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Objectives: We present a case of a combined tumor consisting of solid tubular gland adenoma (TA) and syringocystadenoma papilliferum (SCAP) of the external auditory canal and review of the literature on this subject., Methods: Tumour of the external auditory canal was removed by retroauricular approach with good clinical outcome. Histopathological and immunohistochemical study was performed., Results: In the histopathological assessment tumour revealed an extraordinary combination of syringocystadenoma papilliferum and ceruminous tubular gland adenoma pattern. It was positive for epithelial markers with presence of basal type cytokeratins. The proliferative index was low within the neoplastic cells., Conclusions: Tubular gland adenoma and syringocystadenoma papilliferum are benign tumors originating from ceruminous glands of the skin, characterized by very rare occurrence especially in the skin of the external auditory canal. Their histogenesis is still controversial. Every tumor arising from the external auditory canal should be examined histologically and immunohistochemically in order to choose the best treatment option.

Unlabelled: Bone destruction in chronic otitis media with cholesteatoma is a common phenomenon. Expanding growth of cholesteatoma in the middle ear causes ischemia of the mucosa and bones with granulation tissue production., The Aim of This Study: was to assess the expression and distribution of the key regulators of bone destruction: osteoprotegerin (OPG), Receptor Activator for Nuclear Factor kappa B Ligand (RANKL) and tumour necrosis factor alpha (TNF-alpha) in chronic otitis media with cholesteatoma and their role in the pathomechanism of bone resorption., Material and Methods: We performed immunohistochemical study of the cholesteatoma tissue collected from 21 patients suffering from chronic otitis media with cholesteatoma and 16 samples of normal external auditory meatal skin. This material was analysed histopathologically and by means of immunoperoxidase immunohistochemical technique with the use of antibodies against OPG, RANKL and TNF-alpha and their quantitive evaluation., Results: In all patients with cholesteatoma, features of auditory ossicles and temporal bone destruction were demonstrated. We found that cholesteatoma and granulation tissue cells release factors of the OPG/ RANKL/RANK system and TNF-alpha. In cholestatoma a higher expression of RANKL, OPG and TNF-alpha positive was demonstrated when comparing to the skin of external auditory meatus. These factors were relatively higher expressed in the stroma rather than in the epithelium of cholesteatoma. RANKL-positive cells were demonstrated mainly in the stroma cells, whereas OPG-positive ones in the cholesteatoma epithelium. The reaction with the antibodies against OPG, RANKL and TNF-alpha was weak in the external auditory meatal skin., Conclusions: Bone destruction in chronic otitis media with cholesteatoma is a common process dependent on osteoclast activating factors. OPG/ RANKL/RANK system and TNF-alpha play a key role in the process of osteolysis in otitis media with cholesteatoma. We found no positive correlation between bone destruction advancement and the level of examinated proteins.

Malignant Triton tumor (MTT) is classified as a variant of a malignant peripherial nerve sheath tumor with a focal rhabdomyosarcomatous differentiation. Nearly one third of described MTTs were located at the head and neck region. In following paper we described a case of MTT of the external nose in a 24 year old man. The tumor was totally exised surgically with the broad margins. Histopathological diagnosis of the tumor was made on the surgical specimen, based on immunohistochemical analysis. Radiation therapy as the next step of treatment of choice was performed in presented case.

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.

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.

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.

The authors described fibrous dysplasia in 8 years old boy with inferior orbit wall destruction and with penetration of the lesion inside the orbit. Surgery with facial degloving approach was performed. Well therapeutic and cosmetic outcome was achieved. Usefulness of imaging data, especially CT, in diagnostic procedure was stressed. The review of contemporary literature on fibrous dysplasia was discussed.

Cytomegalovirus (CMV) belongs to Herpesvirida family and it occurs quite frequently in the human environment. It is a very important pathogen in persons with suppressed or lowered resistance. Having special kindship with epithelium, it may cause primary infection or reveal secondary influence in the latent form. Congenital CMV infection is a major cause of sensorineural hearing loss and neurological impairment in children. Otogenic complications may develop in patients with viral infection immunodeficiency. Aim of the paper was assessment of lateral sinus thrombosis (LST) in children with acute otitis media (AOM) and CMV infection. Authors present a case of LST in 5-year old child with AOM with mastoiditis and acquired CMV infection. In the first phase a disease appeared as mononucleosis-like infection with developing neurological signs resulting from meningitis. In the second phase the signs of acute otitis media, mastoiditis and lateral sinus thrombosis increased. Despite broad spectrum antibiotics therapy the intracranial complication developed which was surgically treated with good outcome. All the symptoms resulting from mastoiditis, LST and meningitis ceased. Clinical symptoms of the secondary CMV infection are rare in children. Complications may develop despite proper treatment of the ear and throat infections, and may result from immunodeficiency after CMV infection.