Bone Damage in Chronic Otitis Media

The middle ear bone destruction in chronic otitis media is activated and regulated by inflammation. Chronic otitis media with granulation is a highly active inflammatory process in which many cytokines are released. The bone is degraded by osteoclasts but, at the same time, protected by cytokines, growth factors, adhesion molecules and osteotropic hormones. Tumor necrosis factor-α, interleukin (IL)-1, IL-6, and OPG/RANKL present in cholesteatoma and granulation accelerate bone lysis and increase the destructive effect on the middle ear.

Epidemiology of dizziness in northern Poland - The first Polish neurootologic survey of the general population

INTRODUCTION

Dizziness is a common complaint among patients seen by primary care physicians, neurologist and otolaryngologist. It presents difficult clinical and diagnostic problems.

OBJECTIVES

The purpose of this study was to determine the prevalence and incidence of dizziness in the general population of the town and district Bytów, northern Poland, and to describe its clinical characteristics.

MATERIAL AND METHODS

Epidemiological questionnaires were completed by 4,799 inhabitants of the town and district of Bytów. All participants were randomly selected from the patients' list of the Family Health Centre 'Salus' in Bytów. The main variables studied were gender, age, school education, work situation, clinical characteristics of dizziness symptoms and circumstances provoking dizziness.

RESULTS

Prevalence of dizziness was diagnosed among 16.4% of the inhabitants of the town and district of Bytów. Symptoms of dizziness appeared more often among the elderly and among women. Among young people, the condition shows as vertigo or presyncope, among people aged 50 or older, the condition showed as disequilibrium. The most common precipitant of dizziness was postural change. Dizziness was more likely to occur among those suffering from high blood pressure, diabetes, increased blood lipids, hypothyroidism, cardiac arrhythmia and depression. Dizziness was more likely to occur among women using OCS or HRT, and individuals taking anti-epileptic drugs.

CONCLUSIONS

The authors present the first Polish neurootologic survey of epidemiology of dizziness in the general population. This condition is common in the general population, and this study indicates its prevalence in 16.4% of the inhabitants of the town and district of Bytów. It is recommendable that epidemiological studies should be carried out.

Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

BACKGROUND

Tympanosclerosis is a pathological process involving the middle ear. The hallmark of this disease is the formation of calcium deposits. In the submucosal layer, as well as in the right layer of the tympanic membrane, the calcium deposits result in a significant increase in the activity of fibroblasts and deposition of collagen fibers.

OBJECTIVES

The aim of our study was to examine the expression level of genes encoding collagen type I, II, III and IV (COL1A1, COL2A1, COL3A1, COL4A1) and osteopontin (SPP1) in the tympanic membrane of patients with tympanosclerosis.

MATERIAL AND METHODS

The total RNA was isolated from middle ear tissues with tympanosclerosis, received from 25 patients and from 19 normal tympanic membranes. The gene expression level was determined by real-time RT-PCR. The gene expression levels were correlated with clinical Tos classification of tympanosclerosis.

RESULTS

We observed that in the tympanic membrane of patients with tympanosclerosis, the expression of type I collagen is decreased, while the expression of type II and IV collagen and osteopontin is increased. Moreover, mRNA levels of the investigated genes strongly correlated with the clinical stages of tympanosclerosis.

CONCLUSIONS

The strong correlations between the expression of type I, II, IV collagen and osteopontin and the clinical stage of tympanosclerosis indicate the involvement of these proteins in excessive fibrosis and pathological remodeling of the tympanic membrane. In the future, a treatment aiming to modulate these gene expressions and/or regulation of the degradation of their protein products could be used as a new medical approach for patients with tympanosclerosis.

Hearing loss in patients with extracranial complications of chronic otitis media

Objective: A pure tone audiomety analysis of patients with extracranial complications of chronic suppurative otitis media (ECCSOM). Material and methods: We retrospectively analyzed audiometric data performed before treatment from 63 patients with ECCSOM (56 single, 7 multiple complications) including groups of frequencies. Results: The greatest levels of hearing loss were noted for 6 and 8 kHz (79.0 and 75.7 dBHL) and for the frequency groups high tone average (76.1 dBHL). As regards the severity of hearing impairment in pure tone average the prevalence of complications was as follows: labyrinthitis (77.8±33.6 dBHL), facial palsy (57.1±14.3 dBHL), perilymphatic fistula (53.9±19.9 dBHL) and mastoiditis (42.2±9.5 dBHL) (p=0.023). Conclusions: Hearing loss in ECCSOM is dominated by mixed, high-tone, moderate type of hearing loss, most profound in labyrinthitis. In 11% of patients the complication causes total deafness.

Prognostic Factors in Sudden Sensorineural Hearing Loss: Our Experience and a Review of the Literature

Objectives:

We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL).

Methods:

Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant.

Results:

Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring.

Conclusions:

A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.

Altered response of fibroblasts from human tympanosclerotic membrane to interacting mast cells: implication for tissue remodeling

Several lines of evidence suggest that a tympanosclerotic (TMS) lesion often develops secondary to acute and chronic otitis media. Histological findings indicate that fibroblasts and inflammatory cells, including mast cells, play a key role in the tympanosclerotic plaque formation. However, details on the functional characteristics of tympanosclerotic fibroblasts (Fs(TMS)) are scanty. Therefore the aim of our study was to examine the activity of human fibroblasts from tympanosclerotic lesions and to evaluate the influence of stimulated by crosslinking of IgE receptor mast cells (HMC-1(FcɛRI)) on fibroblast functional behavior. We observed that fibroblasts from normal tympanic membrane (Fs(TM)) released less TNF-α, TGF-β1 and IL-6 compared to Fs(TMS). Fs(TMS) but not Fs(TM) upon interaction with HMC-1(FcɛRI) released increased quantities of TNF-α and TGF-β1. Exposing the fibroblast to HMC-1(FcɛRI) cells resulted in an increased synthesis of proteins including collagen. We noted that the COL2A1 transcript level increased ∼5- and ∼12-fold in Fs(TM) and Fs(TMS) co-cultured with HMC-1(FcɛRI), respectively. Both Fs(TM) and Fs(TMS) upon maintenance in the primary culture released significant quantities of matrix metalloproteinase 9 (MMP-9). However, Fs(TMS) released ∼5-fold more MMP-9 activity compared to the Fs(TM) cultures. The mast cell-induced release of TNF-α, TGF-β1 and MMP-9 sustained for a longer time in Fs(TMS) cultures compared to Fs(TM). Concluding, our data strongly indicate that increased fibroblast sensitivity to mast cell stimulation greatly contributes to the excessive fibrosis and pathological remodeling of the tympanic membrane. We postulate that the persistency of the Fs(TMS) activated state could be an important factor in the pathogenesis of tympanosclerosis.

Lateral petrosectomy with obliteration cavity for spontaneous cerebrospinal otorrhea in children

PURPOSE

The most common causative factors of CSF otorrhea in children are injuries and congenital abnormalities of the temporal bone. Spontaneous CSF leak as a consequence of congenital temporal bone defects may result in recurrent meningitis. Diagnosis and management of such an entity are particularly difficult in early childhood.

MATERIALS AND METHODS

The aim of this study was to investigate clinical features and to discuss possible methods of treatment of spontaneous CSF otorrhea in children.

RESULTS

Severe unilateral sensorineural hearing loss or total deafness was found in children with CSF otorrhea. CT and MRI of the temporal bones revealed dehiscences in the walls of the tympanic cavity and defects of the inner ear, which were confirmed intraoperatively. Lateral petrosectomy and closure of the fistula with muscle tissue and fat obliteration cavity were performed. The children remain free of otorrhea and recurrences of meningitis.

CONCLUSION

The diagnosis of spontaneous otorrhea in children is based on the severe unilateral sensorineural hearing loss and presence of CSF in the middlę ear cavity. It may be successfully treated by means of lateral petrosectomy with obliteration of the vestibule with muscle tissue and tympanic cavity with fat tissue.

Morphological alterations in the tympanic membrane affected by tympanosclerosis: ultrastructural study

The ultrastructure of tympanoslerotic tissue, surgically excised from patients, has been studied with particular reference to the morphological changes of the connective tissue components and mineralization. Detailed analysis revealed the combination of degenerative and fibroplastic alterations, especially in the circular fibrous layer of the thickened lamina propria. In the biological material in this study the authors recognized different stages of calcium plaque development with discrete, moderate, and severe degree of mineralization. Extracellular matrix vesicles, with or without calcareous deposits, released by degenerating fibroblasts were prominent. In these biopsies no distinct morphological features of an inflammatory reaction were seen.

[Treatment results of otosclerosis regarding different types of prosthesis]

Surgery is the most effective method of improving hearing in patients with otosclerosis. The level of improvement depends on the stage of the disease and the chosen surgical method.

THE AIM OF THIS STUDY

is to present hearing results in patients treated surgically by means of different types of prostheses and methods of vestibule sealing.

MATERIAL AND METHODS

230 cases (160 men, 70 women) between the age of 21 and 64 (median 36 years) treated for the first time in the Department of Otolaryngology of Medical University in Gdańsk underwent epidemiologic and clinical analysis. The researches took into account the level of hearing improvement based on the reduced air-bone reserve for frequencies 0.5, 1.0, 2.0 i 4.0 kHz in groups with where prostheses type 1 and 2 were used.

RESULTS

230 stapedotomies were performed. In 110 patients prosthesis type 1 was used (PTFE) and in 120 type 2 (piston PTFE with platinum tape). Each vestibule was sealed with homogenic fat tissue or fibrin sponge. After 6 weeks from the operation the air-bone reserve was reduced by 5 to 30 dB, the reserve existed after one year from the operation in some patients. 35% of the patients presented with vertigo after the operation and 5% with tinnitus.

CONCLUSIONS

Stapedotomy is a method of hearing improvement in patients with otosclerosis. Best results are achieved when prosthesis type 2 is used and homogenic fat tissue serves to seal the vestibule. Broad opening of the vestibule may be the cause for vertigo and lack of hearing improvement occurrence.

[Assessment of Tumor Necrosis Factor alpha gene expression profile in selected structures of middle ear in patients with tympanosclerosis]

AIM OF THE STUDY

Tympanosclerosis is a middle ear disease located in submucous membrane. It leads to the tympanic membrane and ear ossicles fixation which results in severe conductive hearing impairment. The etiology of tympanosclerosis remains unclear. Cytokines play very important role in development of tympanosclerosis. The research aimed to assess gene expression level of pro inflammatory cytokine TNF-α in selected structures of middle ear in patients with chronic otitis media with tympanosclerosis.

METHODOLOGY

The research was performed on middle ear tissues with tympanosclerosis achieved from 30 patients operated on in the Otolaryngology Department of the Medical University of Gdańsk. The control group was formed by tympanic membranes sampled from 17 corpses of patients who died suddenly. Advancement of tympanosclerotic changes were grouped based on Tos classification. The TNF-α gene expression level was measured by real time PCR with specific hydrolysed probes (TaqMan). The gene expression level for TNF-α was correlated with clinical classification of tympanosclerosis.

RESULTS

The level of gene profile expression for TNF-α in selected structures of the middle ear with tympanosclerosis was statistically significant, higher in comparison with the control group. The highest level of expression was observed in group two which is relevant to more advanced tympanosclerosis.

CONCLUSION

Tympanosclerosis is a result of constant inflammatory process and it is modulated by cytokines including TNF-α. The positive correlation between gene expression level of TNF-α and tympanosclerosis could in the future contribute to antiinflammatory, medical treatment of tympanosclerosis.

[Surgical treatment results of acquired external auditory canal atresia]

Acquired post inflammatory external auditory canal atresia is a rear complication of external ear disease. It is presented as a connective tissue scar in bony part of external auditory canal. The aim of this study is clinical and epidemiological analysis and presentation of diagnostics and treatment results of patients with atresia treated in the Otolaryngology Department of Medical University of Gdansk.

MATERIAL AND METHODS

In the period of 3 years (2008-11) 10 patients (8 women and 2 men) aged 30 to 70-years-old (medium 53 years) were treated for acquired atresia. All of these patients had medial closure of EAC with thick connective tissue scar and tympanic membrane involvement. Intrameatal access was performed in 5 patients, intraural access in 3 patients and retroaurical access in 2 patients. In all cases canaloplasty with meato-tympanic angle enlargement was performed, skin defect was replaced with free epidermal flap, silicon foil with fibrinous sponge was used for coverage.

RESULTS

In all of our patients external auditory canal widening and hearing improvement was achieved. Due to increasing EAC narrowing four patients underwent second surgery with another free epidermal flap grafting.

CONCLUSION

The selection of surgical access in patients with acquired atresia should comply with the etiology of the disease and the shape of EAC. During surgery we aim at maximal broadening of the bony part of EAC. The success of the treatment depends on meato-tympanic angle enlargement and free epidermal flap grafting.

Jan Mikulicz-Radecki (1850-1905): a fundamental contributor to world surgery; surgeon of the head, neck, and esophagus

We present some of many valuable and unique achievements of Jan Mikulicz-Radecki with special regard to his contribution to laryngology. He constructed esophagogastroscope, and was one of the first to perform endoscopy of esophagus and ventricle. He published several papers describing new approaches to maxillary sinus through inferior meatus, surgical management of tonsillar cancer via lateral pharyngotomy, correction of post-traumatic nasal deformations, and the use of iodophorm in healing wounds. Among Mikulicz's many celebrated scientific achievements, the most important remains the development of asepsis and creation of a surgical school, which was a modernized continuation of Langenbeck-Billroth achievements.

[Nonchromaffin paragangliomas (chemodectoma) of the middle ear in the material of the ENT Department Medical University of Gdańsk]

INTRODUCTION

Nonchromaffin paraganglioma (chemodectoma) is the most common neoplasm of the middle ear. The diagnosis and treatment is one of the most challenging in otolaryngology.

THE AIM OF THE STUDY

was clinical and epidemiological analysis of patients with nonchromaffin paraganglioma of the middle ear.

MATERIAL AND METHODS

The material consisted of 13 patients (10 females, 3 males), age 19-62 years, treated for paraganglioma of the middle ear in the ENT Department Medical University of Gdańsk between 1968 and 2009. We analyzed the symptoms and results of additional diagnostic tests necessary to establish the diagnosis.

RESULTS

We have diagnosed 12 cases of benign chemodectoma (92.3%) and 1 case of chemodectoma malignum (7.7%). The surgical treatment was applied in 6 patients (46.1%), 4 patients (30.8%) received complementary radiotherapy and 3 patients (23.1%) were treated only with radiotherapy.

CONCLUSIONS

The diagnosis of paragangliomas of the ear is difficult and should be based on clinical data, audiometric tests, CT, MRI and histological examination. Surgical treatment of paragangliomas is limited to early stages of the disease. The results of the research show that the best therapeutic method in advanced cases is surgical treatment with complementary radiotherapy.

Sir Felix Semon (1849-1921): pioneer in neurolaryngology

This article will attempt to review the historical and scientific literature pertaining to the life and work of Felix Semon (1849-1921). Sir Felix Semon was one of the most distinguished figures in the early development of laryngology. He was an astute researcher of laryngeal pathophysiology and an active participant in laryngological scientific societies. Felix Semon was a talented doctor and was one of the most esteemed laryngologists in London for 35 years (1875-1910). Primarily, his scientific interests included complications after thyroid surgery, laryngeal cancer, tuberculosis and motor innervation of the larynx, and movement disorders of the larynx. Semon formulated the law regarding the sequence of occurrence of the laryngeal muscle paralysis-abduction before adduction. The 132 articles he had published over the years have had a significant impact on contemporary medical knowledge. At the 160th anniversary of Semon's birth, we attempt to summarize his invaluable contribution to laryngology.

[Osteomas and exostoses of external auditory canal in material of Otolaryngology Department Medical University of Gdańsk]

INTRODUCTION

Osteomas and exostoses of the external auditory canal are benign tumours arising in bones, leading to its obstruction and causing hearing loss. The treatment of these entities may present a therapeutic dilemma.

AIM OF THE STUDY

To assess epidemiological and clinical data and surgical treatment effectiveness.

SUBJECTS AND METHODS

The study group consisted of 21 patients (14 men and 7 women) between 18 to 63 years of age, treated in the Otorhinolaryngology Department of Medical University of Gdańsk from 1995 to 2009. The results of audiometric, radiological and histopathological examination were taken into consideration.

RESULTS

Unilateral osteomas developing in tympanosquamous suture in 5 patients, in tympanomastoid suture in 4. Bilateral exostoses occured in 12 patients in anterior, posterior and inferior wall of the external auditory canal. In all patients: conductive hearing loss ranged from 15 to 30 dB (average 29.9 dB), in 6 patients with concomitant sensorineural component. Osteomas were removed via intrauricular approach according to Mawson-Goodhill's method. Exostoses were removed via intrauricular, intracanal or postauricular approach. Histological examination confirmed benign overgrowth of compact and trabecular bone. The auditory canal was successfully reamed, the hearing improved in all patients.

CONCLUSIONS

Osteomas are benign tumours leading to obstruction of the external auditory canal. Exostosis is the overgrowth of the external auditory canal's compact bone in adults. Osteomas and exostoses may lead to hearing loss. Indications to surgical treatment are ear pain, progressive hearing loss and recurrent otitis external.

Expression of tumor necrosis factor-α, interleukin-1α, interleukin-6 and interleukin-10 in chronic otitis media with bone osteolysis

The purpose of this study was to evaluate the expression of proinflammatory and immunoregulatory cytokines in chronic otitis media. The expression levels of TNF-α, IL-1α, IL-6 and IL-10 were determined by Western blot analysis of tissue samples obtained during ear surgery. The expression levels of TNF-α, IL-1α and IL-6 in cholesteatoma tissues were substantially higher compared to those determined in the granulation tissue. The highest levels of TNF-α, IL-1 and IL-6 proteins were observed in patients with bone destruction. There were no significant differences in the expression of IL-10 levels in cholesteatoma and normal skin, but in the granulation tissue its level was substantially higher. The level of IL-10 in cholesteatoma tissues inversely correlated with the expression of proinflammatory cytokines, the degree of bone destruction and cholesteatoma invasion. Increased expressions of TNF-α, IL-1α and IL-6 in chronic otitis media and a strong positive correlation between these cytokine levels and the degree of bone destruction indicate the destructive behavior of cholesteatoma or granulation tissue.

Expression of the receptor activator for nuclear factor-κB ligand and osteoprotegerin in chronic otitis media

BACKGROUND

The receptor activator for nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) are the key factors controlling the osteoclast and osteoblast action in the bone.

PURPOSE

The study objective was to investigate the expression level of RANKL and OPG in cholesteatoma and granulation tissue, and to assess the relationship between their expression levels and osteolysis.

MATERIAL AND METHODS

Patients with chronic otitis media with cholesteatoma (n = 28) and without cholesteatoma (n = 24) treated surgically at the Department of Otolaryngology of the Medical University of Gdańsk were included in the study. RANKL and OPG expressions were analyzed by immunohistochemistry and Western blot.

RESULTS

RANKL and OPG were expressed in all cholesteatoma and granulation tissues. RANKL expression was mainly observed in cholesteatoma subepithelial stroma, whereas OPG-positive cells originated from the epithelium. The number of OPG-positive cells in the normal skin was significantly higher than in cholesteatoma tissues. The RANKL protein level in cholesteatoma tissues was 1.8- and 1.5-fold higher than in the auditory canal skin and granulation tissues, respectively. The number of RANKL-positive cells in cholesteatoma tissues was significantly higher than in the normal skin. No substantial differences were found in average OPG protein levels between cholesteatoma tissues and the normal auditory canal skin. The ratio of RANKL/OPG was significantly higher in cholesteatoma tissues (2.93 ± 0.79) than in the skin samples (1.36 ± 0.34).

CONCLUSIONS

Altered ratio of RANKL/OPG protein level in cholesteatoma tissues suggests that these proteins might be somehow involved in the pathogenesis of cholesteatoma. However, to resolve this issue a study on a larger group of patients should be conducted.

[Mucoceles of the paranasal sinuses]

INTRODUCTION

Paranasal sinus mucocoele is a benign pseudocystic lesion, which may originate from any sinus cavities when their natural ostia are blocked. Raising mucocoele in frontal, ethmoid or sphenoid sinus causes headache, disorders of eye mobility and deformities of forehead or orbit.

AIM OF THIS STUDY

was clinical analysis of treatment results taking into consideration the method of surgical treatment.

MATERIAL AND METHOD

Presented material consists of 42 patients (39 adults and 3 children), 22 females and 20 males, in the age from 8 to 76 treated at Department of Otolaryngology of Medical University of Gdansk in the years from 1995 to 2005 for paranasal sinuses mucocoele.

RESULTS

Fronto-ethomidal mucocoele was found in 22 (52.4%) patients, ethmoidal--in 10 (23.8%), frontal--in 4 (9.5%), spheno-ethmoidal--in 4 (9.5%) and maxillar in 2 (4.8%) patients. 14 (33.3%) cases were primary and 28 (66.7%) secondary of mucocoeles. The most frequent symptoms of frontal or ethmoidal mucocoele were: headache, lacrimation, deformity of orbit, blepharoedema, and diplopia. Sphenoethmoidal and maxillar mucocoele caused mostly nose obstruction and severe headache. Destruction of sinuses and orbital bony wall was found in 16 patients (38.1%), and in 9 of them (21.4%) there were in medial wall of orbit, in 3 (7.1%)--in inferior wall of frontal sinus, in 3 (7.1%)--in anterior wall of frontal sinus, and in 1 (2.3%) in anterior wall of maxillary sinus. In 3 patients (97.1%) with fronto-ethmoidal mucocoele as the consequence of disease the development of empyema was observed. Endoscopic intranasal treatment was applied in 9 patients (21.4%) with fronto-ethmoidal, spheno-ethmoidal and maxillar mucocoele. Complete recovery was observed in 30 (71.4%) patients, recurrence was noted in 12 (28.6%) and these patients were operated from extranasal approach.

CONCLUSIONS

Paranasal sinuses mucocoele is found when natural ostia of sinuses are blocked after prior operation. They cause destruction of bony walls of sinuses. Extranasal approach is an optimal method of treatment in extended mucocoele and their complications.

[HIV infected child in otolaryngological practice]

The authors present material about 12 HIV infected children at the age between 0 and 18 years observed and treated in Department of Infectious Diseases Medical University of Gdansk in the period between 1991 till 2006. Retrospectively medical records of 4 of them currently undergoing observation and treatment have been analyzed taking into consideration: ways of HIV infection, applying the possible retroviral profilactic to a mother and a child, the damaging o of immunological condition in the period of observation and treatment as well as the possible head and neck changes. The authors come to conclusion that changes in oral cavity may be the first symptom of child HIV infection and in the oral candidiasis symptoms the possibility of HIV infection should be taken into account.

[Keratosis obturans of the external auditory canal]

Keratosis obturans is a rare condition of the bony part of external ear canal cased by hyperkeratosis of epiderm and disorders of migration process. Hyper-cumulation of desquamated epiderm in the external ear canal leads to hearing loss, earache and inflammation of ear canal skin. We present 2 cases of keratosis obturans as examples of epiderm migration disorders and difficulties in diagnosis and treatment of this disease. Keratosis obturans was diagnosed in both cases in histopathological and immunohistochemical examinations. Histopathological and molecular structure of keratosis obturans was discussed. In presented cases surgical, anti-inflammatory and keratinolytic treatment was applyied.

[Complications of acute mastoiditis in children]

OBJECTIVE

The incidence of complications resulting from acute otitis media has significantly decreased since the introduction of antibiotics. The use of antibiotics has lead to decrease in the complications of acute mastoiditis as well as the mortality of the disease. The purpose of the study was to review our experience in the diagnosis and treatment of complications of acute mastoiditis in children. Study design. Retrospective clinical study.

MATERIAL AND METHODS

We present a retrospective study of 70 children with extracranial and intracranial complications of acute mastoiditis who were treated in the period from 1968 to 2006 at Department of Otolaryngology, Medical University of Gdansk. Their treatment has been documented with long period of otologic follow-up.

RESULTS

Extracranial complications occurred in 41 (30.4%) of treated acute mastoiditis cases, and subperiostal abscess was the commonest one in 37 (90.2%) patients. Intracranial complications occurred in 29 (21.4%) of acute mastoiditis cases and facial paralysis was the commonest one in 14 (40.0%) cases, followed by sigmoid sinus thrombosis and perisinus abscess. Ear cultures grew in patients with otogenic complications, the most often Staphylococcus aureus, Streptococcus sp. and Pseudomonas aeruginosa were found. Mastoidectomy with myringotomy resolved the disease in 46 (65.7%) children, only myringotomy in 6 (8.6%) and canal wall down mastoidectomy in 18 (25.7%) children. Complete resolution was achieved in all cases.

CONCLUSION

The persistent othorrea, otalgia and headache, prolonged high fever, neurological signs were the most common symptoms associated with the development of intracranial complications of acute mastoiditis in children. Computed tomography and MRI are necessary tools for diagnosis and surgery planning in every case of latent mastoiditis. Antibiotic treatment of acute mastoiditis does not prevent otogenic complications. Extracranial or intracranial complications of acute mastoiditis need surgical treatment and prolonged antibiotic therapy. The present study found evidence for decreased incidence of mastoiditis and their suppurative complications during last years.

[Primary cholesteatoma of the middle ear and petrosal bone]

Petrosal cholesteatomas are rare lesions, which may be primary or acquired in nature. We report a case of primary cholesteatoma in petrous bone occurring in 51-year old woman who presented with a unilateral facial nerve palsy and conductive hearing loss, despite normal tympanic membrane appearance. Early diagnosis was facilitated by computed tomography scanning and magnetic resonance imaging. Complete cholesteatoma removal was accomplished using a transtemporal supralabyrinthine approach, which allowed hearing preservation. Facial nerve function is the main complication of these lesion. We suggest that use of CT scanning and MRI in unilateral conductive hearing loss may allow the earlier detection of the most cases of petrosal cholesteatomas.

[Post-traumatic cholesteatoma of temporal bone]

Posttraumatic cholesteatoma of the middle ear is a rare condition that may present years after temporal bone fracture. We present the 36 years old woman with acquired cholesteatoma of the middle ear and perilymphatic fistula six years after a temporal bone fracture. CT scan was extremely helpful in determining the sites of fracture and fasioning the surgical approach. The middle ear was cleaned with cholesteatoma, perilymphatic fistula was sealed with 3 layers of tissues and the ossicular chain was reconstructed in one stage. The presence of fracture lines in temporal bone years after trauma may prove hindered healing, which promotes migration of epithelium from external ear canal into the middle ear. We recomend long term follow-up in any patient with longitudinal temporal bone fracture with CT for any new otologic complaints.

Expression patterns of Ki-67 and telomerase activity in middle ear cholesteatoma

BACKGROUND

Keratinocytes in cholesteatoma demonstrate uncoordinated hyperproliferation, migration, and invasion properties. There is a controversy regarding the impact of Ki-67 and telomerase activities on cellular proliferation in cholesteatoma. We studied expression of Ki-67 protein and telomerase activity in cholesteatoma and its relationship with clinical findings.

METHODS

The expression level of Ki-67 protein was examined by immunohistochemical analysis of 51 cholesteatomas and 6 skin tissues obtained from patients during ear surgery. Telomerase activity was determined in 23 samples of cholesteatomas and 6 skin samples by polymerase chain reaction-based telomeric-repeat amplification protocol assay.

RESULTS

The presence of Ki-67 protein was observed in 21 (41.2%) of 51 samples of acquired cholesteatoma. The average Ki-67 labeling index in the cholesteatoma group was 28.9 +/- 9.2 and was higher than that in the skin group (18.2 +/- 6.1). Telomerase activity was detected in 2 (8.7%) of 23 samples of cholesteatoma (21 of them were Ki-67 staining positive and 2, negative) and in 3 (50%) of 6 of control skin samples (p < 0.05).

CONCLUSION

This study showed increased expression of Ki-67 in cholesteatoma, whereas there was no significant difference in rate of Ki-67 positive staining between skin and cholesteatoma (p = 0.066). Telomerase activation is a rare event in cholesteatoma. We assume that the absence of telomerase may lead to generation dysfunctional telomeres what in turn may impair the proliferative capacity of cholesteatoma.