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The significance of plasminogen activation during the tympanic membrane (TM) healing is known mainly from studies performed on knock-out mice. In the previous study, we reported activation of genes coding proteins of plasminogen activation and inhibition system in rat's TM perforation healing. The aim of the present study was the evaluation of protein products expressed by these genes and their tissue distribution using Western blotting and immunofluorescent method, respectively, during 10-day observation period after injury. Otomicroscopical and histological evaluation were employed to assess the healing process. The expression of urokinase plasminogen activator (uPA) and its receptor (uPAR) were significantly upregulated in the proliferation phase, with subsequent gradual attenuation during remodeling phase of healing process, when keratinocyte migration was weakening. The expression of plasminogen activator inhibitor type 1 (PAI-1) also showed the highest levels during the proliferation phase. The increase of tissue plasminogen activator (tPA) expression was observed during the whole observation period, with the highest activity during the remodeling phase. Immunofluorescence of these proteins was present mainly in migrating epithelium. Our study found that plasminogen activation (uPA, uPAR, tPA) and inhibitory (PAI-1) molecules form a well-structured regulatory system of the epithelial migration that is critical to the healing of TM after its perforation., (© 2023. The Author(s).)

Objectives: The study objective was to assess the levels of VEGF-A and TGF-β cytokines in the children with adenoid hypertrophy concomitant with exudative otitis media (OME) and in children with adenoid hypertrophy (HA) alone., Methods: The study material consisted of hypertrophic adenoids removed during adenoidectomy from 39 children (20 girls and 19 boys), aged 2-7 years suffering from OME. The reference group included 41 children (19 girls and 22 boys), aged from 3 to 9 years with adenoid hypertrophy. The levels of VEGF-A and TGF-β were determined in supernatants obtained from phytohemagglutinin-stimulated cell cultures of the adenoids using a commercial enzyme-linked immunosorbent assay kit., Results: The median VEGF-A and mean TGF-β concentrations in the study group were significantly higher than those in the reference group (503 pg/mL versus 201 pg/mL, P < 0.001 and 224 pg/mL versus 132 pg/mL, P < 0.001, respectively). ROC analysis revealed that the area under the curve (AUC) for VEGF-A was 0.952 with diagnostic sensitivity and specificity of 95%, whereas for TGF-β it was 0.902 with 60% sensitivity and the same specificity as for VEGF-A. There was no significant difference between the AUC for VEGF-A and TGF-β (P = 0.573)., Conclusions: The changes in the levels of VEGF-A and TGF-β may indicate bacterial pathogen as one of the causes of exudative otitis media in children. Determination of VEGF-A and TGF-β could be used as additional and objective tests to confirm the clinical diagnosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

We report on two unrelated families of Polish origin with variable expression of Fraser syndrome (FS; MIM#219000) due to homozygosity for the same pathogenic variant, c.6963&#95;6964dup, of FRAS1. In one family, the disorder presented with perinatal and prenatal lethality. One affected female from family 2 who was followed-up for 32 years, represented a relatively favorable long-term outcome. She displayed the typical craniofacial dysmorphism, including right cryptophthalmos, cutaneous syndactyly, abnormalities of the stomathognatic system, bilateral atresia of the external ear canals resulting in conductive hearing loss, and malformations of the larynx, spleen, kidney, and genitourinary tract. Her intellectual capacities were normal. Our observations illustrate that expression and severity of FS, even when caused by the same pathogenic variant, may be quite different ranging from a lethal disorder to a condition with multiple physical malformations but normal psychomotor development. In addition, we propose that the FRAS1 c.6963&#95;6964dup variant may be a founder mutation in the Polish population. Therefore, it would be reasonable to test specifically for this variant first in any FS1 patient of Polish ancestry., (© 2020 Wiley Periodicals, Inc.)

&lt;b&gt;Aim:&lt;/b&gt; The aim of the current study was to assess the serum levels of insulin-like growth factor-1 (IGF-1) and ghrelin in hypertrophied adenoids in children suffering with or without otitis media with effusion before and after adenoidectomy. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Serum IGF-1 and ghrelin concentrations were measured with specific enzyme-linked immunoassay (ELISA) methods. The study was carried out in 20 children with otitis media with effusion. The reference group comprised 24 children with hypertrophied adenoid, while control group included 19 children. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; This mean values of IGF-1 in children with otitis media with effusion and children with hypertrophied adenoid before adenoidectomy were significantly lower than those found in healthy children. Serum levels of IGF-1 were higher after adenoidectomy. There was a significant difference of serum ghrelin levels between both examined groups and the control group. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Our results suggest that adenoidectomy in children with hypertrophied adenoids and in children with otitis media with effusion significantly increases the level of IGF-1 in serum compared to before surgery through the effect of the GH-IGF-1 axis, which could contribute to children's growth.

Objectives: The aim of the current study was to assess the levels of MMP-8, MMP-9 and TIMP-1 in the group of children with adenoids who suffered from exudative otitis media., Methods: The study included 20 patients (10 females and 10 males) with adenoid hypertrophy coexisting with otitis media with effusion. The reference group included 24 patients (10 females and 14 males) with adenoid hypertrophy without otitis media. The levels of MMP-8, MMP-9 and TIMP-1 were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated cell cultures of the tonsils, using commercial enzyme-linked immunosorbent assay kits (R@D Systems, USA)., Results: The median MMP-8, MMP-9 and TIMP-1 concentrations (220.8 ng/mL, 311.1 ng/mL, 53.5 ng/mL, respectively) in the study group were significantly higher (p = 0.000, p = 0.000, p = 0.048, respectively) than those in the reference group (93.5 ng/mL, 112.5 ng/mL, 36.95 ng/mL, respectively). ROC analysis revealed that the area under a curve (AUC) for both metalloproteinases MMP-8 and MMP-9 was 1 with a diagnostic sensitivity of 100% and diagnostic specificity of 95.8%, as compared to 0.690 for TIMP-1. Significant differences were found between the AUC for MMP-8 and TIMP-1 and MMP-9 and TIMP-1 (p < 0.001 for both comparisons)., Conclusions: The changes in the concentrations of MMP-8, MMP-9 and TIMP-1 may indicate an increased remodeling of the extracellular matrix in children with adenoid hypertrophy and otitis media with effusion. The findings can have clinical as well as diagnostic utility. Determination of MMP-8 and MMP-9 may help qualify a child for adenoidectomy and differentiate pediatric patients affected by adenoid hypertrophy with and without otitis media., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Our preliminary study performed on perforated rat's tympanic membrane (TM) using Rat Wound Healing RT2 Profiler PCR Array showed significantly increased levels of mRNA for collagens type I and V. Enhanced expression of those genes does not assure that their protein products are indeed present, and in what quantity. Therefore, this study was undertaken to analyze the collagen type I and V content in the healing TM., Methods: Sixty rats were used, of which 10 served as controls and the others had their TM perforated. The experimental animals were divided into five subgroups on the basis of time points (03, 06, 09, 14, 20 day after injury). Videootoscopy and histology were employed to assess the morphology of the healing process. The expression of collagen type I and V was evaluated using Western blot analysis. Tissue localization of collagens was determined by the immunofluorescence method., Results: The collagen type I expression was three times higher on the third day after injury and remained on that level for whole period of observation, up to day 20. The increase of the collagen type V expression was gradual, reaching the highest level on day 14 following injury. In comparison to the control TM statistically significant increase in the level of expression was observed starting from day 09 to the end of observation period. In healing TM immunofluorescent labeling of collagen type I and V was seen on the surface of remnants of previous lamina propria and in the loose proliferating fibrous tissue. On day 20 immunofluorescence was present mainly on the surface of thin connective tissue layers forming the scar in the place of previous perforation., Conclusion: Although the collagens type I and V are present only in subepithelial layer in the normal rat's TM they play significant role in TM healing process., (Copyright © 2018. Published by Elsevier B.V.)

We present a natural history of a 32-year-old man with Hajdu-Cheney syndrome (HJCYS), because of the de novo truncating mutation in the exon 34 of NOTCH2 (c.6424-6427delTCTG, p.Ser2142ArgfsX4), who has been followed up for a period of 23 years (between 9 and 32 years). During follow-up, we observed abnormalities of vision, hearing, voice, and progression of craniofacial features in the form of skeletal dysplasia with affected skull, dentition, spine, limbs, fingers, and toes. Low bone mineral density and history of fragility fractures also suggested primary osteoporosis being a clinical manifestation. According to Stengel-Rutkowski, Schimanek, and Wernheimer (1984; Human Genetics, 6, 272-295), systematic data acquisition has been used for quantitative analysis of anthropological, radiographic, and clinical features at childhood, adolescence, and young adulthood separately. A detailed phenotype description together with the results of reanalysis of 14 reports so far published on patients with HJCYS and NOTCH2 mutation showed similar phenotype evolution with age. The spectrum of observed features may improve diagnostic tools for HJCYS at different periods of the lifespan., (© 2018 Wiley Periodicals, Inc.)

Objectives: The present study was performed to investigate the expression of hepatocyte (HGF), epidermal (EGF) and vascular endothelial (VEGF) growth factors in the course of healing of experimental tympanic membrane (TM) perforations in rats. The goal was to explain the role of these growth factors in the healing process of TM and to assess the possibility of their future application as healing promoters., Methods: Seventy rats were used, of which 10 served as controls and the others had their TM perforated. The experimental animals were divided into six subgroups on the basis of time points (01, 03, 05, 07, 09, 15 day after injury). Videootoscopy and histology were employed to assess the morphology of the healing process. The expressions of HGF, EGF and VEGF were evaluated using Western blot analysis. Tissue localization of HGF was determined by the immunofluorescence method., Results: HGF was hardly detectable in normal TM; however, a significant increase was noted in its expression starting from the third day after injury throughout the follow-up period, with the highest level on day 05. The analysis of HGF tissue localization with immunofluorescence revealed diffuse staining in the cytoplasm of proliferating epithelial cells. The expression of EGF was elevated on the first day after injury, not reaching statistical significance, and then returned to the level observed in the control TM. No significant differences were noted in the expression of VEGF., Conclusion: High expression of HGF during the healing process of acute TM perforations makes it a promising candidate for further studies oriented towards its possible use in augmentation of TM healing., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: The aim of the study was to analyze the presenting signs and symptoms, diagnostic procedures, clinical course, pathogenic organisms and management of neck abscesses in children., Materials and Methods: This retrospective medical records review comprised of 51 pediatric cases referred because of neck abscess from 2001 to 2014. Medical records of the patients were reviewed for demographic data, clinical presentation, treatment before referral, localization of the abscess, imaging evaluation, medical and surgical treatment, bacteriological data and complications., Results: Average age of the patients was 4.9 years. 18 (35%) of the children were below one year of age. The submandibular was the most common area involved (41,2%). Contrast-enhanced computed tomography (CECT) was performed in 45% of patients mainly with deep neck abscesses. All CECT scans showed the fluid collections. In all but one of the patients treated surgically and diagnosed with ultrasound and/or CECT surgical intervention revealed presence of pus. The most common pathogen was Staphylococcus aureus- SA (78% of all isolates) of which 24% were methicillin resistant Staphylococcus aureus - MRSA. Clindamycin resistance was detected in 28% of all SA isolates and in 67% (4/6) of all MRSA isolates. All MRSA isolates were sensitive to vancomycin., Conclusions: CECT is reliable imaging technique for diagnosing deep neck abscesses in children. Infants with neck abscesses are at higher risk of having MRSA as offending pathogen which should be taken into consideration when considering empiric treatment. Vancomycin is recommended as empiric antibiotic therapy in newborns with neck abscess.

Introduction: Tympanic membrane (TM) perforations are commonly seen in clinical practice as a result of trauma or in the course of otitis media. The TM is a unique structure suspended in air which makes its healing processes different than in the skin wounds. The aim of the study was otoscopical and histological evaluation of the rat's TM healing process., Material and Methods: 56 male Wistar rats were used for the study. Fifty of them had TMs perforated bilaterally using CO2 laser, additional 6 served as a controls. The animals were sacrificed on either day 1, 2, 3, 6 and 10 post injury. Process of healing was assessed otoscopicaly, subsequently TM were dissected and processed for histological evaluation., Results: At day 6 after perforation half and on day 10 all of TM were healed. On the first day, in histological evaluation, focal thickening of the epithelial layer was observed at some distance from the edge of perforation, on the side of annulus. On the following day proliferation of epithelium covering outer surface of TM on the side of the malleus handle and annulus was clearly visible. An eosinophilic mass containing macrophages and granulocytes was seen in front of the migrating epithelium. On day 3-6 migrating epithelium reached the edge of perforation. Proliferation of the connective tissue layer followed the epithelium., Conclusions: The present results indicate that the squamous epithelium covering the outer surface of TM constitutes the first layer which restores continuity of TM. The proliferation of the connective tissue occurs in the direct vicinity of the proliferating and migrating epithelium., (Copyright © 2014 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Objective: From 10 to 15% of children suffer from recurrent acute otitis media (AOM). An association between polymorphism in TLRs and their co-receptor CD14 with otitis media proneness has been described in children. Moreover, the experiments on animal models have shown that TLRs and their signaling molecules are critical for timely resolution of bacterial otitis., Aim: The aim of this study was to determine the expression of TLR1, TLR2 and TLR4 on lymphocytes, monocytes and granulocytes in peripheral blood in children with recurrent or persistent AOM., Methods: The study was performed on a group of 25 children hospitalized for recurrent AOM, failures of previous treatments and/or acute mastoiditis. The results were compared to the control group of healthy children at the same age. The expression of TLRs on peripheral blood white cells was measured by flow cytometric analysis. The results were expressed as mean fluorescence intensity (MFI). The statistical analysis was performed using the Mann-Whitney U test., Results: The highest expression of TLR was found on monocytes, the lowest on lymphocytes in both groups of children (AOM and the control one). The expression of TLR1 was the lowest and expression of TLR4 was the highest on all examined cells. The expression of all examined TLRs on monocytes was significantly higher in the AOM group., Conclusions: Peripheral blood monocytes are characterized by increased expression of TLRs in the course of recurrent AOM., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

The hypertrophic adenoid may promote chronic suppurative otitis media in children as it fulfills its immune function. The number of lymphocytes in the adenoid and their cooperation in the immune response depend of on their proliferation and migration to the effector sites. Interleukin 7 (IL-7) is essential for the normal development and function lymphocytes. IL-7 plays pivotal role for activation and proliferation of T and B cells. The heterodimeric interleukin-7 receptor (IL-7R) is composed of the IL-7Rα (127) and the common cytokine receptor γc (CD132). The aim of this study was to evaluate the percentage of lymphocytes T (CD4(+) and CD8(+)) with IL-7R (CD127 and CD132) expression in hypertrophic adenoid in children suffering with otitis media with effusion for a duration of 3 months. Adenoid excised due to hypertrophy with or without chronic otitis media with effusion was used as study material. CD4(+) CD127(+), CD4(+)132(+), CD8(+)CD127(+) and CD8(+)CD132(+) cell subpopulations were identified using monoclonal antibodies and flow cytometry. The percentage of CD4(+) and CD8(+) T cells with CD127 receptor expression in hypertrophic adenoid of children with otitis media with effusion was statistically significantly higher than in hypertrophic adenoid group. The percentage of CD4(+) T cells with CD132 expression in the study group was statistically significantly higher than in the reference group. The percentage of CD8(+) T cells with CD132(+) expression was not statistically different in both groups. The increased percentage of T lymphocytes with IL-7R expression (CD127 and CD132) in hypertrophic adenoid seems to influence the quantity of lymphocytes and upset the immunological function of tonsils which can influence the course of otitis media with effusion.

Hypertrophic adenoids with otitis media with effusion is a common infectious disease and present a serious otological problem in children. Cytokines, potent inflammatory mediators, play important role in the initiation of immunological response in otitis media. Adenoids excised due to hypertrophy with or without chronic otitis media with effusion were used to isolate mononuclear cells. Secretion of cytokines by non-stimulated and PHA-stimulated cells was determined by specific ELISAs. We found a significant increase in the production of IL-5 and TNF-α secreted by adenoidal cells of children with otitis media with effusion compared to group with hypertrophic adenoids. No differences were found in the secretion of IL-8, IL-6, and IL-10 between these two groups of patients. Our results suggest a difference between the immunological responses in the course of hypertrophic adenoids with otitis media as compared to hypertrophic adenoids.

Introduction: Children cholesteatoma have been shown to demonstrate aggressive growth with greater extension and higher rates residual and recurrent disease compared with adults, due to anatomic and physiologic differences., Aim: This study aimed to determine the clinical and pathological features of cholesteatoma in young children less than 7 years of age., Material and Methods: Retrospective review of a group of 23 children (24 ears) who had cholesteatoma surgery between 1996 and 2004. Patients ages ranged from 1.8 to 7 years, follow up from 3.5 to 12 years (mean 7.4). Medical history (previous otorrhea, hearing loss) and contralateral ear status was analyzed. The extent of cholesteatoma and ossicular destruction for attic, pars tensa I and pars tensa II type and congenital of cholesteatoma was graded using of Saleh and Mills classification. Residual and recurrent disease depending on type of cholesteatoma, extent of the disease, type of surgery and contalateral ear status was assessed., Results: Otorrhea and hearing loos are the most common clinical symptoms observed in 90% and 59% children. 70% of treated children had otitis media with effusion and/or its sequel in contralateral ear. 60% of acquired cholesteatomas were classified as S3 and S4 extension during surgery with ossicular destruction in 46% of attic cholestatoma. 75% operated ears had a signs of mucosa inflammation during surgery. Residual cholesteatoma was observed in 38.5% ears with attic cholesteatoma and in 25% with pars tensa I cholesteatoma., Conclusion: Acquired cholesteatoma in young children are diagnosed in the advanced stages with ossicular chain destruction. High rate of recidivism after surgery, particularly in attic cholesteatomas is observed. Most of operated ears have symptoms of inflammation of middle era mucosa during surgery and otitis media with effusion in contralateral ear and because of that need long-term follow up and constant observation.

Introduction: The aim of the study is to analyze the relationship between otoscopic tympanic membrane abnormalities, results of impedanace and extended-high-frequency audiometry in subjects with history of treatment of secretory otitis media (SOM) and ventilation tube insertion., Material and Methods: 97 subjects treated because of SOM were examined in years 1999-2000. Videootoscopic examinations, extended-high-frequency audiometry and tympanometry with ispilateral acoustic reflex were performed in each patient. The results were analysed in three groups: no otoscopic abnormalities (BZO), retraction pockets (KR) and atrophy and myringosclerosis (AM). The results were compared to otologicaly healthy control group in the same age., Results: The most common tympanic membrane abnormality were focal atrophy (64.7%) of ears and myringosclerosis (37.2%). Mean pure-tone audiometric threshold were significantly higher in groups KR and AM than in control and BZO groups. Low degree of positive correlation was found between the presence of myringosclerosis and atrophy and audiometric thresholds above 1 kHz. No such correlation was observed with the presence of retraction pockets. In the BZO group middle ear admittance was observed significantly higher than in control group. The absent ipsilateral stapedial reflex was observed in 10.8% ears in BZO group, 16.9% in AM and 33.3% in KR. No correlation was found between the parameters of tympanometric evaluation and results of extended-high-frequency audiometry., Conclusions: In ears treated because of SOM with ventilation tube insertion the middle ear compliance is higher. In the presence of myringosclerosis and atrophy higher audiometric thresholds are observed. Tympanic membrane abnormalities have been more clearly indicated by the absent ipsilateral stapedial reflex than tympanometry.

Introduction: Otitis media with effusion is the most common cause of hearing loss in children and myringotomy with tympanostomy tube insertion is recommended procedure to deal with the problem. The objective of the present study was to determine the results of treatment, incidence and prevalence of middle ear sequelae and hearing results among children with chronic otitis media with effusion who received standard treatment with tympanostomy tubes., Material and Methods: The group of 97 patients treated by tympanostomy tubes insertion in the years 1999-2001 was reevaluated after mean period of follow up 7.3 years. At the control examination videootoscopy and audiologic examinations were performed. Audiological assessment consisted of tympanometry and pure-tone thresholds of air and bone conduction., Results: Recurrent otitis media with effusion requiring tube insertion occurred during follow up period in 23.7% of patients. At the control examination 16.5% of children had an ongoing otitis media or ventilation tube in place or tympanic membrane perforation. Most common tympanic membrane abnormality were focal atrophy (67.2% of ears) and myringosclerosis (39.5%) followed by retraction pockets of pars flaccida (29.9%) and tensa (9.6%). Mean pure-tone audiometric threshold were significantly higher in ears with tympanic membrane abnormality by the difference did not excide 5dB HL in ears with focal atrophy and myringosclerosis and 6.5 dB HL in ears with retraction pockets., Conclusions: As the percentage of recurrences after tympanostomy tubes insertion are not uncommon prolonged period of follow up of those children is recommended. Although ventilation tubes have proven very effective in improving hearing in short term, they have not proven effective in preventing long-term sequelae of tympanic membrane and some degree of hearing loss. The decision about surgical treatment should be taken cautiously taking into account the chance of spontaneous resolution.

Evaluation of lymphocyte homeostasis within the chronically inflamed adenoid, closely related to the functioning of the immune system, may have a role in qualifying children for adenoidectomy. Apoptosis is a major process maintaining balance between tonsillar lymphocytes. The Fas receptor and Bcl-2 protein family which show pro-apoptotic and anti-apoptotic actions are of particular significance in apoptosis induction. Adenoid excised due to hypertrophy with or without chronic otitis media with effusion was used as study material. Flow cytometry was used to assess the percentages of apoptotic lymphocytes and CD4(+), CD8(+), CD19(+) cells with CD95(+) antigen and Bcl-2 protein in the group of children who underwent adenoidectomy due to adenoid hypertrophy and accompanying otitis media with effusion. The percentages of CD4(+)Bcl-2(+), CD8(+)Bcl-2(+) and CD19(+)Bcl-2(+) lymphocytes in the group of children with adenoid hypertrophy and acute otitis media were lower as compared to the reference group. However, the percentages of CD4(+), CD8(+) and CD19(+) cells with CD95(+) antigen were higher in the study group comparing to the reference group. The tendency of reduced percentages of T and B lymphocytes with Bcl-2 expression and elevated percentages of these cells with CD95(+) expression within the adenoid may reflect local immunity disorders., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of this study was evaluation of the percentage and mean fluorescence intensity of lymphocytes B with expression CD80 and CD86 in hypertrophied adenoids in children with otitis media with effusion., Material and Methods: Expression coreceptors CD80 and CD86 on lymphocytes B in adenoid tissue were estimated by flow cytometry method. 15 children with otitis media with effusion and 15 children with hypertrophied adenoid were tested., Results: This study showed significantly higher percentage of lymphocytes CD19+ CD80+ in children with otitis media with effusion (OME 1.42% +/- 0.91) than in comparative group with hypertrophied adenoids (AH 0.63% +/- 0.21). The receptor CD86 didn't show differences in expression on lymphocytes B between both examinated groups., Conclusion: Low expression of CD80 and CD86 indicates that local immunity response in hypertrophied adenoids in children with otitis media with effusion is weakened. It can contribute to the otitis media with effusion.

Introduction: In hypertrophied adenoid lymphocytes B make up about 60% all lymphocytes. When the lymphocytes B come in interaction with antigens this membranes signal be passed through their receptor (BCR) to interior of cell. This signal affect modulation on gene expression, activation from which depends activation, anergy or apoptosis of lymphocyte B. Accompany BCR co-receptors regulate his functions influence stimulate or inhibitive. To the most important co-receptors stepping out on lymphocyte B belong: CD40, CD22, CD72., Aim of Study: The aim of study was evaluation of lymphocytes B (CD19) with co-expression with CD72 and CD40 receptors in hypertrophied adenoid with at children with otitis media with effusion., Material: An investigation was executed in hypertrophied adenoids with or without otitis media with effusion., Methods: By flow cytometry percentage of lymphocytes B with co-receptors CD 40, CD22 and CD72 in was analyzed., Results: The percentages of CD19+CD72+ lymphocytes in the group of children with adenoid hypertrophy and exudative otitis media were lower as compared to the reference group. However, the percentages of CD19+CD22+, CD19+CD40+ in the study group was approximate to the reference group., Conclusions: The lower percentage of lymphocytes B CD72 + near approximate percentages of lymphocytes B CD40+ and BCD22+ at children with otitis media with effusion can be the cause of incorrect humoral response in hypertrophied adenoid at children. Maybe it is cause reduced spontaneous production IgA and IgG through lymphocyte at children with otitis media with effusion.

Introduction: Adenoid has particular meaning to develop of immunological response to inflammations in upper respiratory inclusive middle ear. The mining of antigen CD27 on lymphocytes T and B in creation of memory cells is still unclear., Aim: CD27 on lymphocytes T and B has a crucial role in development of immune response against inflammatory state. Aim of this study was evaluation functions of lymhocytes with expression CD27 in hypertrophied adenoid in children with otitis media with effusion., Material and Methods: [corrected] We tested 24 children in examine group with hypertrophied adenoid and otitis media with effusion (OME), and 29 children in comparative group only with hypertrophied adenoid (HA). We also divided both groups into two groups, above 5 and over 5 years old. We made the research by flow cytometry method. We used anty-CD19, anty-CD3, anty-CD5 and anty-CD27 monoclonal antibodies to examinations., Results: We showed the lowest percentage lymphocytes B CD5+ with expression of CD27 in subgroup older children with otitis media with effusion (O.M.E. 22.43 +/- 2.66%) in compartative to younger children in the same group (15.96 +/- 5.31%; p < 0.005) and to older comparative subgroup (H.A. 15.50 +/- 8.03; p < 0.001). Percentages of B CD5 cells with expression of CD27 was statistical lower in examinated group (7.25 +/- 3.81) than in comparative group (H.A. 16.26 +/- 5.82; p < 0.04). In group with hypertrophied adenoid showed higher percentages of CD5-CD27+CD19+ cells both in younger and older supgroup than in equivalent supgroups with O.M.E., Conclusions: Iteraction of CD27-CD70 regulates many functions of T and B lymphocytes. It seems that disorders humoral immunologucal answer in hypertrophied adenoids are supported to develop of otitis media with effusion.

Introduction: Chemokine receptors play a crucial role in the recruitment of leucocytes into inflamed tissue from secondary lymphoid organs., Aim of This Study: was evaluation of the percentage Th (CD4+) lymphocytes with expression of chemokine receptors: CCR3, CCR4, and CCR5 in hypertrophied adenois tissue in children with otitis media with effusion., Material and Methods: 36 children with otitis media with effusion and 25 children with hypertrophied adenoids were tested. Expression of chemokine receptors CCR3, CCR4 and CCR5 on T CD4 lymphocytes of hypertrophied adenoid's tissue was estimated by flow cytometry method., Results: Average percentage of T CD4+ lymphocytes with expression CCR4 in hypertrophied adenoid in children group with otitis media with effusion (OME = 64.11%) was significantly higher than in comparative group with hypertrophied adenoid (HA = 75.05%, p < 0.04). We showed statistically lower percentage of CD3+CD4+ cells with expression CCR3 in examinated group (OME = 47.19%) than HA group (62.66%; p < 0.003)., Conclusion: Results suggests that intensify of humoral immunological answer in hypertrophied adenoid depends on Th2 lymphocytes with expression CCR3 and CCR4 chemokine receptors in course of inflammatory state in middle ear.

Introduction: Adenoid hypertrophy is a problem of more than 1/3 of children and is the predominant reason of otolaryngology consultations in this population. Diagnosis and surgical qualification are based on physical examination and other methods introduced more than 100 years ago. Development of endoscopic techniques has been found this method to be a gold standard in adenoid assessment up to date. However, the method is difficult to performed in some young patient because of their invasiveness. Acoustic assessment of nosopharyngs seems to be a new promising method., The Aim of the Study: Were an assessment of nasal obstruction due to adenoid hypertrophy in group of patients referring to adenoidectomy and an objective evaluation of changes in the volume of the nasopharynx after adenoidectomy., Material and Methods: The examination was carried on the group of 30 patients aged 5-10 y.o. with adenoid hypertrophy admitted for adenoidectomy. The control group consisted of 10 children free of otolaryngological problems. All studied individuals had acoustic rhinometry performed and additionally, endoscopic method such as rhynofiberoscopy and endoscopy of nasopharyngs were introduced in the patient's group., Results: The study showed that children with adenoid hypertrophy have statistically significant reduction of nasopharyngeal volume (NPV) vs control group. Adenoidectomy increases the NPV parameter and makes it equal to control group., Conclusions: The acoustic rhynometry seems to be a promising method in assessment of nasopharyngeal volume. This and further studies may help to reduce the number of "unnecessary" adenoidectomies, by making standards for NPV in different group of age.

Objective: The recognition of inflammatory mediators in middle ear effusions and their correlation with clinical parameters may allow better understanding of many complex events leading to development of permanent sequelae of otitis media and hopefully help to develop future interventions. The aim of the study was to evaluate the presence and level of proinflammatory interleukin (IL) 1beta, IL-6 and immunoregulatory IL-10 in the middle ear effusions, their mutual correlation and relationship with age, duration of the illness, number of episodes of acute otitis media, and presence of retraction pockets., Methods: The study included 25 children (41 ears), who had been scheduled for myringotomy with the insertion of tympanostomy tubes due to otitis media with effusion. The interview (duration of the illness, number of episodes of acute otitis media), clinical and audiological examination was conducted according to the developed examination check list. Middle ear effusions (MEE) were collected aseptically, the samples centrifuged and supernatant frozen at a temperature of -80 degrees C. The IL-1beta, IL-6 and IL-10 were assayed using enzyme-linked immunosorbent assay (ELISA) kits incorporating monoclonal antibodies and the ETI system reader. The nonparametric Mann-Whitney U test was used for statistical analysis and Pearson's linear correlation coefficient was calculated., Results: IL-1beta was detected in 80% of examined effusions, IL-6 in 78%, and IL-10 in 88%. There was a strong statistical correlation between IL-1beta and IL-6 concentrations (r=0.627, P=0.000), as well as IL-6 and IL-10 (r=0.66, P=0.000) No statistically significant correlation was found between levels of cytokines and clinical parameters., Conclusions: Proinflammatory and immunoregulatory cytokines participate in middle ear inflammatory response. The lack of direct correlation between IL-1beta and IL-10 may be responsible for chronic character of the disease. As no correlation between the levels of cytokines and clinical parameters was found it seems that the time of duration of inflammation rather than its intensity measured by levels of cytokines is the main factor in development of middle ear mucosa pathology.

Objective: Myringoplasty is successfully performed in children since many years. However still considerable controversy surrounds the subject of proper timing of surgery and other factors influencing the success rate. The aim of this study was to assess the results of myringoplasty in children and to determine which factors influence the postoperative results., Material and Methods: Retrospective study of the anatomic and functional results of 82 consecutive myringoplasties performed in children between 1996-2004. Seventy one children (mean age 13 +/- 2,9 years, range 6,4-18 years) who had undergone myringoplasty because of central perforation or retraction pocket in the pars tensa were evaluated. All of the children underwent myringoplasy using endaural or post-auricular approach and underlay technique. Temporalis fascia, perichondrim or cartilage were used as a graft material. The results were assessed on the basis of otoscopic and audiometric examination pre and postoperatively. Following factors have been analyzed to assess their influence on the success rate: age, size and site of perforation, status of the operated ear (dry/discharging), status of the contralateral ear., Results: Closure of the perforation was achieved in 91,5% of children. A good anatomic outcome was observed in 87,8%. The Air Bone Gap between 0-20 dB was observed in 95,6% of patients. Age below 10 years was found to significantly affect the results of surgery. The rate of success was lower in cases with pathological process in the contralateral ear but the difference was not statistically significant., Conclusions: Myringoplasty with underlay grafting of the fascia temporalis or perichondrium gives good anatomic and functional results in children. The results are significantly worst in children below 10 years of age. Pathological changes in the contralateral ear influence the risk of an abnormal postoperative tympanic membrane.

Introduction: Apoptosis of lymphocytes can be induced by different factors mainly however the activation of antigen Fas (CD95) and his ligand FasL (CD95L) route. Apoptosis induced by Fas-FasL has large significance in elimination of lymphocytes T in final phase immune response designate AICD (activation induced cell death). Lymphocytes B undergo apoptosis induced by Fas-FasL in germinal center, which has special meaning in elimination of cells about low specificity and weak affinity of receptor BCR ( B-cell antigen receptor)., Aim of Study: The aim of this study was evaluation of percentage of apoptotic lymphocytes and expression of Fas and FasL in CD4+, CD8+, CD19+ lymphocytes in hypertrophied adenoid and hypertrophied adenoid and otitis media with effusion., Methods: CD4+Fas+, CD8+Fas+, CD19+Fas+CD4+FasL+, CD8+FasL+, CD19+FasL+ cells subpopulation were identified using monoclonal antibodies and flow cytometry method., Results: The percentage of lymphocytes CD4+ Fas+, CD8+Fas+, CD19+Fas+ was higher in hypertrophied adenoid and otitis media with effusion compored to the control group. Their was no significant difference the percentage CD4+ Fas+, CD8+Fas+, CD19+Fas+CD4+FasL+, CD8+FasL+, CD19+FasL+ in hypertrophied adenoid and otitis media with effusion then the control group. The percentage of apoptotic lymphocytes was higher in hypertrophied adenoid and otitis media with effusion compored to the control group., Conclusions: The susceptibility the individual subpopulation of lymphocytes in hypertrophied adenoid seems to influence on change of relations of quantitative lymphocytes and upset the immunological function of tonsils which can influence on course otitis media with effusion at children.

Introduction: Otitis media with effusion and hypertrophied adenoid are still common diseases in childhood. Adenoid has particular meaning to develop of immunological response to inflammations in upper respiratory inclusive middle ear. The origin CD19+CD5+ B cells remains controversial. The differentiation response to ligation of CD5 resulting in apoptosis or proliferation lymphocytes. The aim of this study was compare the percentage of CD19+CD5+ lymphocytes in hypertrophied adenoid tissue at children with otitis media with effusion to comparative group without inflammatory state in middle ear., Material and Methods: We tested 37 children in examine group with hypertrophied adenoid and otitis media with effusion (OME), and 32 children in comparative group only with hypertrophied adenoid (HA). We also divided both groups into two groups, above 5 and over 5 years old. We made the research by flow cytometry method. We used anty-CD19 and anty-CD5 monoclonal antibodies to examinations., Results: In this study we showed significantly higher percentage of the CD19+CD5+ lymphocytes at children with examined group (OME 22.12 +/- 4.31%) than in comparative group (HA 19.16 +/- 4.32%), p < 0,04. Percentage of the subpopulation CD5+ B cells was significantly higher (p < 0,02) at younger subgroup (21.55 +/- 5.34%) than in older subgroup (18.24 +/- 2.35%) of children with both groups (OME + HA)., Conclusions: The significant higher percentage of B lymphocytes with expressions of CD5+ receptor in hypertrophied adenoid tissue at children with otitis media with effusion are important to develop of early immunological response to inflammatory state in middle ear.

Introduction: The CD44 on lymphocytes binding to its ligand hyaluronan can mediate primary adhesion (rolling interactions) of lymphocytes on high endothelial venules (HEV). This adhesion molecule plays an important role to maturation and proliferation of lymphocytes in the secondary lymphoid organs. CD44 has a crucial role in migrate of lymphocytes to inflammatory sites. The AIM of this study was evaluation of the percentage and MFI (mean fluorescence intensity) of lymphocytes CD4+, CD8+, CD19+ with expression of surface adhesive molecule CD44 in hypertrophied adenoids in children with otitis media with effusion., Material and Methods: 42 children with otitis media with effusion and 30 children with hypertrophied adenoids were tested. Children were also divided into two subgroups: young (below 5 years) and older children (above 5 years old). Expression of adhesion molecule CD28 on lymphocytes of adenoids tissue was estimated by flow cytometry method., Results: This study showed significantly higher percentage of lymphocytes CD19+CD44+ in children with otitis media with effusion (OME 87,83%) than in comparative group with hypertrophied adenoids (AH 85,61%). We did not find difference between OME and AH in mean fluorescence intensity of subpopulations lymphocytes T and B with expression CD44., Conclusions: Adhesion molecule CD44 is important for developing of effectors lymphocytes in hypertrophy adenoid. Increase percentage of lymphocytes CD19 with expression CD28, especially in older children confirms their participation in developing and forming of immunological response in otitis media with effusion.

Eustachian tube (ET) dysfunction play an important role in the development, persistence and recurrence of otitis media with effusion (OME) and chronic otitis. Evaluation of the type of obstruction in the cartilaginous portion of ET is important for decision concerning methods of treatment and prognosis of surgical outcome. The aim of this study was to identify characteristics of dynamic function of the pharyngeal orifice of ET in children with OME and chronic otitis by video endoscopy. Transnasal endoscopic examination of the nasopharyngeal opening of ET during swallowing was performed on 21 children - 13 with OME, 8 with chronic otitis. Video recording were made for dynamic slow-motion analysis of ET dilation and closing processes. Most cases of ET dysfunction in children were obstrucive (81%), associated with mucosal oedema and hyperplasia. Dynamic type of dysfunction is caused by the reduced movement of the tensor veli palatini. Dynamic video analysis is useful in the identify type of ET dysfunction in children. Obstructive dysfuntion need diagnostic procedures for chronic infection, nasopharyngeal reflux and alergic diseases.

Otogenic complications in children occur most commonly secondarily to acute otitis media. Intratemporal complications are predominant and mastoiditis is most frequently seen. Meningitis in the course of acute otitis media is the most common intracranial complication. Complications of chronic otitis media are rare today, but can be more difficult to diagnose, because antibiotics may mask symptoms and change clinical presentation. Antibiotic use, however, has not completely eradicated the otogenic complications and ENT doctors should remember about this possibility.

Introduction: Otitis media with effusion (WZU) is highly prevalent among young children. The hypertrophied adenoid favorables to development (WZU). The pharyngeal tonsil delivers the essential lymphocytes for developed immunological answer. The migrations of lymphocytes to pharyngeal tonsil and to places inflammatory proceed with part of adhesive molecules (CD11a, CD54) presented on lymphocytes. The aim of this study was examination the percentage of the lymphocytes CD4+, CD8+ and lymphocytes B with expression of adhesion molecules ICAM-1 (CD54) and LFA-1 (CD11a). We examined their expression in hypertrophied adenoid by children with otitis media with effusion., Results: In investigations was showed statistically significant decrease of percentage of lymphocytes CD4+CD11a+ and CD8+CD11a+ and increase of percentage of lymphocytes CD19+CD54+ in otitis media with effusion in comparison to group with hypertrophied adenoid., Conclusions: Molecule adhesive ICAM-1 and LFA-1 fulfills important part in many immunological processes proceed to pharyngeal tonsil. The considerably lower percentage of lymphocytes T CD4+ and CD8+ with expression LFA-1 in hypertrophied adenoids is possibly of causes of incorrect their immunological answer, and the same factor favourables to prolonging the otitis media with effusion at children.

Introduction: The expansion of an optimal immune response requires fully activated T lymphocytes. For complete activation several signals are needed. The first signal is an antigen dependent via the TCR receptor, and the second signal is a costimulatory that can be delivered by the CD28 molecule after binding to their ligands. Fully activated T lymphocytes are competent to deliver activation to B cells. We suppose that this way can be important for development of immune response in hypertrophied adenoid (AH) in children with otitis media with effusion (OME). The aim of this study was evaluation of the percentage and MFI (mean fluorescence intensity) of lymphocytes CD4+, CD8+, CD19+ with expression of superficial adhesive molecule CD28 in hypertrophied adenoids in children with otitis media with effusion., Material and Methods: 37 children with otitis media with effusion and 35 children with hypertrophied adenoids were tested. Children were also divided into two subgroups: young (below 5 years) and older children (above 5 years old). Expression of adhesion molecule CD28 on lymphocytes of adenoids tissue was estimated by flow cytometry method., Results: This study showed significantly higher percentage of lymphocytes CD4+CD28+ in children with otitis media with effusion (OME 93,87%) than in comparative group with hypertrophied adenoids (AH 91,01%). Mean fluorescence intensity CD28 was higher on subpopulation lymphocytes CD4+ to children with OME (3,94) than AH (3,32). We did not find difference between OME and AH in percentages and MFI of subpopulations CD8+CD28+ and CD19+CD28+ lymphocytes., Conclusions: Adhesion molecule CD28 is very important for adenoidal lymphocytes activation and protection against apoptosa. Higher percentage of lymphocytes CD4 with expression CD28 confirms their participation in developing and forming of immunological response in otitis media with effusion.

Introduction: Otitis media with effusion (OME) and hypertrophy adenoid (AH) are still common diseases during childhood. Adenoid has particular meaning in develop of immunological answer to inflammation in upper respiratory inclusive middle ear. The CD62L lymphocyte adhesion molecule plays an important role in controlling lymphocyte extravasations into adenoid and at sites of tissue infection. The aim of this study was evaluation of the percentage lymphocytes CD4+, CD8+, CD19+ with expression of superficial adhesive molecule CD62L and its expression in hypertrophied adenoids at sick's children with otitis media with effusion., Material and Methods: In investigations has tested 37 children with otitis with effusion and 35 children from hypertrophied adenoids. Expression of adhesion molecule CD62L on lymphocytes of tissue adenoids estimated by flow cytometry method., Results: In this study showed higher significant percentage of lymphocytes CD19+CD62L+ in children in otitis media with effusion (OME. 59.33 +/- 9.65%) with reference to comparative group with hypertrophied adenoids (AH 53.47 +/- 9.67%). Mean fluorescence intensity CD62L was higher on subpopulation lymphocytes CD8+ and CD19+ at children with OME than AH., Conclusions: The increase of percentage's lymphocytes CD62L+ in tissue of adenoids can to testify to enlarged migration lymphocytes from whole blood to adenoid. The increase of density of CD62L receptor on lymphocytes can be effect local inflammatory process.

Objective: The aim of this study was to identify lymphocyte subpopulations in middle ear effusions, peripheral blood, and adenoids in children suffering from otitis media with effusion., Setting: Tertiary referral center., Patients: Thirty-three children (55 ears) undergoing myringotomy for otitis media with effusion., Methods: CD3, CD4, CD8, CD19, and natural killer cell populations were investigated in middle ear effusion, peripheral blood, and adenoids using a three-color monoclonal antibody and flow cytometry method for quantitative estimation., Results: T cells (CD3) are dominating lymphocytes in middle ear effusion. Among T lymphocytes, the majority are those of the helper type (CD4). The dominating isoform among CD4 lymphocytes are memory cells (CD4CD45RO); among CD8 lymphocytes, naive cells (CD8CD45RA). The percentage of CD4 cells, CD8 cells, and the CD4/CD8 ratio was significantly higher in middle ear effusions than in blood. The percentage of memory CD4 lymphocytes and naive CD8 lymphocytes was significantly lower in the middle ear effusion. Lymphocyte subsets were compared between 22 pairs of effusions from each patient. The percentage of each type of cell did not differ significantly., Conclusion: The results of this study indicate local regulation of the lymphocyte profile in middle ear effusions and the same phase of immune response in two ears of the same patient.

Otitis media with effusion is a leading cause of conductive hearing loss in children. Myringotomy and insertion of tympanostomy tubes is the accepted form of treatment. Recently, several studies utilizing laser myringotomy have been published, but few of them present late results. The objective of this study was to compare late results of the treatment with laser and classical myringotomy. A clinical effectiveness trial was conducted in three groups of children: (1) 37 children treated with laser myringotomy (ML), (2) 29 children treated with laser myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children treated with classical myringotomy and the insertion of tympanostomy tubes (MC+V). All types of surgery were performed under general anesthesia because adenoidectomy and/or tonsillectomy was done at the same time. The results of treatment were assessed on the basis of the otoscopic examination (recurrences of effusion, condition of the tympanic membrane, and audiological examination (pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in the ML group (36%). The difference between ML+V and MC+V was not significant. Permanent changes in the tympanic membrane were observed in 8% of the ears after ML, 19% after ML+V and 31% after MC+V. The difference was significant between the ML and MC+V groups. PTA was significantly higher in the MC+V group than in the control group of otologically healthy children. Mean amplitudes of DPOAE, measured in treated children with normal tympanometry results, were significantly lower than in the control group, but within the normal range. The use of CO(2) laser during myringotomy has no negative effect on the function of the cochlea. Healing of the tympanic membrane after laser myringotomy was uneventful with a low percentage of permanent sequelae.

Background: The pharyngeal tonsil is the place of immunological system first contact with pathogenic factors in the nasopharyngeal region, which is responsible for local defence from infection. Chronic antigenic stimulation can lead to adenoid dysfunction and hypertrophy (PMG). Significant role in PMG and in the otitis media with effusion (WZU) play lymphocytes T (CD3(+)) and T-TCR gammadelta. THE AIM of the study was a quantitative analysis of lymphocytes T (CD3(+)) and T-TCR gammadelta in adenoid hypertrophy and otitis media with effusion lasting more than 3 months., Material and Methods: An investigation was executed by flow cytometry in hypertrophied adenoids from children after tonsillectomy. The study and control groups were divided in to 2 subgroups: children younger than 5 years and those aged from 5 to 17 years., Results: The study showed a statistically significant reduction from 35.6+/-3.1% to 32.0+/-2.8% (p < 0.04) of lymphocytes T gammadelta CD3(+) in the examined group (WZU) compared to the control group (PMG). There was a higher percentage of lymphocytes with TCR gammadelta receptor expression in children with WZU (2.04+/-1.13%) than in PMG group (0.99+/-0.44%) (p < 0.002). The lowest percentage of lymphocytes T-TCR gammadelta was found in younger children with PMG (0.67+/-0.17%) and the highest in WZU in younger children (2.13+/-1.04%) (p < 0.0001). We observed a statistically significant difference in expression of TCR receptors (p < 0.02) between younger children with PMG (0.67+/-0.17%) and older children with PMG (1.24+/-0.43%). We did not find significant differences in lymphocytes T CD3(+) related to age., Conclusions: The enlarged percentage of lymphocytes T gammadelta in adenoid hypertrophy in children with WZU create a possibility of a more rapid response to inflammatory factors.

Aeration of the middle ear is the prerequisite of it proper function. It is also necessary for successful surgical reconstruction in cases of chronic otitis media. The anterior epitympanic recess (AER) has attracted the attention in recent years as possible additional route of ventilation. The preoperative axial CT scans of the temporal bones were compared with the operative findings in retrospective analysis of cases operated because of cholesteatoma. 25 ears with perforation in pars tensa and 29 ears with the perforation in pars flaccida were analysed as well as 34 healthy ears. In 1/2 of healthy ears AER consisted of a single cell and in 1/3 of multiple small cells. The structure of the AER was much more difficult to assess in cholesteatoma ears but still it was possible in more than 1/2 of them, and it did not differ significantly from healthy ears. In the majority of ears with attic cholesteatoma the structure of AER was not identified because of cholesteatoma involvement of this area. Aeration of the AER in cases of pars tensa cholesteatoma when the tympanic isthmus was closed suggests the presence of additional route of ventilation through anterior attic.

The results of treatment of acute rhinosinusitis in children are presented. The study was based on retrospective analysis of data of 34 children treated with clarithromycin (Fromilid). The clinical efficacy of this drug was confirmed by the study.

Middle ear cholesteatoma is characterized by the presence in the middle ear cavity of a stratified squamous epithelium with keratin deposits which by constant proliferation leads to extensive bone destruction. The goal of this study was to evaluate, by immunohistochemical study, the expression of epithelial markers of proliferation--Ki-67 and PCNA in the matrix of cholesteatoma. The materials used in this study were 16 acquired cholesteatoma tissues collected from patients in the age 6-17 years during surgery. The specimens from the skin of the external ear canal were employed as the control. In the immunohistochemical specimens staining intensity and distribution of Ki67 and PCNA positive cells in various layers of the epithelium were assessed in three stages scale. The results were compared to the clinical parameters such as--type of cholesteatoma (pars flaccida or tensa), presence of ear discharge, degree of ossicular destruction and involvement of attic and mastoid. In the cholesteatoma matrix Ki-67 and PCNA positive cells were present in basal and suprabasal cell layers and also more superior layers, unlike the control skin were only basal cells show positive staining. The number of positive cells and intensity of staining was also greater in the cholesteatoma matrix than in skin of external auditory meatus. No correlation was found between results of immunohistochemical examination and clinical parameters.

Computed tomography is today the best method of imaging to study chronic middle ear diseases. The aim of this study was to assess the diagnostic value of CT scan in cases of middle ear cholesteatoma in children. The preoperative CT scans were compared with the operative findings in retrospective analysis of 60 ears operated between 1998-2001. Our results show good radiosurgical correlation in cholesteatoma for most middle ear structures except for the integrity of long process of incus. The disadvantage of CT scans is inability to distinguish between cholesteatoma, granulation tissue and effusion. CT scans are an important investigative tool prior to cholesteatoma surgery.