External Ear Canal Skin Research Articles

Distribution and anti-nociceptive function of endomorphin-1 in the rat cranial sensory ganglia.

Distribution of endomorphin-1 (EM-1) was immunohistochemically investigated in the rat cranial sensory ganglia. Small to medium-sized neurons in the trigeminal (TG), petrosal (PG), and jugular ganglia (JG) expressed EM-1-immunoreactivity. However, EM-1-immunoreactive (-ir) neurons were infrequent in the nodose ganglion. In the brainstem, EM-1-ir varicose fibers were detected in the superficial layer of the medullary dorsal horn and the caudal part of the nucleus tractus solitarius. By trichrome immunofluorescence analysis, approximately 70% of EM-1-ir neurons were also immunoreactive for transient receptor potential vanilloid 1 (TRPV1) in all the examined ganglia. Additionally, 56.8% of EM1-ir TG neurons and approximately 30% of EM-1-ir PG and JG neurons showed calcitonin gene-related peptide (CGRP)-immunoreactivity. By a retrograde tracing method, several TG, PG, and JG neurons innervating the facial and external ear canal skin expressed EM-1-immunoreactivity. However, EM-1-ir neurons innervating the tooth pulp, circumvallate papilla, and pharynx were relatively rare. Thus, EM-1 expression and its coexistence with TRPV1 and CGRP in the cranial sensory neurons may depend on their various peripheral targets. EM1-ir neurons probably project to the superficial layer of the medullary dorsal horn and caudal part of the nucleus tractus solitarius. EM-1 may be involved in nociceptive transmission from the skin.

Comparison of Tissue Factors in the Ontogenetic Aspects of Human Cholesteatoma.

An acquired cholesteatoma is a benign but locally aggressive lesion in the middle ear. It is characterized by chronic inflammation and the destruction of surrounding bone. Therefore, the aim of this study was to compare defensins HβD-2 and HβD-4; pro- and anti-inflammatory cytokines IL-1α and IL-10; proliferation marker Ki-67; transcription factor NF-κβ; angiogenetic factor VEGF; Sonic hedgehog gene protein SHH; and remodeling factors MMP-2, MMP-9, TIMP-2, and TIMP-4 in adult and pediatric cholesteatoma tissue, and to compare these groups with control skin tissue. The study included 25 cholesteatoma tissue material samples from children, 25 from adults, and 7 deep external ear canal skin samples from cadavers. The tissues were stained immunohistochemically and evaluated using semi-quantitative methods. Nonparametric tests, such as the Kruskal-Wallis test and Spearman rank correlation, were used. There were no statistically discernible differences between the adult and children groups when comparing the relative numbers of factor-positive cells. There are no histopathological differences between adult and children cholesteatoma tissues.

Transient receptor potential melastatin-3 in the rat sensory ganglia of the trigeminal, glossopharyngeal and vagus nerves

Transient receptor potential melastatin-3 (TRPM3) is a nonselective cation channel, has permeability of Ca2+, and probably participates in thermosensitive nociception. In this study, immunohistochemistry for TRPM3 was conducted in the rat trigeminal, glossopharyngeal and vagal sensory ganglia. TRPM3-immunoreactivity was expressed by half of sensory neurons in the trigeminal (TG), petrosal (PG) and jugular ganglia (JG), and by about 80% of sensory neurons in the nodose ganglion (NG). They mostly had small to medium-sized cell bodies. A trichrome immunofluorescence method showed co-existence of TRPM3 with TRP vanilloid 1 (TRPV1) and calcitonin gene-related peptide (CGRP). Approximately 70% of TRPM3-immunoreactive (-IR) neurons contained TRPV1-immunoreactivity in all the examined ganglia. More than 40% of TRPM3-IR neurons exhibited CGRP-immunoreactivity in the TG, PG and JG. Only a few sensory neurons co-expressed TRPM3- and CGRP-immunoreactivity in the NG. In addition, more than 40% of TRPM3-IR neurons bound to isolectin B4 in all the examined ganglia. By combination of retrograde tracing method and immunohistochemistry, half of TG neurons innervating the facial skin and incisive papilla expressed TRPM3-immunoreactivity whereas approximately 20% of those innervating the tooth pulp contained TRPM3-immunoreactivity. Co-expression of TRPM3-immunoreactivity with TRPV1- or CGRP-immunoreactivity was common among cutaneous and papillary TG neurons but not among pulpal TG neurons. More than 60% of PG and JG neurons innervating the external ear canal skin and circumvallate papilla contained TRPM3-immunoreactivity. Co-expression of TRPM3 with TRPV1 or CGRP was common among PG and JG neurons innervating the external ear canal skin. However, a smaller number of TRPM3-IR neurons co-expressing TRPV1- or CGRP-immunoreactivity innervate the circumvallate papilla in the PG. The present study suggests that expression of TRPM3 and its co-existence with TRPV1 and CGRP in sensory neurons depend on the variety of their peripheral targets in the trigeminal, glossopharyngeal and vagal nervous systems.

Self-injury in schizophrenia as predisposing factor for otomycosis

Ear self-mutilation have been reported in schizophrenia, Mechanical damages to the auditory canal, like cleaning ear with hard and unsterile objects are predisposing factors of otomycosis.We present a case of repeated self-induced auricular trauma in schizophrenic patient. Aural swab were collected and examined by direct microscopy and culture, revealing Aspergillus flavus. A traumatized external ear canal skin can present favourable condition for fungal growth in the psychiatric population.

The Role of Rho/Rho-Kinase Pathway in the Pathogenesis of Cholesteatoma.

To assess the role of Rho/Rho-kinase pathway in the pathogenesis of cholesteatoma. Thirty-eight patients with cholesteatoma, who had gone mastoidectomies were enrolled in this prospective study. Cholesteatomas matrix (CM) and a piece of the external ear canal skin (EECS as control) were taken and transferred to the liquid nitrogen and kept at -86 °C for Rho A and Rho-kinase (ROCK) analysis with Western blotting and commercial ELISA kits (Cell Biolabs Inc., San Diego, CA). The tissues were homogenized by an appropriate ice-cold lysis buffer. Following centrifugation, the supernatant was taken and total protein amount was detected by the Bradford method. Thereafter, tissue homogenates were subjected to sodium dodecyl sulphate (SDS)-polyacrylamide gel electrophoresis electrophoresis then transferred to nitrocellulose membrane where it was treated with specific monoclonal primary antibody against to ROCK-2 and HRP-conjugated seconder antibody, respectively. The protein blots were visualized with commercial x-ray film and dansitometrically analyzed by the Scion Image Program (Cell Biolabs Inc., San Diego, CA). In another series of experiments, Rho-kinase activities were assessed by ROCK-2 ELISA kits. There were no statistical differences in Rho A translocation between CM and EECS. However, ROCK activity was found to be lower in CM than EECS as detected by ELISA kits. Furthermore, ROCK protein expression was also significantly lower in CM than EECS as demonstrated by Western blotting. Given Rho-kinase could take essential roles in cell differentiation, the results of this study implicate that down-regulated Rho-kinase could be responsible for the keratinocyte undifferentiation seen in cholesteatoma pathogenesis.

Risk of External Ear Canal Skin Injury by an Unsheathed Straight Drill and Safety of a Sheathed Curved Drill for Transcanal Endoscopic Ear Surgery

To investigate the potential risk of external ear canal injury using an unsheathed straight drill for bone dissection during transcanal ear surgery.Twenty-two consecutive patients (13 men and 9 women, age range: 7-78 years) who underwent transcanal endoscopic tympanoplasty with atticotomy or atticoantrostomy for cholesteatoma. Eight patients underwent transcanal endoscopic ear surgery (TEES) using a conventional unsheathed straight drill and 14 patients underwent surgery using a sheathed curved drill. The condition of the skin in the cartilaginous portion of the external ear canal was assessed after TEES. The difference in condition between patients treated with an unsheathed straight drill and sheathed curved drill was investigated.

Study of long non-coding RNA HOTAIR expression in middle ear cholesteatoma

Objective:To discuss the different expression of some long-chain noncoding RNA between middle ear cholesteatoma epithelial tissue and normal external ear canal skin.Method:Real-time quantitative PCR was used to detect the expression of 6 kinds of lncRNA: HOTAIR, ANCR, TINCR, PRINS, BANCR, PICSAR in 25 cases of cholesteatoma epithelial tissues and 15 cases of normal external auditory canal skin tissue samples, respectively. And compared the expression level of lncRNA in patients with different degree of bone destruction.Result:Expression level of HOTAIR was significantly increased in cholesteatoma epithelial tissues compared with the normal external auditory canal skin tissues,and the difference is statistically significant (P< 0.01). While there was no statistically significant difference expression of the rest of the five kinds of lncRNA between middle ear cholesteatoma epithelial tissues and normal external ear canal skin (P> 0.05). And there was no statistically significant difference expression of HOTAIR in patients with different degree of bone destruction (P> 0.05).Conclusion:Expression level of HOTAIR was up-regulated in middle ear cholesteatoma epithelial tissue compared with the normal external auditory canal skin tissues, and the expression level of HOTAIR has no obvious correlation with degree of bone destruction in patients with cholesteatoma.

Therapeutic effect of Castellani's paint in patients with an itchy ear canal.

To examine the effects of Castellani's paint on symptomatic relief and skin flora in patients with an itchy external ear canal. Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellani's paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. Castellani's paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.

Clinical diagnosis and treatment progress of acute otitis externa

Acute otitis externa(AOE) is defined as diffuse inflammation of the external ear canal skin or subdermis occurred in 3 weeks,which sometimes may also involve the pinna or tympanic membrane.Clinical manifestations include:otalgia,itching,fullness,sometimes with hearing loss.The hallmark sign of AOE is tenderness with movement of the tragus or pinna AOE Often occurs in adults or children older than age of 2,while little morbidity in children under the age of 2.Lifetime incidence is up to 10% in a persons life.Recently,a lot of different versions of the AOE clinical practice guidelines were published abroad.In this review ,the etiology,diagnose,therapy,prevention,are comprehensive described,which on the basis of evidence-based medicine.

An objective analysis of sebum, pH and moisture levels of the external ear canal skin

ObjectiveTo determine sebum, pH and moisture levels of external ear canal skin, and compare the patients who complain of ear itching and the normal population for these parameters. And evaluate the improvement subjectively in the ones given dexamethasone sodium phosphate (DSP) cream or placebo-water in oil emulsion type cream, and to determine the changes in sebum, pH and moisture levels after the treatment. Methods32 females with the complaint of isolated external ear canal itching and 42 healthy women were included in this randomized prospective controlled study. The sebum, pH and moisture levels of ear skin of the patients and the controls were determined from baseline and following treatment. Patients used DSP in their right and the placebo in their left ears for 15days. Subjective analysis of itching level was measured at baseline, and on 15th and 30th days using visual analog scale (VAS). ResultsThere was no statistically significant difference between pretreatment and post-treatment pH and sebum levels of the study group and the control group. However, pretreatment and post-treatment moisture levels of the study group were significantly higher (p<0.001). ConclusionThe study found an association of increased moisture levels of the external ear canal skin and isolated ear itching.

A Practical Use of a 16-Gauge Peripheral Angiocatheter as an Aspiration Cautery in Endoscopic Ear Surgery

To define a technique for the practical use of a 16-gauge peripheral venous catheter as an insulated aspiration cautery in endoscopic ear surgery. Retrospective case review. Tertiary referral center. A 16-gauge intravenous catheter was prepared as a cauterization instrument with aspiration. After simple rearrangement of the exterior plastic portion, it was connected to a suction system. With the help of an unipolar cautery, aspiration of the blood and homeostasis was achieved. Hemorrhage of the external ear canal skin after incision can be easily coagulated with this instrument. During follow-up, there were no wound infection, facial nerve paresis, scar formation, and inadvertent burn of the external canal and auricular skin. With the help of this instrument, bleeding control during incision can be easily maintained. It is a simple, easily prepared, and alternative homeostasis technique in endoscopic ear surgery.

Quantitative measurement of m-RNA levels to assess expression of cyclooxygenase-II, inducible nitric oxide synthase and 12-lipoxygenase genes in middle ear cholesteatoma

To assess expression of three main inflammatory genes, COX-II, ALOX-12 and i-NOS, quantitatively at transcriptional level in cholesteatoma matrix tissue. Ten patients who have chronic otitis media with primary acquired cholesteatoma were included in this study. Tissue samples obtained from cholesteatoma matrix and external ear canal skin (control tissue). Expression of the targeted genes (COX-II, i-NOS and LOX-12) was assessed using real-time quantitative polymerase chain reaction (RT-PCR) technique. The amount of COX2 mRNA was significantly higher in cholesteatoma matrix at transcriptional level (p=0.038). There was no statistically significant difference regarding expression of iNOS and LOX12 mRNA levels (p>0.05). There is a significant overexpression of the mRNA of COX-II in cholesteatoma matrix, which indicates a difference between the normal skin and cholesteatoma matrix at molecular level. COX-II gene overexpression seems to be associated with pathogenesis of cholesteatoma. This molecular change is similar to the molecular abnormalities observed in some benign and malignant neoplasms. Invasive and locally destructive nature of cholesteatoma may be due to COX-II overexpression. Absence of an increase in the gene expressions of i-NOS and LOX-12 in cholesteatoma matrix suggests that these mediators may not be related with the pathogenesis and evolution of cholesteatoma.

Role of Langerhans cells, Ki-67 protein and apoptosis in acquired cholesteatoma: prospective clinical study

To investigate the role of Langerhans cells in the pathogenesis and clinical picture of middle-ear cholesteatoma. The study included 40 patients operated upon for a diagnosis of chronic otitis due to acquired cholesteatoma. A closed surgical technique was used in 20 per cent of patients and an open technique in 80 per cent. Langerhans cells were more densely accumulated in cholesteatoma epithelium, compared with external ear canal skin (p < 0.001). Staining for Ki-67 protein was greater in cholesteatoma epithelium (p < 0.001) and Apo2.7 protein staining (indicating apoptosis) was more prominent (p < 0.001), compared with ear canal skin. Regarding significant relationships between clinical and pathological findings, staining for Ki-67 (p = 0.046) and Apo2.7 (p = 0.037) was more prominent in patients undergoing open versus closed surgery. Using cell proliferation and apoptosis markers, a dense Langerhans cell infiltration was found to occur as a host response to middle-ear cholesteatoma.

Expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma

Proteases of the disintegrin and metalloproteinase family (also known as ADAM proteins) are involved in various physiological and pathological processes. This study assessed the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma. The study evaluated cholesteatoma specimens from 19 patients, and external ear canal skin samples from 7 of the same patients (as controls), for the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17, using immunohistochemical methods. The study observed over-expression of proteins 10 and 17 in blood vessels, and over-expression of proteins 12 and 17 in cholesteatoma stroma. Immunostaining scores for proteins 10, 12 and 17 in epithelial and inflammatory cells from cholesteatoma specimens versus control specimens showed no statistically significant differences. Over-expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma may be related to cholesteatoma pathogenesis. These proteins deserve further study as they may represent potential targets for cholesteatoma treatment.

Expression of metallothionein 2 in middle ear cholesteatoma and its correlation with interleukin 1α and interleukin 6

To detect the expression and distribution of metallothionein 2 (MT-2) in middle ear cholesteatoma, and to explore the relationship of MT-2 with interleukin 1α (IL-1α) and interleukin 6 (IL-6), and well as to explore the role of MT-2 in the pathogenetic mechanism of middle ear cholesteatoma. Using the immunohistochemistry and reverse transcription polymerase chain reaction to examine the expressions of MT-2, IL-1α and IL-6 protein and MT-2 mRNA in twenty-five middle ears' cholesteatoma and seven normal external ears' canal skin. The influence of cholesteatoma debris on the MT-2 mRNA and protein of HaCaT cell were further analyzed. According to immunohistochemistry research, the expressions of MT-2, IL-1α and IL-6 were extremely higher in middle ear cholesteatoma than those in normal external ears' canal skin (P < 0.05). The result of RT-PCR showed that there was significant difference between the expression of MT-2 mRNA of and middle ear cholesteatoma than those in normal external ear canal skin (t = 15.38, P < 0.05). There was a positive correlation between the expression of MT-2 and that of IL-1α (r = 0.856, P < 0.05). There was also positive correlation between the expression of MT-2 and that of IL-6 (r = 0.714, P < 0.05). MT-2 mRNA and protein of HaCaT cell significantly increased when exposed to cholesteatoma debris in a dose dependent manner. MT-2, IL-1α and IL-6 may play an important role in the pathogenetic process of middle ear cholesteatoma. Cholesteatoma debris may involve in the proliferation of middle ear cholesteatoma by activation of MT-2.

Keratinosis: A New Entity in the Tropics?

A patient presented with the symptoms of ear block, itching and whitish exudates from the left ear. There was no history of pain, foul smell, tinnitus, or giddiness. Clinical examination revealed whitish keratin like substance filling the external auditory canal. There was no foul odor like cholesteatoma. There was no pain on pulling the pinna to indicate an acute external otitis. Tuning fork tests revealed a mild conductive hearing loss with Rinne test positive and weber lateralizing to the left ear. After a suction toilet of the ear, the tympanic membrane looked normal with no attic or any perforation of the ear drum. The skin of external ear canal was not inflamed. The canal was not widened. There was an absence of wax. Repeated ear swabs did not grow any organisms. Histopathology was keratin. The remaining parts of the external ear including pinna and tragus were normal with no signs of allergic skin reaction. The other ear and rest of otolaryngological examination was normal. A dermatology consultation did not reveal any other skin pathologies. Hence steroid cream (betamethasone) was applied to the external canal after an ear toilet, with instructions to avoid water getting into the ears. This was repeated on a weekly basis. The external auditory canal was back to normal in 3 weeks time. This patient was followed up for 6 months period up to date on a monthly basis and there has been no recurrence. Normal wax had started to be secreted. This condition has been seen and treated by me in a similar fashion for another 10 patients including children, with similar results. However for children and infants since toileting is difficult and hesitancy to application of a steroid cream, olive oil drops two or three times daily for a period of 3 weeks usually clears up this condition. Since this does not fit in with an external otitis acute/chronic of an infective, seborrheic or allergic type, keratosis obturans or an external ear canal cholesteatoma, I feel it is a hitherto undescribed entity. I have worked in the UK, gulf (Oman), and India and not seen a similar condition elsewhere in my 40 years of otolaryngology practice and hence this report

Pimecrolimus kremin (%1) atopik dermatit tedavisindeki etkinliği

SummaryBackgroundIn recent years, pimecrolimus 1% cream has been demonstrated to reduce symptoms of atopic dermatitis in patients when applied topically.Material/MethodsIn our study we compared the therapeutic effects of local 1% pimecrolimus to 1% hydrocortisone, and to a control group in a mouse model with atopic dermatitis in the external ear canals. Atopic dermatitis was created by application of Dinitrochlorobenzene in the external ear canals of mice. The development of atopic dermatitis was detected by clinical observation score and determination of total serum IgE levels. Pimecrolimus and hydrocortisone cream were topically applied to the external ear canal skin once a day for 14 days.ResultsThere was no significant difference between the hydrocortisone and the pimecrolimus therapy groups, while there was a statistically significant difference between these 2 groups and the control group (p<0.05) Assessment of the clinical observation scoring carried out on the 14th day of therapy revealed that there was no difference between the hydrocortisone and pimecrolimus groups. Biopsies were taken on the 14th day following treatment. Tissue samples were histologically evaluated; contact dermatitis was observed microscopically in the control group, but in the therapy groups only minimal evidence of contact dermatitis was found.ConclusionsThe results of our study reveal that the therapeutic efficacy of 1% pimecrolimus was equivalent to 1% hydrocortisone treatment in the artificially developed atopic dermatitis model in external ear canals of mice. These results clearly demonstrate that 1% pimecrolimus cream can be an effective alternative therapeutic agent in cases where steroid treatment proves to be insufficient or in cases where treatment must be discontinued due to its adverse effects.

Expression of Reversion-Inducing Cysteine-Rich Protein with Kazal Motifs and Matrix Metalloproteinase 9 in Middle Ear Squamous Cell Carcinoma

Objective: Reversion-inducing cysteine-rich protein with kazal motifs (RECK) may negatively regulate matrix metalloproteinase 9 (MMP9) activity and suppress tumor invasion and metastasis. The aim of this study was to investigate whether RECK and MMP were involved in regulating middle ear carcinoma invasion and metastasis. Methods: RECK and MMP9 were measured in 30 middle ear squamous cell carcinoma tissues and 20 adjacent normal external ear canal skin tissues using immunohistochemical analysis. Results: The positive rate of RECK expression in the middle ear squamous cell carcinoma was much lower than that in the normal external ear canal skin. In contrast, the positive rate of MMP9 expression was higher in middle ear squamous cell carcinoma tissue than that in normal external ear canal skin tissue. The expressions of RECK and MMP9 were correlated with the histological grade and tumor stage, but not with patient age or gender. Conclusions: RECK and MMP9 are involved in middle ear squamous cell carcinoma and may serve as markers to evaluate progression and metastasis.

Ｍｅｄｉａｌ Ｍｅａｔａｌ Ｆｉｂｒｏｓｉｓ例

We report a case of medial meatal fibrosis, a rare external auditory canal condition, in which hearing improved postoperatively. A 60-year-old woman had undergone surgery and 6-month follow up. Extrinsic stimulus-induced fibrosis was attributed to her daily swimming. External auditory meatus inflammation was quite moderate, so the external ear canal skin was preserved, the removed thickened subdermal connective tissue removed, and the bony external ear canal drilled to enlarge the meatus diameter. We confirmed hearing improvement and no fibrosis recurrence. Medial meatal fibrosis may thus be treated satisfactorily with surgical intervention.

Exclusive Transcanal Surgical Approach for Vibrant Soundbridge Implantation

An alternative transcanal surgical technique named "exclusive transcanal approach" for Vibrant Soundbridge (VSB) implantation is presented. The surgical steps and our experience in a series of 12 patients are reported. Retrospective study. : Tertiary referral center. University hospital. Twelve patients, 8 women and 4 men, mean age 50 years (range, 41-71 yr), were implanted with the VSB through the exclusive transcanal approach. In 7 patients with moderate sensorineural hearing loss, the floating mass transducer (FMT) was placed on the incus, whereas in 5 patients with a mixed hearing loss for chronic otitis media and/or previous middle ear surgeries, the FMT was placed on the round window. Hearing rehabilitation. Postoperative surgical and anatomic results. Anatomic results and functional results in patients operated with the FMT on the round window. The exclusive transcanal approach proved to be faster, simpler, and safer in comparison to the classic surgical technique through the facial recess, reducing the risk of chorda tympani and facial nerve lesions. All the patients and, in particular, those operated placing the FMT on the round window achieved improvements in hearing thresholds and speech perception tests from the use of the VSB. Moreover, after a mean 21-month follow-up (range, 15-32 mo), we did not observe any complication such as tympanic membrane perforations, external ear canal skin lesions, or extrusion of the coil in the external ear canal.