Age-related changes of the cochlear lateral wall [stria vascularis] in the guinea pigs: an ultrastructural study

It is current opinion that the morphological changes in the stria vascularis and acquired hearing impairment appear to be the most prominent anatomic characteristic of aged human cochlea. The stria vascularis generates positive endocochlear potential and secretes endolymph which contains high concentration of potassium. Both of them are essential for normal sound transduction carried out by hair cells. Is to compare between the structure of stria vascularis in adult and senile guinea pigs, in an attempt to explain impairment of transduction of sound in old age [presbyacusis]. Cochleae of guinea pigs were extracted and processed to semithin and ultrathin sections, stained, examined and photographed. The senile stria vascularis showed herniations or protrusions from the luminal surface with blebs formation. Some marginal cells were vacuolated with pyknotic nuclei. The majority of mitochondria appeared fragmented, or swollen with disrupted cristae. However, the tight junctions between these cells were preserved. The most apparent ultrastructure alteration with age was loss of basolateral infolding with reduction of interdigitation between the marginal and intermediate cells. Dramatic decrease of the amount of melanin pigments with abundant myelin like figure was clearly noticed. The basal lamina of the strial blood capillaries was thickened and folded in some areas. The endothelial cells remained intact; however pericytes were not observed. The present findings proved that there were marked structural changes in the stria vascularis of senile guinea pigs, suggesting that these might be one of the causes of acquired hearing impairment in old age

Korner's septum; clinical, radiological and cadaveric studies

To describe the anatomy of the Korner's septum [KS] or petrosquamosal suture [PSS], its incidence, variations in normal and inflamed middle ears, and to evaluate its clinical importance. Review of 100 CT scans temporal bones were done to determine the degree of visualization of Korner's septum [KS]. Cadaveric dissection of 100 temporal bones were done in temporal bone dissection laboratory of Ain Shams University Specialzied hospital in addition to 100 mastoidectomies performed in the ENT inpatient department. KS or PSS is not only a bony plate dividing the mastoid cells at the level of the antrum, but is also a lamina starting from the posterior aspect of the glenoid fossa that extends above the middle ear cavity and courses inferiorly lateral to facial canal and proceeds to mastoid apex. Korner's septum was seen radiologically in 26% of CT scans of temporal bones, and in 25% of temporal bone specimens. Clinically "KS" was seen in [29%] of cases with COM and in [24%] in cases without COM with a total incidence of [28%]. Frequently there was a hidden cholesteatoma or cholesterol graunloma behind the septum. Rarely the cog [anterior part of the septum] may extend to fix the ossicels. KS is an imporatn anatomic observation in patients with chronic otitis media, it may contribute to middle ear infection and it may hide cholesteatoma or cholesterol granunloma behind it which may be missed if superficial compartment was sclerosed

Ciliary dyskinesia in severe chronic rhinosinuitis patients and using a modified fess approach for management

Defective ciliary ultrastructure and impaired mucociliary clearance play an important role in the development of severe or refractory chronic respiratory tract disease which is still a challenging problem. The aim of this study was to define the role of ciliary dyskinesia in severe chronic rhinosinusitis. Also, the validity of a modified functional endoscopic sinus surgery [FESS] for treating such patients is evaluated in this study. Fifteen patients [8 males and 7 females with a mean age = 17.2 years] with severe chronic rhinosinusitis [i.e., refractory to medical treatment] with suspected ciliary dyskinesia [i.e., with prolonged saccharin test more than 45 minutes] were included in this study. All patients had a preoperative computerized tomographic [CT] sean documentation of their severe multiple sinus disease. They were treated with a modified FESS under general anaesthesia during which nasal biopsies from the middle turbinate were taken for evaluation by transmission electron microscopy [TEM] to detect ultrastuctural abnormalities. Also, two nasal biopsies from normal volunteers were taken as controls. The patients were followed up postoperatively for a period of 9 to 18 months [average 12 months] both clinically [by nasal endoscope] and radiologically [by coronal CT scan] with special emphasis on patency of middle meatal antrostomy [MMA]. Transmission electron microscopic [TEM] study of nasal epithelium of control subjects revealed normal ciliated pseudostratified columnar epithelium. While in the study group, ciliated cells were detected in 11 [73%] biopsies with 4[27%] cases having no cilia. However, foci of normal ciliated epithelium were found in only 7 [47%] biopsies and often in epithelial invaginations. Six patients [40%] in the study group had shown rimary Ciliary dyskinesia [PCD]. Nine [60%] of study group patients showed Secondary Ciliary dyskinesia [SCD] with variable ultratructural defects affecting minor population of cilia in the specimen [5 secimens or 33%], or with squamous metaplsia or denuded surface with complete loss of cilia [4 specimens or 27%]. All biopsies showed variable loss of differentiated epithelial cells ranging from denuded epithelim to basal cell hyperplasia often associated with squamous metaplasia secondary to chronic sinonasal disease. This study demonstrated that patients with severe or refractory chronic rhinosinusitis exhibit a prominent loss of differentiated epithelial cells, as well as ciliary defects, most of which are likely to be secondary to the chronic disease process. The modified FESS used in this study was highly effective in treating patients with severe or refractory chronic rhinosinusitis with ciliary dyskinesias [either primary or secondary] with patent MMA and relief of their severe manifestations as it improves the gravitational drainage and aireation of the paranasal sinuses besides respecting the mucociliaray clearance concepts

range of morphological variation of the middle meatus of the nose in cases without clinical sinusitis

Twenty cadaveric head regions were sagitally sectioned and examined for the anatomy of the middle meatus region. Serial coronal CT section [1-3 mm] of fifty persons were done. Twenty five of tehm belong to patients suffering from chronic sinusitis, and the other twenty five of sinusitis-free persons. Selected measures were applied on both cadaveric speciments and coronal CT scans. The results of the present study showed a wide range of anatomical cariations in this region, even in the sinusitis-free. Certain anatomical structures showed marked discrepancy in frequency of variations or its dimensions in patient suffering from chronic sinusitis in relation to sinusitis-free persons. The most important variation in the middle turbinate was the concha bullosa which was present in 28% of sinusitis-free bit it was found in 52% of sinusitis patients. Also, the curvature of the middle turbinate was abnormal in 20% sinusitis patient while no cases of abnormal curvature were recorded in sinusitis-free persons. The distance between the middle turbinate and the bulla ethmoidalis was wider in sinusitis-free persons as it was of mean value 1.9 mm than in sinusitis patients which was of mean value 1.7 mm. As regards the uncinate process, it showed abnormal deflections in 28% of sinusitis-free persons and in 60% of sinusitis patients. Concerning the hiatus semilunaris and the infundibulum, it was found that in sinusitis-free persons the hiatus semilunaris was more wide as it was of mean value 2.7 mm while in sinusitis patients the mean width was 1.4 mm. The infundibulum depth was more shallow in sinusitis-free persons as its mean depth was 5.6 mm, while in sinusitis patients, the mean depth was 6.6 mm. Concerning the bulla ethmoidalis size, it was larger in sinusitis patients as it was of mean value 17 x 7 mm while in sinusitis-free persons, it was of mean value 14 x 6 mm. Haller's cells were detected in 28% of sinusitis-free persons and in 60% of sinusitis patients. As regards the maxillary sinus ostium, it was found that its transverse diameter was of mean value 6 mm in sinusitis-free persons while it was 3.5 mm in patients of sinusitis. Scanning of the anatomical variations and measures in cadavers and sinusitis-free persons could act as an accurate Egyptian guide serving surgical procedures. The higher incidence of variations in certain parts and discrepancy in dimensions of other parts between the sinusitis and non-sinusitis cases may support the theory that emphasizes the role of anatomical variations in the aetiology of chronic sinusitis and consequently may help to settle the controversy around this point

Resistant and recurrent bacterial diffuse otitis externa causes and management

Diffuse bacterial otitis externa is a common ear disease. Sometimes the condition resists the conventional treatment of antibiotic ear drops or recurs after primary improvement. This prospective study was done on 120 patients with resistant or recurrent otitis externa to investigate the causative organisms, causes of resistance or recurrence and how to manage this problem. The most frequently isolated organisms were staphylococci [40% of cases], pseudomonas aeruginosa [20%] and fungi [40%]. Failure of response to the current treatment was attributed to development of resistant organisms or skin hypersensitivity to the used drugs, and the presence of underlying chronic otitis media or resistant fungal infection and the inadequacy of otic drops as a medical treatment. These cases were successfully managed by filling the external meatus with an ointment containing broad spectrum antibiotic, antifungal and steroid, using special home made applicator. The used antibiotics were chosen according to the culture and sensitivity testing for the different bacterial isolates. Recurrence was avoided by the prolonged use of the proper antibiotic ear drops for 2-3 months