The mechanism of the epithelial hyperplasia has not clearly been investigated.In order to examine the relation between the mitotic activity of cholesteatoma epithelium and inflammation, we investigated the mitotic activity of cholesteatoma epithelium with and without otorrhea within 1 month before operation using proliferating cell nuclear antigen (PCNA) as theproliferating index. Furthermore inflammatory cell density in the underlying granulation were determined by observing hematoxiline and eosin (HE) stained section, and the relation between inflammatory cell density and the mitotic activity of cholesteatoma were investigated.Twenty specimens were obtained from patients during operation.Each ten of twenty specimenswas taken from patients with or without otorrhea within 1 month before operation.Five other specimens were taken from external auditory canal skin as control.Sections were stained with HE and immunohistochemicaly with PCNA antibody.The Labeling Index (LI) was determined by counting the number of PCNA-positive epithelial cells per 1000 epithelial cells as the mitotic activity of epithelium.LI of cholesteatoma epithelium with and without otorrhea were investigated, and compared with LI of the external auditory canal skin as control. Furthermore inflammatory cell density of all specimens was divided into 4 groups (slight, mild, moderate, severe) by observing the HE stained sections, and LI of each 4 groups was calculated.LI of cholesteatoma with otorrhea (6.62±1.72) was significantly higher than that of the external auditory canal (4.12±1.72) and cholesteatoma without otorrhea (2.46±1.12).LI of cholesteatoma without otorrhea was significantly lower than that of the external auditory canal skin.LI of severe group (7.87±5.15) was significantly higher thanthat of mild group (2.45±0.06) and slight group (2.50±1.59).LI of moderate group (6.48±2.24) was significantly higher than that of mild and slight groups.From our study, it is considered that the increasing mitotic activity of cholesteatoma epithelium maydepend upon inflammation, and cholesteatoma epithelium itself has low mitotic activity.
This investigation was conducted by a questionnaire that was administered to the parents of children suspected of hearing impairment and received hearing tests. A total of 31 completed and valid questionnaires were returned.The questions were about the background of the detection of their children's hearing loss, the otorhinolaryngologists' support at the result of their children's audiometry test and the information they received. Sixteen children were found having hearing loss as their parents suspected. Eleven cases had satisfaction of the otorhinolaryngologist's support, but Thirteen cases were dissatisfied. Twenty six cases obtained some information about the deafness or training method of hearing-impaired children from webpages or acquaintances.The results suggested that the support and the precise information from otorhinolaryngologists are needed to the patients' parents.
It is controversial whether preoperative or postoperative bone conduction thresholds should be utilized in calculating postoperative air-bone gap for evaluation of ossiculoplasty results. In 1995, committee on Hearing and Equilibrium Guidelines (American Academy of Otolaryngology-Head and Neck Surgery) recommended reporting the air-bone gap by using air-and bone-conduction values determined at the same time, rather than comparing postoperative air-conduction thresholds with the preoperative bone-conduction thresholds. Whereas a Guideline in Reporting Hearing Results in Middle Ear and Mastoid Surgery (Otological Society of Japan) defined to utilize preoperative bone conduction thresholds in calculating postoperative airbone gap in 2000. We compared the results of postoperative air-bone gap with pre- andpost-operative bone conduction thresholds in 121 ossiculoplasty cases to elucidate which value is suitable for evaluation of postoperative airbone gap.Audiometric evaluation was based on pure tone audiograms, taken before and 6 months after surgery, and the mean hearing levels at three speech frequencies were utilized for calculation. Cases with postoperativeair-bone closure less than 15dB were 64 ears (52.9%) when utilizing pre-operative bone conduction thresholds, whereas they were 62 ears (51.2%) when utilizig post-operative ones.In thesetwo groups, incidence of overclosure showing negative value was significantly higher in thecases calculated by pre-operative bone conduction threshold (34.4%) than in those by post-operative ones (6.5%)(Fisher's exact probability test; p=.0003).In addition, comparing the change of bone conduction values after surgery in these two groups, it was significantly better in the former with a mean of 8dB improvement (paired t-test;p<.0001) while it was not significant in the latter with a mean of 2.8dB improvement.On the other hand, cases showing deterioration of postoperative bone conduction thresholds more than 10dB were 1 ear (1.6%) in the former while 5 ears (8.1%) in the latter: no significant difference was noted between these two groups, indicating incidence of underestimation of air-bone gap due to worsening ofpostoperative bone conduction is not so different between two groups. Cases which met any of the three criteria for success defined by a Guideline in Reporting Hearing Results in Middle Ear and Mastoid Surgery (2000) i.e.hearing gain of more than 15dB, postoperative hearing level within 30dB, and postoperative air-bone gap less than 15dB were 79 ears when utilizing pre-operative bone conduction thresholds, whereas they were 82 ears when utilizing post-operative ones, being no significant difference in success rate between two groups. These results indicated that postoperative air-bone gap calculated by pre-operative bone conduction thresholds is apparently overestimated due to improvement of bone conduction after surgery in successful cases although overall hearing results were almost the same in comparison betweencalculation by pre-and post-operative bone conduction thresholds. Thus, post-operative air-bone gap should be calculated utilizing values examined at the same time i.e. postoperative air-and bone-conduction values as recommendation of Committee on Hearing and Equilibrium Guidelines in American Academy of Otolaryngology-Head and Neck Surgery.
Three cases of bilateral congenital conductive deafness were reported. They had never received otological and audiological treatments such as surgery and wearing a hearing aid til ages of 6-years, 7-years and 12-years, respectively. We performed an operation of hearing improvement and enforced intelligence test (WISC-R) for the evaluation of language development before and after the operation in each case. A certain improvement of the score of WISC-R was noted for one case, but the rest of two cases did not reveal any improvement. It is suggested that delayed discovery of hearing loss, even if conductive deafness, lead to the significant influence to language development.
We investigated the clinical symptoms, examinations and surgical results in 9 patients with perilymph fistula. The inducing factor of perilymph fistula such as diving was found in only one patient, while, the other patients had no inducing factors. Hearing loss was themost common symptom, which occured suddenly in most patients. There was no characteristic tinnitus, such as pop sound and tinnitus expressed as a stream in our patients. Audiogram showed profound deafness in most of patients and configuration of audiogram varied. Positional nystagmus was observed in 4 patients. Fistula sign was not observed in two patients examined. Progressive hearing loss was observed in 6 patients and head floating sensation was remaining in all cases. Hearing was improved in 5cases (55.6% as success rate of tympanoplasty) postoperatively, but evident improvement was observed in only 2 patients according to the criteria of sudden deafness. Head floating sensation was immediately disappeared in all cases postoperatively. We concluded suggestion of perilymph fistula for the patients with sudden hearing loss and early exploratory tympanotomy was necessary.
The otoscope examination of the ear is often difficult in cases of Down's syndrome, although they are often associated with hearing loss and otitis media. We present temporal bone histopathologic findings of the external auditory meatus and middle ear in a new born caseof Down's syndrome. The external auditory meatus was narrow forming the very sharp angle with tympanic membrane and mesenchyme tissue remained in the middle ear, which suggested difficulty of otoscope examination of the ear. Audiogram, in clinical settings CT scan of the temporal bone and other examinations were considered to be necessary for the accurate diagnosis and adequate treatment of the ears in the case of Down's syndrome.
Wegener's Granulomatosis (WG) is a rare form of systemic necrotizing vasculitis characterized by inflammation of the walls of the blood vessels and affects the upper and lower respiratory tracts and kidneys. The nose and paranasal sinuses are often the first or main sites to be affected. Otologic symptoms as a complication of Wegener's granulomatosis (WG) isrelatively rare. The authors report a 50-year-old femal suffering from bilateral hearing loss. She had been diagnosed as having otitis media with effusion, and received medical treatment, but the symptoms and signs failed to respond the treatment. She had no other sitesof involvement, such as the nose, paranasal sinus, pharynx, and larynx. Audiometry showed bilateral mixed hearing impairment with a loss of 100 dB. The histological findings of theswollen and eczematous right external auditory canal revealed granulomatous inflammation accompanied by epithelioid cell aggregation around capillaries. Chest X-ray showed a small nodule in the right lower lung field and TBLB revealed leukocytoclastic vasculitis of capillary vessels. Laboratory studies revealed positive CRP and RA. Anti-neutrophil cytoplasmic autoantibody (cANCA) was negative. Thus, the diagnosis of a localized form of Wegener's granulomatosis was made. She was given prednisolone 60mg/day, cyclophosphamide 75mg/day and sulfamethoxazole trimethoprim 960mg/day, which greatly improved mixed hearing loss to 20-30 dB bilaterally. The patient had no complications' during the treatment and showed good recovery.
Fibrous dysplasia involving the temporal bone is unusual. Surgery may be necessary for restoration of conductive hearing loss and prevention of complications from occult cholesteatoma. Meatoplasty has often been selected as surgical treatment, and the postoperative restenosis of external auditory canal (EAC) was found in most cases requiring management to prevent restenosis of EAC. The patient was a 36-year-old woman, who complained of hearing loss in the left ear because of stenosis of the left EAC. To enlarge the EAC, normal bone chips and bone paste on the healthy side were used for meatoplasty. The EAC was patent and hearing was improved 14 months later. Use of normal bone chips and bone paste was effective in preventing stenosis of the EAC in a case of fibrous dysplasia of the temporal bone.