Cholesteatoma is a destructive disease characterized by the progressive expansion of keratinizing squamous epithelium in the middle ear and mastoid, and chronic inflammatory reaction of the subepithelial connective tissue. N-Acetyl-β-d-hexosaminidase (HEX) catalyzes the release of terminal non-reducing N-acetyl-d-hexosamine residues acting on glucosides and galactosides in glycoproteins, GM2-gangliosides and glycosaminoglycans (GAGs). In this study the activities of HEX were measured in cholesteatoma tissue and in normal skin to demonstrate a possible role of HEX in bone resorption in the area adjacent to cholesteatoma. Cholesteatomas (n = 21) and normal adult retroauricular skin (controls, n = 21), were collected from patients during surgery due to chronic otitis media. In 20 of 21 specimens a significantly higher activity of HEX was observed in cholesteatoma tissue compared with that in normal skin. Mean release of HEX from the activated cells was 68.55 ± 30.77 nkat/g wet tissue in cholesteatoma and 31.79 ± 10.02 nkat/g wet tissue in skin specimens. It may explain the process of bone resorption in the area adjacent to cholesteatoma, i.e. ossicles or temporal bone. This study suggests that drugs inhibiting HEX activity, such as iminocyclitols, may be useful in cholesteatoma treatment.
Introduction: Despite the recent advances in otosurgery diagnosis of cholesteatoma and qualification for surgery remains an issue in contemporary laryngology. In cases of cholesteatoma recidivism, it is of utmost importance to properly locate the pathology in the middle ear to plan surgical approach. Magnetic Resonance imaging in diffusion-weighted non-echoplanar sequences (non-EPI DWI) enables cholesteatoma detection as small as 2 mm and could potentially prevent unnecessary second-look surgery. Computed Tomography of the temporal bone allows precise visualization of bony structures and topographical landmarks of the middle ear. A fusion of both imaging modalities combines the advantages of these techniques. Material and methods: Five patients treated in the Department of Otolaryngology, the Medical University of Lodz for probable cholesteatoma recidivism were included in this study. A high-resolution CT scan of the temporal bone and an MRI scan including non-EPI sequences was obtained in all patients. A fusion of CT and MRI studies was conducted using OsirixMD software. Fist, CT studies were fused with MRI BFFE sequences, then non-EPI sequences were added. Finally, if the patient qualified for surgical treatment histopathological diagnosis was compared with MRI results. Results: CT scans were analyzed to establish the extent of previous surgical interventions and anatomical landmarks preservation. In all cases, MRI results were suspicious of cholesteatoma recidivism. Four cases were confirmed in postoperative histopathological evaluation, there was one false positive case when intraoperatively scar tissue was identified, which was later confirmed as connective tissue upon histopathological evaluation. Conclusions: CT and MRI fusion provides a helpful diagnostic tool in preparation for surgery in patients with suspected cholesteatoma recidivism.
Petrosal cholesteatomas are rare lesions, which may be primary or acquired in nature. We report a case of primary cholesteatoma in petrous bone occurring in 51-year old woman who presented with a unilateral facial nerve palsy and conductive hearing loss, despite normal tympanic membrane appearance. Early diagnosis was facilitated by computed tomography scanning and magnetic resonance imaging. Complete cholesteatoma removal was accomplished using a transtemporal supralabyrinthine approach, which allowed hearing preservation. Facial nerve function is the main complication of these lesion. We suggest that use of CT scanning and MRI in unilateral conductive hearing loss may allow the earlier detection of the most cases of petrosal cholesteatomas.
Introduction: Despite the recent advances in otosurgery diagnosis of cholesteatoma and qualification for surgery remains an issue in contemporary laryngology. In cases of cholesteatoma recidivism, it is of utmost importance to properly locate the pathology in the middle ear to plan surgical approach. Magnetic Resonance imaging in diffusion-weighted non-echoplanar sequences (non-EPI DWI) enables cholesteatoma detection as small as 2 mm and could potentially prevent unnecessary second-look surgery. Computed Tomography of the temporal bone allows precise visualization of bony structures and topographical landmarks of the middle ear. A fusion of both imaging modalities combines the advantages of these techniques. Material and methods: Five patients treated in the Department of Otolaryngology, the Medical University of Lodz for probable cholesteatoma recidivism were included in this study. A high-resolution CT scan of the temporal bone and an MRI scan including non-EPI sequences was obtained in all patients. A fusion of CT and MRI studies was conducted using OsirixMD software. Fist, CT studies were fused with MRI BFFE sequences, then non-EPI sequences were added. Finally, if the patient qualified for surgical treatment histopathological diagnosis was compared with MRI results. Results: CT scans were analyzed to establish the extent of previous surgical interventions and anatomical landmarks preservation. In all cases, MRI results were suspicious of cholesteatoma recidivism. Four cases were confirmed in postoperative histopathological evaluation, there was one false positive case when intraoperatively scar tissue was identified, which was later confirmed as connective tissue upon histopathological evaluation. Conclusions: CT and MRI fusion provides a helpful diagnostic tool in preparation for surgery in patients with suspected cholesteatoma recidivism.
Introduction: The treatment and rehabilitation of hypoacusis with the use of cochlear implants is a safe and reliable method suitable for both children and adults. In people affected by chronic otitis media cholesteatomatosa or such who have previously undergone open repair of the ear, we use a special surgical technique known as lateral/subtotal petrosectomy. Material and methods: The study group consisted of patients with profound bilateral sensorineural hearing loss, in which otitis media with and without cholesteatoma has been diagnosed or after open repair of the middle ear. A retrospective analysis of patient data, as well as radiological and audiological results, was conducted. Results: In the Clinic of Otolaryngology and Laryngological Oncology of the Pomeranian Medical University in the years 2008–2018 we performed 90 cochlear implant surgeries, including a petrosectomy in 1 child with cholesteatoma (5 years) and in 2 adults after open repair (62 and 73 years). In all cases the procedure was done in a single stage. Healing proceeded correctly in all patients undergoing petrosectomy. The observation period ranges from 26 to 32 months, computed tomography examinations revealed no indirect characteristics of recurrent cholesteatoma. The patients remain under constant ENT supervision. The child has risk factors for autism and mental retardation, he displays good auditory responses and speech understanding; he has not developed active speech. As regarding free field pure tone audiometry, in adults hearing in the cochlear implant remains at 35 and 40 dB, and speech understanding at 80%. Discussion: Patients with chronic otitis media can be treated efficiently and safely with a cochlear implant using lateral petrosectomy. Lateral/subtotal petrosectomy is the access of choice when deep sensorimotor hearing loss coexists with chronic inflammation in the middle ear.
The aim of the study was to find out the potential prognostic value of proliferation activity and apoptosis in cholesteatoma and granulation tissue removed during middle ear reoperation in recurrent middle ear inflammation. Granulation tissues and recurrent cholesteatoma were analysed after being surgically removed from the middle ear in a group of 25 patients qualified for middle ear reoperation procedure. Paraffin sections were stained with haematoxylin and eosin according to Mallory’s method. Immunohistochemical reaction Anti-PCNA was performed. Apoptosis was evaluated using the TUNEL method. The percentage of PCNA-positive cells was 42–95% in the matrix of the cholesteatoma and 29–81% in the perimatrix. In the granulation tissue it was 35–75%. The percentage of apoptotic cells was 12–73% in the matrix of the cholesteatoma, 5–72% in the perimatrix and 1–65 % in the granulation tissue. The prognostic value of the parameters studied in the recurrent middle ear inflammatory process is questionable, probably due to the small number of cases under examination.
Cholesteatoma is a destructive disease characterized by the progressive expansion of keratinizing squamous epithelium in the middle ear and mastoid, and chronic inflammatory reaction of the subepithelial connective tissue. N-Acetyl-β-d-hexosaminidase (HEX) catalyzes the release of terminal non-reducing N-acetyl-d-hexosamine residues acting on glucosides and galactosides in glycoproteins, GM2-gangliosides and glycosaminoglycans (GAGs). In this study the activities of HEX were measured in cholesteatoma tissue and in normal skin to demonstrate a possible role of HEX in bone resorption in the area adjacent to cholesteatoma. Cholesteatomas (n = 21) and normal adult retroauricular skin (controls, n = 21), were collected from patients during surgery due to chronic otitis media. In 20 of 21 specimens a significantly higher activity of HEX was observed in cholesteatoma tissue compared with that in normal skin. Mean release of HEX from the activated cells was 68.55 ± 30.77 nkat/g wet tissue in cholesteatoma and 31.79 ± 10.02 nkat/g wet tissue in skin specimens. It may explain the process of bone resorption in the area adjacent to cholesteatoma, i.e. ossicles or temporal bone. This study suggests that drugs inhibiting HEX activity, such as iminocyclitols, may be useful in cholesteatoma treatment.
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