ABSTRACT
BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a rare entity that may go undiagnosed for years. Aims of this study were to assess the characteristic features and recurrence of CMEC in pediatric patients of different stages and to determine the value of preoperative CT scan in CMEC. SUBJECTS AND METHOD: Thirty cases of CMEC under 15 years old that had been treated at the hospitals of the Catholic University from 1995 through 2005 were reviewed retrospectively. The age range was from 2 to 13 with the mean age of 6.2. The main outcome measures were CT findings, surgical findings, recurrence rate and hearing assessment. RESULTS: Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 25/30 (83.3%). The recurrence rate of CMEC was 6.7% (2/30) and all of recurrent cases were belonged to stage IV. In the recurrent cases, cholesteatomas were extended to sinus tympani and facial recess at revisional operation as well as at the initial operation. CONCLUSION: Preoperative CT scan is essential in defining the extent of existing pathology. The intra-operative CMEC extension and location influence the outcome of surgery. In the higher stages, careful eradication of disease, particularly in the region of sinus tympani and facial recess, are recommended.
Subject(s)
Adolescent , Child , Humans , Cholesteatoma , Cholesteatoma, Middle Ear , CME-Carbodiimide , Ear, Middle , Hearing , Outcome Assessment, Health Care , Pathology , Recurrence , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a keratinous mass behind an intact tympanic membrane. CMEC does not have a history of instrumentation and is less common than acquired one. Many theories have been put forward to explain the pathophysiology of CMEC, however, none of these so far have been convincingly proven. This clinical study was performed to investigate the characteristic features of CMEC and to evaluate the correlation between pathophysiology and CMEC by retrospectivly reviewing the cases. MATERIALS AND METHOD: The medical records of patients who underwent otologic procedures at the hospitals of the Catholic university from January 1993 to September 1998 have been reviewed. They were ten males and four females, ranging in age from 4 to 59 (mean age 18). RESULTS: Three of the 14 patients had the lesions isolated to the anterosuperior quadrant of the mesotympanum which were cystic, easily removed and did not affect hearing. The others had more serious condition with extension into the posterior mesotympanum, which were large, often too extensive to indicate a formative site, and causing ossicular damage. CONCLUSION: CMEC presents in two distinctive forms according to the site of formation: the anterosuperior and posterior mesotympanum. The review suggest that the pathophysiology of posterior lesions may be different from anterior ones. For early diagnosis of CMEC, screening program should be carried out in children to prevent the more extensive diseases.
Subject(s)
Child , Female , Humans , Male , Cholesteatoma, Middle Ear , CME-Carbodiimide , Ear, Middle , Early Diagnosis , Hearing , Mass Screening , Medical Records , Tympanic MembraneABSTRACT
La interacción de complejos inmunes (CI) con receptores para el fragmento Fc de IgG (RFcgama) expresados en leucocitos pone en marcha mecanismos efectores y regulatorios de suma relevancia en el curso de la respuesta inmune. En trabajos anteriores, empleando la citotoxicidad celular dependiente de anticuerpos (ADCC) como expresión funcional de los RFcy, hemos demostrado que las células monocucleares periféricas humanas (CMPH), previamente bloqueadas en CI, recuperan la capacidad de mediar la ADCC a través de la activación de la vía alternativa del complemento (VAC). El objetivo de este trabajo fue analizar los mecanismos de recuperación funcional de los RFcgama cuando éstos han sido bloqueados por CI no fijadores de complemento (C). A tal fin, la IgG usada para preparar los CI se trató con carbodiimida (CDI), procedimiento que modifica su capacidad para fijar C, sin alterar mayormente su sitio de combinación con el antígeno, ni su habilidad para unirse a los RFcgama. Los resultados obtenidos demostraron que el C sólo es eficiente para revertir el bloqueo de la ADCC por CI, cuando éstos son capaces de fijar C