[Current theories on the origin of cholesteatoma].
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Cholesteatoma, Middle Ear↗
Biomedical subjects
H Hildmann
Publications and source records attributed to H Hildmann.
[Hearing disorders in children with Down's syndrome].
Among 4947 children in an outpatients unit for hearing disorders 102 children with Down's syndrome were seen and checked for hearing disorders. 57 had hearing deficiencies, 50 (88 %) conductive hearing loss, 4 (7 %) combined and 3 (5 %) a sensory neural hearing loss. Compared to other publications the number of very young children was very high. 32 patients under two years of age had a hearing disorder. The results underline the necessity of early diagnosis and follow up also in children with normal reactions during the first presentation. Early diagnosis enables early treatment, conservative, surgical or fitting with hearing aids, especially important in the rehabilitation of these children. Hearing aids may be given temporarily imploring communication during the development of the child.
Child↗
[Sonography and scintigraphy in the diagnosis of cystadenolymphomas (warthin tumor)].
BACKGROUND: Is scintigraphy in the preoperative diagnosis of cystadenolymphomas dispensable? PATIENTS AND METHODS: In this prospective study 35 patients with tumors of the parotid gland were examined sonographically and scintigraphycally and the results were compared with the histological findings. RESULTS: By means of sonography 88 % (22/25) of the cystadenolymphomas were correctly diagnosed and by means of scintigraphy 80 % (20/25). CONCLUSIONS: Sonography is recommendable as the first-line diagnostic procedure in cystadenolymphomas because it is without radiation load, the free choice of the echographic plane, and it can be repeated as often as desired. Scintigraphy adds in selected cases, as in elder patients, additional informations. The combination of sonography and scintigraphy confirms the presence of cystadenolymphoma and allows the surgeon to make a decision and to avoid surgery especially in high-risk patients.
Adenolymphoma↗
[Diagnosis of recurrences of head and neck carcinoma with the tumor marker SSC-antigen].
BACKGROUND: The follow-up of squamous cell carcinomas of the head and neck is often challenging. Due to tissue alteration and anatomic changes after primary treatment or submucosal tumor growth, recurrences are sometimes detected very late. The tumor marker SCC-Antigen (SCC-Ag) may provide additional information for early detection of such tumor recurrences. PATIENTS: Serum levels of SCC-Ag in 578 patients with primary squamous cell carcinomas of the head and neck were assayed by SCC-RIA and IMx-SCC before treatment and every 2-3 months during follow-up. During the observation period of 30-84 (mean 50) months, 179 recurrences were verified by histologic examination. RESULTS: Seventy-seven patients (43%) with tumor recurrence showed elevated serum levels of SCC-Ag (< 2.0 ng/ml). Fifty-eight (32%) of them exhibited elevated levels of SCC-Ag up to 11 months (mean 6.1 months) prior to histopathologic diagnosis. This mainly became evident in 48 (83%) patients whose SCC-Ag serum levels were elevated before treatment. CONCLUSION: Use of SCC-Antigen in head and neck tumors follow-up can provide early evidence of almost one third of all recurrences of squamous cell carcinomas of the head and neck. For clinical purposes, we recommend an initial analysis of the SCC-Ag serum level in every patient with primary squamous cell carcinoma of the head and neck. The SCC levels of all SCC positive patients should be closely monitored. Elevated SCC should be regarded as a potential early sign for recurrence and therefore indicates the need for intensified follow-up. Depending on the individual situation this should include ultrasonography, CT, MRI and especially frequent endoscopy in general anesthesia with multiple biopsies of suspicious regions.
Adult↗
Glomus tumors.
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Diagnosis, Differential↗
Angiogenesis and angiogenic growth factors in middle ear cholesteatoma.
HYPOTHESIS: This study aimed to analyze the localization and distribution of vessels and of these angiogenic growth factors: basic fibroblast growth factor (FGF-2), transforming growth factor-alpha (TGF-alpha), transforming growth factor-beta1 (TGF-beta1), and vascular endothelial growth factor (VEGF) in middle ear cholesteatoma in comparison with normal middle ear mucosa and auditory meatal skin. BACKGROUND: Angiogenesis is particularly important in many normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for the expansion of cholesteatoma. METHODS: The expression of FGF-2, TGF-alpha, TGF-beta1, and VEGF was studied by immunohistochemistry. The amount of vessels (collagen type IV staining) was determined by an automatic imaging analyzing system. RESULTS: The results showed an altered expression and distribution of VEGF, FGF-2, TGF-alpha, and TGF-beta1 in cholesteatoma in relation to middle ear mucosa and auditory meatal skin. The results were consistent with rapidly growing, activated keratinocytes and stromal cells. Vascularization within the perimatrix of cholesteatoma showed a 4.3-fold increase compared with middle ear mucosa and a twofold increase compared with ear canal skin. An increase of 3.2- to 4-fold in the number of vessels was observed. A close relationship was seen between the density of capillaries, degree of inflammation, and expression of the angiogenic factors investigated, and an increased number of microvessels in cholesteatoma tissue. CONCLUSIONS: Angiogenesis enables and supports the sustained migration of keratinocytes into the middle ear cavity. Therefore, it is a pivotal factor in the destructive behavior of middle ear cholesteatoma.
Angiogenesis Inducing Agents↗
Cholesteatoma in children.
Cholesteatoma in children is generally considered to be more aggressive and destructive than in adults. Each otologic surgeon has experienced widely extended cholesteatomas in children with large pneumatized mastoid processes. In this paper, we want to present clinical and experimental observations which imply that the destructive potential in children is similar to that in adults. Factors and observations that have led to the assumption that cholesteatoma in children is more aggressive will be discussed. Based on our experience and the literature, we tried to distill the current and leading thoughts concerning this intriguing entity.
Adolescent↗
[Postoperative treatment after ear surgery].
The paper gives an overview on postoperative treatment after ear surgery, especially tympanoplastic, mastoid-surgery and stapes-surgery. Suggestions for treatment are given according to the different post-operative stages and situations. Careful cleaning of the ear canal, using the operative microscope, removal of debris, granulations and polyp and drying of the canal are most important.
Ear↗
[Value of B-image ultrasound in diagnosis of paranasal sinus diseases in comparison with computerized tomography].
BACKGROUND: In diagnostic imaging of the paranasal sinuses, the A-mode technique is increasingly being substituted by B-mode ultrasonography. To assess the value of B-mode sonography we compared in a double-blind study computed tomography with our ultrasound findings. PATIENTS AND METHODS: Seventy-eight patients were examined by CT and subsequently by ultrasound, two-thirds before endonasal surgery and one-third for diagnosis of serious facial pain and swelling. RESULTS: Among 114 pathological maxillary sinus tomograms, 83 findings could also be diagnosed by ultrasound (sensitivity 72.8%). In the frontal sinuses only 12 of 52 of pathological findings could be detected (23.1%) and only 9 of 80 in the frontal ethmoid (11.3%). Except for circumscribed polyps and moderate general swelling of the mucosa, the detection rate by sonography was 97.4% for the maxillary sinuses, 31.5% for the frontal and 18% for the ethmoid sinuses. CONCLUSIONS: Ultrasound usually only demonstrates the presence of absence or unspecific findings. Differential diagnosis between tumors and sinusitis is generally difficult. The healthy individual is correctly assessed as healthy due to the total reflection of the air-filled healthy sinus. According to our findings ultrasound has a certain value in the diagnosis of maxillary sinuses. It can be used to obtain a preliminary diagnosis and as a screening method although a negative result never excludes a disease of the sinuses. As it does not involve radiation exposure, ultrasonography can be recommended as first step in diagnosis for children, pregnant women, and young women especially in acute sinusitis, because in acute sinusitis the maxillary sinuses are generally affected.
Adolescent↗
[Immunohistochemical studies with middle ear mucosal remnants in cholesteatoma].
The development of a middle ear cholesteatoma is usually associated with chronic inflammation and displacement of the mucosa present by the invading squamous epithelium. To analyze the clinically different behaviors of both epithelia, we used immunohistochemical methods to study the distribution and expression of interleukin-1 (Il-1), transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), epidermal growth factor-receptor (EGF-R), the proliferation marker MIB 1, c-myc proto-oncogene product and activation marker 4F2. Results stromal that keratinocytes in a cholesteatoma exhibited a much higher activation and proliferation rate when compared to middle ear mucosa cells. Middle ear epithelial cells showed no immunoreactivity for TGF-alpha, EGF-R, Il-1 and c-myc in contrast to the markedly positive immunoreactivity found in cholesteatoma matrix. The local release of cytokines and growth factors, such as TGF-alpha, EGF and Il-1 by inflammatory cells seems to be an important factor for the hyper-proliferative behavior of cholesteatoma epithelium. Our findings could contribute to the pathogenesis of middle ear cholesteatoma and give a possible explanation for the sustained progression of its growth leading to displacement of the middle ear mucosa.
Biomarkers↗
Immunohistochemical detection of proliferating cell nuclear antigen in middle ear cholesteatoma.
Cholesteatoma epithelium is characterized by a keratinocyte dysregulation accompanied by destruction of the ossicles and temporal bone. Immunohistochemical methods using antibodies to cell-cycle-related antigens can be used as a means for assessing various aspects of proliferation in cholesteatoma tissue. They also have the important advantage of preserving the spatial orientation of proliferating cells in histological sections. Proliferating cell nuclear antigen (PCNA) is a 36 kDa DNA-delta-polymerase-associated protein that is directly involved in the mechanisms of DNA synthesis. In the present study the expression of PCNA was investigated in formalin-fixed, paraffin-embedded biopsy specimens of cholesteatomas and normal skin. Normal skin revealed nuclear staining in a small number of keratinocytes (PCNA grade, 1.5) located in the basal cell layer. In contrast, an increased number of PCNA-labeled basal and suprabasal epidermal cells (PCNA grade, 9.3) were found in cholesteatoma samples. Our findings indicate that PCNA represents a reliable marker for epithelial proliferation, showing that cholesteatoma epithelium proliferates at a higher rate than normal epidermis. These findings also support the concept of keratinocyte dysregulation in middle ear cholesteatoma.
Cell Division↗
[Using cartilage in middle ear surgery].
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Cartilage↗
Basement membrane in middle ear cholesteatoma. Immunohistochemical and ultrastructural observations.
We investigated the distribution of basement membrane zone (BMZ) components collagen type IV, collagen type VII, and fibronectin in human middle ear cholesteatoma, auditory meatal skin, and middle ear mucosa using both immunohistochemical and ultrastructural methods. Collagen type IV immunoreactivity of skin and middle ear mucosa is continuous in the BMZ, whereas cholesteatoma frequently showed absent immunoreactivity or focal discontinuities. Collagen type VII immunoreactivity is detected similarly within the BMZ of cholesteatoma and skin. Fibronectin immunoreactivity is observed within the dermoepithelial junction of skin and middle ear mucosa. In cholesteatoma, however, fibronectin immunoreactivity is markedly increased within the extrinsic BMZ and the subepithelial connective tissue. The ultrastructural arrangement of the BMZ of cholesteatoma is like that of skin; however, it exhibits distinct alterations of the lamina fibroreticularis and lamina densa. Our results outline cholesteatoma as a disease with disturbed cell matrix interactions analogous to those of wound reepithelialization.
Basement Membrane↗
[In vitro studies of the effect of papain on isolated chondrocytes: clinical relevance for correction of structural abnormalities of the ear].
A permanent change of shape of the auricle can be achieved by local application of papain to the elastic cartilage. To assess possible clinical use of papain, we investigated its effect on isolated and cultured chondrocytes derived from human cartilage of the auricle. We determined cellular vitality using the trypan blue method. The release of the cytokines IL-1 alpha and IL-6 measured by ELISA and HLA-DR antigen expression evaluated by histological procedures was used as a parameter of the state of activation of chondrocytes. Cell proliferation was also determined by the number of Ki-67 positive cells. A papain concentration above 160 micrograms/ml led to decreasing vitality and number of proliferating cells. A papain concentration above 160 micrograms/ml solvent led to expression of HLA-class-II-antigen on the surface of the chondrocytes. The release of IL-6 was reduced depending on the concentration of papain. However, IL-1 alpha was detected in low concentration with and without application of papain. These investigations show for the first time that papain not only leads to direct destruction of the matrix as described in literature, but also influences the integrity of the matrix by the function and state of activation of chondrocytes. A concentration of papain above 160 micrograms/ml should not be exceeded in clinical application.
Cartilage↗
Expression of a cell-cycle-associated nuclear antigen (MIB 1) in cholesteatoma and auditory meatal skin.
Middle ear cholesteatoma is often invasive with consequent bone destruction. Inflammatory stimulation of the underlying connective tissue, as well as an autocrine mechanism, may be responsible for the dysregulation and abnormal proliferative features of the keratinocytes in cholesteatoma. Comparative investigations were performed to assess the epithelial cell kinetics of cholesteatoma and normal auditory meatal skin. Monoclonal antibody MIB 1 immunostaining (which recognizes a nuclear antigen expressed by dividing cells) was applied using the alkaline phosphatase antialkaline phosphatase immunolabeling method. Specimens of normal auditory meatal skin (n = 7) revealed an average MIB 1 score (quotient of the MIB 1-positive cells and the total number of cells) of 7.6 +/- 2.2%. Cholesteatoma samples (n = 13) showed an average MIB 1 score of 17.4 +/- 8.9% and a heterogeneity of proliferating epithelial areas. Epithelial cones growing toward the underlying stroma exhibited high mitotic activity. Statistically, the results of this study confirm a highly significant increase in the proliferation rate of cholesteatoma keratinocytes, which had an MIB 1 score that was 2.3 times higher than the score for keratinocytes of normal external auditory meatal skin.
Antibodies, Monoclonal↗
[Tympanic effusion].
Since epidemiologic studies have shown, that the majority of middle ear effusions disappear spontaneously and sequelae a less frequent than expected, a more conservative treatment strategy is advisable. In this review pathogenetic factors are discussed and a treatment policy is recommended as it appears logic to the authors. It is stressed that exact audiologic data are difficult to obtain in children. If an effusion persists at least for 3 months, adenoidectomy, paracentesis and aspiration of the middle ear fluid has to be considered. The insertion of middle ear ventilation tubes is not the first step in our treatment. Special strategies for treatment have to be applied in some groups such as children with Francheschetti or Down Syndrome and children with cleft palates as well as in children with retardation in speech development.
Child↗
[Use of cartilage transplants in middle ear surgery. A histologic long-term study of cartilage implants].
30 autogenic and allogenic (homologous) cartilage grafts removed from the middle ear after an average time of 9 years and a maximal time of 25 years were studied by light microscopy. Half of the grafts showed signs of cellular vitality. Degeneration and avital cells are predominant in all grafts. Persisting residual vitality does not influence resorption and matrix necrosis in other areas of the graft. More than two thirds show structural changes by cellular resorption, infraction and vascularisation. These changes appear mainly independent of the time elapsed after transplantation. 5 grafts show bone new formation. Circumscript necrosis of the cartilage matrix was seen in 12 grafts. The study indicates that in comparison to ossicles or alloplastic material cartilage is less advisable to be used for the reconstruction of the ossicular chain due to the unpredictable degradation and loss of form stability.
Cartilage↗
Ingestion and aspiration of foreign bodies.
Foreign bodies may be swallowed as well as aspirated, but patients and their relatives may not understand the distinction. Fortunately, swallowing occurs more often than aspiration. Dental prostheses present specific problems in this regard. Their configuration impedes easy gliding through the esophagus and makes their extraction difficult. Swallowing of foreign bodies in elder patients is often explained by a decrease in psychological or neurological function, which undoubtedly may occur. The loss of tactile sense of the hard and soft palate as a result of complete denture use is another reason for frequent occurrence of this problem in elder patients.
Bronchoscopy↗