ABSTRACT
Abstract Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.
ABSTRACT
Background: Otitis media [OM] has the highest incidence among all medical conditions in children younger than age five, Otitis media with effusion [OME] is the most common cause of childhood deafness. Gastroesophageal reflux disease [GERD] refers to the symptoms and complications of abnormal passage of gastric contents into the esophagus. Laryngopharyngeal reflux [LPR] is the movement of gastric contents beyond the esophagus up to the laryngeal and pharyngeal area. As well as pepsin and acid of gastric contents can include bile acids and pancreatic enzymes, all of which can injure tissues not adapted to them. Although Gasteroesophogeal Reflux [GER] may be normal, LPR [Laryngopharyngeal Reflux] should never be considered physiologic. LPR has been implicated in the OME pathogenesis: therefore, it is necessary to identify the presence or absence of gastric juice in the middle ear
Hypothesis: The objective was to investigate the potential use of pepsin and pepsinogen as diagnostic marker for Laryngopharyngeal reflux disease in otitis media with effusion
Study design: We studied 100 children with symptoms suggestive of either gasroeosophgeal reflux [GER] or OM clinically; all patients were subjected to pharyngeal PH test, Tympanometry, middle ear fluid samples [obtained by myringotomy from patients with Otitis media with effusion] were examined for the presence of pepsin and pepsinogen by using a proteolytic enzyme assay
Result [s]: There was a statistical significant difference as regarding the effect of LPR proved by pharyngeal PH <4.0,in cases of otitis media with effusion. Of 34 patients with OME subjected to myringotomy 61.76% were positive for pepsin and pepsinogen
Conclusion: A strong significant relation was found between LPR and OME [evidenced by pharyngeal PH <4.0 and Middle ear fluid pepsin and pepsinogen] We suggest a causative link between LPR and OME in young children