EAR SMEARS 



109 



EAR SMEARS 



to the size of the cell the nucleus is 

 small and ovoid, often obscured by 

 the lipoid globules which completely 

 fill the cytoplasm. Pseudopodia may be 

 present but active motility has never 

 been observed. They stain positively 

 with Sudan III in the fresh condition. 

 The stain dissolves the globules and the 

 cytoplasm fills with the orange dye. 

 These large phagocytes, when not filled 

 with lipoid material, may be seen to 

 phagocytose cellular debris, red blood 

 cells and entire neutrophiles as well as 

 bacteria. 



All of the cellular elements should 

 be taken into consideration in order 

 to evaluate the inflammatory response. 

 The display of polymorphonuclear neu- 

 trophilic leucocytes is important. It 

 can be demonstrated that 45-65% of 

 these cells will engulf carmine particles 

 suspended in tyrode or neutral saline 

 solution. If the same preparation is 

 counterstained with dilute neutral red 

 the identical vacuoles containing car- 

 bon will react to neutral red dye, in- 

 dicating that neutral red staining is a 

 fairly accurate criterion for judging 

 phagocytic activity. Hesse, Herr 

 (Ztschr. f. Hals, Nasen u. Ohrenh., 

 1927-1928, 18, 377-382) studied fresh 

 exudates from middle ear suppurations 

 and distinguished phagocytic and non- 

 phagocytic leucocytes, but he stated 

 that ceil death occurred very rapidly. 

 For staining he used the Synderhel- 

 mishe dye, a preparation of trypan blue 

 and Congo red. The dye has been used 

 here and found to be very toxic for the 

 cells. It does not give sufficient time 

 for observation in the living state. He 

 made no mention of the giant bone 

 phagocytes. 



Other cells encountered in acute mas- 

 toiditis include monocj^tes, lympho- 

 cytes, eosinophiles and basophiles. 

 Many variations in the mononuclear 

 cells are found. Besides the typical 

 blood monocytes there are gradual tran- 

 sitions between these cells and the 

 giant phagocytes. Often it is advisable 

 to distinguish between these cells when 

 they are not engorged with lipoid ma- 

 terial, but yet are larger than the 

 typical monocyte with many varying 

 shades of neutral red vacuoles and a 

 smaller ovoid eccentric nucleus, rather 

 than the typical horse-shoe nucleus 

 of the monocyte. These are termed 

 "transitional mononuclears", or cor- 

 respond in appearance to the "clasmato- 

 cytes" in the classification of Sabin, 

 F. R., Doan, C. A. and Cunningham, 

 R. S. (Contrib. to Embryol., 1925, 16, 

 127-162). The lymphocytes may show 

 slight motility in fresh preparations 



and sometimes a few neutral red in- 

 clusions. If Janus Green is used the 

 mitochondria may be observed. Eosin- 

 ophiles, if seen in these secretions, may 

 exhibit motility in the living state but 

 are never seen to store particulate 

 matter. In acute mastoiditis there are 

 rarely more than a few seen. Baso- 

 phile cells are also noted in many cases. 

 They are usually few in number and 

 their significance is not known. 



In contrast to the various cells as- 

 sociated with active mastoiditis, there 

 are those observed in chronic mas- 

 toiditis, namely, large numbers of de- 

 generated neutrophiles, fattj^ degen- 

 erated squamous epithelial cells and 

 masses of mixed bacteria. Bacteria are 

 numerous along with cellular debris. 

 Giant phagocytes are rarely found in 

 the chronic condition unless there is an 

 acute exacerbation of the infection. 

 Many other cellular details require to 

 be correlated with the symptoms of the 

 patient in these diseases. 



Cytological studies aid in differentiat- 

 ing the many types of external otitis. 

 Senturia, B. H., Matthews, J. I. and 

 Adler, B. C. (The Laryngoscope, 1950, 

 60, 543-550) have made important con- 

 tributions showing that the smear gives 

 information as to the causative agents 

 in external otitis, whether they are 

 bacilli, cocci or fungi. Examination of 

 the smear is helpful in distinguishing 

 between suppurative otitis media and 

 external otitis (except the circum- 

 scribed type). Senturia states that the 

 ear with a hidden tympanic perforation 

 and a secondary diffuse external otitis 

 may be difficult to differentiate from a 

 diffuse external otitis with exudate cov- 

 ering the tympanic membrane. Cyto- 

 logical examination usually makes the 

 difference clear. Otitis media with per- 

 foration shows neutrophiles, lympho- 

 cytes, mucus strands, with a few bac- 

 teria and epithelial cells. Diffuse 

 external otitis shows a predominance of 

 epithelial cells and bacteria, with per- 

 haps an occasional leucocyte or mucus 

 strand in the secretion. The most 

 striking finding in the exudates of acute 

 and diffuse external otitis is the absence 

 of neutrophiles. 



In regard to the early diagnosis of 

 malignant and benign tumors of the 

 middle ear and external canal, the 

 cytology of the discharge should be 

 studied carefully with the staining tech- 

 nique developed by Papanicolaou, G. 

 N. (Science, 1942, 95, 438-439). This 

 is a reliable aid in conjunction with 

 biopsy and it is especially important if 

 biopsy is not possible. Fortunately 

 carcinoma of the middle ear is somewhat 



