatomy, Jikei University School of Medicine, Tokyo, Japan
| | - Masataka Okabe
- Department of Anatomy, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Nishimura R, Miuchi S, Ikehata M, Sakagami M, Tsuzuki K. Change in chorda tympani nerve function after two-stage tympanoplasty for cholesteatoma. Laryngoscope Investig Otolaryngol 2022; 7:2035-2042. [PMID: 36544921 PMCID: PMC9764802 DOI: 10.1002/lio2.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Chorda tympani nerve (CTN) function may be damaged more by two-stage than by one-stage surgery for middle ear cholesteatoma. However, few studies have reported the relationship between two-stage cholesteatoma surgery and CTN function. This study aimed to investigate CTN function after two-stage surgery for cholesteatoma. Methods In this prospective study, 35 patients underwent two-stage canal wall up tympanoplasty (CWUT). Perioperative CTN function was assessed using questionnaires and electrogustometry (EGM). Participants were categorized into minor, major, and section groups, based on the degree of CTN manipulation during surgery. Results In the first-stage surgery, posterior tympanotomy with an intact canal wall reduced the degree of CTN manipulation. The incidence of taste disorder after the first-stage surgery was 71.4%. Postoperative taste disorder and the EGM threshold improved early in the minor manipulation group. In the second-stage surgery, no new CTN damage occurred, even if this surgery involved removal of residual cholesteatoma. The incidence of taste disorder after second-stage surgery was less than that after first-stage surgery, independent of CTN preservation. However, the recovery rate of the EGM threshold after second-stage surgery was significantly lower in the section group than in those with CTN preservation. Conclusion CTN function, including symptoms and EGM threshold, can be preserved during two-stage cholesteatoma surgery if care is taken to preserve the CTN in both the first- and second-stage surgeries. A two-stage CWUT, ensuring an intact bony annulus, may be effective to facilitate CTN preservation. Level of Evidence 2b.
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Affiliation(s)
- Riu Nishimura
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Shinya Miuchi
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Miki Ikehata
- Department of OtolaryngologyAmagasaki Chuo HospitalHyogoJapan
| | - Masafumi Sakagami
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Kenzo Tsuzuki
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
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Fujikawa T, Tanimoto K, Kawashima Y, Ito T, Honda K, Takeda T, Sonobe A, Aoki N, Bai J, Tsutsumi T. Cholesteatoma has an altered microbiota with a higher abundance of Staphylococcus species. Laryngoscope Investig Otolaryngol 2022; 7:2011-2019. [PMID: 36544934 PMCID: PMC9764795 DOI: 10.1002/lio2.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To compare the microbiota between cholesteatoma and chronic suppurative otitis media (COM) and to identify potential pathogens that explain the relevant phenotypes of cholesteatoma. Study Design Prospective cohort study. Methods Surgical specimens collected from 20 cholesteatomas and nine COMs were treated to dissolve biofilms and subjected to 16S ribosomal RNA (rRNA) gene sequencing and amplicon sequence variant-level analysis for microbiota profiling and quantitative comparison. Correlations between the relative abundance of potential pathogens and the volume of the primary resected cholesteatomas were examined. Results Differences in bacterial composition (beta diversity) were observed between cholesteatomas and COM (p = .002), with a higher abundance of Staphylococcus in cholesteatomas than in COM (p = .005). Common genera in the external auditory canal (EAC) flora, such as Staphylococcus, Corynebacterium, and Cutibacterium, were predominant in both cholesteatoma and COM; Staphylococcus aureus and Pseudomonas aeruginosa were increased in both diseases compared with the EAC flora. Furthermore, coagulase-negative staphylococci (CoNS) were more abundant in cholesteatomas than in COM (p = 0.002). Linear discriminant analysis coupled with effect size measurements (LEfSe) identified four CoNS as potential biomarkers for cholesteatoma. The relative abundance of S. aureus, a potential pathogen, was positively correlated with cholesteatoma volume (r = .60, p = .02). Conclusion The microbiota of cholesteatoma and COM originated from EAC flora, but the bacterial composition was largely altered. Our results suggested that S. aureus infection is involved in cholesteatoma progression. Level of Evidence 3b.
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Affiliation(s)
- Taro Fujikawa
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kousuke Tanimoto
- Genome Laboratory, Medical Research InstituteTokyo Medical and Dental UniversityTokyoJapan
| | | | - Taku Ito
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Keiji Honda
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takamori Takeda
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Akane Sonobe
- Genome Laboratory, Medical Research InstituteTokyo Medical and Dental UniversityTokyoJapan
| | - Natsuki Aoki
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Jing Bai
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takeshi Tsutsumi
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
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Lin M, Geng Y, Sha Y, Zhang Z, Zhou K. Performance of 2D BLADE turbo gradient- and spin-echo diffusion-weighted imaging in the quantitative diagnosis of recurrent temporal bone cholesteatoma. BMC Med Imaging 2022; 22:132. [PMID: 35883055 PMCID: PMC9327346 DOI: 10.1186/s12880-022-00860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has become an important tool for the detection of cholesteatoma. The purpose of this study was to explore the value of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) DWI in the quantitative diagnosis of recurrent temporal bone cholesteatoma (CS). METHODS From March 2018 to October 2021, 67 patients with suspected recurrence of temporal bone CS after assessment by clinical otorhinolaryngologists who had undergone previous ear surgery for CS were prospectively evaluated by magnetic resonance imaging (MRI). Two radiologist assessed images independently. Quantitative parameters such as signal intensity ratio (SIR) calculated using, as a reference, the inferior temporal cortex (SIRT) and the background noise (SIRN), apparent diffusion coefficient (ADC) value, and ADC ratio (with pons as reference) measured on TGSE BLADE sequences were assessed. Using receiver operating characteristic (ROC) curve analysis, the optimal threshold and diagnostic performance for diagnosing recurrent CS were determined. Pair-wise comparison of the ROC curves was performed using the area under the ROC curve (AUC). RESULTS Finally, 44 patients were included in this study, including 25 CS and 19 non-cholesteatoma (NCS). Mean SIRT and mean SIRN on TGSE BLADE DWI were significantly higher for CS than NCS lesions (p < 0.001). Meanwhile, mean ADC values and mean ADC ratios on ADC maps were significantly lower in the CS group than in the NCS group (p < 0.001). According to ROC analysis, the diagnostic efficacy of quantitative parameters such as SIRT (AUC = 0.967), SIRN (AUC = 0.979), ADC value (AUC = 1.0), and ADC ratio (AUC = 0.983) was significantly better than that of qualitative DWI (AUC = 0.867; p = 0.007, 0.009, 0.011 and 0.037, respectively). CONCLUSIONS Residual/recurrent temporal bone CS can be accurately detected using quantitative evaluation of TGSE BLADE DWI.
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Affiliation(s)
- Mengyan Lin
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
| | - Yue Geng
- grid.411079.a0000 0004 1757 8722Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Yan Sha
- grid.411079.a0000 0004 1757 8722Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Zhongshuai Zhang
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336 China
| | - Kun Zhou
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336 China
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23
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Accuracy of 2D BLADE Turbo Gradient- and Spin-Echo Diffusion Weighted Imaging for the Diagnosis of Primary Middle Ear Cholesteatoma. Otol Neurotol 2022; 43:e651-e657. [PMID: 35261384 DOI: 10.1097/mao.0000000000003521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of 2D BLADE turbo gradient- and spin-echo diffusion weighted imaging (TGSE BLADE DWI) for primary middle ear cholesteatoma diagnosis, using qualitative and quantitative methods. STUDY DESIGN Retrospective case series. SETTING University hospital. PATIENTS Participants included those with suspected primary middle ear cholesteatoma after assessment by clinical otorhinolaryngologists combined with magnetic resonance imaging (MRI) examination. Finally, of the 85 ears from 65 patients enrolled in the study, 73 had cholesteatoma, and 12 had otitis media. INTERVENTION Two radiologists independently assessed images and measured apparent diffusion coefficient (ADC) values. Sensitivity, specificity and accuracy were evaluated. Kappa (k) statistics, the intraclass correlation coefficient (ICC), the Kolmogorov-Smirnov normality test, the independent t test, and receiver operating characteristic (ROC) analysis were used for statistical analysis. Pair-wise comparison of the area under the ROC curve (AUC) was also performed using the Delong test. MAIN OUTCOME MEASURES Imaging and histopathologic findings. RESULTS The mean ADC value of cholesteatoma group (mean, 0.923 ± 0.246 × 10 -3 mm 2 /s) was significantly lower than that of noncholesteatoma group (mean, 1.744 ± 0.205 × 10 -3 mm 2 /s; p < 0.001). In ≤3 mm cholesteatoma group, the AUC of qualitative DWI was 0.846; the sensitivity, specificity, and accuracy for diagnosing cholesteatoma were 69.23%, 100%, and 84%, respectively; while the AUC of quantitative diagnosis was significantly increased to 1.0 ( p = 0.0209); and based on the optimal threshold of ADC, ≤1.352 × 10 -3 mm 2 /s, the sensitivity, specificity and accuracy improved to 100%. For >3 mm cholesteatoma group, there were no significant differences in diagnostic performance. Excellent interobserver agreement and ICC for the qualitative and quantitative evaluations (k = 0.90 and ICC = 0.80, respectively) was noted between reviewers. CONCLUSION TGSE BLADE DWI is useful for the detection of primary middle ear cholesteatomas, especially ≤3 mm lesions.
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Lin M, Lin N, Sheng Y, Sha Y, Zhang Z, Zhou K. Detection of cholesteatoma: 2D BLADE turbo gradient- and spin-echo imaging versus readout-segmented echo-planar diffusion-weighted imaging. Eur Arch Otorhinolaryngol 2022; 279:5223-5229. [PMID: 35482118 DOI: 10.1007/s00405-022-07370-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study is to compare the accuracy of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) diffusion-weighted imaging (DWI) with that of readout-segmented echo-planar (RESOLVE) DWI in the detection of primary and residual/recurrent temporal bone cholesteatoma. METHODS The prospective study population consisted of 58 patients who were underwent magnetic resonance (MR) imaging for the evaluation of suspected temporal bone cholesteatoma. Two radiologists independently evaluated the two sequences. Kappa (k) statistics, the intra-class correlation coefficient (ICC), and a paired t test were used for statistical analysis. RESULTS Of the 58 patients included, all had histo-pathologically confirmed cholesteatomas. In ≤ 3 mm group (n = 13), TGSE BLADE sequence correctly identified all cases except one that was recorded as equivocal on both sequences because of high signal intensity on T1WI; while on RESOLVE sequences, 6 were positive, 4 were equivocal, and 3 were false negative. For > 3 mm group (n = 45), detection performance was similar between the two sequences. The mean ADC of cholesteatoma on TGSE BLADE DWI was 0.923 × 10-3 mm2/s, and the mean ADC of cholesteatoma on RESOLVE DWI was 0.949 × 10-3 mm2/s, with no significant difference in the mean ADC values of cholesteatoma measured on the two sequences (p = 0.9216). CONCLUSION TGSE BLADE outperforms RESOLVE in the detection of small temporal bone cholesteatoma ≤ 3 mm.
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Affiliation(s)
- Mengyan Lin
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Naier Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yaru Sheng
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Zhongshuai Zhang
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336, China
| | - Kun Zhou
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336, China
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Yanez-Siller JC, Wentland C, Bowers K, Litofsky NS, Rivera AL. Squamous Cell Carcinoma of the Temporal Bone Arising from Cholesteatoma: A Case Report and Review of the Literature. J Neurol Surg Rep 2022; 83:e13-e18. [PMID: 35155077 PMCID: PMC8824697 DOI: 10.1055/s-0041-1741069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective
Present a case of squamous cell carcinoma of the temporal bone (SCCTB) arising in a 61-year-old female with a prior history of cholesteatoma and persistent otologic symptoms and review the current literature regarding this disease presentation.
Setting
Tertiary academic center.
Patient
A 61-year-old female with a history of left ear cholesteatoma for which she had undergone surgery 54 years prior. The patient presented with a persistent history of otorrhea since first surgery and developed exacerbation of symptoms just prior to presentation at our department. The clinical picture was highly suspicious of cholesteatoma recurrence. However, the biopsy was consistent with squamous cell carcinoma.
Intervention
Surgical debulking of the lesion was followed by a brief course of radiation therapy later halted by the patient due to side effect intolerance.
Conclusion
SCCTB may arise from cholesteatoma. A high index of suspicion for SCCTB should be maintained in patients with a prior history of cholesteatoma and evidence of a temporal bone mass with persistent otologic symptoms.
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Affiliation(s)
- Juan C Yanez-Siller
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, United States
| | - Carissa Wentland
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, United States
| | - Kelly Bowers
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, United States
| | - N Scott Litofsky
- Division of Neurosurgery, Department of Surgery, University of Missouri, Columbia, Missouri, United States
| | - Arnaldo L Rivera
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, United States
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26
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Lahel R, Tripathi S, Chail A. Comparative analysis of preoperative high-resolution computed tomography temporal bone and intraoperative surgical findings in cases of cholesteatoma. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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27
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Pchelenok EV, Tarasova OY, Kosyakov SY. New classification of EAONO/JOS cholesteatoma and SAMEO-ATO middle ear surgery: relevance and clinical significance. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Middle ear cholesteatoma (MEC) is a common problem of modern otology. The European Academy of Otology and Neurootology in cooperation with the Japanese Otological Society (EAONO/JOS) published consensus recommendations on the definition, classification and stages of MEC in 2017. In 2018, the classification of middle ear surgery was presented under the auspices of the International Otology Outcome Group. The leading problem of MEC surgery remains the high recurrence rate, which ranges from 5 to 32% depending on the type of surgical intervention. The main purpose of this article is to describe the new EAONO/JOS classification of MEC and SAMEO-ATO middle ear surgical interventions with an analysis of their possible clinical significance in determining the risk of cholesteatoma recurrence as well as the prognosis for hearing recovery after surgery.
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28
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Moneir W, Hemdan A, El-Kholy NA, El-Kotb M, El-Okda M. Endoscopic transcanal attico-antrostomy versus endoscopic-assisted canal wall up mastoidectomy in management of localized cholesteatoma: a randomized clinical trial. Eur Arch Otorhinolaryngol 2021; 279:4371-4378. [PMID: 34851451 DOI: 10.1007/s00405-021-07200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to compare results of endoscopic transcanal tympanoplasty with attico-antrostomy with endoscopic-assisted canal wall up mastoidectomy in treatment of cases of limited attic cholesteatoma. MATERIALS AND METHODS A prospective randomized single-blinded study involving 40 patients with limited attic cholesteatoma was conducted. Randomization of the patients into two groups was done; 20 patients are managed by endoscopic transcanal tympanoplasty with attico-antrostomy, while the other 20 patients are managed by endoscopic-assisted canal wall up mastoidectomy. Primary outcome is recidivism, while secondary outcomes include hearing results, operative time, pain score and associated complications. RESULTS Comparable recidivism rate was found in the two groups. The endoscopic-assisted canal wall up mastoidectomy group was associated with significantly longer duration of surgery and higher postoperative pain score. There was no significant difference between both the groups regarding hearing results and associated complications. CONCLUSION In localized attic cholesteatoma cases, endoscopic transcanal tympanoplasty with attico-antrostomy is a time-saving less-invasive reliable technique with good eradication results. CLINICAL TRIAL REGISTRY ClinicalTrials.gov (NCT04959539) "retrospectively registered" at 12/7/2021.
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Affiliation(s)
- Waleed Moneir
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed Hemdan
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt
| | - Noha Ahmed El-Kholy
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt.
| | - Mohamed El-Kotb
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt
| | - Mohamed El-Okda
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt
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胡 瑞, 张 晓, 耿 鹤, 李 栋, 张 青, 林 彦. [Diagnostic value of multi-slice spiral CT in tympanic wall destruction of middle ear cholesteatoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:961-965. [PMID: 34886596 PMCID: PMC10128368 DOI: 10.13201/j.issn.2096-7993.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate the correlation between preoperative temporal bone Computed Tomography (CT) findings and intraoperative manifestations in patients with middle ear cholesteatoma. Methods:The patients with cholesteatoma undergoing surgery in our hospital from March 2017 to November 2020 were retrospectively analyzed.The temporal bone CT findings of tympanoid wall status before operation and the state of tympanic wall during operation were compared. Results: A total of 148 cases (148 ears) were included in the analysis. Compared with intraoperative observation, 142 cases showed the same findings of tympanoid lid by preoperative CT examination, and 144 cases showed the same findings of mastoid lid by preoperative CT examination.The CT manifestations of facial nerve canal state in 18 patients was different from intraoperativen findings. Among the 12 cases of lateral wall destruction of the tympanic chamber observed by CT, 10 cases were consistent with the intraoperative findings.CT showed sigmoid sinus destruction in 6 cases, of which 5 cases were consistent with intraoperative findings. In 142 cases no sigmoid sinus destruction was found by CT , but in one case the CT findingswas different from intraoperative findings.The diagnostic efficiency of the exposed opposite neural tube was poor in the tympanoid wall observed by CT(Se=78.6%,Sp=90.0%,PPV=64.7%,NPV=94.7%,AUC=0.84,Kappa=0.63,P<0.05), but the diagnostic efficiency of lateral wall failure of the drum chamber was good (Se=83.5%,Sp=98.5%,PPV=83.3%,NPV=98.6%,AUC=0.91,Kappa=0.82,P<0.05). Conclusion:CT is effective in preoperative diagnosing of tympanic wall destruction caused by cholesteatoma of the middle ear, especially in detecting the destruction of tympanic lid, mastoid lid, lateral wall of the tympanic chamber and sigmoid sinus.Preoperative temporal bone CT scan is beneficial to clincal preoperative decision-making and intraoperative guidance.
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Affiliation(s)
- 瑞利 胡
- 河北北方学院附属第一医院耳鼻咽喉头颈外科(河北张家口,075000)Department of Otolaryngology Head and Neak Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - 晓辰 张
- 河北北方学院附属第一医院医学影像部Department of Medical Imaging, the First Affiliated Hospital of Hebei North University
| | - 鹤群 耿
- 河北北方学院附属第一医院医学影像部Department of Medical Imaging, the First Affiliated Hospital of Hebei North University
| | - 栋 李
- 河北北方学院附属第一医院耳鼻咽喉头颈外科(河北张家口,075000)Department of Otolaryngology Head and Neak Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - 青俊 张
- 河北北方学院附属第一医院耳鼻咽喉头颈外科(河北张家口,075000)Department of Otolaryngology Head and Neak Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - 彦涛 林
- 河北北方学院附属第一医院耳鼻咽喉头颈外科(河北张家口,075000)Department of Otolaryngology Head and Neak Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
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30
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Dambergs K, Sumeraga G, Pilmane M. Complex Evaluation of Tissue Factors in Pediatric Cholesteatoma. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100926. [PMID: 34682191 PMCID: PMC8534875 DOI: 10.3390/children8100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to describe the appearance and distribution of tissue remodeling markers (MMP-2, MMP-9, TIMP-2, TIMP-4), Sonic hedgehog gene protein (Shh), pro- and anti-inflammatory cytokines (IL–1, IL–10), transcription factor (NF-κβ), proliferation marker (Ki–67), angiogenetic factor (VEGF), tissue defensins (HβD–2, HβD–4) of the pediatric cholesteatoma. Sixteen cholesteatoma samples were obtained from children, eleven skin controls from cadavers. Tissues were stained for MMP-2, MMP-9, TIMP-2, TIMP-4, Shh, IL–1, IL–10, NF-κβ, Ki–67, VEGF, HβD–2, HβD–4. Non-parametric statistic, Mann–Whitney, and Spearman’s coefficient was used. A statistically significant difference was seen between Shh and HβD–2 in perimatrix and control connective tissue, between NF-κβ in cholesteatoma and control skin, and between HβD–4 in matrix and skin epithelium. Complex intercorrelations between MMPs, NF-κβ and VEGF cause the intensification of angiogenesis in cholesteatoma. The persistent increase in Shh gene protein expression in cholesteatoma perimatrix suggests the stimulation of the cholesteatoma growth in children. Similar expression of IL-1 and IL-10 and their intercorrelation, proves there is a balance between pro- and anti-inflammatory cytokines. NF-κβ, and not Ki-67, seems to be the main inducer of cellular proliferation. The main antimicrobial protection is provided by HβD-2.
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Affiliation(s)
- Kristaps Dambergs
- Department of Otorhinolaryngology, Riga Stradiņš University, LV-1002 Riga, Latvia;
- Correspondence:
| | - Gunta Sumeraga
- Department of Otorhinolaryngology, Riga Stradiņš University, LV-1002 Riga, Latvia;
| | - Māra Pilmane
- Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradiņš University, LV-1007 Riga, Latvia;
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Fukuda A, Kano S, Nakamaru Y, Morita S, Hoshino K, Fujiwara K, Homma A. Notch Signaling in Acquired Middle Ear Cholesteatoma. Otol Neurotol 2021; 42:e1389-e1395. [PMID: 34172659 DOI: 10.1097/mao.0000000000003245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS We hypothesized that an anomalous change of Notch signaling might be involved in the pathophysiology of cholesteatoma. BACKGROUND The Notch signaling pathway regulates integrated growth and differentiation control of keratinocytes. Its involvement in cholesteatoma proliferation has not been elucidated. METHODS We obtained cholesteatoma and external auditory canal (EAC) skin samples from patients with middle ear cholesteatoma who underwent tympanomastoid surgery. We performed polymerase chain reaction using the RT2 Profiler™ PCR Array Human Notch Signaling Pathway (Qiagen) in the cholesteatoma and EAC skin samples (n = 6 each). This was followed by immunohistochemical staining of Notch1, enhancer of split-1 (HES1), and p53 in 41 and 8 cholesteatoma and EAC skin samples, respectively. RESULTS The fold change of Notch1 gene expression was lowest in cholesteatoma, with a statistically significant difference (p = 0.0424). Moreover, the fold change of HES1 expression decreased (p = 0.272). The positive rates of Notch1 and HES1 protein expressions in the cholesteatoma (48.5 ± 32.4% and 44.9 ± 17.8%, respectively) were significantly lower than in the EAC skin (83.4 ± 17.5% and 55.7 ± 7.1%, respectively) (p < 0.001 and p < 0.01). In contrast, the positive rate of p53 expression in the cholesteatoma (8.5 ± 11.4%) was significantly higher than in the EAC skin (0.5 ± 0.7%) (p < 0.001). CONCLUSION The decreases in Notch1 and HES1 protein expression might play an important role in the hyperproliferative character of the keratinizing squamous epithelium in cholesteatoma. An increase in p53 might reflect the reaction to cellular hyperproliferation.
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Affiliation(s)
- Atsushi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Cals F, van der Toom H, Metselaar R, van Linge A, van der Schroeff M, Pauw R. Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn? J Otol 2021; 17:25-30. [PMID: 35140756 PMCID: PMC8811380 DOI: 10.1016/j.joto.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- F.L.J. Cals
- Corresponding author. Department of Otorhinolaryngology and head and neck surgery, Erasmus Medical Center, Room NT-310, Postbus 2040, 3000, CA, Rotterdam.
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Keratinocyte growth factor signaling promotes stem/progenitor cell proliferation under p63 expression during middle ear cholesteatoma formation. Curr Opin Otolaryngol Head Neck Surg 2021; 28:291-295. [PMID: 32796271 DOI: 10.1097/moo.0000000000000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Middle ear cholesteatoma is an epithelial lesion that expands into the middle ear, resulting in bone destruction. However, the pathogenesis of this has been unknown. The purpose of this review is to understand the role of keratinocyte growth factor (KGF) during epithelial stem and/or progenitor cell proliferation in middle ear cholesteatoma. RECENT FINDINGS Many researchers have investigated the molecular mechanism of middle ear cholesteatoma to establish a conservative treatment. Recently, some studies have focused on the stem cells of middle ear cholesteatoma and their detection, but the key molecules for stem cell formation were not shown. SUMMARY We established an animal model for middle ear cholesteatoma and are showing the results of our studies. KGF expression accelerates the proliferation of stem/progenitor cells through the induction of transcription factor p63 expression in the epithelium of the tympanic membrane and mucosal epithelium overlying the promontory of the cochlea and within the attic. This is typical in middle ear cholesteatoma. Moreover, the partial epithelial-mesenchymal transition under the p63 signaling pathway plays an essential role in epithelial cell growth in middle ear cholesteatoma formation. Understanding p63 expression following KGF expression and associated signaling events can improve therapeutic outcomes in patients with middle ear cholesteatoma.
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Leichtle A, Leffers D, Daerr MG, Draf C, Kurabi A, Ryan AF, Rupp J, Bruchhage KL. [Immunomodulation in Cholesteatoma]. Laryngorhinootologie 2021; 101:310-319. [PMID: 34233375 DOI: 10.1055/a-1516-4447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The etiopathogenesis of chronic otitis media epitympanalis/cholesteatoma and its proliferative destructive course with possible complications such as destruction of bony structures with hearing loss, vestibular dysfunction, facial nerve paralysis and intracranial complications are still unexplained. Surgery is still the way to go. New studies are increasingly looking at the innate immune system. METHODS Our studies were carried out in a mouse model in WT mice and immundeficient KO-mice, as well as in cholestatoma and healthy ear canal skin and middle ear tissue, which was removed during ear surgery. The expression analyses were carried out at the gene and protein level using TNF as the major target for therapy evaluation. By means of TUNEL staining and immunohistochemistry the level of apoptosis was evaluated. RESULTS The uncontrolled undirected cholesteatoma growth shows an immunomodulatory profile with up and down-regulation of various gene networks, especially those involved in TNF downstream and upstream signaling pathways. TNF in cholesteatoma is modulated both inflammatorily and apoptotically and therefore is suitable as a possible therapeutic approach in various models. CONCLUSIONS Cholestatoma might be immunomodulatory regulated.
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Affiliation(s)
- Anke Leichtle
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lubeck, Germany
| | - David Leffers
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lubeck, Germany
| | - Markus Georg Daerr
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lubeck, Germany
| | - Clara Draf
- Department of Surgery/ Otolaryngology, University of California San Diego, La Jolla, United States
| | - Arwa Kurabi
- Department of Surgery/ Otolaryngology, University of California San Diego, La Jolla, United States
| | - Allen F Ryan
- Department of Surgery/ Otolaryngology, University of California San Diego, La Jolla, United States
| | - Jan Rupp
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Luebeck, Germany
| | - Karl-Ludwig Bruchhage
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lubeck, Germany
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Yamamoto-Fukuda T, Akiyama N, Kojima H. Super-enhancer Acquisition Drives FOXC2 Expression in Middle Ear Cholesteatoma. J Assoc Res Otolaryngol 2021; 22:405-424. [PMID: 33861394 PMCID: PMC8329101 DOI: 10.1007/s10162-021-00801-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/29/2021] [Indexed: 12/21/2022] Open
Abstract
Distinct histone modifications regulate gene expression in certain diseases, but little is known about histone epigenetics in middle ear cholesteatoma. It is known that histone acetylation destabilizes the nucleosome and chromatin structure and induces gene activation. The association of histone acetylation with chronic inflammatory diseases has been indicated in recent studies. In this study, we examined the localization of variously modified histone H3 acetylation at lysine 9, 14, 18, 23, and 27 in paraffin-embedded sections of human middle ear cholesteatoma (cholesteatoma) tissues and the temporal bones of an animal model of cholesteatoma immunohistochemically. As a result, we found that there was a significant increase of the expression levels of H3K27ac both in human cholesteatoma tissues and the animal model. In genetics, super-enhancers are clusters of enhancers that drive the transcription of genes involved in cell identity. Super-enhancers were originally defined using the H3K27ac signal, and then we used H3K27ac chromatin immunoprecipitation followed by sequencing to map the active cis-regulatory landscape in human cholesteatoma. Based on the results, we identified increased H3K27ac signals as super-enhancers of the FOXC2 loci, as well as increased protein of FOXC2 in cholesteatoma. Recent studies have indicated that menin-MLL inhibitor could suppress tumor growth through the control of histone H3 modification. In this study, we demonstrated that the expression of FOXC2 was inhibited by menin-MLL inhibitor in vivo. These findings indicate that FOXC2 expression under histone modifications promoted the pathogenesis of cholesteatoma and suggest that it may be a therapeutic target of cholesteatoma.
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Affiliation(s)
- Tomomi Yamamoto-Fukuda
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Naotaro Akiyama
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Edward Y, Decroli E, Ali H, Tjong DH. Expression of CCL27 in Middle Ear Cholesteatoma. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cholesteatoma is a lesion of the temporal bone lined by stratified squamous epithelium that contains desquamated keratin. Cholesteatoma is considered more aggressive during childhood. The molecular mechanism of the pathogenesis of cholesteatoma formation is still unclear. Previous studies reported on immunohistochemical examination and quantitative polymerase chain reaction (PCR) found that TCN1 and CCL27 were involved in the process of cholesteatoma keratinocytes and dermal endothelial cells. In skin tumors derived from keratinocytes, there is a protective mechanism of antitumor T cell-mediated by reducing CCL27 expression.
AIM: The objective of this study was to investigate the expression of chemokine ligand 27 (CCL27) in cholesteatoma.
METHODS: This is a cross-sectional comparative study. Cholesteatoma specimens were obtained from 15 patients who underwent surgery and 15 normal retroauricular skin as control. The specimen’s gene expression was examined with real-time PCR (RT-PCR).
RESULTS: The expression of CCL27 was 36.215 ± 45.848 ng/ul in cholesteatoma, while it is 9.692 ± 15.760 ng/ul in normal retroauricular skin. The expression of CCL 27 in cholesteatoma was higher than in normal retroauricular skin, but it was not significant (p > 0.05)
CONCLUSION: The expression of CCL27 in cholesteatoma was higher than in normal retroauricular skin.
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In vitro study on immune response modifiers as novel medical treatment options for cholesteatoma. Int J Pediatr Otorhinolaryngol 2021; 145:110743. [PMID: 33933986 DOI: 10.1016/j.ijporl.2021.110743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate cytokine profile of cholesteatoma and to collect information about important intercellular signaling pathways by establishing two different cell culture models, to block important intercellular signaling pathways in cholesteatoma by applying immune system modifier drugs to develop alternative medical therapy options for cholesteatoma. METHODS To observe the pathogenesis of cholesteatoma and to apply the immunomodulatory drugs, cholesteatoma tissue culture models were constituted with HEKa cells and cholesteatoma keratinocytes, which were obtained from 3 patients who underwent operations for cholesteatoma. Medicines including 5-fluorourasil, imiquimod, cyclosporine, and tacrolimus were applied on both cholesteatoma keratinocytes and HEKa cells. After 48 h of incubation, IL-1, IL-6, IL-8, IL-10, TNF-α, and Ki67 levels were measured to determine cell viability rates. RESULTS In the cholesteatoma control group, IL-6 and TNF-α levels were found higher than in the HEKa control group. All repurposed drugs in the study demonstrated anti-inflammatory, anti-proliferative, and cytotoxic effects on cholesteatoma. Imiquimod and tacrolimus in particular are potential treatment prospects for cholesteatoma due to their strong anti-inflammatory and cytotoxic effects. CONCLUSION Medical therapy options for cholesteatoma are still missing and surgery is not the ultimate solution. We have focused on intercellular inflammatory processes, which play significant roles in the pathogenesis of cholesteatoma in our paper. Inflammation and proliferation of cholesteatoma decreased after all repurposed drug applications in our study. Anti-inflammatory and anti-proliferative effects of tacrolimus and imiquimod was more significant than other drugs in the study. For this reason, tacrolimus and imiquimod should be examined in depth with in vivo studies in terms of efficacy and safety for medical treatment of cholesteatoma.
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The Effect of Oral Montelukast Administration in Cholesteatoma Development and Inflammation: An Experimental Animal Model. Otol Neurotol 2021; 42:e568-e572. [PMID: 33481545 DOI: 10.1097/mao.0000000000003061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS We hypothesized that oral montelukast treatment could inhibit cholesteatoma formation in an experimental animal model. BACKGROUND Inflammation and excessive proliferation have been described in the histopathology of cholesteatoma. The aim of this study was to determine the effect of oral montelukast on cholesteatoma development. METHODS Eighteen healthy female Wistar albino rats weighing 250 g were chosen for the study. The animals were divided into two groups: group 1 received montelukast and group 2 was the control group. Intratympanic propylene glycol injection was administered into the left ears and physiologic serum was instilled into the right ears of the animals on the first, eighth, and fifteenth days. The effects of montelukast administration were evaluated by histological examination of the tympanic membrane and middle ear. RESULTS Group 1 (montelukast group) showed significant differences in terms of cholesteatoma formation, granulation, epithelial invagination, and inflammation. Cholesteatoma formation in the left ear was observed in 2 (22%) and 8 (89%) rats in groups 1 and 2, respectively (p = 0.015). CONCLUSION Development of cholesteatoma and inflammation was significantly lower in the montelukast-administered group. Thus, oral montelukast was found effective in preventing cholesteatoma formation.
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Abstract
OBJECTIVE Chronic ear disease presents a unique challenge to otolaryngologists in both rural and urban settings. Cholesteatoma remains a difficult disease to treat in rural populations due to limited healthcare access and high risk of recurrence. The purpose of this study was to determine if there are differences in surgical outcomes among patients with acquired cholesteatoma residing in rural versus urban settings. STUDY DESIGN Single-surgeon retrospective case series with chart review. SETTING Tertiary care private otolaryngology practice. PATIENTS One hundred twenty-two patients presenting to the Kentuckiana ENT otology and neurotology practice from January 2011 to May 2017. MAIN OUTCOME MEASURES Surgical outcomes including recurrence, air-bone gap improvement, ossicular integrity, and complications were reviewed and compared between the rural and urban cohorts. RESULTS Presence of postoperative residual cholesteatoma (OR = 8.667, 95% CI = 2.022-37.141, p = 0.008) and number of surgeries per patient (OR = 5.185, 95% CI = 1.086-24.763, p = 0.024) were significantly increased among patients in rural nonmetropolitan areas. No significant differences were found when comparing risk of recurrence, size of cholesteatoma, presence of complications, air-bone gap improvement, and ossicular chain integrity. There were significantly more second-look surgeries performed in privately insured patients (OR = 8.582, 95% CI = 1.937-38.017, p = 0.001). CONCLUSIONS Patients in rural communities have an increased number of surgeries and postoperative risk for residual cholesteatoma compared to patients residing in urban settings. This study provides the basis for larger, multicenter, prospective examinations of outcomes among urban versus rural patients, which would enable a better understanding of difference in surgical outcomes between rural and urban cohorts.Level of Evidence: IV.
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Hara S, Kusunoki T, Nakagawa H, Toyoda Y, Nojiri S, Kamiya K, Furukawa M, Takata Y, Okada H, Anzai T, Matsumoto F, Ikeda K. Association Between Earwax-Determinant Genotypes and Acquired Middle Ear Cholesteatoma in a Japanese Population. Otolaryngol Head Neck Surg 2021; 166:139-145. [PMID: 33722103 DOI: 10.1177/01945998211000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A single-nucleotide polymorphism 538G>A in the human ABCC11 gene is a determinant of the earwax morphotype. ABCC11 538GG and GA correspond to wet earwax and 538AA to dry earwax. Despite a putative positive correlation between the frequency of the 538G allele and the prevalence of cholesteatoma, minimal clinical information is currently available. We aimed to evaluate this association between the ABCC11 genotypes and acquired middle ear cholesteatoma. STUDY DESIGN Case-control study. SETTING Single-center academic hospital. METHODS We recruited 67 Japanese patients with acquired middle ear cholesteatoma (cholesteatoma group) and 100 Japanese controls with no history of middle ear cholesteatoma. We assessed the ABCC11 genotypes for all participants. Clinical information was collected from the cholesteatoma group. The genotype data of 104 Japanese people from the 1000 Genomes Project who represent the general population were used. RESULTS The proportion of participants with ABCC11 538GG or GA was significantly higher in the cholesteatoma group than in the control group or general Japanese population (P < .001). The ABCC11 538G allele frequency was also significantly higher in the cholesteatoma group than in the control group or general Japanese population (P < .001). Multivariate logistic regression analyses revealed a significant association between the ABCC11 genotype and acquired middle ear cholesteatoma (odds ratio, 5.49; 95% CI, 2.61-11.5; P < .001). CONCLUSION Our results suggest that the ABCC11 genotypes could be associated with the development of acquired middle ear cholesteatoma among Japanese people.
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Affiliation(s)
- Satoshi Hara
- Department of Otorhinolaryngology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takeshi Kusunoki
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Nakagawa
- Department of Applied Biological Chemistry, Graduate School of Bioscience and Biotechnology, Chubu University, Japan
| | - Yu Toyoda
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Kazusaku Kamiya
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Masayuki Furukawa
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Westerberg J, Tideholm E, Piersiala K, Drakskog C, Kumlien Georén S, Mäki-Torkko E, Cardell LO. JAK/STAT Dysregulation With SOCS1 Overexpression in Acquired Cholesteatoma-Adjacent Mucosa. Otol Neurotol 2021; 42:e94-e100. [PMID: 33201080 DOI: 10.1097/mao.0000000000002850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Surgery remains the gold standard in cholesteatoma treatment. However, the rate of recurrence is significant and the development of new nonsurgical treatment alternatives is warranted. One of the possible molecular pathways to target is the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. OBJECTIVE To investigate the JAK/STAT pathway in the middle ear mucosa in patients with acquired cholesteatoma compared with middle ear mucosa from healthy controls. DESIGN Case-control study. SETTING Linköping University Hospital, Sweden, and Karolinska Institutet, Stockholm, Sweden. Sampling period: February 2011 to December 2016. PARTICIPANTS Middle ear mucosa from 26 patients with acquired cholesteatoma undergoing tympanoplasty and mastoidectomy, and 27 healthy controls undergoing translabyrinthine surgery for vestibular schwannoma or cochlear implantation was investigated. MAIN OUTCOMES/MEASURES The expression of Interleukin-7 receptor alpha, JAK1, JAK2, JAK3, STAT5A, STAT5B, and suppressor of cytokine signaling-1 (SOCS1) were quantified using quantitative polymerase chain reaction. In addition, expression level of cyclin D2, transforming growth factor beta 1, thymic stromal lymphopoietin, CD3, and CD19 was evaluated. RESULTS In cholesteatoma-adjacent mucosa, SOCS1 was significantly upregulated (p= 0.0003) compared with healthy controls, whereas STAT5B was significantly downregulated (p = 0.0006). The expression of JAK1, JAK2, JAK3, and STAT5A did not differ significantly between groups. CONCLUSIONS AND RELEVANCE To the best of our knowledge, this is the first article reporting dysregulation of the JAK/STAT pathway in cholesteatoma-adjacent mucosa. The main finding is that important players of the aforementioned pathway are significantly altered, namely SOCS1 is upregulated and STAT5B is downregulated compared with healthy controls.
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Affiliation(s)
- Johanna Westerberg
- Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication, Linköping University, Region Östergötland, Sweden
| | - Ellen Tideholm
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm
| | - Krzysztof Piersiala
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Drakskog
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm
| | - Elina Mäki-Torkko
- Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication, Linköping University, Region Östergötland, Sweden
- Audiological Research Center, Faculty of Medicine and Health, Örebro university, Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
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Liu D, Ma X. MiR-508-3p promotes proliferation and inhibits apoptosis of middle ear cholesteatoma cells by targeting PTEN/PI3K/AKT pathway. Int J Med Sci 2021; 18:3224-3235. [PMID: 34400892 PMCID: PMC8364443 DOI: 10.7150/ijms.60907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Cholesteatoma of the middle ear is a common disease in otolaryngology, which can lead to serious intracranial and extracranial complications. Recent studies showed that the dysregulation of microRNA may be involved in the formation of middle ear cholesteatoma. This study aimed to explore the regulatory effect of micro ribonucleic acid 508-3p (miR-508-3p) on proliferation and apoptosis of middle ear cholesteatoma cells and excavate its underlying regulatory mechanism. We found miR-508-3p expression was upregulated in tissues and cells of cholesteatoma which was inversely related to the expression of hsa_circ_0000007. Overexpression of miR-508-3p could notably facilitate cholesteatoma cell proliferation. Luciferase reporter assay showed that miR-508-3p bound the 3'-untranslated region of its downstream mRNA PTEN. Gain and loss of functions of miR-508-3p were performed to identify their roles in the biological behaviors of cholesteatoma cells, including proliferation and apoptosis. Rescue assays confirmed that PTEN could reverse the effect of miR-508-3p overexpression on cell proliferation. In a word, this study validated that the development of cholesteatoma may regulated by hsa_circ_0000007/miR-508-3p/ PTEN/ PI3K/Akt axis.
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Affiliation(s)
- Dongliang Liu
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Liaoning 110004, China
| | - Xiulan Ma
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Liaoning 110004, China
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Kurabi A, Cooper M, Spriggs M, Xu Y, Schaerer D, Ryan AF. Molecular Screening Strategy to Identify a Non-invasive Delivery Mechanism for the Treatment of Middle Ear Disorders. Front Med (Lausanne) 2020; 7:503819. [PMID: 33392211 PMCID: PMC7775502 DOI: 10.3389/fmed.2020.503819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
Middle ear ailments include a broad range of pathological conditions. Otitis media is the leading middle ear disease of childhood, which incurs significant health care resources in developed countries and, in developing countries, causes significant mortality and morbidity. Recurrent and chronic infections of the middle ear lead to the prolonged presence of inflammatory factors and cellular infiltrates resulting in temporary hearing loss. However, long-term alteration of the middle ear space can pose the risk of permanent damage to the delicate ear structures and cause tissue remodeling. While the etiopathogenesis of middle ear diseases is multifactorial, targeting the biological mechanisms and molecular networks that drive disease development is critical. Yet, a pivotal step in realizing the potential of molecular therapies is the development of methods for local drug delivery, since systemic application risks side effects. Utilizing bacteriophage display in the rat, we discovered rare peptides that are able to transit the intact tympanic membrane from the external canal to the middle ear cavity by an active process. An in vitro assay demonstrated that transport occurs across the tympanic membranes of humans and that the peptides cross the membrane independent of phage. Transport of phage, which is ~900 nm in length, suggests that these peptides could non-invasively deliver drug packages or gene therapy vectors into the middle ear.
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Affiliation(s)
- Arwa Kurabi
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States
| | - Molly Cooper
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States
| | - Meghan Spriggs
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States
| | - Yuge Xu
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States
| | - Daniel Schaerer
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States
| | - Allen F Ryan
- Department of Surgery/Otolaryngology, UCSD School of Medicine, San Diego, CA, United States.,Department of Neurosciences, UCSD School of Medicine, San Diego, CA, United States.,San Diego VA Healthcare System, San Diego, CA, United States
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Şahin MM, Sözmen Cılız D, Çayönü M, Kayalı Dinç S, Akbal Ş, Boynueğri S, Eryılmaz A. Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma. J Int Adv Otol 2020; 16:373-377. [PMID: 33136019 DOI: 10.5152/iao.2020.7508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy contralateral ear to determine if there are anatomical differences. MATERIALS AND METHODS Of the 217 patients with cholesteatoma evaluated, 36 patients with unilateral cholesteatoma were included in the study. All of the patients had a healthy contralateral ear with no history of surgery. Nine different paratubal parameters were measured through contrast-enhanced magnetic resonance imaging (MRI). The measurements of the ear with cholesteatoma were compared with those of the healthy ear. RESULTS The bimucosal thickness of the ET lumen, the mucosal thickness of the pharyngeal orifice, the lengths and diameters of the tensor veli palatini muscle and the levator veli palatini muscle, the diameter of the pharyngeal orifice of the ET, the diameter of the lateral pharyngeal recess mucosal thickness, and the diameter between the posterior border of the inferior nasal concha and the pharyngeal orifice of the ET were measured in MRI scans. No statistically significant difference was observed between the healthy ear and the ear with cholesteatoma for any of the parameters measured (p>0.05). CONCLUSION We did not observe any anatomical differences in the measurements of the ET and the paratubal structures on MRI scans. Although ET dysfunction is considered to be the leading etiologic factor in acquired cholesteatoma, the ET and the paratubal structures may not exhibit an anatomic difference between the ear with cholesteatoma and the healthy contralateral ear.
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Affiliation(s)
- Muammer Melih Şahin
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Sözmen Cılız
- Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Melih Çayönü
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Seçil Kayalı Dinç
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Şeyda Akbal
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Süleyman Boynueğri
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Adil Eryılmaz
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Benson JC, Carlson ML, Lane JI. MRI of the Internal Auditory Canal, Labyrinth, and Middle Ear: How We Do It. Radiology 2020; 297:252-265. [PMID: 32960730 DOI: 10.1148/radiol.2020201767] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
MRI is firmly established as an essential modality in the imaging of the temporal bone and lateral skull base. It is used to evaluate normal anatomic structures, evaluate for vestibular schwannomas, assess for inflammatory and/or infectious processes, and detect residual and/or recurrent cholesteatoma. It is also extensively used in pre- and postoperative evaluations, particularly in patients with vestibular schwannomas and candidates for cochlear implantation. Nevertheless, despite the widespread use of MRI for these purposes, many radiologists remain unfamiliar with the complex anatomy and expected imaging findings with such examinations. The purpose of this review is to provide an overview of the most useful MRI sequences for internal auditory canal and labyrinthine imaging, review the relevant anatomy, and discuss the expected appearances of the most commonly encountered pathologic entities. In addition, the features at pre- and postprocedural MRI will be discussed to help ensure that diagnostic radiologists may be of greatest use to the ordering physicians. © RSNA, 2020.
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Affiliation(s)
- John C Benson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Matthew L Carlson
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John I Lane
- From the Departments of Radiology (J.C.B., J.I.L.) and Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Extensive qPCR analysis reveals altered gene expression in middle ear mucosa from cholesteatoma patients. PLoS One 2020; 15:e0239161. [PMID: 32915926 PMCID: PMC7485814 DOI: 10.1371/journal.pone.0239161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
The middle ear is a small and hard to reach compartment, limiting the amount of tissue that can be extracted and the possibilities for studying the molecular mechanisms behind diseases like cholesteatoma. In this paper 14 reference gene candidates were evaluated in the middle ear mucosa of cholesteatoma patients and two different control tissues. ACTB and GAPDH were shown to be the optimal genes for the normalisation of target gene expression when investigating middle ear mucosa in multiplex qPCR analysis. Validation of reference genes using c-MYC expression confirmed the suitability of ACTB and GAPDH as reference genes and showed an upregulation of c-MYC in middle ear mucosa during cholesteatoma. The occurrence of participants of the innate immunity, TLR2 and TLR4, were analysed in order to compare healthy middle ear mucosa to cholesteatoma. Analysis of TLR2 and TLR4 showed variable results depending on control tissue used, highlighting the importance of selecting relevant control tissue when investigating causes for disease. It is our belief that a consensus regarding reference genes and control tissue will contribute to the comparability and reproducibility of studies within the field.
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Oncolytic virotherapy: a potential therapeutic approach for cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2020; 28:281-285. [PMID: 32833886 DOI: 10.1097/moo.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the principles of oncolytic virotherapy and summarize the recent preliminary evidence on the efficacy of oncolytic virotherapy for cholesteatoma (CHST) treatment in vitro in human CHST cells and in a gerbil CHST model. RECENT FINDINGS The use of oncolytic virotherapy for nonmalignant lesions is innovative. In-vitro results showed that oncolytic herpes simplex virus 1 (oHSV) selectively targets and kills CHST cells. In a gerbil model of CHST, local oHSV injections were associated with a decrease in CHST volume and modulation of bony changes. SUMMARY Surgical treatment options for CHST are limited by high morbidity and recidivism, emphasizing the need for developing treatment alternatives. Preliminary results support the potential therapeutic effect of oncolytic virotherapy on CHST, yet further research is needed to evaluate this novel approach.
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Casazza G, Carlson ML, Shelton C, Gurgel RK. The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology. Ann Otol Rhinol Laryngol 2020; 130:38-46. [PMID: 32602346 DOI: 10.1177/0003489420937731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base. STUDY DESIGN Retrospective case series. SETTING Two tertiary care academic centers. PATIENTS Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017. INTERVENTIONS Surgical management of medially-invasive cholesteatomas. MAIN OUTCOME MEASURES The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed. RESULTS Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence. CONCLUSIONS The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.
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Affiliation(s)
- Geoffrey Casazza
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Clough Shelton
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
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Jung J, Jung SY, Kim MG, Kim YI, Kim SH, Yeo SG. Comparison of Autophagy mRNA Expression between Chronic Otitis Media With and Without Cholesteatoma. J Audiol Otol 2020; 24:191-197. [PMID: 32521994 PMCID: PMC7575920 DOI: 10.7874/jao.2020.00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives Autophagy is known to be associated with pathogen infection. However, the expression of autophagy-related proteins has not been studied in chronic otitis media without cholesteatoma (COM) or with cholesteatoma (CholeOM). This study aimed to determine whether there is a difference between COM and CholeOM in autophagy-related gene mRNA expression. Subjects and Methods For 47 patients with chronic otitis media, the inflammatory tissues were classified into granulation tissue (COM) or cholesteatoma (CholeOM) according to biopsy results. Results PI3K mRNA expression (COM vs. CholeOM, mean±SD, 0.009±0.010 vs. 0.003±0.004; p=0.004) was lower, whereas Beclin-1 mRNA expression (0.089±0.107 vs. 0.176±0.163; p=0.034) was higher in the CholeOM group. Expression of PI3K mRNA in the CholeOM group was lower than that in the COM subgroups with presence of bacteria (0.022±0.019 vs. 0.001±0.001; p=0.001), otorrhea (0.049±0.068 vs. 0.003±0.004; p=0.004), and hearing loss over 40 dB (0.083±0.130 vs. 0.003±0.004; p=0.005). Conclusions The data suggested that different autophagy proteins play important roles in chronic otitis media according to the presence or absence of cholesteatoma.
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Affiliation(s)
- Junyang Jung
- Department of Anatomy and Neurobiology, School of Medicine, KyungHee University, Seoul, Korea
| | - Su Young Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Myung Gu Kim
- Department of Otorhinolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Il Kim
- Medical Science Research Institute, KyungHee University Medical Center, Seoul, Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology, School of Medicine, KyungHee University, Seoul, Korea
| | - Seung Geun Yeo
- Medical Science Research Institute, KyungHee University Medical Center, Seoul, Korea.,Department of Otorhinolaryngology, School of Medicine, KyungHee University, Seoul, Korea
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Partial Epithelial-Mesenchymal Transition Was Observed Under p63 Expression in Acquired Middle Ear Cholesteatoma and Congenital Cholesteatoma. Otol Neurotol 2020; 40:e803-e811. [PMID: 31348131 DOI: 10.1097/mao.0000000000002328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Partial epithelial-mesenchymal transition (p-EMT) is a process by which epithelial cells partially lose their intercellular adhesion and change to obtain migration ability. The transcription factor p63 regulates the expression of cadherin family and induces epithelial cell proliferation. In this study, we hypothesized that p-EMT under p63 expression may be a key factor in epithelial cell growth in middle ear cholesteatoma. METHODS Specimens were surgically excised from patients with congenital cholesteatoma (CC) (n = 48), acquired middle ear cholesteatoma (AC) (n = 120), and normal skin tissue (n = 34). We analyzed immunohistochemically for the EMT marker (N-cadherin), adherence junction marker (E-cadherin), and tight junction marker (claudin-1, claudin-4, occludin). We also examined the labeling index (LI) of p63 and Proliferating cell nuclear antigen (PCNA) (late S phase marker), and Snail expression as a mobility marker. RESULTS The expression of p63 (CC 51.0 ± 7.4%, AC 50.0 ± 5.9%) was significantly higher in the thickened epithelium of CC and AC compared with normal skin tissue (p < 0.0001). The loss of E-cadherin was observed (CC 50.0%, AC 55.8%) but the expression patterns in the tight junction were almost normal. N-cadherin was partially detected in the basal and upper layer of epithelium in CC and AC. In contrast to that of normal skin tissue, the LI of PCNA was significantly higher in AC (p < 0.0001). The positive rate of Snail was significantly higher in CC (p < 0.0001). CONCLUSION This study indicates that p-EMT via the p63 signaling pathway might plays an essential role in epithelial growth in AC and CC formation, although tight junction formation and terminal differentiation were not affected in those processes.
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