Epithelial Migration in Open Mastoidectomy Cavities

Cholesteatoma in chronic otitis media secondary to pars tensa perforation

BACKGROUND

Acquired cholesteatoma secondary to pars tensa perforation was rare in clinic.

OBJECTIVES

In this study, we explored factors related to acquired cholesteatoma in chronic otitis media patients with pars tensa perforation.

MATERIAL AND METHODS

262 adults (296 ears) with pars tensa perforation were divided into four groups: anterior perforation group, posterior perforation group, central perforation group, and marginal perforation group. Analysis was carried out in terms of cholesteatoma formation, adhesion of perforation edges, mastoid pneumatization, and the function of eustachian tube.

RESULTS

Cholesteatoma was found in 34% (18 in 53 ears) in posterior perforation group, 14.3% (14 in 98 ears) in marginal perforation group, and 2.5% (2 in 80 ears) in anterior perforation group. For subjects with adhesion in perforation edges, cholesteatoma was approved in 94% of posterior perforation, 42% of marginal perforation and 25% of anterior perforation groups. The adhesion in perforation edges and function of eustachian tube instead of mastoid pneumatization were statistically significant for cholesteatoma formation.

CONCLUSIONS AND SIGNIFICANCE

Acquired cholesteatoma was mostly found in patients with posterior and marginal perforation, followed by anterior perforation. Adhesion of perforation edges was another risk factor for cholesteatoma formation. Eustachian tube also functioned by influencing the ventilation of middle ear.

Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study

OBJECTIVES

To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures.

MATERIALS AND METHODS

The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity.

RESULTS

Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively.

CONCLUSION

Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Introduction

Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure.

Objective

To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction.

Methods

In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups.

Results

The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively).

Conclusions

Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Study of epithelial migration in the tympanic membrane and bony external auditory canal wall in patients with irradiated nasopharyngeal carcinoma

OBJECTIVE

The objectives of this study were to determine the presence of epithelial migration in patients with postirradiated nasopharyngeal carcinoma (NPC) and to compare the rate of epithelial migration in the tympanic membrane (TM) and the bony external auditory canal (EAC) of postirradiated NPC ears with normal ears by means of the ink dot method.

STUDY DESIGN

Prospective, nonrandomized case-control study involving patients with NPC and control subjects with healthy ears seen in an otorhinolaryngology outpatient clinic.

SETTING

Otorhinolaryngology Outpatient Clinic, University Malaya Medical Centre, Kuala Lumpur.

PATIENTS

Patients with NPC who have completed radiotherapy and patients with normal ear presenting with other complaints.

INTERVENTION

Patients who fulfilled the inclusion and exclusion criteria were chosen for this study. All the selected patients' ears were visualized under a microscope and were cleaned, and ink dots were applied at the umbo and annulus. They were followed up on a 2- to 3-weekly basis until the ink dots reached the specified landmarks. The distance and pattern of migration were recorded and calculated. The mean radiation dose received by both the right and left TM and EAC was mapped and calculated.

MAIN OUTCOME MEASURES

Rate and pattern of epithelial migration in the NPC group compared with that in the control group.

RESULTS

The mean radiation dose to both the TM and EAC did not show a significant difference (p > 0.05). The entire TM study group showed epithelial migration from the umbo toward the annulus and EAC, except in 1 ear. The mean rate of epithelial migration on the TM of the study group was 51.35 μm/d compared with that on the control group, which was 64.68 μm/d, and this difference was statistically significant (p < 0.05). Of the ears in the control group, 42.5% showed a migration pattern toward the posterior-superior direction, whereas 45% of the ears in the study group showed a migration pattern toward the posterior-inferior direction. In the EAC of the study group, the mean epithelial migration was noted to be accelerated compared to that of the control group (144.75 and 94.33 μm/d, respectively; p < 0.05). The mean rate of migration between the TM and the EAC was also different. Both the study and control groups showed a significant difference in migration, with a faster rate of migration in the EAC (p < 0.05).

CONCLUSION

We noted a significant delay in the rate of epithelial migration in the TM of patients with postirradiated NPC and an accelerated rate of migration in the EAC of patients with postirradiated NPC. In addition, epithelial migration in the EAC was also noted to be faster than that in the TM of the control population.

Acquired cholesteatoma pathogenesis: stepwise explanations

BACKGROUND

Since Virchow's first, 1855 publication on cholesteatoma, this disease has been the subject of extensive debate. The pathogenesis of acquired cholesteatoma is repeatedly explained on the premises of the migration, hyperplasia and metaplasia theories, but proof for the latter theory remains limited. In retrospect, there is progress toward better understanding of all the pathological mechanisms involved, as expounded in this review.

DISCUSSION

The triggers for cholesteatoma onset are diverse, and may involve tympanic membrane trauma (i.e. perforation, displacement, retraction or invagination), tympanic membrane disease, and/or tympanic cavity mucosa disease. Research has revealed that cell migration is replaced under inflammatory conditions by hyperplasia, which triggers the onset of cholesteatoma. Lately, the hyperplasia theory gained prominence and circumscription of the papillary cone formation concept provided insight into cholesteatoma progression (growth and expansion). Diseased mucosa can contribute to the development of retraction pockets and cholesteatoma. The type of cholesteatoma trigger and the role of chronic inflammation during disease progression and recurrence are important in guiding clinical intervention.

Epithelial migration in the atelectatic tympanic membrane

OBJECTIVE

To determine whether epithelial migration in the atelectatic tympanic membrane (secondary to any pathology) occurs in a similar fashion to that in the normal (non-pathological) tympanic membrane, by calculating and comparing the epithelial migration rate and pattern.

STUDY DESIGN

Prospective, non-randomised, case-control study. This study was a pilot study. We included patients with an atelectatic pars tensa region of the tympanic membrane and a healthy contralateral tympanic membrane (the latter used as the control).

SETTING

Otorhinolaryngology out-patient clinic. The study was conducted from January 2006 to January 2008.

INTERVENTION

A total of 40 patients (80 ears) were included based on their otoscopic appearance and tympanography findings. All patients' ears were examined under an operating microscope. A dot of methylene blue dye was applied in the immediate vicinity of the umbo of the atelectatic tympanic membrane, and in the same position on the tympanic membrane of the control ear. Patients were then followed up weekly until the dye dot had migrated to reach the annulus.

MAIN OUTCOME MEASURES

Direction and rate of epithelial migration.

RESULTS

In the atelectatic tympanic membranes, epithelial migration proceeded from the centre of the retraction pocket toward the annulus in a lateral, radiating manner. Thirty-three (82.5 per cent) of the 40 patients showed a similar migratory pattern in both the study and control ears. Sixty per cent of the retracted tympanic membranes showed no migration in the first week after methylene blue staining. After the first week, the migration rate was nearly constant from the umbo towards the periphery, in both the study and control ears. The mean daily epithelial migration rate in the study and control ears was 62.6 and 64.7 microm/day, respectively; however, this difference was statistically insignificant (p = 0.202, independent samples t-test).

CONCLUSION

There is no difference in the epithelial migration rate or pattern, comparing atelectatic tympanic membranes and normal tympanic membranes. However, there may be a significant difference in the epithelial migration rate with increased grades of tympanic membrane atelectasis.