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Fragestellung: In der vorliegenden Arbeit wurde untersucht, welchen Einfluss eine mehrwöchige Therapie mit Budesonidspray (Rhinocortol®-Spray) auf die mittlere Zilienschlagfrequenz und den rhinoskopischen Befund hat. Patienten und Methoden: Die Zilienschlagfrequenz wurde photometrisch bei Patienten mit chronischer Sinusitis an von der Nasenschleimhaut entnommenen Biopsien vor und nach Therapie bestimmt. Ergebnisse: Es resultierte keine signifikante Zilienschlagfrequenzänderung. Der Rangsummentest nach Wilcoxon ergab einen p-Wert von 0,856. Der rhinoskopische Befund besserte sich nach lokaler Kortikosteroidtherapie bei 9 Patienten (57%), während er bei 6 Patienten (37%) unverändert blieb. Zilienschlagfrequenz und rhinoskopischer Befund korrelierten nicht (rs = 0,06). Schlussfolgerungen: Die vorliegende Untersuchung deutet darauf hin, dass Rhinocortolspray nicht schädigend auf das Flimmerepithel wirkt und dass das Präparat zur Therapie der chronischen Sinusitis geeignet ist.

Hyperplastic lesions of the laryngeal mucosa can eventually develop into squamous cell carcinoma The relationship between dendritic cell infiltration of head and neck cancers and prognosis is well known. Surprisingly, data regarding dendritic cell infiltration in precancerous lesions are not available today. It was the purpose of our study to extend these observations and to investigate in more detail the density and distribution of dendritic cells in pre-cancerous lesions.Retrospective survey by immunohistochemistry.For this study we investigated paraffin-embedded tissue sections of 41 specimens. Histological diagnosis disclosed precancerous lesions of the larynx in 34 cases and in 7 cases, squamous cell carcinoma Immunohistochemical study was performed using antibodies against the cell surface markers S-100, HLA-DR, CD20, CD45 RO, CD45 RA, and Lag. Typical dendritic cell distributions of the immunostained specimens were photographed and measured on a quantitative basis. The medical histories of the patients were then analyzed retrospectively.HLA-DR+ cells could be detected in 14 of 16 cases in mild dysplastic lesions. The infiltration of the dysplastic lesions was sparse compared to cases with higher-graded dysplastic lesions. The distribution patterns of the dendritic cells in specimens with severe dysplastic lesions, but squamous cell carcinoma were extremely similar and markedly different from those in grades I and II specimens. Memory T lymphocytes (CD45 RO+) were detected more often in the group with severe dysplastic lesions (8 of 9 cases) than in the group with squamous cell carcinoma (3 of 8 cases). The inverse became evident for CD20 and CD45 RA immunolabeling.Few dendritic cells were found in the precancerous lesions. This may suggest that these early lesions (grades I and H) are not efficiently monitored by the immune system. Therefore they may develop into carcinomas unimpaired by cytotoxic T cells. As the degree of malignancy rises (grade III), more dendritic cells infiltrate the tumor.

Dendritische Zellen bilden ein System von antigenprasentierenden Zellen, das im Korper weit verbreitet ist. Sie sind charakterisiert durch typische dendritische Zellfortsatze und durch die Expression von MHC-Klasse-II-Molekulen aus ihrer Zelloberflache. Sie kommen in 2 Formen vor: In nichtlymphoiden Organen, wie z.B. in der Haut, treten sie als unreife dendritische Zellen auf. Als solche besitzen sie die Fahigkeit der Antigenerkennung und -verarbeitung und der Migration uber die Blutzirkulation bzw. uber efferente Lymphgefase in Lymph-knoten. In lymphoiden Organen (Lymphknoten, Milz) finden sich reife dendritische Zellen, die antigenspezifische T-Lymphozyten finden und stimulieren konnen. Dendritische Zellen sind somit in hohem Mase befahigt, eine primare Immunantwort auszulosen.

Acetylcholin ist der wichtigste efferente Neurotransmitter im Vestibularapparat der Saugetiere.

First clinical experiences with the anti-androgenic drug cyproterone-acetate in treatment of pachydermia laryngis are reported in eleven male and female patients. This endocrine therapy led to complete healing in four and to marked improvement in six patients. One did not respond. Evaluation of the endocrine state of these patients showed imbalance in the androgen/estrogen equilibrium. As the larynx constitutes a secondary sex characteristic and an endocrine target organ, the significance of endocrine factors for pathogenesis and therapy of epithelial changes on the vocal cords is discussed.

The macromolecular transport in the middle ear mucosa of the guinea pig was investigated by means of light and electron microscopy using tracer substances such as Evans blue, India ink, and horseradish peroxidase (HRP). HRP particles were readily taken up by the middle ear mucosa and Eustachian tube. They were absorbed by all cell types, including ciliated, secretory and nonsecretory cells. The particles were first taken up by the pinocytotic vesicles and then transported into the intercellular spaces by reverse pinocytosis. These particles were transported toward the connective tissue through the basilar membrane. Some of the tracer particles were engulfed by the tissue histiocytes, but most of the particles entered into lymphatic and blood capillaries. By Evans blue instillation of the bulla, the retroauricular and junctional lymph nodes were positively identified as those draining the middle ear and the Eustachian tube. When HRP was used, the tracer particles were detected in the ipsilateral retroauricular and junctional lymph nodes as early as 5 minutes following the tympanic instillation. HRP in these lymph nodes were mainly found in the specific granules of the macrophages.

EVIDENCE indicating the presence of secretory cells in normal middle ear mucosa in man and animals is increasing. Sade 1 reported the normal human middle ear lining to be a true mucosa that possesses cilia and secretes mucus. He also found, from mucosal biopsy in a case of serous otitis media, a PAS-negative glandular structure. 2 Senturia and co-workers 3 described goblet cells in the epithelium of the canine tympanic cavity. Lim et al, 4 in a recent study, reported on the ultrastructure of the eustachian tube and middle ear mucosa in guinea pigs. They found two types of secretory cells: goblet cells in the epithelium of the eustachian tube and dark granulated cells in the transitional zone between the orifice of the tube and the epithelial lining of the bulla. These authors further stated that the latter cells resembled the serous secreting cells found in

In der normalen Mittelohrschleimhaut des Meerschweinchens und des Menschen wurden auf Grund histochemischer and elektronenmikroskopischer Untersuchungen verschiedene Typen von Drusenzellen festgestellt. Beim Meerschweinchen finden sich Becherzellen, Intermediarzellen and dunkel granulierte Zellen, beim Menschen nur die beiden ersten Typen. Becherzellen entsprechen der sero-mukosen, Intermediarzellen and dunkel granulierte Zellen der serosen (nicht-mukosen) Kategorie des vonShackleford u.Klapper angegebenen Klassifizierungsschemas der Speicheldriisen der Saugetiere.

An attempt was made to create serous effusions in the middle ear cavity of the guinea pig by obstructing the eustachian tube. Histologic sections, however, indicated that only an incomplete occlusion of the tube was present. Among the 11 animals used, six developed a serous or seromucous effusion. The predominant findings were: (1) the loss of ciliated cells in the early stages (eight days) and (2) an increase in the number of dark-granulated cells. The thickening of the submucosal layer was due to an increased cellularity with the deposition of dense cottony spheres in the matrix. These densities are similar to calcium crystals found in early ossification centers. There was also an increased cellular infiltration consisting primarily of polymorphs, but also including round-cell types and macrophages. No evidence of bacterial invasion was found.

An Hand einer Beobachtung werden, neben den ublichen histologischen Verfahren,auch auf mikroradiographischem Wege, die Skeletabanderungen der Chondrodysplasia fetalis hyperplastica untersucht. Als Ergebnis dieser Bemuhungen kann festgehalten werden, das der Primordialknorpel a priori Fehlbildungen aufweist, die sich vor allem in einer vollig abwegigen enchondralen Ossifikation ausern. An wesentlichen Umgestaltungen sind zu erheben: a) Mangelhafte Ausbildung und vielfache Fehlorientierung der Zellsaulen des epiphysaren Knorpels. b) „Albumoidkornige“ Entartung der Zwischensubstanz sowie ortliche Fibrillendemaskierung. c) Volliges Fehlen einer enchondralen Chondroklasie; es werden lediglich Knorpelblocke aus den Epiphysenknospen gelost. d) Die Spongiosa wird aus noch zellhaltigen, mit Knochengrundsubstanz gesaumten (epiphysaren) Knorpeltrummern gebildet.

Considering the larynx as a hormone dependent secondary sex characteristic has previously led to successful antiandrogentherapy of pachydermia of the vocal cords, which may constitute a precancerous state. As a first step to further evaluate the endocrine state of patients with precancerous lesions or cancer of the larynx, the urinary excretion of 17-hydroxysteroids, 17-ketosteroids, testosterone and estrogens has been determined in male patients with pachydermia laryngis (n = 15) or cancer of the larynx (n = 20) as compared to controls with different other otorhino-laryngological affections (n = 20). No difference between groups was found in 17-hydroxysteroids and no significant difference in 17-ketosteroid excretion. The pachydermia group as a whole showed significantly increased levels of testosterone (p = 0.01) and estrogen (p = 0.04) of 64.6 +/- 39.9 microgram/24 hr testosterone versus 34.7 +/- 19.3 microgram/24 hr in controls and 31.7 +/- 16 microgram/24 hr in laryngeal cancer and 277 +/- 14.8 microgram/24 hr total estrogens versus 19.1 +/- 12 microgram/24 hr and 17.8 +/- 8.1 microgram/24 hr respectively. These data further support the idea of hormonal factors playing an important role in the pathogenesis of pachydermia and thus possibly cancer of the larynx. So far, however, they do not permit definite conclusions on the pathogenetic mechanisms involved.

Morphological and audiological early and late results after reconstruction of the ossicular chain with Plastipore prosthesis (TORP's and PORP's) were compared with those achieved by using autogenous or allogenic ossicles. In particular 32 tympanoplasties with TORP's were compared with 25 cases of columella and 29 PORP cases with 75 interpositions. Only Plastipore prostheses were extruded, up to now in 11.4% of cases. The final extrusion rate will be even higher since perforations of the fascia graft or the drum over the head of the prostheses as signs of imminent extrusions were noted in 9.8% of tympanoplasties at the end of the 2-year follow-up period. However, only in one third of tympanoplasties cartilage had been interposed between the head of the prosthesis and the fascia graft or drum. Audiological results, early as well as late ones, using the mean postoperative air-bone gap as criterion of success, showed no statistically significant differences between the compared groups. Only the comparison of the mean air-bone gaps in late results versus the preoperative values seemed to favour the PORP group over the interposition group. In some PORP cases, however, greater reduction of the air-bone gap was caused by postoperative deterioration of the bone conduction threshold level. In addition, hearing gains were more lasting in the interposition than in the PORP group. Because of the high extrusion rate and the fact that the audiological results were not significantly better than in the compared groups we will cease using PORP's and will employ TORP's only with careful interposition of cartilage and then only in selected cases with good tubal function.

Case-report about a 56 year old white female patient with pachydermia laryngis and hirsutism, successfully treated with cyproterone-acetate, a testosterone antagonist. The significance of androgenic hormones for the development of epithelial changes in the female larynx is emphasized. The administration of antiandrogenic substances as a new therapeutic measure is discussed.

Immunological phenomena occurring in the mucosa of the middle ear and Eustachian tube were investigated following tubal obstruction in squirrel monkeys which produced middle ear effusions. Although there are many variations among specimens, in general all classes of immunoglobulin producing plasma cells have shown an increase in number and/or an increase in intensity of fluorescence. IgG and IgA-producing plasma cells were more prominent than those producing other immunoglobulins. These findings support the concept that the middle ear and Eustachian tube in monkeys as in humans is protected by an immunodefense system.

The clinical picture of otitis nigra (idiopathic sero-hemmorrhagic otitis media) as independent clinical entity is shown, presenting 5 cases requiring mastoid surgery. Samples of mastoid mucosa were investigated by light- and electron-microscopy employing histochemical, immunofluorescent and virological techniques. Pathological changes of the small vessels in the subepithelial connective tissue with increased vascular permeability and extravasation of red blood cells and serum play a central role in the pathogenetic course of the disease. Disintegration of erythrocytes leads by catabolism of hemoglobin to formation of hemosiderin and ferretin, whereas by processing of phospholipids of the cell-membrane cholesterin cristals are deposited in the connective tissue. These cholesterin deposits in turn induce a foreign body reaction with formation of typical cholesterol granulomas. The mucosa shows secretory activity in intraepithelial secretory cells and glandlike structures in the subepithelial connective tissue. Neutral and acidic mucopolysaccharides are demonstrated in the secretory product. As possible cause for the vascular lesion that in turn sets off the pathomechanisme of otitis nigra a subclinical viral infection is discussed. This conjecture is supported by demonstration of virus-like inclusion bodies in macrophages and fibrocytes and of virus-like particles in antral smears. In addition myxoviruses of the parotitis-epidemica group could be identified in these smears by serological methods. Furthermore, the stimulation of the local immunological defense system, evidenced by the presence of numerous immunoglobulin-producing plasmacells in the tissue, is in concord with a viral infection. Therapy requires mastoidectomy in combination with posterior tympanotomy in order to eradicate completely the intractably diseased mastoid mucosa.

IN CONTRAST to the hitherto prevailing opinion that the normal human middle ear lining consists of flat or cuboidal cells and lacks mucus secreting elements, Sade 1 found it to be a true mucosa that possesses cilia and secretes mucus. Secretory cells were also reported in the tympanic epithelium in dogs by Senturia et al, 2 and in guinea pigs by Lim et al. 3 Hussl and Lim 4 further distinguished three morphologically and cytochemically different types of secretory cells—dark granulated, intermediary, and goblet cells—in the transitional zone of the guinea pig middle ear mucosa. This study is concerned with the fine morphology and cytochemistry of the epithelium lining the normal human tympanic cavity. Material and Methods Biopsies from presumably normal middle ear mucosa were obtained from nine patients undergoing stapedectomy for otosclerosis and from one patient undergoing labyrinthectomy for Meniere's disease. All patients were adult, ranging from 28

The innervation of cholinergic efferent fibers in the vestibular endorgans of the rats was investigated using a modified preembedding immunostaining technique of immunoelectron microscopy. A monoclonal antibody to choline acetyltransferase (ChAT) was used as a marker of cholinergic fibers. It was found that there were four types of cholinergic innervation in the vestibular endorgans of the rat: (1) cholinergic nerve endings formed axo-dendritic synapses with afferent chalice surrounding the type I sensory hair cells; (2) cholinergic nerve endings formed axo-somatic synapses with type II hair cells; (3) cholinergic fibers synapse with afferent nerve fibers and (4) a synaptic contact developed between cholinergic nerve endings. The results demonstrated that a multiform innervation of the cholinergic efferents exists in the rats vestibular periphery.