Unsuspected inner- and middle-ear disease associated with fatal non-aural conditions in young children

Mucopolysaccharidosis I-H (Hurler's syndrome) and human temporal bone histopathology

Six temporal bones from three patients with mucopolysaccharidosis I-H are described. All three patients were diagnosed as having mucopolysaccharidosis I-H by enzyme analysis, and all fit the phenotypic criteria of this disease. Family histories of the three cases described were negative for mucopolysaccharide-storage diseases. All three of the patients suffered chronic recurrent otitis media from infancy through death. Common histopathologic findings include otitis media, residual mesenchyme in the round window niche, partial occlusion of the middle ear cavity, and basophilic concretions within the stria vascularis. The common severe histopathologic changes observed in this study and similar findings in the temporal bones described in other studies lead the authors to believe that ear involvement in this disease may be more common than was previously suspected.

Temporal bone pathology in an active case of glue ear

A child aged 3 1/2 died from a cardiac condition after many and prolonged antibiotic courses: bilateral glue ear had been treated for the previous 18 months. Histopathology showed cholesterol granulomata in the mastoid air cells, with evidence of old hemorrhage, and of former inflammation of bone. The exudate was histiocytic with some giant cells. An 'orange spot' on the tympanic membrane was hyperaemic middle-ear mucosa, heavily infiltrated by plasma cells, lymphocytes and histiocytes. There was no evidence of hypersecretion. Some of the most abnormal areas were around the stapedial niche and the round window.