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At least 19 recordsLinked to original sources
PubMed1998

Mastoid pneumatization in children with congenital cholesteatoma: an aspect of the formation of open-type and closed-type cholesteatoma.

OBJECTIVES: To clarify mastoid pneumatization in children with congenital cholesteatoma and compare their clinical characteristics. STUDY DESIGN: The mastoid pneumatization of 34 children with congenital middle ear cholesteatoma, of 34 age-matched children with unilateral acquired cholesteatoma, and of 17 age-matched control children without middle ear diseases was studied. METHODS: The sizes of the mastoid cells were measured from 1.5-mm sliced semiaxial sections of a temporal bone computed tomography scan. The sum of the two areas from the two images, one showing the lateral semicircular canal and the other, 3 mm below this, was defined as the area of the pneumatized mastoid cells. RESULTS: The mastoid cells in ears of children with congenital cholesteatoma were poorly pneumatized compared with those of control children without middle ear diseases, but were better pneumatized compared with those of children with acquired cholesteatoma. In children with congenital cholesteatoma, the degree of pneumatization in the cholesteatoma side was significantly poorer than that in the opposite side. A well-pneumatized mastoid was seen in ears with no episode of otitis media, in ears with the open-type cholesteatoma, and in ears with ossicular anomalies. CONCLUSIONS: The presence of cholesteatoma matrix accelerates the inflammatory response when middle ear infections occur, and this probably leads to the suppression of mastoid pneumatization. The authors also propose the hypothesis that cholesteatoma in most congenital cases is the open type, and that middle ear inflammation may contribute to the formation of cystic and closed-type cholesteatoma.

Adolescent↗
PubMed1990

[Epidermal growth factor in cholesteatoma--the first report: the localization in the cholesteatoma tissue].

The localization of epidermal growth factor (EGF) in human cholesteatoma tissue was examined immunohistochemically, using sections of formalin-fixed, paraffin-embedded tissue with avidin-biotin peroxidase complex method. Thirty-three cases of active cholesteatoma which had abundant granulation and debris were studied. Out of 33 cases, EGF was positive in 32 cases (97%) in the epidermis, 30 cases (91%) in the fibroblast, and 21 cases (64%) in the endothelial cells. In 9 cases of inactive cholesteatoma, on the other hand, EGF was positive in 5 cases (56%) in the epidermis, no case in the fibroblast, and a case (11%) in the endothelial cells. Active cholesteatoma had higher immunoreactivity in the epidermis than inactive cholesteatoma. This suggests that the activity of cholesteatoma is indicated by the immunoreactivity of EGF. Difference of EGF immunoreactivity between active and inactive cholesteatoma was bigger in the fibroblast in the subcutaneous tissue of cholesteatoma than in the epidermis. This gives the reason that the activity of cholesteatoma exists in the subcutaneous tissue. These results suggest that EGF plays an important role in accelerating the growth of cholesteatoma.

Adolescent↗
PubMed1994

The nature of the epithelium in acquired cholesteatoma: Part 3--Cytokeratin patterns in aural epithelial and cholesteatoma cells grown in cell culture.

The nature and origin of the epithelial layers in acquired cholesteatoma is still unclear. Although previous morphological studies comparing external meatal and cholesteatoma epithelium have shown no significant difference, bone resorption is generally much more severe with cholesteatoma than with chronic otitis media without cholesteatoma. It is possible that cholesteatoma epithelium has undergone transformation leading to its enhanced bone destroying role. In this study the cytokeratin patterns of aural and cholesteatoma epithelia grown in cell culture were compared using monoclonal antibodies. No significant difference in staining patterns were found suggesting that there has been no change in cell phenotype which maintains that of external auditory meatus epithelium. This study therefore supports the immigration theory of cholesteatoma genesis.

Antibodies, Monoclonal↗
PubMedDate not supplied

Primary acquired and recurrent cholesteatoma versus residual cholesteatoma. A light- and electron-microscopical study.

A comparative morphological study was performed between the primary acquired and recurrent cholesteatoma on the one hand and the residual type on the other. Between these two groups of cholesteatomas, one can distinguish differences in the pathogenesis and clinical features which may have therapeutic implications. This study, based on light- and electron microscopy, revealed no essential differences in morphology between the two groups of cholesteatoma. In particular, infiltration of matrix into subepithelial tissues could be found in cholesteatoma both with and without signs of inflammation or infection in the perimatrix, and this phenomenon could be applied to both types of cholesteatoma. This morphological uniformity suggests that the differences in clinical features and pathogenesis should not influence the otologist's choice of therapeutic approach. The results of this study emphasize the importance of removing as much as possible of the adjacent subepithelial tissue during eradication of the cholesteatoma, regardless of clinical type of cholesteatoma or signs of infection.

Cholesteatoma↗
PubMed1991

Bone destruction mechanisms in chronic otitis media with cholesteatoma: specific production by cholesteatoma tissue in culture of bone-resorbing activity attributable to interleukin-1 alpha.

To clarify specific mechanisms underlying cholesteatoma-induced bone destruction, surgical specimens of middle ear inflammatory granulation tissue with or without cholesteatoma were maintained in vitro and the bone-resorbing activity in their culture supernatants was analyzed by means of calcium release from mouse calvaria. Almost the same levels of bone-resorbing activity and prostaglandin (PG) E2 were found in the supernatants of both types of tissue. By contrast, aural polyp tissue yielded hardly any such activity or PGE2. Under the influence of indomethacin, however, only tissue with cholesteatoma produced considerable bone resorption activity, whereas PGE2 production was suppressed completely. Such activity in the cholesteatoma culture supernatant was not due to contamination of endotoxin and proved to be blocked by the introduction of anti-interleukin (IL)-1 alpha antibody into the calvarial assay system. Anti-IL-1 beta antibody had no effect on such activity. Interleukin-1 alpha was detected only in cholesteatoma tissue culture supernatants by means of enzyme-linked immunosorbent assay and by bioassay. These data suggest that the bone destruction in otitis media with cholesteatoma may be attributed to IL-1 alpha in addition to PGE2.

Animals↗
PubMed1980

Bone destruction due to the rupture of a cholesteatoma sac: a pathogenesis of bone destruction in aural-cholesteatoma.

Severe bone destruction in a cholesteatoma is one of the characteristic clinical features. To clarify the mechanism of bone destruction in cholesteatoma, the matrix of cholesteatoma and the attached bone, obtained during middle ear surgery, was observed by light microscope. Rupture of the epithelial lining in a cholesteatoma and the escaping contents (keratin), which gave rise to intense characteristic granulations in subepithelial tissue, were found. Furthermore bone destruction was always found at the site of subepithelial tissue of cholesteatoma. From these facts, the escape of contents from the sac of cholesteatoma into the subepithelial layer is considered to be an important factor in the mechanism of bone destruction.

Bone Resorption↗
PubMed1982

Post-operative cholesteatomas and retraction pockets after obliterative surgery in ears without cholesteatoma.

The frequency of post-operative cholesteatomas, epidermizations and retraction pockets in a series of 343 chronically infected ears (315 patients) without cholesteatoma at primary surgery was evaluated. The ears were operated on radically, exclusively by the Palva method, with removal of the bridge in 248 ears and preservation of it in 95 ears. Musculo-periosteal obliteration and seclusion of the aditus were performed in every case with a Palva flap and with a temporalis muscle-fascia graft. The primary operations took place over the period 1964-1972, and all the ears without cholesteatoma at primary surgery were included; they were followed up annually. The evaluation of this material was carried out in 1976-1979 and the follow-up time was on an average of 8.5 years (5-15 years). Cholesteatoma was found in six (6/343; 1.7 per cent), epidermization of the tympanum in four (4/343; 1.2 per cent), and retraction pockets without cholesteatoma in six (6/343; 1.7 per cent) of the ears. Preservation or removal of the bridge at operation did not cause any significant difference in the frequency of the post-operative complications mentioned (p greater than 0.05). Most of the complications were discovered after the first postoperative year.

Adolescent↗
PubMed1995

Cytokeratin expression patterns by one- and two-dimensional electrophoresis in pars flaccida cholesteatoma and pars tensa cholesteatoma.

Expression patterns of cytokeratins (CKs) in normal skin, in pars flaccida type cholesteatoma (PFTC), and in pars tensa type cholesteatoma (PTTC) were examined by means of one- and two-dimensional electrophoretic techniques. Both CKs 14 and 5 pair (CKs 14/5) and CKs 10/1 were found in all materials. Neither CKs 16/6 nor 19 was found in the skin. CKs 16/6 and 19 were both found in 3 out of 5 PFTCs, only CKs 16/6 in 1 out of 5 and neither CKs 16/6 nor 19 in 1 out of 5. CKs 16/6 and 19 were both found in 1 out of 3 PTTCs, only CKs 16/6 in 1 out of 3 and neither CKs 16/6 nor 19 in 1 out of 3. There was no significant difference in the CKs expression patterns between PFTC and PTTC. The expression of CKs 16/6 and 19 suggested that their matrix epithelia were hyperproliferative. However, not all of the cholesteatomas were always hyperproliferative. Patterns of the terminal differentiation of CKs 1, 5, 10 and 14 in the PFTC or the PTTC were basically the same as those in the skin. In the cholesteatoma, eack CK gradually diminished in molecular weight in the cornified layer and debris. Desmosomal proteins were abundant in skin but not in cholesteatomas.

Adult↗
PubMed1998

Surgery for acquired cholesteatoma in children: long-term results and recurrence of cholesteatoma.

The aim of the study was to evaluate the long-term results after surgery for acquired cholesteatoma in children and to contribute to the search for predictors of recurrence. During a 15-year period, 114 children underwent surgery. The patients were re-evaluated with a median observation time of 5.8 years. At the last re-evaluation 85 per cent of the ears were dry with an intact drum. Recurrence of cholesteatoma developed in 27 ears. The cumulated total recurrence rate was 24 per cent using the incidence rate calculation, applying Kaplan-Meier survival analysis the corresponding recurrence was 33 per cent. Recurrent disease occurred significantly more frequently in children younger than eight years, with a negative pre-operative Valsalva, with ossicular resorption and with large cholesteatomas. In conclusion, young children with poor Eustachian tube function and a large cholesteatoma with erosion of the ossicular chain, are at special risk of recurrence and should be observed for several years after surgery.

Adolescent↗
PubMed1983

[Cholesteatoma formation in an ear fistula--model of the development of genuine cholesteatoma?].

A 20-year-old patient had developed a cholesteatoma in the depth of an ear fistula. Fistula and cholesteatoma had formed a canal in the mastoid bone running parallel to the outer ear canal and behind it, being of almost the same size. This canal ended in a "blind alley" merely fractions of a millimeter lateral of the attic without establishing contact to the middle ear. Histologically, ceruminal glands could be demonstrated in the tissue layer of the fistula. A possible interpretation is that this fistula represents remnants of a duplication of the outer ear canal. The development of "genuine" cholesteatomas out of cases similar to this one is discussed--when the cholesteatoma reaches the middle ear behind an intact drum.

Adult↗
PubMed1995

[Detection of DNA of human papillomaviruses (HPV) in an "aggressively" growing cholesteatoma. Is cholesteatoma a virus-induced tumor?].

It is yet unknown why under certain circumstances the benign epithelium covering the outer ear canal in a protective role causes an erosion of bony structures after migration into the middle ear. Histologically, a papillomatous growth and clusters of koilocytes are typical features of the aggressively growing, bone-destructive areas of the cholesteatoma. Since these resemble the characteristics of a papilloma, biopsies originating from cholesteatomas were examined for the presence of human papillomavirus (HPV) DNA. Findings demonstrated that HPV-11-related DNA was present in one such lesion. In general, papilloma viruses need specific conditions to be able to replicate and induce a papillomatous growth. Retraction pockets of epithelium, junction lines between squamous epithelium and mucosa as well as inflammatory processes may stimulate this replication. Because these conditions are characteristic for cholesteatoma, we therefore suggest a possible papillomavirus etiology for the development of aggressive cholesteatoma.

Biopsy↗
PubMed1987

Complicated cholesteatomas: CT findings in inner ear complications of middle ear cholesteatomas.

Patients with facial palsy and middle ear disease, which may be chronic but clinically occult, may have a cholesteatoma with extension medially along the facial canal. In two patients, axial computed tomographic (CT) scans demonstrated involvement of the medial petrous bone. Patients with vertigo and chronic middle ear disease may have a cholesteatoma with a "fistula" between the middle and inner ears. Although the fistula usually involves the lateral semicircular canal, the cholesteatoma may pass through the oval window. In two patients, coronal CT scans showed extension to the oval window in one and through it in the other.

Adult↗
PubMed1984

Biochemical study of cholesteatoma and cholesterol granuloma--occurrence of delta 7-cholestenol in the tissues of cholesteatoma.

Qualitative and quantitative analyses of sterol derivatives in the tissue of cholesteatoma and cholesterol granuloma were performed by gas-liquid chromatography, mass spectrometry and mass fragmentography after the extraction of total lipids with organic solvents. Cholesterol was the major component in both tissues. The molar ratios of cholesterol to lipid-bound phosphorus in cholesterol granulomas were higher than those in cholesteatomas. In addition, delta 7-cholestenol (lathosterol) was contained in all tissues of cholesteatoma examined. However, cholesterol granuloma tested did not contain delta 7-cholestenol, indicating that the metabolism of cholesterol differed from that in cholesterol granuloma.

Chemical Phenomena↗
PubMed1988

[Cholesteatoma of the facial sinuses. Apropos of an ethmoid-orbital cholesteatoma].

A case of cholesteatoma of the ethmoid extending to the orbit is reported. These cholesteatomas of facial sinuses are rarely reported, those documented involving localization in maxillary or frontal, or ethmoido-frontal or ethmoido-maxillary sinuses. Primary perisinusal cholesteatomas of embryonic origin must be distinguished from the rarer secondary iatrogenic or post-traumatic lesions. Histopathology allows distinction between epidermoid cysts and cholesterol type granulomas. Treatment is by surgery using a wide approach.

Aged↗
PubMed2003

Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity.

The post-operative outcome of hearing, the reconstructed external auditory canal, and the state of the reconstructed middle-ear cavity after canal wall down tympanoplasty with canal and attico-antrum reconstruction was studied in 103 ears with middle-ear cholesteatoma. The reconstructed mastoid cavity was re-aerated in 36.5 per cent of the cases, which was significantly lower than for the epitympanum (63.5 per cent) and tympanic cavity (82.4 per cent). Tympanoplasty was successful in terms of hearing results in 68.9 per cent of all subjects and in 75.4 per cent of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 per cent for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p<0.03) high incidence in ears with no re-aerated space in their reconstructed mastoid cavities. It was revealed that the post-operative outcome of this surgical technique was significantly related to the state of re-aeration of the reconstructed middle-ear cavity.

Adolescent↗