Human antimicrobial proteins in ear wax.

The external auditory canal is vulnerable to bacterial infections, but little is known about thechemical compositions of ear wax regarding antimicrobial peptides. We, therefore, studied the proteinconcentrations of ten well-known human antimicrobial peptides from ear wax.Twenty ear wax samples from healthy individuals were analysed using enzyme-linked immunosorbent assay (ELISA) to determine theprotein concentrations of the antimicrobial peptides hBD1-3, lactoferrin, LL-37, BPI, hSLPI and HNP1-3. All ten antimicrobial peptides are present in ear wax. Some of these proteins seem to be merelycell-bound in ear wax. Antimicrobial peptides in ear wax prevent bacteria and fungi from causing infections inthe external auditory canal. The role and importance of these proteins for the blind-ending ear externalcanal is discussed. If this local defence system fails, infections of the external auditory canal may result.The knowledge about the presence of antimicrobial peptides in cerumen may lead to new concepts ofthe local treatment of external auditory canal diseases in the future.

[Use of the internet for health information by ENT patients]. / Informationsverhalten von HNO-Patienten im Internet.

INTRODUCTION: The internet is becoming increasingly more important as a source of information for patients, so that nowadays internet-based information must be more frequently considered in the dialogue with patients. MATERIAL AND METHODS: This study is based on an analysis of ENT patients' habits in acquiring information from the internet. The data were collected by a questionnaire for in-patients over a period of 9 months during 2006 and 2007. A total of 503 patients with different family backgrounds were interviewed and the answers analyzed with respect to the illness, age, gender, education and information acquisition from the internet. RESULTS: The younger generation was found to use the internet in general more than older patients and there were no differences between males and females. Middle aged patients in particular used the internet for answering questions on health. Patients with complex elective surgery used the internet more often than patients undergoing simple elective surgery and patients with tumors and private patients used the internet more often than those with social health insurance. Among the questioned patients it was noticeable that a high proportion of those using internet to obtain information were well educated. DISCUSSION: Despite the high quality of information available for ENT patients on the internet, information obtained from the treating physician is still preferred by many patients. Due to demographic changes an increased use of the internet for patient information is to be expected in the future. The correlation found in this study between education, insurance status and the use of the internet might play a role in a target group oriented improvement of information supply.

[Growth behavior of spiral ganglion explants on cochlear implant electrodes and their materials]. / Wachstumsanalyse von Spiralganglienexplantaten auf Kochleaimplantat-Elektroden und deren Materialkomponenten.

BACKGROUND: With the increasing use of cochlear implants (CIs), the insertion of alloplastic material into the inner ear is nowadays an established treatment for severe to profound hearing loss in children and adults. Beyond its widespread use, the biocompatibility of the CI electrode and its interaction with the neural structures of the cochlea is not yet established. METHODS: To investigate the survival and growth behavior of spiral ganglion neurons on different CI materials, spiral ganglion explants from newborn rats were cultured on silicone and platinum, on a surface combination of silicone and platinum, and, finally, on a CI electrode. RESULTS: The results of this study indicate that the growth of spiral ganglion neurons in vitro is strongly influenced by the different materials and their arrangement, with platinum exhibiting the highest degree of biocompatibility with respect to neurite extension. Level differences in the surface structure between silicone and platinum lead to inhibition of neurite outgrowth. Furthermore, the culturing of spiral ganglion explants on a CI electrode leads to neurite sprouting toward the electrodes made of platinum. CONCLUSION: The biocompatibility of CI materials with spiral ganglion neurons was shown in this study, but it differs with different CI materials. Besides the material itself, the arrangement of the materials can affect the neurite extension.

Human beta-defensins--at the front line of the peritonsillar abscess.

Antimicrobial proteins like human beta-defensins 1-4 (hBD1-4) protect the surface of organs against different bacteria. Little is still known about these proteins within an abscess formation. The purpose of this study was to analyse and describe the distribution of the antimicrobial proteins hBD 1-4 within the peritonsillar abscess. A total of 17 peritonsillar abscesses were analysed. Immunohistochemical stainings were performed, characteristic pictures were taken, and the mean colour intensity was measured using a specific imaging software. A statistical analysis compared the areas of interest of the specific protein staining with the one of the control staining. A total of 4,573 areas of interests were measured. A significantly stronger expression was detected for hBD1 in the surface epithelium, crypt, epithelium of the crypt, lymphocytic cap, and abscess formation in the hBD1 staining in comparison to the control samples. But there was no significance in the specific hBD1-protein expression in comparison to the control samples in the lymphoid follicle and in the germinal centre. There was a significantly stronger hBD2, hBD3, and hBD4 expression in all areas of interest for the specifics stainings in comparison to the control samples. In conclusion, we developed different scenarios which could lead to a peritonsillar abscess formation.

[Are blood tests prior to ear operations in children necessary?--A retrospective analysis]. / Ist die Blutabnahme vor einer elektiven Ohroperation im Kindesalter notwendig?--Eine retrospektive Analyse.

BACKGROUND: Operations in children are often drastic events for patients and their parents. Most ENT operations are elective. Often blood tests are done even though there is no clinical evidence for coagulation disorders or anaemia in the medical history of the patient and their family. Since the joint statement of the German Societies of Oto-Rhino-Laryngology, Head and Neck surgery, of pediatrics and of anesthesiology regarding the necessity of coagulation tests prior to adenoidectomy or tonsillectomy in children we wanted to know whether blood tests have any effect for ear operations. METHODS AND PATIENTS: Data of 81 children were analysed, undergoing an ear operation during 2006/2007 at the department of Oto-Rhino-Laryngology in Bochum, retrospectively. Information on sex, age, hemoglobin concentration, platelet count, INR, thromboplastin time, prothrombin time, count of the white blood cells, Cholinesterase (CHE), Glutamat-Oxalacetat-Transaminase (GOT), Glutamat-Pyruvat-Transaminase (GPT), gamma-Glutamyltransferase (GT), Creatinkinase (CK), creatinine, c-reactive protein (CRP) and clinical history of postoperative complications (bleeding, infections) were collected. RESULTS: Out of 698 registered parameters 10,5 % were differing from the reference parameters. There were no abnormal bleedings or complications which could have been predicted by blood tests. CONCLUSIONS: The preoperative blood tests have no influence on the management of an elective ear operation. A thorough medical patient's and family history should be taken and may be added by a calculated analysis of special blood tests.

[Significance of blood tests prior to adenoidectomy]. / Stellenwert der Blutabnahme vor Adenotomie.

BACKGROUND: Hörmann recently published a joint statement of the German Societies of Oto-Rhino-Laryngology, Head and Neck surgery, of pediatrics and of anesthesiology regarding the necessity of coagulation tests prior to adenoidectomy or tonsillectomy in children. According to many studies, these societies agreed that coagulation tests should be performed only in children with an unusual bleeding history. We analyzed our adenoidectomy-database to investigate the need for preoperative blood tests to prevent bleeding events during and following an adenoidectomy. METHODS AND PATIENTS: Data of 1137 children were collected, undergoing adenoidectomy during a period of 18 months (2005/2006) at the Bochum department of Oto-Rhino-Laryngology, retrospectively. Information on sex, age, hemoglobin concentration, platelet count, INR, thromboplastin time and prothrombin time and clinical bleeding history were collected. RESULTS: 3 % of the laboratory investigations showed pathological parameters. Only 0.12 % of the tests resulted in the cancellation of the operation (7 cases). The reasons for cancellation were: platelet count less than 100 000/microl (3 patients), anemia (Hb < 10 g/dl) (3 patients) and prolongated thromboplastin time (1 patient). 3 of these 7 patients were operated later on. Postoperative hemorrhage was noticed in 11 patients following adenoidectomy. In these 11 patients with bleeding complications all laboratory parameters were found to be normal. CONCLUSIONS: In accordance with the current literature our data show that bleeding after adenoidectomy is a rare complication. In contrast to many other studies, we also report weak bleedings from the epipharynx. Blood tests were routinely performed prior to every operation with little benefit. Only 4 patients were definitely not scheduled for surgery as a consequence of the preoperative blood test. Patients with bleeding complications were not suspicious regarding laboratory workup. We therefore conclude that blood tests prior to adenoidectomy have no relevance for the course of the operation and postoperative bleeding event. Blood tests should only be performed on patients with an unusual bleeding history, family bleeding history or indications for anemia. The documentation of a standardized bleeding history prior to surgery is strongly recommended.

[Silicone as a foreign body in the middle ear: a rare complication after taking an impression of the auditory canal]. / Silikonfremdkörper im Mittelohr: Eine seltene Komplikation im Rahmen der Gehörgangsabdrucknahme.

For the individual design of ear moulds, silicone is generally used for taking the impression of the external meatus and the cavum conchae. Complications are rare with only a few accounts in the literature. We report on three cases of accidental displacement of silicone into the middle ear cavity during impression taking. Clinical symptoms and detection of silicone as a rare middle ear foreign body are presented and discussed.

[Bilateral auditory canal squamous cell carcinoma]. / Bilaterales Gehörgangskarzinom.

Only a small number of cases of bilateral carcinomas of the external ear canal have been described in the literature. We present the first case of a 72 year old male patient with a bilateral squamous cell carcinoma of the external ear canal at a very early stage. A computed tomography of the temporal bone revealed a well-pneumatized mastoid on both sides. Both external ear canals were filled with soft tissue without radiological signs of destruction of the adjacent bone. The carcinomas of the external ear canal were surgically removed using a canal-wall down technique and a selective neck dissection of regions II-IV. Histology confirmed a well differentiated squamous cell carcinoma of the external ear canal without lymph node metastasis on both sides (TNM classification: pT1 G2 N0 M0 R0). Bilateral radiation therapy with 59.4 Gy resulted in stenosis of both ear canals. Hearing rehabilitation was achieved with bone conductive hearing glasses. Diagnosis und therapy of bilateral external ear carcinomas are presented and discussed.

[Muramidase and lactoferrin in adenoidal hypertrophies, hypertrophic and chronic infected tonsil tissue--a quantitative analysis]. / Lysozym und Laktoferrin in Adenoiden, hyperplastischen und chronisch entzündeten Tonsillen--eine quantitative Analyse.

BACKGROUND: Muramidase and lactoferrin are important components of the antimicrobial defense system. Muramidase has the ability of opsonization and immunopotentiation and therefore a close relation to the lymphatic tissue. Till now there are only immunohistochemical and microbiological studies on the presence of muramidase and lactoferrin in adenoid and tonsil tissue available. METHOD: We investigated the concentrations of muramidase and lactoferrin in palatine tonsils and adenoidal hypertrophies quantitatively using ELISA. MATERIAL: We investigated tissue of 18 palatine tonsils and 16 pharyngeal tonsils. RESULTS: We found a significant difference in the concentration of muramidase but no difference in the concentration of lactoferrin between adenoids and tonsils. There was no significant difference in the concentration of lactoferrin and muramidase between the hypertrophic and chronic infected tonsils. There was no correlation between the age of the patients and the concentration of muramidase and lactoferrin. A connection between the microbial biofilm, the concentration of the proteins and the recurrent tonsillitis is discussed. CONCLUSIONS: Due to the production of muramidase and lactoferrin adenoids and tonsils play an important role in the local antimicrobial defense in any age or inflammation.