Cellular Events Involved in Middle Ear Fluid Production
01 Aug 1970-Annals of Otology, Rhinology, and Laryngology (SAGE PublicationsSage CA: Los Angeles, CA)-Vol. 79, Iss: 4, pp 766-779
TL;DR: The finding that some of these problems in children can become refractory and lead to complications, including chronic granulomatous otitis media and mastoiditis, seems to be a valid clinical observation.
Abstract: Inflammation of the middle ear and mastoid can result in fluid which is serous, mucoid, bloody, purulent or a combination of the above. Middle ear fluid problems are more common in children. That some of these problems in children can become refractory and lead to complications, including chronic granulomatous otitis media and mastoiditis, seems to be a valid clinical observation. This suggests that predisposing underlying factors for middle ear fluid problems and certain forms of chronic inflammatory mastoid disease exist as common denominators for both entities.
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TL;DR: Bacterial recovery rate was inversely related to the dramatic increase with age of IgA and IgG and lysozyme levels in effusions, indicating local production in middle ear effusions.
Abstract: Middle ear effusions from 100 patients (ages 6 months to 10 years) with serous otitis media were examined. The IgA, IgG, and lysozyme were demonstrated at a higher level in the effusions than the corresponding sera, indicating local production. The mucoid type contained higher level of immunoglobulins and lysozyme compared to serous type effusions. Bacteria were found in 77% of the effusions by means of a smear, and 52% yielded positive bacterial culture. The incidence of positive culture in effusions of the patients less than 6 years of age was 60%, while the group older than 6 years old was 32%, and the group over 8 was only 22%. Bacterial recovery rate was inversely related to the dramatic increase with age of IgA and IgG and Iysozyme levels in effusions.
173 citations
TL;DR: Serous otitis media (SaM) is one of the most common childhood diseases and it is generally agreed that the Eustachian tubal dysfunction is associated with this condition.
Abstract: Serous otitis media (SaM) is one of the most common childhood diseases. In spite of numerous investigations on the subject, its pathogenesis still remains obscure. Even the terminology sterile otitis, middle ear effusion, catarrhal otitis. and secretory otitis is diverse and confusing. However, it is generally agreed that the Eustachian tubal dysfunction is associated with this condition.
155 citations
TL;DR: A new hypothesis is proposed that attempts to explain the pathogenesis of petrous apex cholesterol granuloma by explaining the unique proclivity of the healthy and well-pneumatized PA to form a CG.
Abstract: Objective To propose a new hypothesis that attempts to explain the pathogenesis of petrous apex cholesterol granuloma (PA CG). CLASSIC OBSTRUCTION-VACUUM HYPOTHESIS: PA CGs form when mucosal swelling blocks the circuitous pneumatic pathways to the apical air cells. Trapped gas resorption results in a vacuum that triggers bleeding, and CG forms through anaerobic breakdown of blood products. PROBLEMS WITH THE CLASSIC (OBSTRUCTION-VACUUM) HYPOTHESIS: Impaired ventilation of mucosa-lined pneumatic tracts in the middle ear, mastoid, paranasal sinuses, and lung are very common, but CG is rare. The extraordinary levels of temporal bone pneumatization typically observed in PA CG cases is indicative of excellent ventilation and freedom from inflammatory mucosal disease. Were under pressure due to gas absorption alone sufficient to trigger hemorrhage, CG ought to be frequent in otitis media with effusion. Patients The opposite PA of 13 patients with PA CG compared with 31 highly pneumatic PAs in patients undergoing imagery for non-otologic reasons. Main outcome measure The nature of the bony partition, as seen on computed tomography, between the PA air cell system and the adjacent marrow compartment. Results 4 of 13 PAs with CGs on the opposite side showed deficient septation between air cells and marrow, whereas this was not observed in any of the 31 extensively pneumatized normal ears. NEW HYPOTHESIS (EXPOSED MARROW): As cellular tracts penetrate the apex during young adulthood, budding mucosa invades and replaces hematopoietic marrow. The bony interface becomes deficient, with coaptation of richly vascular marrow and the mucosal air cell lining. Hemorrhage from the exposed marrow coagulates within the mucosal cells and occludes outflow pathways. Sustained hemorrhage from exposed marrow elements provides the engine responsible for the progressive cyst expansion. As the cyst expands, bone erosion increases the surface area of exposed marrow along the cyst wall. This exposed marrow theory explains the unique proclivity of the healthy and well-pneumatized PA to form a CG.
143 citations
Cites background from "Cellular Events Involved in Middle ..."
...Other authors have shown serous and bloody middle ear effusions by changing the barometric pressure (34,35)....
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TL;DR: The ability of certain types of otitis media to evolve into another substantiates the concept of the continuum for some patients, and chemical factors involved in pathogenesis and defense were studied.
Abstract: Pathogenesis of otitis media was studied in humans and various animal models primarily from a pathological and chemical point of view. Findings were correlated and interpreted for various forms of ...
117 citations
TL;DR: Demonstration of lamellar substances similar to phospholipids in the secreta of the tube and middle ear mucosa of the guinea pig suggests the presence of auditory surface-active agent(s) (surfactant).
Abstract: A large part of normal middle ear cavity and Eustachian tube is provided with a mucociliary transportation system which is considered the first line of defense of the middle ear Secretory cells of
111 citations
References
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TL;DR: The new p-nitrophenyl substituted ditetrazole is introduced, which possesses most of the properties of an ideal reagent for histochemical purposes and permits the cytochemical visualization of the sites of enzymic activity in tissue sections from 2-8 µ thick, under aerobic conditions, after a relatively short incubation period.
Abstract: 1. A new p-nitrophenyl substituted ditetrazole, 2,2'-di-p-nitrophenyl-5,5'-diphenyl-3,3'-(3,3'-dimethoxy-4,4'-biphenylene) ditetrazolium chloride (Nitro-BT), is introduced, which possesses most of the properties of an ideal reagent for histochemical purposes. It permits the cytochemical visualization of the sites of enzymic activity in tissue sections from 2-8 µ thick, under aerobic conditions, after a relatively short incubation period.2. A comparison was made of the various tetrazoles in common use with several new p-nitro substituted analogues of these agents.3. A survey was presented of the enzyme distribution in the major tissues of the rat and dog. Evidence for the reliability of cytochemical localization is provided by illustrative material in selected tissues.4. The new tetrazole can be employed for the diphosphopyridine nucleotide and triphosphopyridine nucleotide diaphorase systems as well as for the succinic dehydrogenase system by substituting Nitro-BT for blue tetrazolium (BT) in the incubati...
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TL;DR: An ultraviolet spectrophotometric method for the determination of proteins has advantages over other methods in simplicity, rapidity, accuracy, specificity, and sensitivity, but is not useful for thedetermination of protein in urine.
1,253 citations
TL;DR: By killing animals at varying intervals after injections, it was found that the carbon particles were slowly removed from the vascular walls by the action of phagocytic cells, and after 10 months there was still enough carbon locally to be recognized by the naked eye.
Abstract: While it is an established fact that histamine and serotonin increase the permeability of blood vessels, the exact portion of the vascular tree which is so affected has not been conclusively demonstrated. The present study was undertaken to clarify this point. Our experiments were based on a method to which we refer as "vascular labeling," and which permits one to identify leaking vessels by means of visible accumulations of foreign particles within their walls. The mechanism of the labeling, elucidated by previous electron microscopic studies, is the following. Histamine and serotonin cause the endothelial cells of certain vessels to separate, and thus to create discrete intercellular gaps. Plasma escapes through these gaps, and filters through the basement membrane. If the plasma has been previously loaded (by intravenous injection) with colloidal particles of a black material such as carbon or mercuric sulfide, these particles—too large to pass through the basement membrane—will be retained and accumulate in visible amounts within the wall of the leaking vessel. This method is used to maximal advantage if the tissue is cleared and examined by transillumination in toto, so that leaking vessels can be accurately identified in their relationship to the vascular tree. As a test tissue we used the rat cremaster, a laminar striated muscle which can be easily excised with its vascular supply virtually intact. The rats were prepared with an intravenous injection of carbon or HgS, and a subcutaneous injection into the scrotum of histamine, serotonin, or NaCl (as a control). The injected drug diffused into the underlying cremaster and the vessels became labeled. One hour later, when the carbon had been cleared from the blood stream, the animal was killed. The cremaster was excised, stretched, fixed in formalin, cleared in glycerin, and examined by transillumination under a light microscope. The lesions induced by histamine and serotonin were identical. The leaking vessels, as indicated by the carbon deposits, always belonged to the venous side of the circulation. The heaviest deposits were found in venules 20 to 30 micra in diameter. The deposits decreased towards larger venules up to a maximum diameter of 75 to 80 micra, and towards the finer vessels until the caliber reached approximately 7 micra. Essentially spared by the deposits were the finest vessels, 4 to 7 micra in diameter, and constituting an extensive network oriented along the muscular fibers. By killing animals at varying intervals after the injections, it was found that the carbon particles were slowly removed from the vascular walls by the action of phagocytic cells. After 10 months there was still enough carbon locally to be recognized by the naked eye.
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