Spontaneous External Auditory Canal Cholesteatoma: Case Series and Review of Literature.

External auditory canal cholesteatoma is a rare disease. Main symptoms of this entity are ear discharge and dull chronic ear pain and significant findings are bony erosion of the external canal with keratin debris accumulation. Inadequate diagnosis and delay in the treatment of this condition can leads to serious complications. We are presenting our experience of eight patients of spontaneous EACC treated by surgical management. As the spontaneous EACC is a rare condition, the aim of the study is to share the experience of diagnosis and management of spontaneous EACC.

Schwannoma of the cheek.

Sehwannomas are tumors arising from nerve sheaths. In Ute Head- Neck region, they are commonly encountered in the parapharyngeal space. Occasionally they also occur in other less common sites.

Facial nerve schwannoma.

An uncommon case of bilobed facial nerve schwannoma and its management is presented.

Plester's Angled Prosthesis for Ossicular Chain Reconstruction.

Reconstruction of a defect of the long process of the incus by means of bone chips, cartilage grafts or other material do not give satisfactory long term results. Plester developed therefore an angled prosthesis to reconstruct the defect. It consists of a cross-slit gold bell which is connected with a double band titanium cuff by a tiny gold wire. The prosthesis crimped on the stamp of the long process with open tatanium bands, the bell is kept overthe head of the stapes, The authors have inserted 81 angled prosthesis. In 63 cases, the post operative conductive hearing loss amounted to 15 dB on an average.

Cholesteatoma--pathology and treatment.

(1) The prerequisite for development of cholesteatoma is a cholesteatoma bed, that is a loose subepithelial connective tissue layer which acts as a nutrient bed and makes papillary growth of squamous epithelium possible. (2) The formation of cholesteatoma is facilitated by disturbed tubal function with reduced ventilation of the middle ear. (3) The progression of cholesteatoma, especially the bone destruction, is due to enzyme-activated cell groups. The epidermal layer in the postero-superior area of the tympanic membrane has a higher papillary content and during an inflammatory process there is a marked vascular reaction. This particular area has a special nutritional zone and the epidermis is especially well nourished [Lange, 1925]. The main artery to the tympanic membrane travels along the handle of the malleus and gives off branches. In our animal experiments epithelial cones grew into this well-nourished subepithelial zone and formed cholesteatoma. The importance of tubal function as regards cholesteatoma formation can be seen in everyday clinical practice. In stapedectomy patients, the lateral attic wall is usually removed to allow full visualisation of the stapes, but retraction pockets in this area are never seen at subsequent follow-up. However, if the lateral attic wall is removed during surgery for chronic otitis media, reconstruction with cartilage or ceramic is necessary to prevent retraction. This adds weight to the hypothesis that tubal dysfunction is an important aetiological factor in cholesteatoma. This is further supported by the 30 times greater incidence of retraction pockets in patients with cleft palate.

Paraganglioma of the tympanic membrane.

Von Haller, in 1743, first described the carotid body and was so impressed with the richness of its innervation that he called it 'ganglion minutum', thinking it to be a sympathetic ganglion. Valentine, in 1840, saw a peculiar structure in the tympanic canaliculus in which a nerve cell was present and called it 'gangliolum tympanicum'. Almost 100 years later, in 1941, Stacey Guild reported the presence of some structures near the wall of the jugular bulb and described them as 'glomus jugulare'. Following this report, Rosenwaser (1945) and Otani were able to make a correct classification of these tumours in the middle ear. There have been innumerable reports of them and various authors have called them by various names. We report here a case of paraganglioma which was localized entirely to the tympanic membrane without involving any other part of the middle-ear cleft.

Pedunculated pleomorphic adenoma of the tongue base manifesting with dysponea. A case report.

Pleomorphic adenomas of the minor salivary glands are rare. The most common site is in the palate. We have come across a case of pedunculated pleomorphic adenoma of the base of the tongue which came to us only when the tumour had caused respiratory distress.

Histological findings in arytenoid cartilages after long-lasting recurrent nerve paralysis.

The histological findings in 15 excised arytenoid cartilages are reported. In all the cases there was a long-term recurrent nerve paralysis without additional inflammatory disease. In one of the cases there was fibrous ankylosis of the crico-arytenoid joint. This is the first report made on the histological findings in the arytenoid cartilage in cases of paralysis. It is confirmed that there are differences in joint pathology between cases of immobility due to inflammatory conditions and those due to pure noninflammatory recurrent paralysis. The fixation caused by arthritis of the joint has a relatively poor prognosis after surgery while, if the fixation is due to recurrent nerve paralysis, the chances of recovery are good in long-term cases.

The effects of fibrin tissue adhesive on the middle ear.

This study investigated the effects of fibrin glue ('Tissucol', Immuno Pty. Ltd.) in the middle and inner ear. Small amounts of the adhesive were used in 36 operations performed on 18 rabbits. The light microscopic examination of these ears four, eight and 12 weeks after surgery showed that the adhesive was well tolerated and that it did not have any toxic effect on the middle ear or membranous labyrinth. The fibrin tissue adhesive can therefore safely be used to facilitate reconstructive middle-ear surgery and, with the aid of fascia, also for the closure of labyrinthine fistulae; or to achieve a definite seal of oval window niche after stapes surgery.

[Histological findings of 15 excised arytenoid cartilages after long-lasting recurrent nerve paralysis (author's transl)]. / Histologische Untersuchungen am Stellknorpel nach langdauernder Rekurrensparese.

Histological findings of 15 excised arytenoid cartilages are reported. In all cases there was a long-term recurrent nerve paralysis without additional inflammatory disease. In one of the cases there was fibrosed ankylosis of the cricoarytenoid joint. This is the first report made on the histological findings of the arytenoid cartilage in cases of paralysis. It is confirmed that there is a difference in the joint pathology in cases of immobility due to inflammatory conditions and pure non inflammatory recurrent paralysis. The fixation caused by arthritis of the joint has relatively poor prognosis after surgery while if fixation is due to recurrent nerve paralysis the chances of recovery are good in long-term paralysis.

The anterior tympanomeatal angle: the aetiology, surgery and avoidance of blunting and annular cholesteatoma.

Forty-eight cases of anterior annular cholesteatoma were treated surgically. All these cholesteatomas had occurred following surgical repair of the tympanic membrane by the onlay method. To confirm the likely aetiological causes, 49 specimens of the anterior annular sulcus were studied histologically. It was found that in 31% of specimens there was a fold of epithelium penetrating deep into the subepithelial tissue. In 6 specimens there were epithelial cones present and in 9 specimens excessive subepithelial fibrous tissue was noted. The complication of "blunting" caused by the onlay technique is almost impossible to avoid. A more dangerous complication is annular cholesteatoma. The surgery of blunting and annular cholesteatoma and the principles of the underlay method of grafting are described.

Middle ear tuberculosis.

Fourteen cases of tuberculous otitis media are reported. With the declining incidence of pulmonary tuberculosis, the number of reported cases of tuberculous otitis media has become scanty. Nowadays the so-called classical signs of the lesion such as a profuse discharge, profound hearing loss, facial paralysis and multiple perforations, are hardly ever seen. Surgical intervention when done under cover of anti-tubercular drugs has no deleterious effect on the result of surgery. In order not to miss tuberculous otitis media, whenever the otologist is dealing with chronic middle ear disease, the following points should always be kept in mind: (a) A dull ache in the ear without obvious inflammatory signs. (b) A whitish-grey appearance of the mucosa. (c) Bulging of granulation tissue from the mastoid cells during surgery.