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Extracellular and intracellular melanin in inflammatory middle ear disease
Author(s) -
Fritz Mark A.,
Roehm Pamela C.,
Bannan Michael A.,
Lalwani Anil K.
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24507
Subject(s) - melanin , histiocyte , cholesteatoma , pathology , inflammation , stain , mastoiditis , middle ear , medicine , extracellular , otitis , biology , staining , anatomy , immunology , microbiology and biotechnology , surgery , genetics
Objectives/Hypothesis Melanin is a pigmented polymer with a known role in dermal solar protection. In vertebrates, melanogenesis has been reported in leukocyte populations, suggesting a potential role in innate immunity. In this study, we report the novel finding of melanin associated with chronic inflammation and speculate on its potential role in the middle ear and mastoid. Study Design Retrospective review of case series. Methods Medical records of six patients who demonstrated melanin in the ear were reviewed. Results Six patients from 1 to 63 years of age were identified with extracellular melanin and melanin‐laden histiocytes within the middle ear and/or mastoid air cells at time of surgery. Concurrent intraoperative findings included cholesteatoma (n = 3), chronic suppurative otitis media (n = 2), and coalescent mastoiditis (n = 1). Histologically, extracellular melanin and melanin‐laden histiocytes were identified by Fontana‐Masson stain; absence of melanocytes was confirmed by the absence of Melan‐A staining. One patient had a positive stain for CD163 (a marker for macrophages). Conclusion This case series is the first demonstration of melanin within middle ear mucosa without melanocytes in immediate proximity or metastatic melanocytic lesions. Melanin's presence in the setting of inflammation suggests that there may be a heretofore unreported link between the pigmentary and immune systems in the middle ear. Level of Evidence 4. Laryngoscope , 124:E241–E244, 2014