Objectives: Several studies reported low detection rates of otosclerosis in high-resolution computed tomography (HRCT), especially when the scans were reviewed by non-specialized general radiologists. In the present study, we conducted a retrospective review of the detection of otosclerosis in HRCT by general radiologists and the impact of inadequately filled radiological request forms on the detection rate. Methods: Retrospective analysis of hospital records, HRCT reports, and radiological referral notes of 40 patients who underwent stapedotomy surgery for otosclerosis. HRCT imaging data sets were retrospectively reviewed by a blinded experienced neuroradiologist, whose reading served as the gold standard. Results: General radiologists reading HRCT scans had an overall detection rate of otosclerosis of 36.1% in this cohort (13 of 36 available HRCT reports). The neuroradiologist had a much higher detection rate of 82.5% (33 of 40 cases). Interobserver agreement between the general radiologists and the subspecialist neuroradiologist was poor (Cohen’s kappa κ = 0.26). General radiologists missed the diagnosis in 15 of the 33 CT-positive scans, corresponding to a missed diagnosis rate of 45.4%. There was a highly significant association between a missed diagnosis and the lack of an explicitly mentioned clinical suspicion of otosclerosis in the request forms (Pearson’s chi-squared test, p < 0.005). Conclusion: The diagnosis of otosclerosis is frequently missed by radiologists on HRCT scans of the temporal bone in a clinical setting. Possible reasons include a relative lack of experience of general radiologists with temporal bone imaging as well as the failure of clinicians to unambiguously communicate their suspicion of otosclerosis.

The differential involvement of the macrophage activation phenotypes (M1 vs. M2) has been linked to disease severity in various chronic inflammatory disorders. Pharmacologic manipulation of the M1/M2 macrophage polarization has shown therapeutic potential. Cholesteatoma is a destructive chronic middle ear disease with potentially life-threatening complications. The distribution of macrophage polarization phenotypes in middle ear cholesteatoma has not been described. In the present study, human cholesteatoma specimens acquired during tympanomastoidectomy were retrospectively retrieved and immunohistochemically characterized using a combination of antibodies labeling M1 macrophages (CD80), M2 macrophages (CD163), and total macrophages (CD68). The correlations between the immunohistochemical findings and clinical presentation were assessed. The findings revealed that cholesteatomas with more extensive ossicular erosion demonstrated a significantly higher number of M1 (CD80+) cells and a higher M1/M2 ratio than less invasive cholesteatomas (Wilcoxon test, p < 0.05). The extent of ossicular erosion correlated significantly with the M1/M2 ratio (Spearman correlation coefficient ρ = 0.4, p < 0.05). Thus, the degree of ossicular erosion in human acquired cholesteatoma appears to be related to the M1/M2 macrophage polarization. The investigation of macrophage polarization and functions in various clinical presentations of middle ear cholesteatoma is of great interest since it may contribute to the development of pharmaceutical treatment approaches.

Objectives: Cervical lymph nodes are the most common site of peripheral lymphadenopathy. The underlying etiologies are usually benign and self-limiting but may include malignancies or other severe life-threatening diseases. The aim of the current study was to investigate the various underlying pathologies of cervical lymphadenopathy as assessed by the diagnostic yield of excisional lymph node biopsies of the neck in a tertiary adult practice. The evaluation was performed in light of previous literature and regional epidemiological patterns. Methods: Retrospective analysis of hospital charts of 158 adult patients who underwent an excisional biopsy for suspected cervical lymphadenopathy at a tertiary referral head and neck service between January 2017 and December 2019. Results: The most common underlying pathology was unspecific and/or reactive lymphadenitis in 44.5% of specimens, followed by malignant disease in 38.6% of cases. An age above 40 years was significantly correlated with an increased likelihood of malignant disease. Lower jugular and posterior triangle lymph nodes showed higher malignancy rates than other groups (100% and 66.7%, respectively). The overall surgical complication rate was 2.5%. Conclusions: The results of the current study serve as an indicator of the variety of etiologies causing cervical lymphadenopathy. In particular, given the increasing incidence of malignant diseases in recent decades, the findings should alert physicians to the importance of lymph node biopsy for excluding malignancy in persistent cervical lymphadenopathy especially in older adults. The findings emphasize the value of excisional lymph node biopsy of the neck as a useful diagnostic tool in adult patients with peripheral lymphadenopathy.

Zusammenfassung: Hintergrund: Patient:innen mit einseitiger Taubheit („single-sided deafness“, SSD) und asymmetrischem Hörverlust („asymmetric hearing loss“, AHL) werden zunehmend mit Cochleaimplantaten (CI) versorgt, da eine Verbesserung der auditiven Fähigkeiten und der Lebensqualität nachgewiesen wurde. Bisher gibt es nur wenige Veröffentlichungen, in denen die beiden Gruppen vergleichend untersucht werden. Ziel der vorliegenden Studie war es zu prüfen, worin sich diese beiden Gruppen, insbesondere präoperativ, unterscheiden. Methodik: Es handelt sich um eine statistische Sekundäranalyse bereits veröffentlichter Rohdaten von 66 CI-Patient:innen (21 SSD/45 AHL), die prospektiv in die Studie eingeschlossen wurden. Neben dem Sprachverstehen wurden Tinnitusbelastung (Tinnitusfragebogen), krankheitsspezifische Lebensqualität (Nijmegen Cochlear Implant Questionnaire, NCIQ), Stressbelastung (Perceived Stress Questionnaire, PSQ) und psychische Komorbiditäten (Allgemeine Depressionsskala, ADS‑L, und Generalized-Anxiety-Disorder-Fragebogen, GAD-7) bei SSD- und AHL-Patient:innen prä- und postoperativ verglichen. Ergebnisse: Präoperativ zeigte die SSD-Gruppe im NCIQ in den Subdomänen elementare und erweiterte Schallwahrnehmung signifikant höhere Werte als die AHL-Gruppe. Die Stressbelastung (PSQ) und die Angstsymptomatik (GAD-7) waren bei SSD-Patienten signifikant höher als bei AHL-Patient:innen. Diese Unterschiede waren 6 Monate postoperativ stark verringert und teils sogar nicht mehr signifikant. Schlussfolgerung: Präoperativ unterscheiden sich SSD- und AHL-Patient:innen signifikant im Hinblick auf die subjektive Höreinschätzung und psychosoziale Parameter. Bei SSD-Patient:innen können psychische Belastungsfaktoren einen stärkeren Einfluss auf die gesundheitsbezogene Lebensqualität haben als bei AHL-Patient:innen. Diese Aspekte sollten in der präoperativen Beratung sowie in der postoperativen CI-Rehabilitation berücksichtigt werden.

Transmembrane protein 119 (TMEM119) is expressed in a subset of resident macrophage cells of the brain and was proposed as a marker for native brain microglia. The presence of cells expressing TMEM119 in the cochlea has not yet been described. Thus, the present study aimed to characterize the TMEM119-expressing cells of the postnatal and adult cochlea, the latter also after noise exposure. Immunofluorescent staining of cochlear cryosections detected TMEM119 protein in the spiral limbus fibrocytes and the developing stria vascularis at postnatal Day 3. Applying the macrophage marker Iba1 revealed that TMEM119 is not a marker of cochlear macrophages or a subset of them. In the adult murine cochlea, TMEM119 expression was detected in the basal cells of the stria vascularis and the dark mesenchymal cells of the supralimbal zone. Exposure to noise trauma was not associated with a qualitative change in the types or distributions of the TMEM119-expressing cells of the adult cochlea. Western blot analysis indicated a similar TMEM119 protein expression level in the postnatal cochlea and brain tissues. The findings do not support using TMEM119 as a specific microglial or macrophage marker in the cochlea. The precise role of TMEM119 in the cochlea remains to be investigated through functional experiments. TMEM119 expression in the basal cells of the stria vascularis implies a possible role in the gap junction system of the blood–labyrinth barrier and merits further research.