MUC5B expression in middle ear effusions: the main gel-forming mucin responsible for viscous properties of middle ear effusions

Several mucin genes are expressed in the middle ear mucosa resulting in the development of middle ear effusion. However, the detailed mucin protein expression in middle ear effusions has not been studied in individual effusions. This study aimed to explore the expression patterns of the 3 main secretory mucins, known to be expressed in the air-ways, in individual middle ear effusions with studying the possible correlation with the effusion viscosity. Middle ear effusions were collected under general anesthesia from 30 children with otitis media with effusion. The viscosity of individual effusions was studied. Mucins were extracted from the individual effusions and their antigenic identity was studied with ELISA. Mucoid effusions have significantly higher viscosity and mucin content than serous effusions. MUCs2, 5AC and 5B were expressed in middle ear effusions within a wide range. MUC5B was the most abundant mucin with significantly strong positive correlation with the viscosity of middle ear effusions. Middle ear epithelium expresses MUC5B as the major secretory mucin which is likely to be the main determinant of the viscosity, and hence physical and biological characteristics, of middle ear effusions. A secondary role is played by MUC5AC and, to a small extent, by MUC2. This could have significant clinical implications. MUCsSB, 5AC and 2 are expressed in middle ear effusions with MUC5B representing the major secretory mucin which is also the main determinant of mucin viscosity. The clinical implications of these findings need further studies

Modified ribbon gauze packing technique versus merocel nasal packing in reducing nasal adhesions following functional endoscopic sinus surgery. A randomized controlled study

Objective: This study compares the efficacy of 2 common techniques of nasal packing [compressed sponge [Merocel] and Vaseline ribbon gauze] in preventing intranasal adhesions following functional endoscopic sinus surgery [FESS] in adult patients

Study design: Prospective, blinded, randomized controlled trial. Setting: Tertiary care referral hospital

Patients: Sixty seven adult patients aged between 19 - 70 years, who had undergone FESS for chronic sinusitis, were included in the study. All patients had diagnostic nasal assessment and preoperative coronal and axial CT scanning of nasal and paranasal sinuses. FESS was performed following Messerklinger technique. Additional surgical procedures were performed as indicated. After completion of surgery, one side of the nasal cavity was packed with compressed sponge [Merocel] and the other side with Vaseline ribbon gauze filling the nasal cavity from above downward

Main outcome measure: Three months post-operatively, all patients were assessed endoscopically for the development of postoperative intranasal adhesions. Anatomical distribution of post-FESS adhesions was noted

Results: One hundred and thirty four sides were operated upon. On 3 months post-operative follow up, nasal adhesions developed in 18 [27%] and 6 [9%] of sides packed with Merocel and ribbon gauze respectively [p = 0.007]. The described modified technique of ribbon gauze nasal packing has reduced the incidence of post operative adhesions mainly between the middle turbinate and lateral nasal wall. No major complications were recorded in association of either packing technique. Two out of six sides [33%] packed with ribbon gauze had symptoms of recurrent sinusitis and showed endoscopic signs of persistent infection at the middle meatus while 4 out of 18 sides [22%] packed with Merocel showed similar signs. All these patients improved with medical treatment and none of them required revision surgery with a mean follow up 5 months

Conclusion: Vaseline ribbon gauze nasal packing is more effective than compressed sponge [Merocel] in reducing postoperative nasal adhesions. This packing technique is safe and could reduce the need for further [revision] endoscopic surgery