Epithelial migration.We evaluated a 30-year-old man who had chronic bilateral otitis otitis Inflammation of the ear. Otitis externa is dermatitis, usually bacterial, of the auditory canal and sometimes the external ear. It can cause a foul discharge, pain, fever, and sporadic deafness. . Otoscopic examination of the right ear revealed an old posterior perforation, through which the oval window niche could not be seen (figure). The patient's average air-bone gap was 20 dB, which suggested that the ossicular os·si·cle n. A small bone, especially one of the three bones of the middle ear. [Latin ossiculum, diminutive of os, bone; see ost- in Indo-European roots. chain was intact and mobile. The anterior half of the drum was translucent. A layer of epithelial tissue appeared to insinuate in·sin·u·ate v. in·sin·u·at·ed, in·sin·u·at·ing, in·sin·u·ates v.tr. 1. To introduce or otherwise convey (a thought, for example) gradually and insidiously. See Synonyms at suggest. 2. itself around the handle of the malleus malleus /mal·le·us/ (mal´e-us) [L.] the outermost of the auditory ossicles, and the one attached to the tympanic membrane; its club-shaped head articulates with the incus mal·le·us n. pl. , and it extended to the medial surface of the anterior drum remnant. Superiorly, the tissue disappeared under the posterior tympanomalleal ligament. Interiorly, the epithelium appeared to invaginate in·vag·i·nate v. To infold or become infolded so as to form a hollow space within a previously solid structure, as in the formation of a gastrula from a blastula. invaginate to infold one portion of a structure within another portion. toward the posterior recess of the middle ear space. The need for surgery was clear; otherwise, eventual evolution toward a cholesteatoma was inevitable. [FIGURE OMITTED] Epithelial migration is a classic but rare pathogenic pathway in the formation of cholesteatomas. It may be predisposed by the presence of tympanoselerotic plaques, although this did not occur in our patient. Surgeons who encounter such a case must perform a very meticulous dissection of the epithelial tissue and insist on annual follow-up for several years to avoid the risk of an iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. cholesteatoma. From Gap, France (Dr. Deguine) and the Pulec Ear Clinic, Los Angeles (Dr. Pulec). Christian Deguine, MD; Jack L. Pulec, MD ([dagger]) ([dagger]) The late Dr. Pulec was editor-in-chief of EAR NOSE & THROAT JOURNAL from 1992 through 2003. |
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