The role of langerhans cells, ki-67 and apoptosis in acquired cholesteatoma

Objective: The aims of the study were to investigate the relationship of Langerhans cells with pathogenesis and clinical properties of middle ear cholesteatoma, using cell proliferation and programmed cell death markers. Study Design: Prospective, blind, controlled clinical study Study Settlement: Başkent University Departments of Otorhinolaryngology and Pathology Material and Method: Forty patients that had been operated with the diagnosis of chronic otitis due to acquired cholesteatoma, in the years of 2007 and 2008, were included in the study. Findings: 23 male and 17 female patients were included in the study. Mean age of the patients was 35±16 years. The duration of the disease was 12.7±10.7 years. Average pure tone audiometry score was 54±19 dB and air bone gap was 31±12 dB, with an average. The disease was limited to the mastoid bone in 85% and extending out of the temporal bone in 15% of the patients. All of the ossicles were destructed in 32.5% and malleus and incus were destructed in 35% of the patients. Closed technique was used in 20% and open technique was used in 80% of the patients. Facial canal and lateral semicircular canal was found to be dehiscent in 20% and in 17.5% of the patients, respectively. Tegmen mastoideum was defective in 30% and scutum was found to be destructed in 55% of the patients. Langerhans cells were found to be more densely cumulated at cholesteatoma epithelium when compared with external ear canal skin (p<0.001). Ki-67 index was higher in cholesteatoma epithelium (p<0.001). Apoptosis was more prominent in cholesteatoma epithelium (p<0.001). The sole significant relationship between clinical and pathologic findings was the higher Ki-67 index (p=0.041) and apoptosis rate (p=0.032) in patients that had been operated with open technique. Conclusion: It was found that a dense Langerhans cell infiltration occured as a host response against middle ear cholesteatoma, using cell proliferation and programmed cell death markers. Ki-67 scores were found to be higher in the group with high inflammation rates and this finding was stastistically significant. It was found that open technique was the right choice of surgical treatment in patients in whom cell proliferation and programmed cell death rates were high.