Abstract:Objective To investigate an association between human beta defensin (hBD) expression and cholesteatoma formation. Methods hBD-2 mRNA expressions were assessed in healthy external acoustic meatus skin organ cultures before and after stimulation with Pseudomonas aeruginosa. In addition, hBD-1 and hBD-2 protein production of stimulated and non-stimulated external acoustic meatus skin was visualized by immunohistochemistry. Furthermore, hBD-1 and hBD-2 mRNA expression was analyzed in 25 external acoustic meatus skin, 29 cholesteatoma, and 18 non-cholesteatoma control samples. Non-stimulated meatal tissue preparation did not express hBD-2, whereas incubation with P. aeruginosa demonstrated hBD-2 induction. Results The hBD-1 mRNA expression was detected in cholesteatoma (14/17), meatal skin, and middle ear mucosa (11/18). hBD-2 mRNA expression was shown in eight cholesteatoma (28.5%) and in three middle ear mucosa tissue samples (37.5%). Conclusion Our data suggest constitutional hBD-1 and inducible hBD-2 expression in chronic middle ear infection and cholesteatoma. Failure of hBD-1 and hBD-2 expression might dispose to exacerbation of cholesteatoma disease. The organ culture model of the external acoustic meatus skin is effective in order to evaluate germ stimulation experiments.

. Text Box: Defensins are cationic 4-8 kiloDalton antimicrobial peptides classified into alpha (from inflammatory cells) and beta (from epithelial cells) groups, and contribute to innate immune protection of epidermis and mucosa against invading microorganisms. The impaired production of human defensins had earlier been associated with tendency towards chronic infections. The spread of cholesteatoma is known to be influenced by cytokines (TNF alpha and IL-1) that are produced when cholesteatoma get infected. These two facts formed the basis of a recent report from Germany (Meyer, Schwaab, Bier et al, Auris, Nasus, Larynx, Volume 33, Issue 2 , June 2006, Pages 159-165) that observed hbd-1 and hbd-2 expression in chronic ME infection and cholesteatoma, with implication on future therapeutic application of hBD-2 stimulants in these conditions.  Abstract:Objective To investigate an association between human beta defensin (hBD) expression and cholesteatoma formation. Methods hBD-2 mRNA expressions were assessed in healthy external acoustic meatus skin organ cultures before and after stimulation with Pseudomonas aeruginosa. In addition, hBD-1 and hBD-2 protein production of stimulated and non-stimulated external acoustic meatus skin was visualized by immunohistochemistry. Furthermore, hBD-1 and hBD-2 mRNA expression was analyzed in 25 external acoustic meatus skin, 29 cholesteatoma, and 18 non-cholesteatoma control samples. Non-stimulated meatal tissue preparation did not express hBD-2, whereas incubation with P. aeruginosa demonstrated hBD-2 induction. Results The hBD-1 mRNA expression was detected in cholesteatoma (14/17), meatal skin, and middle ear mucosa (11/18). hBD-2 mRNA expression was shown in eight cholesteatoma (28.5%) and in three middle ear mucosa tissue samples (37.5%). Conclusion Our data suggest constitutional hBD-1 and inducible hBD-2 expression in chronic middle ear infection and cholesteatoma. Failure of hBD-1 and hBD-2 expression might dispose to exacerbation of cholesteatoma disease. The organ culture model of the external acoustic meatus skin is effective in order to evaluate germ stimulation experiments. . Text Box: Editor's Choice:    human beta defensins  and Cholesteatoma...? Text Box: Abreast of Ear, Nose, Throat, Head & Neck Advances

Text Box: Volume 3, N0. 8 Text Box: May 28, 2006

Text Box: Otorhinolaryngology News

Text Box: Inside This Issue · hbd & Cholesteatoma · Endoscopic SNB & Tongue lesions · Botox & Parotid Fistula *     Case of the Week

 

 

 Case Review

 Clinical Photo of The Week

A 65-year old male presented with insidious onset of dysphagia, especially to saliva and solids of 3 months duration, and inability to properly open the left eye of one week duration. His medical history revealed well controlled hypertension. He had no nasal symptoms and denied preceding cervico-facial or cranial trauma. Examination revealed the sign shown in this picture. MRI brain was negative. CT-Sinuses showed isolated right maxillary polyp. A follow-up visit a week later revealed bilateral ptosis with additional complaints of muscle weakness and easy fatigability.

What is the Diagnosis?
Text Box: Coming Events of Importance to Otorhinolaryngologists in Africa

1.          8th International Otology Course of the Jean Causse Ear Clinic June 22-24, 2006; Béziers, France

2. 110th American Academy of ORL, Head & Neck Surgery Annual Meeting & OTO EXPO, September 17-20, 2006; Toronto, Canada.

3. 42nd South African ENT Congress joint meeting with the British Association of Otolaryngology - Head & Neck Surgery, October 29-November 1, 2006; Cape Town, South Africa.
Management of post traumatic parotid fistula or post parotidectomy fistula has at best been controversial with plethora of treatment options being offered by different workers. These treatment options include  pressure dressing, suction drain insertion, tympanic neurectomy with or without chorda tympani section, radiotherapy, and even completion of the parotidectomy. Botulinum toxin (Botox) is a pre-ganglionic cholinergic blocker, and since most of the secretomotor fibres to the parotid are cholinergic, earlier attempts at use of Botox in parotid fistula management had previously been described by few workers. A new study from Italy (Marchese-Ragona et al, Americal Journal of Otolaryngology, Volume 27, Issue 3 , May-June 2006, Pages 221-224) re-affirmed the effectiveness of Botox in 3 cases with failed conservative treatment.

Abstract: Purpose Parotid fistula is a well-known complication of parotidectomy or penetrating injury of the parotid gland. The management of parotid fistula has been controversial, and numerous conservative and surgical treatment methods have been described. 

Methods We report 3 cases of parotid fistula after partial parotidectomy, which were treated by botulinum toxin injection under electromyographic control into the residual substance of parotid gland.

Results Complete healing of the fistula was achieved with a single botulinum toxin treatment in all patients. No side effects were observed after the treatment. The patients are disease-free after 21, 18, and 14 months, respectively.

Conclusions In the considered cases, the localized injection of botulinum toxin into the parotid gland resulted to an effective and long-lasting treatment of postparotidectomy fistula.

 

                 Journal Watch : Speech in post maxillectomy patients wearing obturator prosthesis - Arigbede et al, 2006

  1.  Reviewers wanted for otolaryngology news journal's watch page. If you are an Otolaryngologist in Africa and will like to be our journal reviewer, please feel free to email orl-mailer@otolaryngologyinafrica.net

  2.   DODA 2006, capable of advanced hearing measure, and also paediatric hearing assessment is being developed. If you requested for and got a free copy of DODA, you may also look out for this latest version dubbed DODA-i, as well as for an additional page on outcome of hearing assessment using DODA.

 3.  You may want to check out this new site dedicated to early detection of hearing loss in developing countries

 4.  A subweb of this site, dedicated to online publications of otorhinolaryngological grand round presentations across Institutions all over Africa will soon take off. The subweb once active can be accessed at http://grandround.otolaryngologyinafrica.net . Watch out, and please take advantage of this to send in your grand round presentations

 Till Next Week,

 Biodun

 

 

 

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