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In order to isolate Listeria monocytogenes from 42 high-risk infants and infection-suspected neonates, blood, external ear canal, throat and urine cultures were made. But, no Listeria monocytogenes could be isolated. Other cultured microorganisms are discussed.
Malignant otitis externa represents a special form of inflammatory alteration of the external ear. The inflammation can spread to surrounding bones (temporal bone, skull base - to the foramen magnum), as well as to neighbouring tissue, such as the parotid gland, the temporo-mandibular joint and soft tissue near the skull base. Most patients are elderly, latent or manifest diabetics. The causative organism was always proved to be Pseudomonas aeruginosa. The disease is called "malignant" because of its high mortality rate. Decreasing this mortality is possible - as demonstrated in 6 patients - via early diagnosis, sufficient surgery, as well as local and systemic antibiotics.
Matrix vesicles (MV) have been found during normal development in the rabbit and rat aorta and pulmonary trunk as well as in the elastic cartilage of the rat external ear. In spite of the morphological variability of MV, two basic types can be ruled out: MV with dense osmiophilic content, and light or electron-translucent MV. MV of the first type are considered to be extracellular lysosomes. MV in the vessel wall are predominantly localized in the subendothelium, and the border-zones between media and endothelium or media and adventitia; in elastic cartilage they are localized near the perichondrium. Especially often they can be seen at the place of contact between elastic and other fibers of the intercellular space. They can even penetrate the elastic membranes and plates. The parts of the organs mentioned encounter higher functional demands and are more active during development and growth. The MV appear almost exclusively a short time before birth, and predominantly during the first 20-60 days of postnatal life. Their origin may be due to exocytosis and the detachment of parts (Mikroapokrinie) of endothelial cells, smooth muscle cells, fibrocytes and chondrocytes. The MV are considered to be a substrate for subsidiary extracellular mechanisms of adaptation during the normal ontogenesis of the elastic tissue of these organs.
Retinoids are synthetic vitamin A derivatives, particularly used in dermatology. Their prescription in women of childbearing age can cause, if pregnancy occurs, a serious malformative embryopathy, mainly involving external ear, brain and heart. A neonatal case caused by isotretinoin (RoAccutane) emphasizes the clinical and epidemiological data concerning this embryopathy. The aetiopathological hypothesis of an interaction between isotretinoin and Hox genes is advanced. Prophylactic measures are difficult since neonatal reported cases are uncommon, but antenatal exposition to this strong teratogenic agent results in multiple spontaneous abortions or pregnancy interruptions.
A prospective study of 20 patients receiving rehabilitation for a missing external ear revealed the failure of three flanged implants in a total of 60 placed for the support of a prosthesis and 10 for retention of a bone-anchored hearing aid. Factors limiting an optimal outcome were health of the cutaneous cuff around the abutments, bonding of the silicone ear to the acrylic-resin substructure, and the ability to minimize disfigurement of a congenitally deformed face.
Benign necrotizing otitis externa (BNOE) is a rare condition of unknown aetiology which is characterized by the formation of an avascular bony sequestrum of the tympanic plate. The vascular supply of the tympanic plate is easily compromised as demonstrated by the development of avascular necrosis in radionecrosis of the tympanic plate and malignant otitis externa. Recognition of BNOE as distinct from malignant otitis externa and carcinoma of the external ear is important as the treatment differs greatly. BNOE also forms an important part of the differential diagnosis of recalcitrant otitis externa. Management of BNOE has been unclear with long-term medical treatment being advocated. In this series of five patients, the surgical management of four patients with BNOE is described. Surgery was successful in all these patients and is advocated as an alternative to medical management.
Account of the case of a little girl of four and a half years brought to the consulting otologist because of her earache, otorrhoea, retroauricular inflammatory swelling and oedema of the external ear canal on left side. Frequency, evolution, diagnostic means and management measures for first branchial cleft are reviewed.
Histologically were investigated 37 cases of neoplastic growths and 2 cases of hyperplasia in canine sebaceous glands. From this number 24 tumours of circumanal glands (20 adenomas and 4 carcinomas) and 13 tumours of sebaceous glands in extraanal localization were found. The average age of affected dogs was 9 years. In the neoplastic tissue of circumanal adenomas three differentiation degrees of sebaceous cells were identified. Biological behaviour is favourable, tumours destructured the tissue only topically. Malignant neoplasias consisted of tumorously proliferated, lowly differentiated sebaceous cells. Tumours observed in the ear and external ear canal are histologically similar to human cutaneous sebaceous gland adenomas and therefore from the viewpoint of comparative oncology they are important. In therapy, surgical extirpation is applied with possible estrogen combination.
Bilateral accessory tragus is a rare congenital malformation of the external ear. An isolated, nonfamilial occurrence of bilateral accessory tragus in a forty-three-year-old man is presented, and the literature is reviewed. Congenital firm, preauricular papules should be recognized as accessory tragi.
PURPOSE: Tympanic membrane perforations are very common and often require surgical treatment. Recent studies have suggested that growth factors may be an effective nonsurgical alternative for treating chronic perforations. The purpose of this study was to assess the efficacy of a platelet releasate in the treatment of chronic nonhealing perforations in the chinchilla model. METHODS: Bilateral perforations were created in 47 chinchillas by excising 80% of the tympanic membrane with a thermal myringotomy knife. Bilateral perforations > 50% of its surface area persisted for 10 weeks in 34 animals, and unilateral perforations > 50% of its surface area, in nine animals. Only animals with bilateral chronic perforations were included in this study. After deepithelializing the perforation and packing the middle ear and external ear canals with Gelfoam, we treated the perforations with either platelet releasate or buffered saline. Each animal served as its own control. RESULTS: The tympanic membranes were evaluated over a 12-week period by microscopy, photography, tympanometry, and histology. No statistical difference between treated and control ears in the incidence of perforation closure was evident. Histologically, the treated tympanic membranes consistently had a thicker fibrous layer than the controls. CONCLUSIONS: These data suggest that platelet releasate is not effective in enhancing closure of chronic tympanic membrane perforations in the chinchilla model.
Otitis externa is a broad term for a disease state that includes inflammation or infection of the external auditory canal and auricle. It can range from mild inflammation and discomfort to a life-threatening disease. Treatment of otitis externa is dependent on a thorough understanding of anatomy and physiology of the external ear canal, a knowledge of the microbiology of potential pathogens, and familiarity with clinical presentation, so that an accurate and timely diagnosis can be reached.
Chondroid syringoma represents the cutaneous counterpart of mixed tumor ("pleomorphic adenoma") of salivary glands, therefore it is also termed mixed tumor of the skin. The presence of hyaline cells in mixed tumors of salivary gland is a very well known event. Tumors mainly or exclusively composed of hyaline cells are termed myoepitheliomas of hyaline type, accordingly to their alleged myoepithelial origin. Scanty components of hyaline cells in chondroid syringomas of the skin have also been observed since more than a decade. However chondroid syringomas mainly or exclusively composed of hyaline cells have been reported only very recently. If the hyaline cells of chondroid syringomas are myoepithelial or epithelial in origin is still a matter of debate, we prefer to retain the descriptive label "hyaline cell-rich chondroid syringoma" as originally conceived by JA Ferrero and AG Nascimento the patronimic authors of the entity. A case of hyaline cell-rich chondroid syringoma is reported on in a white male patient aged 64, which occurred on the external ear of 1-year duration. This case was studied immunohistochemically and ultrastructurally. Both immunoprofile which included reactivity for vimentin, low molecular weight cytokeratins, S-100 protein, GFAP (focally), alfa-smooth actin and muscle-specific actin, and ultrastructural features including evidence of intermediate filaments (non-bundling filaments, tonofilaments), desmosomes, and thin filaments of actin type sustain a myoepithelial differentiation for hyaline cells of this tumor and site. The authors also remark the importance of being aware of this new entity during the diagnostic practice for avoiding misinterpretation. A list of condition to be taken into account in differential diagnosis is also given.
410 patients with malformations of the external ear or nasal cavity were examined. Basing on this evidence, clinical and diagnostic aspects of agenesias, hypogenesias, hypergenesia, dysgenesia, persistence and dystopias of the nose and intranasal structures are analyzed. Both severe and "minor" anomalies are considered. Endoscopic diagnosis of the malformations is described.
We measured the movements of the external ear, or pinna, using the magnetic search coil technique in cats trained to look at auditory and visual targets for a food reward. No behavioral contingencies were placed on pinna movements. Prominent pinna movements accompany eye movements when the animal orients to either auditory or visual stimuli. In visual trials the pinna movements are coordinated with eye movements, suggesting that they are part of the general orientation response of the animal. In auditory trials the pinna response was composed of two movements: short- and long-latency components. Whereas the long-latency component seemed to occur with the eye movement to the target, the short-latency component was coupled to the onset of the stimulus. The short-latency component ( approximately 25 msec) was highly asymmetrical, being largest in the pinna ipsilateral to the stimuli. In one animal it persisted after >10(5) trials.
The author's personal experience with 83 cases of auricular construction is presented, as well as methods that have evolved through the last 3 decades. The details of reconstructive procedure are discussed. Advisability of external ear reconstruction in unilateral microtia is evaluated. The follow-up ranges from 2 to over 20 years. Major complications occurred in only 3% of cases and were limited to the perioperative period. The significance of the emotional and psychological benefits of the operation is emphasized. Photographic evidence is presented, too.
Treatment of malignant melanoma of the external ear presents unique challenges. Because of the significant debate regarding the efficacy and validity of using sentinel lymph node mapping for the treatment of ear melanomas, data for a population of patients with melanomas of the ear who underwent surgical excision and reconstruction were reviewed to determine the efficacy of sentinel node mapping. A retrospective chart review of cases treated by a single surgical oncologist was performed. All patients who were treated for malignant melanomas and required reconstruction of the external ear by the plastic surgical service between 1995 and 2001 were identified. Nineteen patients were selected, of whom nine underwent sentinel node mapping. The average age of the patients was 65.2 years. Evaluation of melanoma depth, medical history, surgical margins, lymph node metastasis, and recurrence was performed. Lymphoscintigraphy with technetium-99-sulfur colloid and 1% Lymphazurin (isosulfan blue; Zenith Parenterals, Rosemont, Ill.) demonstrated widely variable lymphatic drainage patterns. The lower tail of the parotid gland and the upper cervical area were the two most common locations. The average number of sentinel nodes identified and removed was 3.7. The average Breslow thickness for these patients was 2.3 mm. None of these patients demonstrated micrometastatic disease in their sentinel nodes. The most common reconstructive procedure after surgical resection was the use of rotational advancement flaps. Localization of radioactivity, as detected with external technetium-99 scanning, was the most reliable method for detection of the sentinel lymph node basins and the individual nodes. The average value for the primary injection site was 8375 counts per second, and the average value for the nodes removed was 973.5 counts per second. Of the nine patients who underwent sentinel lymph node mapping, only one, with an initial lesion depth of 5 mm, developed a local recurrence. The average follow-up period in this study was 21 months (range, 12 to 79 months). All patients in this study were evaluated at least 1 year after the initial surgical resection. Patients were monitored by the same surgical oncologist every 3 months for the first 2 years. Little can be found in the literature regarding the efficacy of sentinel node biopsies for ear melanomas. Larger studies are indicated; however, it seems that this method is practical for designing therapeutic methods for patients with melanoma of the ear.
The goal was to determine how the facial nerve path forms normally through the ear region. Five three-dimensional computer reconstructions and eight wax plate-graphic, two-dimensional reconstructions were made from a group of 47 serially sectioned human embryos that were in the blastemal period of ear development, when most of the definitive arrangement is established. The size, shape, and positional changes of the facial nerve relative to the external ear and notochord were studied in both lateral and frontal views. The vertical (dorsoventral) position of the external ear region remains constant but shifts caudally. After formation, the geniculate ganglion assumes a position that gradually becomes rostrodorsal to the external ear. Facial nerve branches form and grow into regions expanding peripherally. The superficial petrosal branch appears to hold the ganglion in position as the horizontal segment of the facial nerve forms when the external ear shifts caudally. Possible growth movements explaining abnormal nerve paths are discussed.
Ten children with gross deformity of the external ear were observed. In six the facial bones were underdeveloped on the same side as the deformed ear. In all six there was a congenital abnormality of the kidney or upper urinary tract, usually on the same side as the deformed ear. In addition there were usually other associated congenital defects in each case.In the remaining four children the facial bones appeared normal, and pyelography showed no abnormality of the urinary tract. In these four children there were no other associated defects.These observations emphasize the importance of investigating the urinary tract in children with gross deformity of the external ear, especially where there is an associated underdevelopment of the facial bones.