Cholesteatomatous Chronic Otitis Media Research Articles

Intratemporal complications of otitis media

Otitis media (OM) is considered a potentially severe disease due to the risk of complications. ObjectiveTo establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors. MethodThis prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined. Results1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis. ConclusionThe incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Isolation of Kerstersia gyiorum from a Patient with Cholesteatomatous Chronic Otitis Media

We describe the first case of a Kerstersia gyiorum strain isolated from a patient with cholesteatomatous chronic otitis media. We emphasize the isolation of members of the family Alcaligenaceae in serious infections and unusual sites and the importance of polyphasic identification addressing the definitive identification.

Myringosclerosis: An Indication of A Blocked Aditus

Tympanoplasty has been the mainstay of treatment in chronic otitis media. In a non cholesteatomatous chronic otitis media, there has been much debate whether a cortical mastoidectomy is required or not. Creating an aerating mastoidectomy in cases of blocked aditus ad antrum helps in reducing the recurrence. However, the status of aditus is not always known unless a mastoidectomy is performed. In this study we try to find out if there is any clinical clue regarding a blocked aditus ad antrum by looking at the tympanic membrane. Fourty-three cases of cortical mastoidectomies were retrospectively studied in this series. Patency of aditus ad antrum was analyzed with respect to presence of myringosclerosis and the status of middle ear mucosa. In this study myringosclerosis was found to be significantly associated with a blocked aditus while no such association was found with the status of middle ear mucosa. The presence of myringosclerosis may indicate a blocked aditus ad antrum and performing a cortical mastoidectomy in such cases may help in creating an aerated mastoid, thereby possibly reducing the recurrence rate.

Participation of mast cells in chronic otitis media

In the pathogenesis of chronic otitis media (COM), much attention is paid to the molecular mechanisms of local inflammatory reactions in which mast cells (MCs) may be involved due to their role not only in allergic but also inflammatory processes. The aim of this study was to assess the density of mast cells in chronic otitis media in relationship to different clinical courses of COM, bacterial infections and types of disease. The MCs expression was measured immunohistochemically in paraffin-embedded granulation tissue specimens taken during surgery, by staining with a monoclonal antibody against tryptase. The density of tryptase-positive mast cells was lower in tissue samples from the group with a good clinical course than in those from the group with poor healing and recurrence (p = 0.006). There were no differences between the groups of patients with granulomatous and cholesteatomatous chronic otitis media (p = 0.66) or between the groups of patients with and without bacterial infection (p = 0.30), although the density of mast cells was lower for those with Pseudomonas aeruginosa/Proteus sp./ /Staphylococcus MRSA infection. In conclusion, the expression of mast cells in chronic otitis media granulation tissue was found to differ depending on the clinical course of the disease, but not on bacterial infection or type of COM. This may suggest that mast cells contribute to the maintenance of the inflammatory process, but not to antibacterial defense in chronic otitis media.

Ocena ekspresji markerów apoptozy w ziarninie w przewlekłym zapaleniu ucha środkowego

There is a growing evidence that molecular and cellular mechanisms may play a role in pathogenesis in chronic otitis media. was to determine the intensity of apoptosis in granulation tissue in chronic otitis media. Fifty four patients with chronic otitis media, who underwent surgical treatment, were enrolled into the study. The apoptosis was measured in paraffin-embedded granulation tissue specimens by an immunohistochemical methods, by staining with a monoclonal antibody against apo-1/Fas/CD95 and P53 protein. The bacteriological evaluation of middle ear discharges were also done. It was found statistically significant difference in expression of apo-1/Fas antigen between the groups with good clinical course (good healing and without recurrence) than those in the group with poor healing and recurrence (mean percentage of immunopositive cells 1.52 vs 3.34 respectively, p<0.001). The activity of apo-1/Fas antigen was more intense in tissue samples from the group with bacterial infection caused by Pseudomonas aeruginosa/Proteus sp/Staphyloccocus MRSA than those in the group without this infection (mean percentage of immunopositive cells 3.78 vs 1.75 respectively, p<0.001). The differences were also observed for P53 protein expression between the same groups, however they were not significant. There was no differences between the groups of patients with granulomatous and cholesteatomatous chronic otitis media. The significant negative correlation was found between expression of apo-1/Fas antigen and expression of P53 protein (r=-0.64, p<0.001). In granulation tissue in chronic otitis media different expression of apo-1/Fas antigen was found in relationship to clinical course of disease and bacterial infection caused by Pseudomonas aeruginosa/Proteus sp/Staphyloccocus MRSA. It may suggest that apoptosis mediated by apo-1/Fas mechanism may contribute to pathogenesis of chronic otitis media.

Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo

We review and discuss the results of treatments for complications of cholesteatomatous chronic otitis media (CCOM) in a tertiary health care center. In a retrospective study, the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period 1994-2004 were reviewed. From a total of 1,803 patients suffering from CCOM, in 91 patients, 55 (60.4%) men and 36 (39.6) women, one or two complications are recorded. The mean age of the subjects was 30 years, and the age range was from 1 to 76 years. Extracranial (EC) complications were observed in 52 cases (57.1%), and intracranial (IC) complications were seen in 29 patients (31.9%). Twelve patients (11%) had multiple complications. For the EC cases, we found that subperiostal mastoidal abscess occurred in 26% of the all patients, facial nerve palsy was seen in 16.48% and labyrinthine fistula occurred in 10%. For the IC cases, meningitis (19.7%) and perisinusal abscess (15.3%) were the most common complications. The most often isolated pathogen from ear swabs was Proteus mirabilis in 33.3% of cases. The most frequent radiological diagnostic procedures were mastoid tip X-rays, which were performed in 77% of the patients, and computed tomography in 24%; magnetic resonance imaging was not performed on any of the patients during the study period. Patients with EC complications were treated in the ENT Clinic, whereas patients with IC complications, after otologic surgical procedures, were transferred to the Neurosurgery Clinic or to the Clinic for Infectious Diseases. In this series, three patients (3.3%) died as a result of complications, while the remaining 96.7% survived. Complications of COM with cholesteatoma can represent life-threatening conditions, and close cooperation between otosurgeons, neurosurgeons and infectious disease specialists is mandatory.

Otologic findings in patients with cleft lip and palate or isolate cleft palate

Objectives: The incidence of middle ear diseases is high in patients with cleft palate. Our objective is to describe otologic findings in 180 patients with cleft lip and palate or isolated cleft palate evaluated and followed at Hospital de Clinicas, Porto Alegre. Methods: From August 2001 to October 2002, 180 patients were studied at our Otolaryngology and Cleft Palate Clinic. Patients were evaluated with a detailed history and accurate registration of the otoscopic and otomicroscopic findings. Statistical analysis was performed with Student’s t, Chi-square and Fisher’s exact tests. Results: At initial evaluation, 130 patients (72.2%) had no otolaryngologic complaints; 109 patients (70.3%) had both lip and palate clefts, while 46 (29.7%) had isolated cleft palates. The overall incidence of otoscopic abnormalities was 77.5%. In 80 patients (46.2%), there was middle ear effusion, in 11 (6.4%) there was chronic cholesteatomatous otitis media, and in 9 (5.2%) noncholesteatomatous otitis media. In 24 patients (13.9%), moderate to severe retraction of the tympanic membrane was the main finding. There was a linear correlation between patient age and the presence of otolaryngologic findings; middle ear effusions were less frequent with increasing age, whereas the occurrence of chronic conditions such as moderate/severe retraction and otitis media with or without cholesteatoma were more common among older patients. Conclusion: Continued otolaryngological evaluation of the patients with cleft palate allows for early intervention and for the preservation of the integrity of the middle ear of these patients.

El pólipo aural en la patología inflamatoria crónica del oído medio

Abstract240 patients with chronic otitis media (COM) were studied: 166 ears termed as non cholesteatomatous otitis media and 74 with cholesteatoma. In 38 ears an aural polyp was found with no evidence of cholesteatoma in 19 ears (11,4%) whereas a cholesteatoma was present in the remaining 19 ears. The histology of the polyp and the characteristics of the chronic process were matched: a) The aural polyp is an infrequent complication in COM. b) After histological analysis was found to present two different pictures: The inflammatory reaction polyp, present in non cholesteatomatous COM; and the polyp with granulation tissue and foreign body reaction (keratina) usually found in cholesteatomatous COM. c) The finding of granulation tissue reaction and keratina in an aural polyp is a good predictor for the presence of a cholesteatoma.

Inhibition of Cholesteatomatous Bone Resorption with Pamidronate Disodium

Bone destruction is known to be an important cause of complications in chronic cholesteatomatous otitis media. A strategy that blocks localized bone resorption may prevent the progression of the disease. The bisphosphonate drug pamidronate is known to inhibit bone resorption and has been used in the treatment of Paget's disease and osteoporosis. The aim of this study was to investigate the effect of pamidronate on the inhibition of bone resorption in cholesteatoma using a neonatal rat calvarial culture system. Radioactive calcium was subcutaneously injected into pregnant rats. Neonatal calvariae were harvested after i.p. injection of pamidronate disodium to neonatal rats and culture supernatants of cholesteatoma keratinocytes were then added to the calvarial culture media. Radioactive calcium release was measured using a beta-ray scintillation counter. The percentage of calcium release was significantly higher in cholesteatoma culture supernatant than in Dulbecco's modification of Eagle's medium. The percentage calcium release in cholesteatoma culture supernatant was significantly lower with the high dose of pamidronate than with the low dose. These results suggest that pamidronate can inhibit the bone resorption caused by cholesteatoma. This study suggests a possible application for pamidronate in the prevention of cholesteatomatous bone destruction.

Labyrinthine Fistula after cholesteatomatous chronic otitis media

To report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre- and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony labyrinth. Retrospective case review. Fifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae. Tertiary referral center. Diagnosis and treatment. Clinical, imaging, and surgical correlation of extensive fistulae and bone fistulae. The incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%). The breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre- and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.