Leslie Michaels

Polymerase Chain Reaction Amplification of Herpes Simplex Viral Dna from the Geniculate Ganglion of a Patient with Bell's Palsy

Bells palsy is the most common cause of facial paralysis. In this study, we demonstrate the presence of herpes simplex viral type 1 (HSV-1) genomic DNA in the geniculate ganglion of a patient who had Bells palsy. This association suggests that in this patient, HSV-1 may have caused Bells palsy. If HSV-1 is a cause of Bells palsy, treatment with acyclovir may be beneficial. Additional studies should be done to establish the prevalence of HSV-1 as an etiologic agent of Bells palsy.

Current review on squamous intraepithelial lesions of the larynx

Squamous intraepithelial lesions (SILs) of the larynx, clinically usually defined as leukoplakia and chronic laryngitis, have remained the main controversial topic in laryngeal pathology for decades as regards classification, histological diagnosis and treatment. SILs are caused by smoking and alcohol abuse. There is also mounting evidence that gastroesophageal reflux is a potential aetiological factor. Human papillomavirus infection seems to play little if any role in laryngeal carcinogenesis.

Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory

Objectives:  Chondrodermatitis nodularis chronica helicis (CNCH) usually presents as a painful nodule affecting the pinna. The aetiology of the disease is unknown. Several theories have been suggested.

Immunohistochemical characterization of the epidermoid formation in the middle ear.

Objective To study the incidence, size, and origin of epidermoid formations after accurately characterizing them by cytokeratin immunohistochemical analysis.

Congenital cerebrospinal fluid fistula through the inner ear and meningitis

Congenital deformities of the labyrinth of the inner ear can be associated with a fistulous communication between the intracranial subarachnoid space and the middle ear cavity. We describe seven such cases, six confirmed by high resolution CT and one by postmortem histological section. The seven patients all presented with meningitis although a cerebrospinal fluid fistula was demonstrated at subsequent surgery or postmortem. The lesions were bilateral in three patients, unilateral in three and probably bilateral in the postmortem case although only one temporal bone was obtained. In every case there was a dilated sac instead of the normal two and a half turn cochlea on the affected side and this was confirmed at surgery. The demonstration of the basal cochlear turn is of paramount importance in any deaf child presenting with meningitis. A true Mondini deformity with a normal basal turn and some hearing is not at risk of developing a fistula.

Epithelial migration in keratosis obturans

Keratosis obturans is a rare condition in which a cholesteoma-like mass is found filling the deep external auditory meatus. It has been suggested that a fault in auditory epithelium migration is responsible for the accumulation of squamous debris, but no studies have been carried out to confirm this. We present two cases of keratosis obturans in which delayed and abnormal pathways of migration of epithelium of the tympanic membrane were discovered, indicating that a fault in auditory epithelium may indeed be the basis of this condition.

Myxoma of the maxillary antrum in children

Myxomas of the maxillary antrum are rare tumours, particularly in childhood. Although circumscribed, they are often more extensive than apparent and so tend to recur despite their benign nature. Myxomas are gelatinous and are composed of stellate and spindle cells embedded in an abundant alcian blue‐positive, mucoid stroma in which blood vessels are often scattered throughout the tumour. Three patients with maxillary myxomas, all presenting in infancy or early childhood, are described.

Development of the fallopian canal in humans: a morphologic and radiologic study.

Aims This study investigated the development of the fallopian canal with particular reference to the mode of ossification and dehiscences, sites of incomplete closure around the facial nerve. Background The precise sequence of events surrounding ossification of the tissues around the facial nerve is uncertain. Incomplete ossification results in dehiscence of the adult structure, which places the nerve at increased risk of damage from disease processes in the middle ear and iatrogenic trauma during otologic surgery. Methods Twenty-four temporal bones from 12-to 36-week human fetuses were resected. Eight temporal bones from 22-to 36-week fetuses were microsliced to produce 1.5-mm horizontal sections and radiographed. Sixteen temporal bones from 12-to 35-week fetuses were serially microtomed to produce 7-&mgr;m slices, which were stained with hematoxylin and eosin. Quantitative and qualitative analyses of these sections were performed to document patterns of closure of the primitive canal and dehiscence formation. Results The tympanic part of the primitive fallopian canal, the facial sulcus, developed anteroposteriorly from the geniculate fossa to enclose the facial nerve. The mesenchyme that formed the facial sulcus underwent endochondral ossification, while the bone which capped or closed the sulcus developed in membrane. In the tympanic segment, permanent congenital dehiscences were elliptical and about 1 mm in length. Conclusions This study clarifies the mode of development of the fallopian canal, with particular reference to dehiscences, and provides a scientific basis for otologic practice.

Temporal bone study of development of the organ of Corti: correlation between auditory function and anatomical structure

OBJECTIVE To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function. MATERIAL AND METHODS Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term. RESULTS By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensens cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term. DISCUSSION AND CONCLUSIONS A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollickers organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.

Effect of Craniotomy and Cerebrospinal Fluid Loss on the Inner Ear An Experimental Study

Craniotomy with cerebrospinal fluid (CSF) suction was performed on 18 guinea pigs to determine the effects on the inner ear morphology. Six control animals received anaesthesia only and 12 were operated on with a postoperative survival time of 1 or 24 h. The histologic examinations showed no signs of endolymphatic hydrops or injury to other structures in any of the animals. In 11 of the operated animals, red blood corpuscles were demonstrated in the perilymphatic space of the cochlea, the subarachnoid space, and the cochlear aqueduct (CA). After 1 h survival time blood had entered primarily the basal part of the scala tympani, but in the animals of 24 h survival time the blood was more abundant in both the scala tympani and the scala vestibuli indicating flow within the inner ear. The CA thus provides a pathway between the CSF and the whole of the perilymph through which noxious effects could take place.