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Biomedical subjects

J Sadé

Publications and source records attributed to J Sadé.

At least 127 records · Page 7Linked to original sources
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The eustachian tube midportion in infants.

The eustachian tube midportion in infants and children was measured in 44 eustachian tubes from normal temporal bones and 11 eustachian tubes from temporal bones harboring acute otitis media. The temporal bones were serially sectioned, and the lumina of the eustachian tubes' midportions were measured with the aid of a grid mounted on a microscope. These measurements showed that the eustachian tube lumen grows to a small degree with age. Each age group showed a considerable variation in the range of the luminal area compatible with natural biologic distribution. No statistically significant difference was found in the sizes of the midportions of the eustachian tube lumina from temporal bones that harbored acute otitis media when compared with the lumina of the eustachian tube midportions from normal ears.

Acute Disease↗
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Growth of the eustachian tube lumen with age.

We undertook measurements of the lumina of 115 eustachian tubes of various ages. Our results showed that, like any other body organ, the eustachian tube lumen grows with age. The cartilaginous part of the eustachian tube was found to grow considerably more than the bony part. These findings, which were statistically confirmed, appear to contradict the theory ascribing the high incidence of acute otitis media in children to an enhanced susceptibility to infection due to their having a wider eustachian tube than adults.

Adolescent↗
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Tissue culture of human adult adenoids and of middle eear mucosa.

The increased number of mucus producing cells as well as the presence of stratified squamous epithelium in pathological and experimental middle ear conditions, point towards the possibility of metaplastic changes of the middle ear mucosa, similar to the metaplastic capabilities of respiratory mucosae in general, as observed clinically or provoked experimentally. The purpose of this study was to develop a model of postembryonic human respiratory mucosae, in vitro, for the study of triggering or inducing factors involved in its normal and metaplastic differentiation. Explants from adenoids and middle ear mucosa were cultured, both as organ cultures and monolayers, for periods of up to two weeks, and their developmental characteristics were studied and described. Over 50% of the explants showed mitosis, epithelial and monolayer growth, ciliary activity and differentiation into ciliated and into mucus-producing cells. Adenoid explants were grown in air without and with added 5% CO2. Under the latter conditions, the proportion of explants and monolayers showing ciliary activity was 50% greater. It is concluded that this model might be suitable for further studies of the factors which control cyto-differentiation in mucociliary epithelia. Maintaining its growth for a longer period would, however, be desirable.

Adenoids↗
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Clearance of middle ear effusions and middle ear pressures.

Twenty-six children presenting bilateral secretory otitis media (SOM) had ventilating tubes inserted into both middle ears. Mucus was, however, aspirated only from one ear, the right side. The vast majority of ears right and left were seen to have cleared their effusion equally well regardless of whether they were aspirated on not. This experiment points toward the essential intactness of the mucociliary system and the patency of the lumen of the Eustachian tube in SOM. Promotion of middle ear clearance through ventilation, which reminds one of the second opening in a beer can, does obviously suggest the relief of some negative pressure. Direct manometric measurements of SOM middle pressure were performed in 41 ears showing negative pressure averaging --1.7 mm H2O, this range being two orders of magnitude less than tympanometric measurements. Normal ears did not have even such a small negative pressure. The validity of these direct manometric measurements was checked against a model of the middle ear. Tympanometry, which is a valid diagnostic tool, does indicate in all probability the presence of middle ear effusion due to its rheologic effects on the drum and ossicles rather than the measure of actual middle ear pressures. This is determined by the fact that direct needling of the middle ear, or even the insertion of a ventilating tube, did not change tympanometric values but aspiration of part of the effusion did: indeed the latter tended to bring manometry to normal values.

Child, Preschool↗
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Atelectasis and secretory otitis media.

That condition where the tympanic membrane is displaced toward the promontory is termed atelectasis. Thirty-seven patients (61 ears) showing various degrees of atelectasis graded from stage 1 to stage 4 were studied. Atelectatic drums are an inflammatory phenomenon occurring in underventilated ears. This conclusion is reached by considering the reversibility of the atelectasis upon ventilation; while the inflammatory factor can be deduced from the history and histopathology of the atelectatic drum, as well as the histology of the necrosed incus, the latter occurs in over a third of our cases. Also pneumatization of the mastoid is almost never present. Twelve (21%) of the ears treated did indeed develop a perforation at one time or another (two had cholesteatomas). Chronic granulating external otitis with specific features occurred in 15% of cases. The characteristics of these ears and their case histories lead us to view atelectatic ears as part of the otitis media syndrome, where their place is somehow transitional between secretory otitis media on the one hand and chronic otitis media on the other.

Adult↗
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Preservation of cochlear function after extensive labyrinthine destruction.

Four ears are presented with extensive destruction of the bony and membranous labyrinth with the loss of caloric function but with retention of hearing. Fourteen similar cases described previously in the literature are reviewed. Our cases are unique in that hearing was preserved after surgical removal of the disease in the inner ear itself. We are unaware of any previous well-documented reports showing such extensive destruction of the pars superior portion of the labyrinth with the preservation of hearing. Possible explanations and theoretical implications are discussed.

Adult↗
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Clearance of middle ear effusions by the mucociliary system.

There are two extreme types of middle ear effusion leading to hearing loss (a) a rubber-like effusion seen in secretory otitis media and (b) a water-like effusion seen in serous otitis media. The possibility is considered that the degree of crosslinking in these two extreme cases is the basis of an altered mucus transport rate that leads to an accumulation of effusions and hence impaired hearing. It has been shown (King et al., 1974) that the requisite rheological property for transport activity is not unique to mucus structural macromolecules but is found with other polymeric systems that are loosely crosslinked e.g. guaran, polyacrylamide, gelatin and agarose. Studies on one of these systems guaran, indicate that the transport rate is dependent on the degree of crosslinking with a maximum rate found close to the gel point, i.e. in a region where there are very few crosslinks per macromolecule. The finding that mucus from different mucociliary epithelial sources involves a chemically similar structural glycoprotein suggests that differences observed in transport rate between various mucus samples are more likely due to differences observed in transport rate between various mucus samples are more likely due to differences in crosslinking than chemical variations of the glycoprotein units.

Animals↗
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Cholesterol granuloma.

The "idiopathic haemotympanum" is in reality a persistent secretory otitis media. Histologically it demonstrates a chronic granular mastoiditis associated with a cholesterol granuloma. This, however, is not a very specific finding and may be frequently found in other types of the 'underaerated middle ear syndrome', wuch as ears with central perforations or indeed with cholesteatoma. In these granulomas, iron deposits are found, as well as the iron-chelating agent--lactoferin, which is known to be part of the defence mechanism of all mucosas. Lactoferrin is specifically secreted by the exocrine glands and it is not surprising to find much of it in the middle ear in a situation where mucus is being abundantly synthesized--as the case may be in any otitis media. There is no real clinical or histological evidence, so far, that neither the iron deposits nor the cholesterol crystals of these granulomas emanate from a previous hemorrhage.

Bacterial Infections↗
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Intratympanic gas-pressure in cases of SOM and atelectasis.

Direct manometric measurement of gas pressure in the middle ear, by piercing the tympanic membrane with a hollow needle, has been made leak-free. Even so, the rather small negative pressures (a few mm of H2O2) found in cases of secretory otitis media (SOM) and in atelectatic ears, are in error due to a previously unsuspected, significant correction factor. For the proper application of the correction, the volume of the free gas-space in each ear would have to be known. This volume was unavailable to us for the individual ear, yet in cases like ours it ranges between 0.5 to 2.5 ml and therefore an average of 1.2 ml was assumed. Our results, calculated on this basis, were -34 +/- 86 mmH2O and -9 +/- 86 mmH2O for 24 cases of SOM and 32 cases of atelectasis respectively. Like all previous measurements, there too show a large scatter. This is accounted for by two factors (i) the use of the average instead of the individual ear volume, (ii) actual fluctuation in middle ear aeration and therefore of pressure, pointing to the fact that underaeration is a functional disorder rather than an obstruction of the Eustachian tube.

Ear Diseases↗
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Cholesterol and cholesteatoma.

This is a histological and biochemical study of cholesterol in the middle ear in various chronic otitis media syndromes of 22 cholesteatomatous temporal bones and 52 bioptic specimens. Only three of the temporal bones and 11 surgical specimens showed cholesterol crystals, all of which were in the granulation tissue surrounding the cholesteatoma and none in its midst. On the other hand, cholesterol crystals were also found in the inflammatory magma of an atelectatic ear, in ears with cholesterol granuloma, as well as in biopsies from simple chronic otitis media and secretory otitis media. These findings point out that cholesterol crystals may be found in the inflammatory magma of any long-standing middle ear inflammatory condition and is not specific for cholesteatoma or "cholesterol granuloma" ears. Biochemical analysis of mucus retrieved from secretory ears as well as of cholesterol granulomas, showed the presence of cholesterol and of very small amounts of cholesterol esters. Cell membranes also contain cholesterol and small amounts of cholesterol esters. This is in contrast to serum, as well as to the findings in atheromas, where cholesterol esters are relatively more abundant than cholesterol. The ratio of cholesterol to cholesterol ester in cholesterol granulomas and middle ear effusions is in fact the inverse of that found in serum--and serum cholesterol is therefore unlikely to be the origin of the former. Contrary to the popular concept, there is also no clinical, histological, or any other kind of evidence for local bleeding as the source of cholesterol crystals. The most likely source of cholesterol in middle ear effusions as well as of the crystalline deposits--is local tissue breakdown. The phenomenon as a whole may be viewed as a side-effect of the basic middle ear disorder. The reason for cholesterol going from solution to crystals is not known, yet experimental evidence implicates hypoxia.

Cholesteatoma↗