External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients

OBJECTIVE: External auditory canal cholesteatoma (EACC) is a rarity. Although there have been numerous case reports, there are only few systematic analyses of case series, and the pathogenesis of idiopathic EACC remains enigmatic. STUDY DESIGN: In a tertiary referral center for a population of 1.5 million inhabitants, 34 patients with 35 EACC (13 idiopathic [1 bilateral] and 22 secondary) who were treated between 1994 and 2006 were included in the study. RESULTS: EACC cardinal symptoms were longstanding otorrhea (65%) and dull otalgia (12%). Focal bone destruction in the external auditory canal with retained squamous debris and an intact tympanic membrane were characteristic. Only 27% of the patients showed conductive hearing loss exceeding 20 dB. Patients with idiopathic EACC had lesions typically located on the floor of the external auditory canal and were older, and the mean smoking intensity was also greater (p < 0.05) compared with patients with secondary EACC. The secondary lesions were assigned to categories (poststenotic [n = 6], postoperative [n = 6], and posttraumatic EACC [n = 4]) and rare categories (radiogenic [n = 2], postinflammatory [n = 1], and postobstructive EACC [n = 1]). In addition, we describe 2 patients with EACC secondary to the complete remission of a Langerhans cell histiocytosis of the external auditory canal. Thirty of 34 patients were treated surgically and became all free of recurrence, even after extensive disease. DISCUSSION: For the development of idiopathic EACC, repeated microtrauma (e.g., microtrauma resulting from cotton-tipped applicator abuse or from hearing aids) and diminished microcirculation (e.g., from smoking) might be risk factors. A location other than in the inferior portion of the external auditory canal indicates a secondary form of the disease, as in the case of 2 patients with atypically located EACC after years of complete remission of Langerhans cell histiocytosis, which we consider as a new posttumorous category and specific late complication of this rare disease.

Materialien zum Zivilgesetzbuch. Die Erläuterungen von Eugen Huber / Text des Vorentwurfs von 1900

Das Werk eröffnet eine Serie von Bänden, die sich die Publikation der wichtigsten Materialien zum Schweizerischen Zivilgesetzbuch zum Ziel gesetzt hat. Sie sollen den Berner Kommentar zum Schweizerischen Privatrecht um eine kodifikationshistorische Dimension ergänzen und den Ausgangspunkt für die Erläuterungen zum geltenden Recht bilden. Der erste Band ist eigens auf die Centenarfeier des ZGB am 10. Dezember 2007 hin fertig gestellt worden. Er enthält mit den Erläuterungen zum Vorentwurf des Eidg. Justiz- und Polizeidepartements von 1900 das vielleicht schönste und anregendste, sicher aber das monumentalste Werk der Materialien. Es zeugt vom magistralen Überblick Eugen Hubers über den zivilrechtlichen Rechtsstoff und einer Weitsicht, die noch heute Vorbild jeder Gesetzgebungsarbeit sein sollte. Erstmals seit Jahrzehnten wird es wieder einem breiteren Publikum in originalgetreuer Form zugänglich gemacht. Zwecks prägnanter Zitierbarkeit sind Randnoten hinzugefügt worden. Ein Stichwortverzeichnis garantiert die schnelle Auffindbarkeit der Textstellen.