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BACKGROUND: Cholesteatoma in the pediatric population is considered an entity with an aggressive nature, it is related to greater extension, number of associated complications and recurrence. Currently there is an increase in closed approaches for its management; however, the need for a safe ear sometimes requires the use of more extensive surgeries. CLINICAL CASES: This paper describes 4 cases of 4, 10, 14 and 18 years old who attended a medical consultation at the Hospital Civil de Culiacan, Sinaloa, México, diagnosed with chronic otitis media with cholesteatoma. All presented long-standing otorrhea. Other manifestations were otorrhagia, history of ipsilateral facial paralysis and meningitis. Radical mastoidectomy was performed in all four cases; as a first therapeutic measure in two of them and as a reoperation in the other two cases. In postoperative follow-up, all required long-term antibiotic treatment. CONCLUSIONS: Radical mastoidectomy is an option in pediatric patients with cholesteatoma. Treatment should be individualized, with a variety of procedures described, each with its advantages and disadvantages to be considered in each case. [ABSTRACT FROM AUTHOR]

BACKGROUND: Petrous apex cholesteatoma is a rare disease. Clinical presentation is frequently facial nerve deficit and unilateral hearing loss. It is a challenge to diagnose and treat because it is one of the most difficult areas to access in lateral skull base. CLINICAL CASE: A 59-year-old male patient from Lima, Peru, who presented with unilateral hearing loss and facial nerve palsy. Computed tomography showed a lesion in petrous apex. Surgical management was proposed with a histopathological result of cholesteatoma. Postsurgical evolution was favorable. CONCLUSIONS: Appropriate clinical and imaging evaluation of the extent of the lesion, facial nerve damage, possibility of hearing preservation, and involvement of adjacent anatomical structures allow for optimal surgical planning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Petrous apex cholesteatoma is a rare disease. Clinical presentation is frequently facial nerve deficit and unilateral hearing loss. It is a challenge to diagnose and treat because it is one of the most difficult areas to access in lateral skull base. CLINICAL CASE: A 59-year-old male patient from Lima, Peru, who presented with unilateral hearing loss and facial nerve palsy. Computed tomography showed a lesion in petrous apex. Surgical management was proposed with a histopathological result of cholesteatoma. Postsurgical evolution was favorable. CONCLUSIONS: Appropriate clinical and imaging evaluation of the extent of the lesion, facial nerve damage, possibility of hearing preservation, and involvement of adjacent anatomical structures allow for optimal surgical planning. [ABSTRACT FROM AUTHOR]

El colesteatoma es una masa de apariencia blanda, comprimible y asociada principalmente a la hipoacusia. Su diagnóstico se realiza mediante otoscopia, pero si el examen físico no es concluyente se deben realizar estudios radiológicos. Su presentación es infrecuente; así, la incidencia de colesteatoma adquirido por cada año en Colombia es de 3/100000 niños y 9,2/100000 adultos. Es importante en las valoraciones que cada personal de salud lo pueda reconocer y derivar, permitiendo realizar de forma temprana la intervención quirúrgica que eviten cuadros clínicos invasivos que pueden aumentar la posibilidad de complicaciones. Nuestro objetivo fue describir la importancia del colesteatoma con sus implicaciones clínicas en los diferentes pacientes con patología auditiva, lo que permite hacer entender la importancia del diagnóstico oportuno. Se realizó una búsqueda de literatura en las bases de datos de PubMed y Scielo, orientada hacia artículos actualizados y relevantes en inglés y español, publicados en los últimos 5 años. Se analizó la relación entre hipoacusia y colesteatoma, su importancia médica, implicaciones y abordaje terapéutico. Los diferentes estudios evidencian la presencia de colesteatoma e hipoacusia unilateral, en algunos casos la presentación clínica se asociada a patologías sindrómicas. En esta patología el tratamiento es quirúrgico, con una previa valoración que establezca el tipo de intervención, adicionalmente, el seguimiento postquirúrgico es obligatorio en todos los pacientes. En conclusión, el colesteatoma es una causa de la hipoacusia, especialmente entre la población pediátrica, la cual debe ser diagnosticada de forma oportuna con el objeto de permitir una valoración especializada que ofrezca un tratamiento quirúrgico de acuerdo al compromiso anatómico y la individualización del paciente.

Although acute otitis media can occur at all ages, it is more common in children, becoming a common cause of visits to the emergency room. Despite advances in diagnosis and treatment, sometimes this condition can be complicated by brain abscesses, meningitis, mastoid abscess and others. We present the case of a 19-year-old male patient, of Bangladeshi origin, who presented to the emergency room of Hamad General Hospital, Doha, Qatar, with intense headache, a history of otitis media, previously treated with augmentin, who began to convulse during his hospital stay. He was studied by means of Computerized Axial Tomography (CAT) of the skull with intravenous contrast, performed as an emergency. A large space-occupying lesion was diagnosed, surrounded by significant perilesional edema, interpreted as a large brain abscess resulting from otitis media and cholesteatoma with erosion of the tegmentum. He underwent emergency surgery, draining 500 mL of pus. He was followed up by CT scanning and MRI, showing a torpid progress. Serial cultures revealed superinfection with methicillin-resistant Staphylococcus aureus, treated with vancomycin and then meropenem, with unsatisfactory results. The clinical manifestations became even more complicated with hemorrhage from the surgical bed, later with segmental pneumonia, anemia and multiple organ failure, progressing torpidly until a fatal outcome. The use of imaging techniques for diagnosis and monitoring of middle ear conditions and the lethality of complications of otitis media were evidenced.

OBJECTIVE: To evaluate the changes in the microbiota in the chronic cholesteatomatous otitis media after the application of sodium 2-mercaptoethanesulfonate (MESNA) in the pediatric population, through 16S bacterial ribosomal RNA sequencing. MATERIALS AND METHODS: A subexperimental, prolective study done at the Otorhinolaryngology service of Hospital Infantil de México Federico Gómez, Mexico City, from December 2017 to December 2018, including children with chronic cholestea-tomatous otitis media who underwent primary or revision mastoidectomy. The RNA of cholesteatomas was obtained (before and after MESNA application). Relative abundance, richness and diversity were determined at the level of phylum and genera. RESULTS: Twenty-six samples were included, corresponding to 13 children of both sexes, without comorbidities. It was possible to identify more than 98% of the sequences at the level of phylum, class, order, and family. The microbiota was represented by the predominant phyla Firmicutes, Proteobacteria, Actinobacteria, Cyanobacteria and Bac-teroidetes. At the genus level, Turicella and Alloiococcus were observed in association with the disease. Likewise, it was observed that after the application of MESNA, the genera Propionibacteria and Staphylococcus associated with the usual microbiota of the middle ear prevailed and increased in abundance. Similarly, an increase in the diversity of bacteria was observed, as well as an increase and emergence of other genera that are part of the endogenous microbiota of the middle ear. CONCLUSIONS: The emergence and prevalence of genera present in the normal healthy middle ear microbiota and the loss of pathogenic genus demonstrate the usefulness of MESNA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cholesteatoma is a cystic structure with the presence of keratin-producing squamous epithelium, which replaces the normal mucosa in the middle ear; its etiology is multifactorial, it is classified as congenital or acquired. Definitive treatment is surgical and aims to eradicate the disease. Patients with progeroid syndrome have an increased risk of presenting alterations in the middle ear such as cholesteatoma; hypohidrotic ectodermal dysplasia causes glandular disorders that increases the frequency of chronic infections at nasal and otic level. CLINICAL CASE: A 24-year-old female patient with cholesteatoma with right mastoidectomy autocavity with a history of progeroid syndrome, probable Wermer syndrome and hypohidrotic ectodermal dysplasia, managed with conservative treatment, without complications after 10 years of follow-up. CONCLUSIONS: Cholesteatoma of middle ear is an infrequent disease that, despite of its benign histology, may cause severe complications; thus, treatment is surgical, and its aim is to eradicate the disease. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe a new proposed retro-conchal approach for middle ear surgery and to evaluate its advantages and postoperative impact., Methodology: A retrospective case-series study was held at a tertiary university hospital from March 2008 to April 2022. We included 196 adult patients who were candidates for middle ear surgery because of chronic otitis media. The retro-conchal approach entailed a skin incision on the medial conchal surface 1 cm anterior to the auricular sulcus. It allowed the harvesting of the required size of conchal cartilage and temporalis fascia through the same incision with access into the middle ear and complete exposure to the mastoid process. In addition, we evaluated the use of this approach in tympanoplasty, including cholesteatoma surgeries with at least one-year postoperative follow-up., Result: The long-term follow-up (22.9 ± 6.37 months) revealed that most operated cases (89%) did not develop postoperative sequelae related to this approach. On the other hand, 22 patients (11%) developed adverse outcomes, with a statistically significant difference regarding adverse outcomes as the P-value <0.001., Conclusion: According to our experience with a relatively large number of patients, the retro-conchal technique was practical for various middle ear surgeries. It allowed optimal access to different middle ear areas and obtaining large-sized conchal cartilage and temporalis fascia (if needed) through the same incision without needing extra surgical steps. In addition, it was a safe maneuver without significant adverse outcomes in the long-term follow-up., (Copyright © 2023 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

INTRODUÇÃO: O colesteatoma do canal auditivo externo é raro e muitas vezes assintomático apesar da insidiosa destruição óssea que vai causando no canal auditivo externo e estruturas vizinhas. Relatos de doença bilateral são episódicos e de causa idiopática. A keratosis obturans é o principal diagnóstico diferencial. CASO CLÍNICO: Criança, 13 anos, com colesteatoma bilateral do canal auditivo externo, com invasão da mastoide e erosão da cadeia ossicular no ouvido esquerdo. A doente apresentava quadro arrastado de otalgia bilateral, com otorreia esporádica e hipoacusia progressiva à esquerda. Após vários procedimentos cirúrgicos para erradicação da doença, mantém-se em vigilância anual sem recidiva aos 4 anos. CONCLUSÃO: Este caso realça a necessidade do reconhecimento precoce desta entidade pouco frequente, mas que pode cursar com lesões extensas e até irreversíveis. O tratamento cirúrgico é curativo, mas a vigilância regular é mandatória.

ABSTRACT INTRODUCTION: Acquired middle ear cholesteatoma can be classified as primary or secondary. Although both can result in hearing loss, it is still controversial whether there is an association between the type of cholesteatoma and the degree of hearing loss. OBJECTIVE: To analyze the association between hearing loss and the type of acquired cholesteatoma, and the status of the ossicular chain. METHODS: This was a cross-sectional historical cohort study involving patients diagnosed with acquired cholesteatoma who were surgically treated. Air and bone conduction thresholds, air-bone gaps and the status of the ossicular chain were analyzed for both types of cholesteatoma. RESULTS: Eighty patients aged 5-57 were included in the study. Fifty-one patients had primary cholesteatoma and 29 had secondary cholesteatoma. Both types of cholesteatoma determined greater air-bone gaps at 0.5 kHz. Secondary cholesteatoma determined greater hearing loss in all analyzed frequencies and higher air conduction and air-bone gap means. CONCLUSION: There was association between hearing loss and the type of cholesteatoma. Secondary cholesteatoma resulted in greater hearing impairment.

Aims: To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD)., Material and Methods: A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12., Results: The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire., Conclusions: Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery., (Copyright © 2023 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

El colesteatoma se caracteriza por el acúmulo de detritus de queratina en el oído/peñasco. Puede ser congénito o adquirido, siendo este último el más frecuente. Recientemente las técnicas de difusión (DWI) por resonancia magnética (RM) han ayudado al diagnóstico por imágenes en los casos en los que la tomografía computada (TC) no es concluyente y, en el escenario posquirúrgico, cuando la TC no logra discriminar entre el tejido inflamatorio y la enfermedad residual o recidivante.

Métodos objetivos de avaliação são frequentemente cobrados em estudos científicos. Exames histológicos com coloração imuno-histoquímica podem ser avaliados por meio de fotometria. OBJETIVO: Comparar este método objetivo com a avaliação subjetiva realizada por três observadores independentes, utilizando lâminas de colesteatoma adquirido da orelha média. MÉTODO: Foram selecionadas um total de 54 imagens de colesteatomas imuno-histoquimicamente coradas pelos anticorpos anti-TNF-R2 (32 lâminas) e anti-TGF-α; (22 lâminas). O anticorpo secundário utilizado nos dois grupos foi o Max Polimer Detection System (Kit Novo Link, Novocastra®, UK). As amostras foram processadas por um scanner digital de lâminas (modelo ScanScope - Aperio). As áreas selecionadas foram submetidas à análise por fotometria. RESULTADOS: A avaliação objetiva por fotometria foi comparada com a avaliação subjetiva por três observadores e submetidas à análise estatística. A análise estatística revelou reprodutibilidade moderada (K valores entre 0,41 e 0,60) para os dois grupos. CONCLUSÃO: O presente estudo demonstrou que as características irregulares das lâminas de colesteatoma da orelha média coradas pela imuno-histoquímica impossibilita a sua adequada avaliação objetiva, enquanto a avaliação subjetiva por observadores experientes se mostrou mais confiável.

Com índices relativamente baixos de lesão recorrente, o colesteatoma residual de orelha média se mostra, hoje, um dos maiores responsáveis pelos altos índices de recidiva da doença. Dada a limitação em visualizar, sob microscopia, todos os acidentes anatômicos distribuídos tridimensionalmente no osso temporal, a endoscopia surgiu como uma ferramenta auxiliar em otocirurgia e está se mostrando uma grande aliada no manejo da otite media crônica colesteatomatosa e na prevenção de sua recidiva. OBJETIVO: Avaliar, por meio de revisão bibliográfica, a importância da otoendoscopia no tratamento cirúrgico do colesteatoma e seu papel na prevenção de lesões recidivadas. MÉTODO: Realizou-se uma busca eletrônica entre março a junho de 2011, nas bases de dados MedLine e LILACS, selecionando-se estudos que analisavam a endoscopia como método auxiliar no manejo do colesteatoma. RESULTADOS: Aplicados os critérios de inclusão e exclusão, restaram três estudos avaliando a endoscopia na cirurgia do colesteatoma frente ao método microcirúrgico tradicional. CONCLUSÃO: Parece que a endoscopia deve ser incorporada à prática diária da otologia, dado seu impacto positivo no manejo da referida enfermidade.

Alguns estudos indicam uma tendência à bilateralidade da otite média crônica. Acredita-se que a orelha contralateral possa fornecer evidências da via de formação da doença da orelha mais afetada, ser um parâmetro da função da tuba auditiva e predizer o sucesso do tratamento. A tomografia computadorizada é um excelente teste para avaliar as estruturas do osso temporal e as alterações decorrentes da da otite média. OBJETIVO: Avaliar tomografias computadorizadas (TC) de osso temporal de pacientes com otite média crônica e descrever anormalidades na orelha contralateral. MÉTODO: Estudo de Prevalências (transversal). Avaliação das TC de 75 pacientes com otite média crônica de um hospital terciário de referência no Brasil por um neurorradiologista. RESULTADOS: A população foi constituída por 50,6% do sexo masculino, com idade média de 36 anos. Encontramos 54,7% de alterações na orelha contralateral claramente relacionadas com otite média crônica. DISCUSSÃO: A prevalência de alterações radiográficas nas orelhas contralaterais de pacientes com otite média crônica corrobora com estudos clínicos, histopatológicos e funcionais desenvolvidos pelo mesmo grupo de pesquisa e sugere que esta doença tem uma característica bilateral.

Middle ear cholesteatoma is an important and relatively common disorder which may have serious consequences. AIM: The purpose was to conduct a retrospective study of the statistics of 1,146 middle ear surgical procedures for middle ear cholesteatoma in adults and children of low income living in distant areas from our city. METHODS: From 1962 to 1988 there were 1,146 surgeries for unilateral or bilateral cholesteatomas in children and adults, which were reviewed for the following criteria: total number of surgeries, sex, onset of the first symptoms, duration of the disease, the site of perforation, the cholesteatoma site, changes in the ossicular chain, the contralateral ear, bilateral cholesteatomas, the site of residual cholesteatoma, and complications. RESULTS: Results are shown graphically on a pie chart. CONCLUSION: The etiology of cholesteatomas remains unknown. Epidemiological and statistical data, surgical reports, and conclusions of experimental studies are welcome, as they may provide support for clarifying the pathogenesis of cholesteatoma. Our results were compared with internationally published papers. We found no published papers on the epidemiology of cholesteatoma in the Brazilian literature.OBJETIVO: O colesteatoma da orelha média é uma doença relativamente comum, podendo ter sérias consequências. Fizemos um estudo retrospectivo de levantamento estatístico de 1146 cirurgias de colesteatoma da orelha média em adultos e crianças oriundas de várias classes sociais de todas as regiões do Brasil. CASUÍSTICA E MÉTODO: No período de 1962 a 1988 foram realizadas 1146 cirurgias de otite média colesteatomatosa uni ou bilateral, tendo sidos avaliados os dados epidemiológicos do colesteatoma sob diversos aspectos: total de intervenções cirúrgicas, sexo, idade de início primeiro sintoma, tempo de evolução, local da perfuração, localização do colesteatoma, alterações da cadeia ossicular, a orelha contralateral, o colesteatoma bilateral, a sede dos colesteatomas residuais e suas complicações. RESULTADOS: Mostraremos os resultados de diversos parâmetros que se seguem sob a forma de gráficos de diagrama de setores. CONCLUSÃO: Ainda somos incapazes de esclarecer a etiologia do colesteatoma. Cada dado, se epidemiológico ou estatístico, cada observação na cirurgia e cada conclusão experimental são bem-vindos para se ter mais subsídios sobre a patogenia do colesteatoma. Comparamos com os artigos internacionais publicados. Salientamos o fato de não termos encontrado nenhum trabalho publicado no Brasil a respeito somente da epidemiologia do colesteatoma.

Vários estudos envolvendo métodos imunoistoquímicos para avaliação da epiderme do meato acústico externo já foram realizados com os mais diversos objetivos. Por estes métodos é possível avaliar a expressão de antígenos como as citoqueratinas, citocinas, marcadores de hiperproliferação, entre outros. OBJETIVO: Revisar, descrever e analisar a expressão dos marcadores imunoistoquímicos de hiperproliferação na epiderme do meato acústico externo normal. MATERIAIS E MÉTODOS: Revisão sistemática de artigos publicados até o ano de 2009 em periódicos internacionais indexados. RESULTADOS: Vários antígenos relacionados à hiperproliferação foram pesquisados por meio de métodos imunoistoquímicos dentre os artigos analisados. Os mais estudados foram a citoqueratina 16, o Ki-67 e o PCNA. CONCLUSÕES: A maioria dos trabalhos utilizou fragmentos de epiderme do meato acústico externo como amostra controle para estudo imunoistoquímico do colesteatoma da orelha média ou externa. Há uma concentração de marcadores de hiperproliferação como a CK16, o Ki-67 e o PCNA no anel fibrocartilagíneo e nas regiões adjacentes do meato acústico externo e da membrana timpânica.Several studies involving immunohistochemical methods to assess external auditory canal epidermis have been performed with different objectives. With this method it is possible to assess the expression of various antigens such as cytokeratins, cytokines, and hyperproliferation markers among others. AIM: to revise, describe and analyze the knowledge generated by identifiable papers published on the worldwide literature about immunohistochemical hyperproliferation markers in normal external auditory canal epidermis. MATERIALS AND METHODS: systematic review of the papers published until 2009, in indexed international journals. RESULTS: Various antigens related to hyperproliferation were investigated by immunohistochemical methods among the included papers. The most studied ones were cytokeratin 16, Ki-67 and PCNA. CONCLUSIONS: most of the studies utilized external auditory canal epidermis as control sample to study external ear or middle ear cholesteatoma with immunohistochemical methods. There is a hyperproliferative antigen concentration, such as CK16, Ki-67 and PCNA, in the annulus tympanicus, adjacent meatus and tympanic regions, mainly in the lower areas.

Many studies have shown the consequent gustatory alteration caused by ear surgeries. However, few have reported this alteration in patients with chronic otitis media (COM), prior to surgical treatment. AIM: to identify gustatory alterations due to chorda tympani nerve involvement in patients with COM without prior surgery. METHODS: Clinical essay, with tests based on "taste strips" with different concentrations of salt, sweet, bitter, and sour, was performed in 45 patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery, using the disease-free ear on the contralateral side as control. The score ranged between 0 and 16. RESULTS: A total of 25 patients presented cholesteatoma and 20 had non-cholesteatomatous disease. The mean score was 6.65 for the affected side and 9.93 for the half of the tongue on the side of the healthy ear (pMuitos estudos mostraram a consequente alteração do paladar após cirurgia otológica. Entretanto, poucos reportaram essa alteração como uma queixa de pacientes com otite média crônica (OMC) previamente à cirurgia. OBJETIVO: Avaliar alterações na função gustatória na área inervada pelo nervo corda do tímpano em pacientes com OMC ainda não submetidos à cirurgia. MATERIAL E MÉTODOS: O ensaio clínico, com teste gustatório baseado em "tiras gustativas" com diferentes concentrações de sal, doce, amargo e azedo, foi realizado em 45 pacientes com OMC colesteatomatosa e não-colesteatomatosa unilateral, nunca antes submetidos à cirurgia otológica, utilizando a metade da língua do lado livre de doença otológica como controle. As notas variavam de 0 a 16. RESULTADOS: 25 pacientes apresentavam colesteatoma e o restante OMC não-colesteatomatosa. A pontuação média foi de 6,65 para o lado afetado e 9,93 para a metade da língua do lado sadio (p

Introduction and Objectives: The aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets., Materials and Methods: Patients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic-endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up., Results: Cholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases., Conclusions: With only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice., (Copyright © 2022 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Acromegaly is a disease caused by a chronic increase of the growth hormone. This is usually due to a pituitary adenoma which also causes typical skeletal changes and also cardiovascular and metabolic alterations when the disease has progressed. Its low prevalence corresponds with the little experience acquired with this disease compared with other diseases more prevalent in the general population. We present the case of a 48-year-old male, who was operated of a bilateral cholesteatomatous chronic otitis media, with very advanced acromegaly and its very typical signs in face and skeleton. [ABSTRACT FROM AUTHOR]

O presente relato descreve um caso de colesteatoma ovariano em uma cadela Yorkshire de 15 anos de idade. O diagnóstico clínico foi de piometra e o animal foi submetido a ovariosalpingohisterectomia. O ovário esquerdo apresentava-se aumentado de volume (4 x 3 x 2cm), firme e esbranquiçado. Histologicamente havia grande número de cristais de colesterol, com acúmulo de macrófagos e algumas células gigantes multinucleadas. A lesão resultou em compressão do córtex ovariano adjacente que não continha nenhuma estrutura funcional, como folículos e corpo lúteo. O ovário contralateral não apresentava nenhuma alteração e continha múltiplos corpos lúteos.

Introduction: The surgical management of cholesteatoma. Can opt for a closed technique (mastoidectomy simple) or open surgery (radical mastoidectomy). The open mastoidectomy with reconstruction of the posterior wall of the middle ear reconstruction in one surgery combines the advantages of both techniques as adequate surgical exposure, eradication of cholesteatoma and anatomical reconstruction of the middle ear structures. Objective: To evaluate the surgical results in the management of cholesteatoma with the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in one surgery. Methods: Prospective analytical observational study conducted between 2009-2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle, performing preoperative clinical monitoring and quarterly postoperative tomography and previous assessments of hearing and pre -and postoperative audiometry. Results: Forty five patients were studied. Mean Postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients as measured by clinical and radiological follow. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry auditory tone average (PTA) by the statistical test for paired samples between preoperative and postoperative PTA. (95% CI -1.47- 12.15). Residual cholesteatoma was presented in 6.6%, three to four times lower than that reported in the literature. Conclusion: This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: The goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media., Material and Methods: We examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively. In this study we only evaluated the second portion of the facial nerve canal., Results: The global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM). Associations were found between facial canal dehiscence, labyrinthine fistula (p˂ .001) and facial nerve paralysis (p˂ .001). Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p=.005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p=.014; OR 4.059) and malleus, incus, and stapes together were eroded (p=.002; OR 4.929)., Conclusions: This study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence. The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles. These findings raise awareness about the usefulness of middle ear findings in predicting FCD, thus providing valuable information for the otological surgeon to avoid iatrogenic injuries., (Copyright © 2021 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Middle ear cholesteatoma is a relevant and relatively common disease that may have severe consequences. In the present pictorial essay, the authors have selected illustrative examples of multislice computed tomography and magnetic resonance imaging depicting the main presentations of cholesteatomas, and describing their characteristics, locations, and major complications. [ABSTRACT FROM AUTHOR]

Surgery in chronic otitis media is a common practice in our country, quite often are patients who have had undergone multiple surgeries without control of the disease as well as others with special conditions such as meningoencephalocele, in whom it is mandatory to intervene completely and properly. This goal is achieved through the practice of timpanomastoidectomy cavity obliteration with Eustachian tube closure and defunctioning external auditory canal and improve the quality of life which is often affected in such circumstances. We communicate the case of two patients with a history of otologic surgery, one of them with meningoencephalocele, and the second with meningoencephalocele and cerebrospinal fluid leak. Both patients are asymptomatic and undergo regular imaging studies, primarily magnetic resonance imaging. We establish the indications for timpanomastoidectomy cavity obliteration with Eustachian tube closure and defunctioning external auditory canal in patients with chronic suppurative otitis media difficult to manage, and surgical technique is briefly described. [ABSTRACT FROM AUTHOR]

Aims: Cholesteatoma is characterised by a squamous epithelium in the middle ear and aggressive destructive behavior. A hyperproliferative epithelium also typically has an overexpression of cytokeratin 16 (CK16). The aim of this study was to compare CK16 expression in cholesteatoma epithelium and the epithelium of simple dry perforations. Methods: Samples were obtained from 60 patients: 30 with cholesteatoma and 30 with simple perforations. The epithelium was immunohistochemically stained for CK16. Correlations were made between the clinical picture and the absence or presence of complications in both groups. Results: Immunohistochemical staining for CK16 was positive in 45% of specimens taken from the edge of simple perforations and in 51% of specimens taken from the cholesteatoma matrix. The difference was not statistically significant. Conclusion: Two implications of our findings may be suggested: in cases of cholesteatoma the change in CK expression from normal epithelium is not the only factor which makes cholesteatoma aggressive; alternatively, in normal tissue the edge of a simple perforation is not as stable as is thought so that at least 45% of perforations can show hyperproliferative activity. It is therefore unclear whether hyperproliferative activity in either cholesteatoma or a simple perforation is a marker of instability or of attempts at healing. [ABSTRACT FROM AUTHOR]