ABSTRACT
OBJECTIVE: The purpose of this study is to introduce and define a disease entity on a continuum of eosinophilic otitis media: eosinophilic mucin otomastoiditis and otopolyposis. METHODS: A case of a 66-year-old woman with complicated chronic otitis media is reported. A literature review of the National Library of Medicine's online database, with a focus on eosinophilic otitis media and eosinophilic mucin rhinosinusitis, was performed. RESULTS: The authors report the case of a 66-year-old woman with a history of asthma, chronic rhinosinusitis, nasal polyposis, and chronic otitis media who presented with allergic middle ear mucin and otic polyps. Treatment involved a tympanomastoidectomy with removal of otic polyps and steroid therapy. CONCLUSION: Eosinophilic mucin otomastoiditis with otopolyposis is a disease entity on a continuum of eosinophilic otitis media. This disease process shares similarities with eosinophilic mucin rhinosinusitis. Otic polypectomy and steroids are suggested therapeutic measures.
Subject(s)
Ear, Middle , Eosinophilia/diagnosis , Mastoiditis , Mucins/metabolism , Otitis Media , Otologic Surgical Procedures/methods , Polyps , Prednisone/administration & dosage , Aged , Asthma/complications , Chronic Disease , Ear, Middle/metabolism , Ear, Middle/pathology , Ear, Middle/surgery , Female , Glucocorticoids/administration & dosage , Humans , Mastoiditis/diagnosis , Mastoiditis/etiology , Mastoiditis/metabolism , Mastoiditis/physiopathology , Mastoiditis/therapy , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/physiopathology , Polyps/diagnosis , Polyps/surgery , Sinusitis/complications , Treatment OutcomeABSTRACT
OBJECTIVES/HYPOTHESIS: Melanin is a pigmented polymer with a known role in dermal solar protection. In vertebrates, melanogenesis has been reported in leukocyte populations, suggesting a potential role in innate immunity. In this study, we report the novel finding of melanin associated with chronic inflammation and speculate on its potential role in the middle ear and mastoid. STUDY DESIGN: Retrospective review of case series. METHODS: Medical records of six patients who demonstrated melanin in the ear were reviewed. RESULTS: Six patients from 1 to 63 years of age were identified with extracellular melanin and melanin-laden histiocytes within the middle ear and/or mastoid air cells at time of surgery. Concurrent intraoperative findings included cholesteatoma (n = 3), chronic suppurative otitis media (n = 2), and coalescent mastoiditis (n = 1). Histologically, extracellular melanin and melanin-laden histiocytes were identified by Fontana-Masson stain; absence of melanocytes was confirmed by the absence of Melan-A staining. One patient had a positive stain for CD163 (a marker for macrophages). CONCLUSION: This case series is the first demonstration of melanin within middle ear mucosa without melanocytes in immediate proximity or metastatic melanocytic lesions. Melanin's presence in the setting of inflammation suggests that there may be a heretofore unreported link between the pigmentary and immune systems in the middle ear. LEVEL OF EVIDENCE: 4.
Subject(s)
Cholesteatoma, Middle Ear/metabolism , Extracellular Fluid/metabolism , Histiocytes/metabolism , Inflammation Mediators/metabolism , Intracellular Fluid/metabolism , Melanins/metabolism , Adolescent , Adult , Biopsy, Needle , Child , Child, Preschool , Cholesteatoma, Middle Ear/pathology , Cholesteatoma, Middle Ear/surgery , Cohort Studies , Female , Histiocytes/pathology , Humans , Immunohistochemistry , Infant , Male , Mastoiditis/metabolism , Mastoiditis/pathology , Mastoiditis/surgery , Melanins/analysis , Middle Aged , Otitis Media/metabolism , Otitis Media/pathology , Otitis Media/surgery , Retrospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
OBJECTIVES: The objectives were to detect and compare the expression of toll-like receptors (TLRs) 2, 4 and nuclear factor kappa B in mucosal lesions of chronic otitis. METHODS: Fifty-five tissue samples obtained from children and adults operated on for otitis were investigated by semiquantitative immunohistochemical methods using polyclonal antibodies for TLR 2, 4 and NFkappaB. Kruskal-Wallis, Mann-Whitney, and Kendall's tau rank correlation tests were used. RESULTS: Stronger expression of TLR2, 4 was found in inflamed mucosa than in the control for children and adults (TLR2: H = 23.86, P < .0011; TLR4: H = 22.80, P < .00 1) (TLR2: H = 17.53, P < .001; TLR4: H = 11.99, P < .001); in cholesteatoma perimatrix compared to tubotympanic lesions in children (TLR2: H = 11.06, P = .004; TLR4: H = 10.61, P = .005) and adults (TLR2: H = 10.73, P = .013; TLR4: H = 9.65, P = .021). No differences were found in NFkB expression (H = 0.042, P = .99). Significant correlations were found for all pairs of molecules in cholesteatoma and tubotympanic mucosa of adults (TLR2, 4: P = .002, P < .001; TLR2-NfkappaB: P = .032, P = .021; TLR4-NFkB: P = .035, P = .0013), only TLR4-NFkappaB in tubotympanic otitis of children (P = .026). CONCLUSIONS: Toll-like receptors 2,4 and NFkB mediate inflammation in cholesteatoma and mucosal lesions oftubotympanic otitis in children and adults. Significant correlations betweenall pairs of molecules in all samples were detected in adults, but only TLR4-NFkappaB in children.
