ORIGINAL ARTICLE
Ultrastructural alterations of the tympanic membrane in retraction pockets from patients with chronic otitis media
1
Department of Otolaryngology, Medical University of Gdansk, Poland
2
Department of Electron Microscopy, Medical University of Gdansk, Poland
Submission date: 2019-11-25
Final revision date: 2020-01-14
Acceptance date: 2020-04-06
Publication date: 2021-02-22
Pol J Pathol 2020;71(4):347-352
KEYWORDS
TOPICS
ABSTRACT
Chronic otitis media with a retraction pocket is one of the forms of chronic otitis media that predisposes to cholesteatoma. The aim of our study was to determine the extent and type of changes in the tympanic membrane fragments which were surgically excised from the retraction pockets of 20 patients treated for cholesteatoma and/or hearing loss. Material evaluation and photographic documentation were performed using a transmission electron microscope (JEM 1200EX II, Jeol, Japan). We found that the morphological changes of the tympanic membrane are particularly related to the structure of the external epithelium, formation of epithelial invaginations, atrophy of the basement membrane of the eardrum and loss of circular and longitudinal collagen fibers. Ultrastructural changes in the tympanic membrane suggest inflammatory processes, epithelial migration, destruction of collagen fibers and autophagy, which indicates that the process of retraction pocket development is active. Tympanic membrane retraction pocket development is an active process, not the sequela of prior illness. The intensification of the keratinization and migration process of the epithelium layer confirms one of the theories of the creation of cholesteatoma and shows that the retention pocket is a pre-cholesteatoma condition.
REFERENCES (27)
1.
Knutsson J, Bagger-Sjöbäck D, von Unge M. Structural tympanic membrane changes in secretory otitis media and cholesteatoma. Otol Neurotol 2011; 32: 596-601.
2.
Özkiriş M, Kapusuz Z, Saydam L. The prevalence of middle ear diseases among 7- to 13-year-old primary school students in Yozgat province. Turk J Pediatr 2012; 54: 493-496.
3.
Jesic SD, Jotic AD, Babic BB. Predictors for Sensorineural Hearing Loss in Patients With Tubotympanic Otitis, Cholesteatoma, and Tympanic Membrane Retractions. Otol Neurotol 2012; 33: 934-940.
5.
et al. Expression of tumor necrosis factor-α, interleukin-1α, interleukin-6 and interleukin-10 in chronic otitis media with bone osteolysis. ORL J Otorhinolaryngol Relat Spec 2011; 73: 93-99.
8.
Olszewska E, Wagner M, Bernal-Sprekelsen M, et al. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol 2004; 261: 6-24.
9.
Grewal DS, Hathiram BT, Moliorikar AV, et al. Retraction pockets in chronic suppurative otitis media – our experience. Indian J Otolaryngol Head Neck Surg 2003; 55: 107-112.
10.
Sudhoff H, Tos M. Pathogenesis of sinus cholesteatoma. Eur Arch Otorhinolaryngol 2007; 264: 1137-1143.
11.
Sadé J. The buffering effect of middle ear negative pressure by retraction of the pars tensa. Am J Otol 2000; 21: 20-23.
12.
D’ Eredità R, Marsh RR. Tympanic membrane healing process and biocompatibility of an innovative absorbable ventilation tube. Otol Neurotol 2006; 27: 65-70.
13.
Pau HW, Punke C, Just T. Tympanometric experiments on retracted ear drums – does tympanometry reflect the true middle ear pressure? Acta Otolaryngol 2009; 129: 1080-1087.
14.
Alzahrani M, Saliba I. Tympanic membrane retraction pocket staging: Is it worthwhile? Eur Arch Otorhinolaryngol 2014; 271: 1361-1368.
15.
Kobayashi T, Toshima M, Yaginuma Y, et al. Pathogenesis of attic retraction pocket and cholesteatoma as studied by computed tomography. Am J Otol 1994; 15: 658-662.
16.
Ala Eddine C, Williams M, Ayache D. Useful imaging of the ear. J Radiol 2006; 87: 1728-1742.
17.
Barbara M. Lateral attic reconstruction technique: preventive surgery for epitympanic retraction pockets. Otol Neurotol 2008; 29: 522-525.
18.
Boedts D, Decock M, Andries L, Marquet J. A Scanning Electron-Microscopic Study of Different Tympanic Grafts. Am.
20.
Boxall JD, Proops DW, Michaels L. Scanning electron microscopy of tympanic membrane epithelium during in vitro migration. J Otolaryngol 1990; 19: 57-61.
21.
Kakoi H, Anniko M, Kinnefors A, Rask-Andersen H. Auditory Epidermal Cell Migration. VII. Antigen Expression of Proliferating Cell Nuclear Antigens, PCNA and Ki-67 in Human Tympanic Membrane and External Auditory Canal. Acta Otolaryngol 1997; 117: 100-108.
23.
V. Transmission electron-microscopic study of tympanic membrane and external auditory canal in the mouse. ORL J Otorhinolaryngol Relat Spec 1996; 58: 280-287.
24.
Tang IP, Prepageran N, Raman R, Sharizhal T. Epithelial migration in the atelectatic tympanic membrane. J Laryngol Otol 2009; 123: 1321-1324.
25.
Sadé J. On the function of the pars flaccida: Retraction of the pars flaccida and buffering of negative middle ear pressure. Acta Otolaryngol 1997; 117: 289-292.
26.
Kutz JW Jr, Fayad JN. Tympanic membrane atelectasis. Ear Nose Throat J 2006; 85: 298.
27.
Shu MT, Wu KC, Chen YC. Middle ear atelectasis. Ear, Nose Throat J 2012; 91: 466.
| eISSN: | 2084-9869 |
| ISSN: | 1233-9687 |
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