Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-19T00:33:30.307Z Has data issue: false hasContentIssue false
  • English
  • Français

Mycological study on cholesteatoma keratin obtained during primary mastoid surgery

Published online by Cambridge University Press:  19 September 2014

K G Effat  and
N M Madany
K G Effat*
Affiliation:
Department of Otolaryngology, El-Sahel Teaching Hospital, Cairo, Egypt
N M Madany
Affiliation:
Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
*
Address for correspondence: Dr Kamal G Effat, 51A El-Madina El-Monawara Street, Madinet El-Mohandeseen, Giza, Egypt E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Established middle-ear cleft cholesteatoma is associated with keratinous debris, which is likely to be an ideal medium for saprophytic fungal colonisation. This prospective case study aimed to explore the incidence and nature of fungal elements in cholesteatoma keratin samples obtained during primary mastoid surgery.

Methods:

All cases of middle-ear cleft cholesteatoma treated with primary mastoid surgery at the El-Sahel Teaching Hospital over a seven-month period were included. Keratinous debris obtained from the mastoid antrum was subjected to mycological analysis at the Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University. A literature search was performed to determine the clinical and pathological relevance of fungal colonisation in cholesteatoma.

Results:

Eighteen patients underwent primary mastoid surgery for cholesteatoma (nineteen ears in total) in a seven-month period starting 30 March 2013. Patients included 13 males and 5 females, with an age range of 9 to 45 years (mean 23 years). Fungal cultures were obtained from 17 keratin samples (89 per cent). Of these, five fungal isolates belonged to the dermatophyte group (21 per cent).

Conclusion:

Fungal colonisation in middle-ear cleft cholesteatoma probably plays a significant role in disease progression. Moreover, saprophytic fungal colonisation in cholesteatoma keratin may be responsible for the fetor commonly associated with the ear discharge.

Keywords

CholesteatomaMicrobiologyFungi
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 10 , October 2014 , pp. 881 - 884
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Shoham, S, Levitz, SM. The immune response to fungal infections. Br J Haematol 2005;129:569–82CrossRefGoogle ScholarPubMed
2Morgan, J, Warnock, DW. Fungi. In: Gleeson, M, Jones, NS, eds. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, Volume 1, 7th edn.London: Hodder Arnold, 2008;213–27Google Scholar
3Bottone, EJ, Hong, T, Zhang, DY. Basic mycology: underscoring medically important fungi. Otolaryngol Clin North Am 1993;26:919–40Google Scholar
4Wang, P-C, Nadol, JB, Merchant, S, Austin, E, Gliklich, RE. Validation of outcomes survey for adults with chronic suppurative otitis media. Ann Otol Rhinol Laryngol 2000;109:249–54CrossRefGoogle ScholarPubMed
5Chole, RA, Sudhoff, HH. Chronic otitis media, mastoiditis, and petrositis. In: Cummings, CW, Harker, LA, eds. Cummings Otolaryngology-Head and Neck Surgery, Volume 6, 4th edn.Philadelphia: Elsevier Mosby, 2005;2988–3012Google Scholar
6Albert, RRA, Job, A, Kuruvilla, G, Joseph, R, Brahmadathan, KN, John, A. Outcome of bacterial culture from mastoid granulations: is it relevant in chronic ear disease? J Laryngol Otol 2005;119:774–8Google Scholar
7Effat, KG, Madany, NM. Microbiological study of role of fungi in primary atrophic rhinitis. J Laryngol Otol 2009;123:631–4CrossRefGoogle ScholarPubMed
8Ibekwe, AO, Shareef, ZA, Benayam, A. Anaerobes and fungi in chronic suppurative otitis media. Ann Otol Rhinol Laryngol 1997;106:649–52Google Scholar
9Vennewald, I, Schönlebe, J, Klemm, E. Mycological and histological investigations in humans with middle ear infections. Mycoses 2003;46:12–18Google Scholar
10Gluth, MB, Tan, BYB, Santa Maria, PL, Atlas, MD. Unique microbiology of chronically unstable canal wall down tympanomastoid cavities: considerations for surgical revision. J Laryngol Otol 2013;127:458–62CrossRefGoogle ScholarPubMed
11Murakami, A, Tutumi, T, Watanabe, K. Middle ear effusion and fungi. Ann Otol Rhinol Laryngol 2012;121:609–14Google Scholar
12Louw, L. Acquired cholesteatoma pathogenesis: stepwise explanations. J Laryngol Otol 2010;124:587–93Google Scholar
13Saunders, J, Murray, M, Alleman, A. Biofilms in chronic suppurative otitis media and cholesteatoma: scanning electron microscopy findings. Am J Otolaryngol 2011;32:32–7Google Scholar
14Healy, DY, Leid, JG, Sanderson, AR, Hunsaker, DH. Biofilms with fungi in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2008;138:641–7CrossRefGoogle ScholarPubMed
15Inoue, Y, Matsuwaki, Y, Shin, S-H, Ponikau, JU, Kita, H. Nonpathogenic, environmental fungi induce activation and degranulation of human eosinophils. J Immunol 2005;175:5439–47CrossRefGoogle ScholarPubMed
16Kauffman, HF, Tomee, JFC, van de Riet, MA, Timmerman, AJB, Borger, P. Protease-dependent activation of epithelial cells by fungal allergens leads to morphologic changes and cytokine production. J Allergy Clin Immunol 2000;105:1185–93CrossRefGoogle ScholarPubMed
17Louw, L. Acquired cholesteatoma: summary of the cascade of molecular events. J Laryngol Otol 2013;127:542–9Google Scholar
18Nyrop, M, Bonding, P. Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol 1997;111:521–6Google Scholar
19Bhatt, YM, Pahade, N, Nair, B. Aspergillus petrous apicitis associated with cerebral and peritubular abscesses in an immunocompetent man. J Laryngol Otol 2013;127:404–7Google Scholar
20Anwar, S, Enam, S, Jooma, R, Shah, A, Shamim, M, Siddiqui, A. Craniocerebral aspergillosis in immunocompetent hosts: surgical perspective. Neurol India 2007;55:274–85Google Scholar
21Chen, C-M, Chiang, C-W. Allergic fungal otomastoiditis: a case report. Laryngoscope 2013;123:1040–2Google Scholar
22Yates, PD, Upile, T, Axon, PR, de Carpentier, J. Aspergillus mastoiditis in a patient with acquired immunodeficiency syndrome. J Laryngol Otol 1997;111:560–1CrossRefGoogle Scholar
23Kuruvilla, G, Job, A, Mathew, J, Ayyappan, AP, Jacob, M. Septate fungal invasion in masked mastoiditis: a diagnostic dilemma. J Laryngol Otol 2006;120:250–2CrossRefGoogle ScholarPubMed