Search

Objective: The aim of this study was to evaluate the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and Eustachian tube dysfunction-related symptoms using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) as an assessment method., Methods: A total of 80 adults were enrolled. Group 1 comprised consecutive patients with enlarged inferior turbinates and group 2 comprised healthy controls. The ETDQ-7 scores and tympanometry results of both groups were analyzed and compared., Results: The median total scores of the ETDQ-7 in groups 1 and 2 were 1.9 (interquartile range, 1.4-2.8) and 1.1 (interquartile range, 1.0-1.7), respectively ( P < .001). There was no significant difference in the abnormal tympanometry results between the groups. There was no significant difference in the ETDQ-7 total score between the patients with allergic sensitization and other patients in group 1., Conclusions: Patients with inferior turbinate enlargement have more symptoms related to Eustachian tube dysfunction than healthy controls. Most patients with Eustachian tube dysfunction had normal tympanometry and normal otoscopy, which indicates a baro-challenge-induced Eustachian tube dysfunction. Whether the patient has allergic sensitization or not does not seem to cause a difference in symptoms related to Eustachian tube dysfunction.

Objective: The purpose of this study is to report a case of otopolyposis and middle ear allergic mucin in a patient with allergic fungal rhinosinusitis (AFRS) and no history of middle ear disease and introduce these as possible otologic manifestations of the AFRS., Methods: A case of a 31-year-old female with the aforementioned findings is reported. A review of the pertinent literature was performed., Results: We report a case of a 31-year-old female with a history of AFRS but no history of middle ear disease or hearing loss who presented to our institution complaining of aural fullness. Physical exam was significant for middle ear masses of unknown etiology. Surgical exploration revealed the presence of allergic mucin and middle ear polyposis histologically identical to tissue sampled during prior sinonasal surgeries at the same institution. Aspiration of the middle ear space did not resolve the otologic symptoms., Conclusion: Otopolyposis and middle ear allergic mucin are extremely rare but possible otologic manifestations of AFRS. We encourage otolaryngologists to consider this in the clinical differential diagnosis of patients with a history of AFRS with new onset otologic symptoms., (© The Author(s) 2016.)

Objective: This study aimed to illustrate the otorhinolaryngologic manifestations of levamisole toxicity and illuminate the features of this diagnosis., Methods: We describe a case of a known cocaine abuser with suspected levamisole toxicity who developed cutaneous necrosis of the cheeks, earlobes, nose, upper and lower lip, and the midline hard palate. We also review the existing clinical literature about this emerging phenomenon., Results: Levamisole is a common adulterant in cocaine distributed in the United States and has been reported to cause microvascular thrombosis and vasculitis with resultant skin necrosis in cocaine abusers. The distribution of skin findings characteristically involves the cheeks, earlobes, nose, lips, and hard palate and responds variably to cessation of cocaine use. In its most severe cases, immune suppression and/or surgical debridement may be required., Conclusion: Levamisole toxicity can frequently involve the ears, nose, and throat tissues. Otorhinolaryngologists should recognize these manifestations to expeditiously diagnose and manage this condition. Failure to do so promptly can lead to complications that may necessitate reconstructive or amputation surgery., (© The Author(s) 2014.)

Objectives: We assessed the prevalence of superior semicircular canal dehiscence (SSCD) through examination of ultrahigh-resolution computed tomography (CT) scans of the temporal bone and attempted to verify the correspondence between a radiologic diagnosis of SSCD and clinical signs of SSCD syndrome., Methods: A prospective study was carried out on 191 consecutive patients who underwent temporal bone ultrahigh-resolution CT scans. Cases that matched the radiologic diagnosis of SSCD were subsequently referred for a comprehensive audiological evaluation that might enable a final diagnosis of SSCD syndrome., Results: Among the 191 patients, 17 had a radiologic diagnosis of SSCD, which was bilateral in 5 cases, for a total of 22 SSCD cases, with a prevalence rate of 5.8%. In 2 of the 17 patients, the audiological examination revealed signs and symptoms indicative of SSCD syndrome, with a total prevalence rate of 0.5%., Conclusions: Our data confirm that the radiologic diagnosis of SSCD, performed by mean thin-section CT scans reformatted in the plane of the superior semicircular canal, is not necessarily related to the clinical presentation of SSCD syndrome. Our study also showed a prevalence rate of SSCD syndrome that was similar to the prevalence of SSCD reported from studies of histologic specimens.

Objectives: We describe the histopathologic findings in the temporal bones of a patient who had, during life, received a diagnosis of superior canal dehiscence (SCD) syndrome., Methods: The patient was found to have SCD syndrome at 59 years of age. She became a temporal bone donor, and died of unrelated causes at 62 years of age. Both temporal bones were prepared in celloidin and examined by light microscopy., Results: The patient developed bilateral aural fullness, pulsatile tinnitus, and difficulty tolerating loud noises after minor head trauma at 53 years of age. The symptoms were worse on the right. She also had Valsalva-induced dizziness and eye movements, as well as sound-induced dizziness (more prominent on the right). Audiometry showed a small air-bone gap of 10 dB in the right ear. Vestibular evoked myogenic potential testing showed an abnormally low threshold of 66 dB on the right, and a computed tomography scan showed dehiscence of the superior canal on the right. Histopathologic examination of the right ear showed a 1.4 x 0.6-mm dehiscence of bone covering the superior canal. Dura was in direct contact with the endosteum and the membranous duct at the level of the dehiscence. No osteoclastic process was evident within the otic capsule bone surrounding the dehiscence. The left ear showed thin but intact bone over the superior canal. Both ears showed focal microdehiscences of the tegmen tympani and tegmen mastoideum. The auditory and vestibular sense organs on both sides appeared normal. No endolymphatic hydrops was observed., Conclusions: The findings were consistent with the hypothesis put forth by Carey and colleagues that SCD may arise from a failure of postnatal bone development, and that minor trauma may disrupt thin bone or stable dura over the superior canal.

Neuroepithelial cysts are lesions of the central nervous system that have previously been reported in cerebral parenchyma, in the spinal cord, and within the ventricles in association with the choroid plexus. We describe 2 cases of neuroepithelial cysts of the middle ear. One was diagnosed after surgery for a retraction pocket and chronic otitis media complicated by an intraoperative cerebrospinal fluid (CSF) leak. The other produced bilateral spontaneous CSF otorrhea and mimicked the presentation of arachnoid granulations. Both cases were verified with immunohistochemical stains. Neuroepithelial cysts, although rare, should be considered in the differential diagnosis of spontaneous CSF otorrhea or an epitympanic mass.

B10.RIII (H-2r) mice were orally administered cyanogen bromide peptide 11 (CB11) or cholera toxin B (CTB)-conjugated CB11 to induce tolerance in collagen-induced autoimmune ear disease. Oral administration of a high dosage of CB11 provided partial protection from chondritis. However, administration of a tiny amount of CTB-CB11 conjugate effectively suppressed chondritis. Oral administration of CTB-CB11 conjugate did not alter the stimulation of T cells in vitro or the fine specificities of B cells. The oral administration of CTB-CB11 caused a higher level of type II collagen-specific IgG and its subclass. Interestingly, increases of TH1 cytokine (interferon-gamma) in Peyer's patches and of TH1/TH2 cytokines (interleukin-2 and interleukin-4) in lymph nodes were detected in mice that had been fed CTB-CB11. An increase of CD8+ T cells in the Peyer's patches with a decrease of CD8+ T cells in lymph nodes was seen in mice that had been fed CTB-CB11. These results suggest that protection from chondritis by oral administration of minute amounts of CTB-CB11 conjugate can be achieved by a mechanism distinct from that of conventional oral tolerance induction.

Posttraumatic cholesteatoma of the external auditory canal is a rare condition that may present years after the original injury. A unique case of multifocal cholesteatoma of the external auditory canal following blast injury is presented and discussed.

Nonneoplastic vascular lesions in the middle ear may be arterial or venous. For the former, ectopic location of the internal carotid artery is the most common; a high jugular bulb is the most common venous abnormality. Both may be clinically misdiagnosed without radiographic studies and, in the event, lead to disaster.

This study aims to elucidate the morphological difference between the noncollapsible physiologic tympanic membrane (TM) and the collapsible atelectatic TM. Histologic examination of atelectatic TMs obtained at surgery from 16 ears revealed inflammatory changes and destruction of the pars tensa collagenous "backbone." The disappearance of the organized collagenous layer seen in atelectatic TMs explains their conversion from the stiff physiologic membrane to a flexible one. This in turn will convert the middle ear from a noncollapsible gas pocket to a partially collapsible gas pocket, in which minimal pressure of only a few millimeters of water can cause retraction or ballooning of the atrophic TM. These pressure differences are too small to equilibrate automatically the difference created with the atmospheric pressure. Integrity of the pars tensa collagenous layer thus appears to be essential for the proper mechanical functioning of the physiologic TM.

Fascia and perichondrium grafts to replace and reinforce thin, atrophic tympanic membranes (TMs) are recommended by several authors to correct middle ear atelectasis by forming a fibrous, collapse-resistant TM. This study reviewed the status of connective tissue grafts performed over the 10-year period from 1979 to 1988 to determine if these grafts would maintain sufficient strength and fibrous character to resist recurrent atelectasis. The author used fascia or perichondrium to repair 89 TM defects, and 63 ears were available for follow-up: 54 had cholesteatomas and 9 had perforations. Graft atrophy was judged by microscopic otoscopy and Kodachrome otophotography. Fascia TM grafts atrophied in 35 of 43 ears (80%), and perichondrium atrophied in 8 of 20 ears (40%). Grafts maintained their relatively thick and fibrous character in only 20 of 63 ears (32%). If fascia and perichondrium used to correct atelectasis were to atrophy at the same rate as the grafts in this series, atelectasis would recur after attempts to reinforce atrophic TMs. Atelectasis-prone middle ears require intubation despite surgery.

We present the case of a 37-year-old man with plasma cell granuloma affecting the middle ear and mastoid. At magnetic resonance imaging scan, the lesion appeared as a homogeneously enhancing mass of soft tissue replacing the majority of the mastoid bone and causing vascular compression. After surgical resection, microscopic examination showed predominantly plasmacytes, and histochemical studies confirmed a polyclonal origin consistent with nonneoplastic plasma cell granuloma. We believe this is the first case report of plasma cell granuloma affecting the middle ear and mastoid.

Cochleae from gerbils with normal middle ears were compared with cochleae from gerbils with experimentally induced cholesteatomas that were in contact with the cochlear wall (stage III cholesteatomas). Cochleae from gerbils with stage III cholesteatomas were further divided into two groups: one without erosion of cochlear bone, and one with cholesteatoma-induced bone erosion but without cochlear fistulae. The cochleae with bone erosion showed significant loss of outer hair cells in the middle and apical turns, but not in the basal turn. The cochleae with stage III cholesteatomas but without bone erosion did not differ from normal controls. These results suggest that an ototoxic agent, involved in the process of bone erosion, acts through the bony cochlear wall.

Eight patients with extensive petrous bone cholesteatomas that invaded the labyrinth and fallopian canal are presented. The eight cases are added to a tabulation of prior literature reports to elucidate concepts of routes of extension of medially invasive temporal bone cholesteatoma. Medially invasive petrous bone cholesteatoma develops insidiously, often without symptoms other than facial palsy and/or unilateral deafness. Typically, a history of chronic ear disease can be obtained. While hearing is unlikely to be preserved in this group of patients, facial nerve function can usually be preserved, and a facial nerve graft was not necessary in our series. Acute facial nerve palsy or facial nerve paresis progressing to palsy in patients with a history of chronic ear disease should be studied radiographically for petrous bone cholesteatoma, even if there is no physical evidence of cholesteatoma.

An analysis of 45 adult ears that underwent a modified radical mastoidectomy for cholesteatoma and remained with an intact unperforated pars tensa is described. 1) While in practically all these ears some air was present behind the tympanic membrane, its amount varied considerably. 2) The air present behind the tympanic membrane was always in communication with the eustachian tube. 3) The regions in the middle ear devoid of air presented a deep atelectasis that was found predominantly in the posterior-superior part of the middle ear. Topographically the regions of air and atelectasis corresponded to the distribution of ciliated and flat epithelia in the middle ear, respectively. The presence of air in the middle ears obliges us to view these ears as being aerated gas pockets. The aeration difference between such an atelectatic ear and one in a physiologic state is probably a difference of degree. This difference can result from reduction in aeration through the eustachian tube or from excessive absorption of gases into the circulation, or from deficient normal diffusion of carbon dioxide or nitrogen from the circulation into the middle ear, or from a combination of these factors. The analogy with the respiratory system is emphasized.

A closed tympanomastoidectomy with subsequent staged surgical procedures leading to the excision of cholesteatoma was validated as described. All elements of staging with a 10-year experience of 354 patients are covered according to categories of child (0 to 9 years), adolescent (10 to 15 years), and adult. The child differed from the adolescent and adult in the following manner: more recurring cholesteatomas, greater ossicular necrosis, poorer hearing results, less aggressive residual cholesteatoma, and significantly poorer results with pars flaccida cholesteatoma than pars tensa cholesteatoma. After the end stage, 90% of the cases remained closed, with acceptable hearing in 60% of the patients.

The membrane of the round window serves as a barrier between the middle and inner ear and has a well-established role in cochlear physiology. It is important in many otological conditions: otitis media, otosclerosis, trauma, sequelae to drugs reaching the middle ear, tumors, congenital dysplasia, sudden deafness. We here describe the first electron microscopic findings in round window membranes from adult humans, and various conditions in reference to these findings. Since surgical lesions are made in this membrane during cochlear implantation, and by some otologists in treating vertigo, preliminary findings of a lesioning experiment in animals are presented. Interestingly, early healing resulted from a mesothelial cellular reaction in the adjacent scala tympani, with formation of clots, while in the middle ear the epithelial cellular layer sealed the edges of the perforation, leading to formation of an indentation ("pocket"). Subsequently, the middle layer of the membrane contributed to healing.

Basophilic deposits in the stria vascularis have been found in association with a multitude of disease entities. Their true significance and nature remain obscure. In the temporal bone collection at the Massachusetts Eye and Ear Infirmary are 22 cases with basophilic deposits in the stria vascularis. The ages of the subjects studied ranged from two days to 83 years. Atrophy of the stria vascularis was the main pathology seen in their temporal bones. The deposits were found in both ears in 82% of cases. They tend to show a striking polymorphism. Special histochemical stains suggest they contain glycogen. Hypertension and uremia were two health problems most of the subjects were suffering from during life. A theory is advanced as to the immune complex nature of these deposits. A review of the literature concerning this subject is also offered.

That condition where the tympanic membrane is displaced toward the promontory is termed atelectasis. Thirty-seven patients (61 ears) showing various degrees of atelectasis graded from stage 1 to stage 4 were studied. Atelectatic drums are an inflammatory phenomenon occurring in underventilated ears. This conclusion is reached by considering the reversibility of the atelectasis upon ventilation; while the inflammatory factor can be deduced from the history and histopathology of the atelectatic drum, as well as the histology of the necrosed incus, the latter occurs in over a third of our cases. Also pneumatization of the mastoid is almost never present. Twelve (21%) of the ears treated did indeed develop a perforation at one time or another (two had cholesteatomas). Chronic granulating external otitis with specific features occurred in 15% of cases. The characteristics of these ears and their case histories lead us to view atelectatic ears as part of the otitis media syndrome, where their place is somehow transitional between secretory otitis media on the one hand and chronic otitis media on the other.

On 64 temporal bones from slightly abnormal and pathological prematures and newborn infants, children, and adults, 35,000-40,000 counts of goblet cells were done in different parts of the Eustachian tube and middle ear. The goblet cells were present in all Eustachian tubes and middle ear areas. In ears previously exposed to infection the density was slightly increased in the tubal orifice and in most parts of the middle ear. In subacute and acute pathological actions, especially tubal occlusion, and chronic diseases, such as active chronic otitis and in secretory otitis media, the goblet-cell density is appreciably increased.

One hundred fourteen human temporal bones from 64 individuals were studied for the presence of melanized melanocytes about the endolymphatic duct and sac. Specimens were from Caucasians (104), Orientals (6) and Negroes (4). Of the specimens from people above nine years of age 79% demonstrated melanized melanocytes about the endolymphatic duct and sac, as well as occasionally about blood vessels in the adjacent bone. These represented 74% of the Caucasian and 75% of the Negro and Oriental individuals. Pigment granules were noted in occasional epithelial lining cells and in macrophage-type cells within the lumen. Heavily melanized melanocytes were noted in five of six specimens of Ménière's disease (all from Caucasian individuals), five of five specimens with previous labyrinthitis (two of which were from a Negro woman), and in occasional specimens from patients with presbycusis, metastatic carcinoma (three of the four adult Oriental patients), chronic otitis media, otosclerosis and lymphoma, as well as in several apparently normal specimens. No clear cut correlation of degree of melanization with specific disease processes can be discerned.

Bone resorption and remodeling are characteristic of chronic otitis media with and without cholesteatoma and otosclerosis. The consequences of this remodeling process may be hearing loss, repeated infection, vestibular disturbance, or intracranial complications. Evidence of osteoclastic bone resorption was found in surgical specimens of 11 of 24 cases of cholesteatoma, two of three cases of chronic otitis media, and three of ten cases of otosclerotic stapes; all three spongiotic lesions had osteoclasts. With careful serial sectioning these cells are almost always multinucleate and have the typical appearance of osteoclasts with ruffled borders. Some specimens had evidence of bone erosion in the absence of osteoclasts; this finding represents an inactive phase of the remodeling process. Since the osteoclast plays an important role in the resorption and remodeling of bone in these middle ear diseases, the source, physiology, and local control of these cells are of prime importance in investigating the pathophysiology of these diseases. At the present time, the local control of activation and recruitment of osteoclasts, as well as their chemotactic responses, is poorly understood.

The cholesterol granuloma does not represent an independent clinical or pathological entity, rather it is a term used for the description of a tissue response of the temporal bone, to the presence of a particular foreign body, i.e., cholesterol crystals. Three factors are considered to play an important role in its development: 1) interference with drainage, 2) hemorrhage, and 3) obstruction of ventilation. The cause of the initial hemorrhage may be a hemorrhagic inflammation or diathesis, a trauma or some other form of vascular disorder. Interference with air exchange and clearance can be caused by: tubal blockage, persistent mesenchyme, polypoid changes, scar formations, tympanosclerosis, cholesteatoma, etc. The cholesterol granuloma may develop in any portion of the pneumatic system of the temporal bone and it can be associated with a variety of middle ear disorders. Its principal precursor is the chronic middle ear effusion or serous otitis media. Its clinical expression and hallmark is the "idiopathic hemototympanum," the dark bluish discoloration of the tympanic membrane. Osteitis and bone erosion are manifestations of an unusual, more advanced stage. Resorption of bone, in a rare instance, may lead to extensive destruction of the temporal bone.

Cochleas from 16 Mongolian gerbils with spontaneous aural cholesteatomas, and four of similar age without cholesteatomas, were examined by scanning electron microscopy to quantify cochlear hair cell loss. Loss of hair cell stereocilia was found in all ears with cholesteatomas and was significantly increased when compared with uninvolved ears from animals of similar age. The hair cell loss associated with gerbilline cholesteatomas appeared to be most marked in the middle turn of the cochlea and increased in severity with increasing size of the cholesteatomas. Outer hair cells were affected more than inner hair cells. Inner and outer hair cell loss was not significantly different in infected cholesteatomas versus sterile cholesteatomas. The greater damage to hair cells at the middle turn compared to the basal turn suggests that these losses may be the result of some agent acting through the cochlear wall rather than through the round window.

A case of bilateral oliterative fibrotic middle ear disease occurring in a patient suffering from leukocytoclastic angiitis is presented. Following a brief discussion of middle ear involvement in systemic vasculitis the pathologic picture and differential diagnosis are considered. Biopsy of unexplained obliterative fibrotic middle ear tissue is recommended.

The temporal bones of a man with poorly differentiated lymphocytic lymphoma, who had had a bilateral conductive hearing loss and incomplete left-sided facial palsy, were obtained. Sections were prepared for histologic study by staining with hematoxylin and eosin and were examined under the light microscope. The left temporal bone showed marked tumor cell involvement, not only of the lateral part of the cartilaginous portion of the eustachian tube (ET) where the tensor veli palatini muscle had been partially destroyed, but also in the anterior part of the temporal bone. A serous middle ear effusion was present, but the lumen of the ET was unaffected by tumor or inflammation. The pathological findings in the right temporal bone were similar to those in the left, although the cartilaginous part of the ET and its surrounding structures were not available for study. The pathogenesis of otitis media with effusion appeared to be secondary to functional ET obstruction, due to the dysfunction of the tensor veli palatini muscle as a result of the tumor destruction. This case is the first to be reported in which functional ET obstruction, secondary to tumor invasion of the active muscle dilator of the ET, has been histologically confirmed.

Specimens of cholesteatoma matrix, meatal epidermis, and middle ear epithelium were removed during surgery, and immunohistochemical techniques were used to investigate cytokeratin expression. The use of five chain-specific anticytokeratin monoclonal antibodies and one broad specific anticytokeratin monoclonal antibody showed the divergent behavior of middle ear epithelium compared with the cytokeratin expression of the other two types of epithelium. Middle ear epithelium was characterized by the presence of cytokeratins 4, 8, 18, and 19, whereas in both cholesteatoma and meatal epidermis cytokeratin 10 predominated. Furthermore, cholesteatoma showed an infrequent focal presence of cytokeratins 4, 18, and 19. The similarity between cholesteatoma and meatal epidermis with respect to morphology, and the presence of cytokeratin 10 support an epidermal origin of cholesteatoma. However, a metaplastic origin cannot be excluded, because of the infrequent occurrence of a small amount of cytokeratins 4, 18, and 19 in cholesteatoma matrix that was not found in meatal epidermis but was a component of the cytokeratin pattern of middle ear epithelium.

The function of the epithelial component of a cholesteatoma has been the subject of intense research. The epithelium does not appear to have proteolytic enzyme activity, yet when it is present, increased amounts of bone resorption occur. Recent evidence suggests that epidermal Langerhans cells within epithelium have an immunologic alerting function. These cells were identified in normal tympanic membranes, canal skin, and cholesteatoma. The Langerhans cells in cholesteatoma displayed morphologic features similar to a contact hypersensitivity state. Langerhans cells within the epithelial matrix of the cholesteatoma may be responsible for generating and maintaining the chronic inflammatory reaction which induces bone resorption in this disease.

An animal model for retraction pocket (primary acquired) cholesteatoma is presented. Bilateral eustachian tube obstruction by electrocauterization of the nasopharyngeal portion was performed in 16 Mongolian gerbils. Animals were killed at 2, 4, 8, and 16 weeks. At 2 weeks all animals had bilateral serous effusions and retracted tympanic membranes. At 4 weeks, four of eight ears had middle ear fluid, retractions, and cholesteatomas. After 8 weeks, five of eight ears had middle ear effusions, and four of these had cholesteatomas; one ear had total atelectasis with a cholesteatoma filling the bulla. By 16 weeks, six of eight ears had developed cholesteatomas. Some animals did not develop effusion or retraction because of failure or recanalization of eustachian tube obstruction. This study provides experimental evidence that aural cholesteatomas may arise by retraction of the tympanic membrane.

An arachnoid cyst of the internal auditory canal causing compression atrophy of nerve trunks was found in each of three human temporal bones. Arachnoid cysts are found in about 0.5% of operations for suspected neoplasm of the internal auditory canal. There is no current method for differentiating intracanalicular neoplasm from arachnoid cysts.

Osteomas of the external auditory canal are considered clinically to be discrete, pedunculated bone lesions arising along the tympanosquamous suture. They are benign lesions but often are slowly progressive in size. Exostoses of the external auditory canal are broad-based elevations of bone usually multiple and bilaterally symmetric, involving the tympanic bone. It appears that both clinical and histopathologic evidence is sufficient to justify the impression that these two lesions should be considered separate entities and clinical diagnostic and histopathologic criteria have been suggested for diagnosis of these lesions.

Osteoclastic activity is seen in areas of bone resorption which are the result of experimental and human cholesteatoma. Many factors may induce osteoclasts, including transmitted pressure. The purpose of this study was to determine if transmitted pressure, in the absence of cholesteatoma, could cause localized bone resorption in the middle ear. Surgical grade silicone was implanted into the middle ear of gerbils without cholesteatoma. Bone resorption was observed only in areas where the implants exerted pressure on bone. It was estimated that pressures of 50 to 120 mm Hg (6.7 X 10(4) to 16 X 10(4) dynes/cm2) resulted in the induction of osteoclastic bone resorption.