Chi-Kyou Lee

Tubular apocrine adenoma with syringocystadenoma papilliferum arising from the external auditory canal.

Tubular apocrine adenoma (TAA) is a very rare sweat gland tumour. Comprehensive review of the literature reveals that TAA in the external auditory canal (EAC) has not yet been reported. We report a case of TAA in the EAC, together with characteristic histopathological findings.

Protective Effect of Minocycline Against Cisplatin-induced Ototoxicity

Objectives Cisplatin, a widely used chemotherapeutic agent, has serious side effects, including nephrotoxicity and ototoxicity. Minocycline is a semisynthetic second-generation tetracycline that exerts anti-inflammatory and neuroprotective effects. The purpose of this study was to elucidate the protective effect of minocycline against cisplatin-induced ototoxicity in the auditory hair cell. Methods The House Ear Institute-Organ of Corti 1 (HEI-OC1) cell line and guinea pigs were used for in vitro and in vivo experiments. Cells were exposed to cisplatin with or without pre-treatment with minocycline. Cell survival was analyzed using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). Whole-cell lysates were collected and immunoblotted with antibodies against Bcl-2, p-c-Jun, active caspase-3, cleaved poly (ADP-ribose) polymerase (PARP), and apoptosis-inducing factor (AIF). The guinea pigs received intraperitoneal injections of cisplatin alone or following minocycline pretreatment. The auditory brainstem response was tested and the cochleae were harvested and evaluated using scanning electron microscopy. Results Survival significantly increased in cells pretreated with minocycline compared with cells exposed to cisplatin alone. Cisplatin treatment increased the expression of active caspase 3, p-c Jun, PARP, and AIF, and pretreatment with minocycline attenuated this response. In animal study, the threshold shift by cisplatin injection in the auditory brainstem response was less pronounced in animals pretreated with minocycline. Scanning electron microscopy revealed more severe damage to the outer hair cells at the basal and middle turns than the apical turn. Conclusion Minocycline partially protects against cisplatin-induced ototoxicity via both caspase-dependent and independent apoptosis pathways.

Combination therapy with systemic steroids, an antiviral agent, anticoagulants, and stellate ganglion block for treatment of sudden sensorineural hearing loss.

Background and Objectives Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. Subjects and Methods A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegels criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. Results The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). Conclusions Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

Spontaneous temporomandibular joint herniation.

An 84-year-old man presented with a history of left otalgia, hearing loss, and otorrhea. He had no history of ear surgery or trauma. The left external auditory canal (EAC) was blocked by a mass that was based anterosuperiorly, changing position with jaw movement. When the patient’s mouth was closed, the mass was visible (Figure 1), whereas it retracted from the EAC during mouth opening (view the video in the Supplemental Material section available online). The medial side of the mass was impacted with earwax. After the earwax was removed, the patient’s hearing improved. The tympanic membrane was intact. He had no more complaints of otalgia and otorrhea. High-resolution computed tomography revealed a 9-mm defect in the anterior EAC wall. Based on physical examination and an imaging study, his condition was diagnosed as spontaneous temporomandibular joint (TMJ) herniation.

Gastric carcinoma metastasis to the internal auditory canal.

A 41-year-old man underwent a radical total gastrectomy and postoperative chemotherapy for advanced gastric carcinoma (Borrmann Type IV, adenocarcinoma). Two years later, a bone scan and abdominal computed tomography were performed as part of the regular followup, and they showed multiple metastases to the bone and the liver. The patient refused further treatment. Three months later, he was referred to the Department of Otolaryngology for an evaluation of a sudden hearing loss and facial weakness on the left side, which had developed 2 days earlier. The physical examination revealed peripheral facial palsy of House-Brackmann grade IV on the left side with no spontaneous nystagmus; there was a normal external auditory canal and tympanic membrane. Pure tone audiometry demonstrated normal right-sided hearing, although there was severe sensorineural hearing loss on the left side with a pure tone average of 80 dB HL. The bone scan revealed multiple areas of uptake in the left temporal bone, 2 ribs, the spine, and the pelvic bones (Fig. 1). These clinical manifestations and the bone scan results suggested the possibility of metastasis to the internal auditory canal (IAC), so magnetic resonance imaging (MRI) of the temporal bone with a contrast study was performed. Fat-suppressed gadolinium-enhanced T1-weighted MRI showed a diffuse enhancing mass in the left petrous apex, clivus, and IAC, which was suggestive of extensive metastasis (Fig. 2, A and B). Direct invasion of the left IAC from the lesion in the petrous apex (Fig. 2C) and an enhancing lesion involving the left IAC and labyrinthine segment of the facial nerve (Fig. 2D) were noticed on the gadoliniumenhanced T1-weighted axial MRI, but there was no abnormal signal intensity or mass formation at the cerebellopontine angle. He was diagnosed with metastasis to the IAC, and he refused further evaluation and management. He is now being managed conservatively. His facial weakness and hearing loss have not improved.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

Background and Objectives The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. Subjects and Methods The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. Results Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. Conclusions Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Is a Solitary Fibrous Tumor in the External Auditory Canal Benign

A solitary fibrous tumor (SFT) is an extremely rare, distinct otological soft-tissue tumor. Only two such tumors in the external auditory canal have been reported. A SFT related to hemangiopericytomas (HPC), which commonly arise in the central nervous system. HPCs act malignant in many cases, while SFTs at other sites are mainly benign. A 25-year-old female presented with highly vascular tumor at the right external auditory meatus and bleeding from the mass when a crust was removed from its surface. After excisional biopsy followed by pre-operative embolization, this tumor confirmed with SFT. The recurrence rate of SFT is very low after complete resection, with a slightly increased risk of recurrence with extrathoracic tumors. We describe the third case of SFT in the external auditory canal and review the literature.