Cholesteatoma: a morphologic study of stratum corneum lipids.

Two different lipid-retaining fixation techniques permitted electron microscopic visualization of both intra- and extracellular lipids in cholesteatoma epithelium obtained from 25 patients. An increased number of intracellular lipid-containing Odland bodies was demonstrated, with a maximum in the basal layer of the stratum granulosum, while the superior layer contained substantially fewer organelles than are found in normal skin. At the stratum granulosum/stratum corneum interface lipids secreted from Odland bodies were found in sac-like invaginations along the cell membrane but premature exocytosis was also frequently observed. In the intercellular spaces of the stratum corneum, multiple long sheets of lamellar structures interrupted by slits or pores enclosed the keratinized corneocytes. The intercellular spaces seemed narrow and an extracellular barrier was not found until well above the stratum granulosum/stratum corneum interface. A similar distribution of Odland bodies and structure of intercellular lipids can occur in several dermatoses, where the formation and maintenance of the cutaneous permeability barrier are defective.

Sino-nasal cancer in Denmark 1982-1991--a nationwide survey.

Cancer of the nasal cavity and paranasal sinuses is a rare disease. The many different histologies and sites make the management of this disease a challenge. The current report from the Danish Society for Head and Neck Oncology comprises a joint analysis of five retrospective series covering the entire country, with 315 patients seen in the 10-year period from 1 January 1982 to 31 December 1991. Tumour sites were nasal cavity (n = 156), maxillary sinus (n = 139), ethmoid sinus (n = 14), sphenoid sinus (n = 5) and frontal sinus (one case). The most common histologies included squamous cell carcinoma (126 cases), adenocarcinoma (41 cases), malignant melanoma (38 cases) and malignant lymphoma (34 cases). A total of 284 patients (90%) received treatment with curative intent; most of these patients were treated with radiotherapy, either alone (120 patients) or in combination with surgery (111 patients). There was no significant difference between the five centres in disease specific survival and overall survival. The results showed that histology, localization and nodal involvement were significant prognostic factors for locoregional control and survival. Patients with squamous cell carcinoma had a significantly poorer prognosis compared with patients with adenocarcinoma. However, a Cox multivariate analysis revealed that this was likely the result of tumour localization, as most adenocarcinomas were in the nasal cavity. The experience from this data collection has inspired the Danish Society for Head and Neck Oncology to arrange common data registration of several other clinical head and neck series. In the future, the Society plans to expand this activity further.

Stratum corneum barrier lipids in cholesteatoma.

Specimens from primary cholesteatomas were examined under the electron microscope using a lipid-retaining method that is best suited for intracellular lipids and a method that is best for intercellular lipids. In the stratum granulosum of the squamous epithelium, a large number of Odland bodies emerged. When the corneocyte reaches the transitional stage to the stratum corneum, the Odland bodies accumulate near the cell membrane and discharge their contents of lipid and enzymes. The lipids are reorganized into multiple long sheets of lamellar structures that embrace the keratinized corneocytes, as seen in the formation and maintenance of the cutaneous permeability barrier. In this study we draw the attention to the facts that the cholesteatoma epithelium is capable of producing not only cholesterol, but also several lipids, and that the lipid molecules are organized in multilamellar structures in the intercellular space. In theory, the failure to desquamate seen in cholesteatomas could be caused by partial or total failure of Odland body delivery to the intercellular region, or to local breakdown of the permeability barrier.

Cancer of the nasal cavity and paranasal sinuses: a series of 115 patients.

A total of 115 patients with sinonasal cancer was assessed during the period 1978-1995. Ninety-one patients received treatment with curative intent. A combination of irradiation and operation was used. The 5-year crude survival for patients, who were treated with curative intent, was 41%; the disease-specific survival throughout the period was 48%. Primary irradiation followed by maxillectomy was widely used in the first half of the period. Treatment in the last part was changed to primary lateral rhinotomy with post-operative irradiation whenever possible. Twelve maxillectomies were performed during the first half of the period, and during the last part, only two. Disease-specific survival was equal in the first and the second halves of the period.

Immediate obturation of the surgical defect after partial maxillectomy in the endentulous patient.

Closure of the surgical defect immediately after partial maxillectomy is the treatment of choice. The advantages are: maintaining facial contour, rapid re-establishment of speech, swallowing and mastication. A number of methods for the fixation of the immediate obturator in patients without teeth have been described. A new technique is reported where a transnasal wire holds the existing denture in position after partial maxillectomy. The method has been carried out on 7 patients with sino-nasal cancer during the period 1978-1994. The advantages of the technique are that the wire acts as an axis of rotation which together with the sponge in the cavity provide good stability of the denture. There is minimal preoperative laboratory work and simplification in replacing the surgical dressing.

Effect of surface-active substance on nasal mucociliary clearance time: a comparison of saccharin clearance time before and after the use of surface-active substance.

Mucociliary clearance measured by saccharin clearance time is depending on ciliary function and on the physiological characteristics of mucus. The aim of this study was to determine whether the application of surface-active substances changed the mucociliary transport time. Twenty healthy persons were manually sprayed with surface-active substance in one of their nose cavities. The saccharin clearance time was measured before spraying and statistically compared with saccharin clearance time after spraying. Saccharin clearance time was significantly shortened immediately after spraying with surface-active substances. This difference was not found 2 h later. Our assay indicates that surfactant increases the rate of mucociliary transport in the upper respiratory tract.

Surfactant-like lamellar bodies in the mucosa of the human nose.

Specimens from the epithelium on the lateral wall of the human nose were examined under the electron microscope using a lipid and carbohydrate retaining method. In many of the ciliated epithelial cells and in some of the cells in the mucosal glands we identified multilamellated granules. These structures resembled lamellar bodies as found in normal alveoles where they are known to represent surfactant. The effect of phospholipid and the upper respiratory system is unknown but the similarities of these granules suggest to us a surface active function as it seems to play a role for normal Eustachian tube function.

Effect of crossed stapedius reflex on vibration of mallear handle in man.

The ear drum was made to vibrate using frequency-modulated sound pulses of 40 ms duration, and the vibration velocity of the tip of the mallear handle (umbo) was measured with laser vibrometry before and during stapedius muscle contractions (elicited by sound of 100 dB HL in the contralateral ear). The stapedius reflex caused: an attenuation of the mallear vibrations below 1 kHz, a slight enhancement of the vibrations between 300 Hz and 1,500 Hz. These effects of the stapedius reflex appear to be caused by an increased stiffness in the structures affecting the mallear vibrations.

Secretory otitis media--a question of surface activity in the eustachian tube?

An improved thin-layer chromatographic assay for monitoring phospholipid ratio in mucus was used to study the respiratory system distribution of children with and without secretory otitis media. Phosphatidylcholine, phosphatidylethanolamine and sphingomyelin abound, while only traces of other phospholipids are found. Analyses show more sphingomyelin and less phosphatidylcholine in the Eustachian tube and nose than in the lung, while phosphatidylethanolamine has about the same distribution. The phosphatidylcholine/sphingomyelin ratio is significantly less in Eustachian tube mucus from children with secretory otitis media compared with otologically healthy children, which indicates a different secretory pattern of the cells in the Eustachian tube of these children. The distribution of phospholipids in middle ear secretion is different from the distribution obtained from the Eustachian tube in children with secretory otitis media thus verifying a clearance 'blocking' of the tube caused by the disease.

Sympathetic influence on the normal Eustachian tube. An experimental study in the rat.

A new variant of the inflation test of the Eustachian tube is presented; a constant air flow generator was constructed with minimal sensitivity to counterpressure, and variations in air pressure were measured, reflecting variations in Eustachian tube patency. By means of this test the effect of Otrivin (alpha 2-receptor stimulation) and Timacar (beta-receptor blocking) on the Eustachian tube was investigated with saline serving as reference. The following results were obtained: Otrivin lowers the opening pressure and the steady state pressure, and reduces the pressure drop during active opening. Timacar alone has no statistically significant effect on the Eustachian tube, but the combined effect of the two drugs is a more pronounced decrease in steady state pressure than the decrease seen following alpha 2-adrenergic stimulation alone. An explanation could be an alpha 2-receptor modulation by the beta-blocking agent. Consequently, autonomous regulation should be further studied in the search for a better understanding of Eustachian tube physiology.

Sequelae of ventilation tubes following tonsillectomy.

The insertion of middle ear ventilation tubes results in persistent scarring in a significant number of the tympanic membranes incised. The present study was done in order to compare the occurrences of tympanic membrane sequelae following ventilation tube insertions in a group of patients with intact tonsils with that of a tonsillectomized group. The study population had been treated with ventilation tubes 3-5 years previously because of middle ear effusions. A total of 104 patients were re-examined (follow-up rate, 85%). Otomicroscopy was performed by examiners who had no prior knowledge of the patient's past history of ear disease or treatment. The results were categorized by a simplified scoring system. It was found that 60% of the tympanic membranes showed pars tensa abnormalities outside the previous site of the tube. The occurrence of pars tensa tympanosclerosis was more prevalent in tonsillectomized patients. This latter observation is probably a secondary occurrence. However, the high incidence of sequelae following insertions of ventilation tubes calls for their restricted usage.

ABR in patients with congenital/early acquired sensorineural hearing loss, abnormal stapedius reflex thresholds and speech retardation.

The auditory brain stem response (ABR) was recorded in 14 young subjects with mild to moderately severe congenital/early acquired sensorineural hearing loss and abnormal stapedius reflex thresholds. The speech problems of these patients as evaluated by experienced examiners were considered to be more pronounced than could be explained from the hearing loss as measured by the pure tone audiometry. Psychological testing yielded intelligence scores within normal limits or above average for age in 11. They all gave abnormal ABR, indicating dysfunction of the auditory brain stem pathways or, in a few cases, of the cochlear part of the auditory nerve. Presumably, the electrophysiologically demonstrable pathological changes were caused by perinatal complications or early life infectious disease. ABR may prove valuable in the evaluation of children with speech retardation.