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Bone destruction in chronic otitis media with cholesteatoma is a common phenomenon. Expanding growth of cholesteatoma in the middle ear causes ischemia of the mucosa and bones with granulation tissue production.was to assess the expression and distribution of the key regulators of bone destruction: osteoprotegerin (OPG), Receptor Activator for Nuclear Factor kappa B Ligand (RANKL) and tumour necrosis factor alpha (TNF-alpha) in chronic otitis media with cholesteatoma and their role in the pathomechanism of bone resorption.We performed immunohistochemical study of the cholesteatoma tissue collected from 21 patients suffering from chronic otitis media with cholesteatoma and 16 samples of normal external auditory meatal skin. This material was analysed histopathologically and by means of immunoperoxidase immunohistochemical technique with the use of antibodies against OPG, RANKL and TNF-alpha and their quantitive evaluation.In all patients with cholesteatoma, features of auditory ossicles and temporal bone destruction were demonstrated. We found that cholesteatoma and granulation tissue cells release factors of the OPG/ RANKL/RANK system and TNF-alpha. In cholestatoma a higher expression of RANKL, OPG and TNF-alpha positive was demonstrated when comparing to the skin of external auditory meatus. These factors were relatively higher expressed in the stroma rather than in the epithelium of cholesteatoma. RANKL-positive cells were demonstrated mainly in the stroma cells, whereas OPG-positive ones in the cholesteatoma epithelium. The reaction with the antibodies against OPG, RANKL and TNF-alpha was weak in the external auditory meatal skin.Bone destruction in chronic otitis media with cholesteatoma is a common process dependent on osteoclast activating factors. OPG/ RANKL/RANK system and TNF-alpha play a key role in the process of osteolysis in otitis media with cholesteatoma. We found no positive correlation between bone destruction advancement and the level of examinated proteins.

Telomerase is an enzyme responsible for maintaining the constant length of chromosomal telomers, which are necessary for normal function of eucaryotic cells. Presence of active telomerase in neoplastic cells prevents shortening of telomers what makes this cells immortal. Telomerase plays an important role in carcinogenesis. Aim of this study was to investigate the activity of telomerase in head and neck tumors and assess its diagnostic and prognostic value.Material consisted of 30 head and neck tumors treated surgically and 9 samples from healthy skin and mucous membranes. Telomerase activity was investigated using TeloTAGGG Telomerase PCR ELISA method.Telomerase activity was found in 24 (80%) malignant tumors. Relative activity of telomerase in neoplasms was from 16.9 to 766,2 RTA. Telomerase expression was much lower in samples of healthy skin and mucous membrane (RTA5). Statistically significant difference was proven for T1 and T2 tumors, comparing to T4 tumors (p0.05). No statistically significant difference in telomerase activity for G1 and G2 differentiation tumors comparing to G3 and for tumors without lymph nodes metastases comparing to tumors with metastases.Malignant head and neck tumors show high activity of telomerase comparing to healthy tissue. Detection of telomerase activity in head and neck malignant neoplasms can be a useful marker for cancer assessment. The quantification of telomerase activity has clinical diagnostic value for head and neck malignant neoplasms. To make a convenience of telomerase as a marker for diagnostic and prognosis in patients with malignant head and neck tumor needs further investigations.

Molecular and cellular mechanisms in chronic otitis media (COM) with cholesteatoma have not been clearly enough known so far. Investigations on cholesteatoma are focused on its immunological and morphological status. The authors presented the results of immunomorphological evaluation of 31 patients with COM with cholesteatoma, divided into three groups. In the first group there were 4 patients with congenital cholesteatoma, in the second group 19 patient with primary acquired cholesteatoma and in the third group 8 patient with secondary acquired cholesteatoma. Immunohistochemical investigations were performed using antibodies for identification the tenascin, S-100 protein, antigens Ki 67, CD 31, FVIII, HLA-DR, and growth factors TGFbeta1 and EGFR. The immunological activity was assessed for three types and matrix and perimatrix of cholesteatoma. High expression of tenascin was proven in the perimatrix of cholesteatoma and protein S-100 was highly expressed in the cholesteatoma matrix. Ki 67 antigen was seen rarely and mostly was present in basal cells of the matrix. The presence of endothelial cells was proven mainly in the connective and vascular tissue of perimatrix (CD 31, FVIII). The high expression of HLA-DR in matrix confirms the presence of Langerhans cells. The presence of growth factors TGFbeta1 and EGFR was observed in peribasal layer of the epithelium and keratinocytes of cholesteatoma matrix. Activity of immunological processes in COM with cholesteatoma confirms their important role in pathophysiology of chronic otitis media with cholesteatoma.

Chronic otitis media (COM) is an inflammatory process involving the middle ear mucosa and the tympanic membrane. The healing and epidermization is mostly impaired by immunological response of the host. Investigating the activity and the function of immunological response elements one can learn the immunological mechanisms taking place in chronic otitis media. The ultrastructural investigations of the tympanic membrane were done on its fragments obtained from 19 patients with COM during middle ear surgery, performed at ENT Department of Medical University of Gdańsk in the years 1997-1999. Immunohistochemical investigations were performed using monoclonal antibodies against tenascin, S-100 protein, Ki 67, CD 31, F VIII, HLA-DR, TGFbeta1 and EGFR. The control group was 11 healthy tympanic membranes from cadavers. The presence of tenascin was proven in all COM tympanic membranes and in 45.5% of those from control group. S-100 protein was present in 88.9% of the patients with COM and absent in control group. Ki 67 was observed in 44.4% of the patients with COM and in 27.3% of the healthy tympanic membranes. Angiogenesis factors (CD 31 and FVIII) were present in 77.8% of the investigated COM tympanic membranes, in control group in 45.5%. HLA-DR expression was observed in 90% COM patients, in control group in 72.7%. Growth factor TGFbeta1 was present in the all cases in mucous and fibrous layer and in 54.5% of healthy tympanic membranes. EGF receptor was present in 60% of COM patients, mainly in epithelial layer of tympanic membrane and in 54.5% of those from control group. The presented investigations confirm the immunological activity of tympanic membrane in chronic otitis media.