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Extracellular and intracellular melanin in inflammatory middle ear disease

Authors

  • Mark A. Fritz MD,

    1. Department of Otolaryngology, New York University School of Medicine, New York, U.S.A
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  • Pamela C. Roehm MD, PhD,

    1. Department of Otolaryngology, New York University School of Medicine, New York, U.S.A
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  • Michael A. Bannan MD,

    1. Department of Pathology, New York University School of Medicine, New York, U.S.A
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  • Anil K. Lalwani MD

    Corresponding author
    1. Department of Otolaryngology, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
    • Send correspondence to Anil K. Lalwani, MD, Professor and Vice Chair for Research, Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology–Head & Neck Surgery, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion HP818, New York, NY 10032. E-mail: anil.lalwani@columbia.edu

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  • Presented at the 2013 American Otological Society Spring Meeting, Orlando, Florida, U.S.A., April 12–14.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

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

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