Toll-like Receptors 2 and 4 and Their Mutations in Patients with Otitis Media and Middle Ear Effusion

OBJECTIVES: Toll-like receptors (TLRs) detect microbial infections and they can directly induce innate host defense responses. TLR 2 has been shown to be primarily involved in the recognition of peptidoglycans and lipoteichoic acid of gram positive bacteria. TLR 4 recognizes lipopolysaccharides and lipoteichoic acids from both gram-negative and gram-positive bacteria. Both mutations lead a reduced capacity to elicit inflammation and they increase the risk for gram-positive and negative infections. This study was performed to investigate the expressions of TLR 2 and 4 and their mutations in patients suffering with otitis media and middle ear effusion. METHODS: Middle ear fluid samples were collected from 40 otitis media effusion (OME) patients who had ventilating tubesinserted. Bacteria in the effusion fluid were detected by standard bacterial culture. The secreted IgG, IgA and IgM were measured by Enzyme-linked immunosorbent assay. TLR 2 and 4 were assessed by performing RT-PCR. The genomic DNA from each patient was isolated from the middle ear fluid samples that were collected from 60 OME patients, and the presence of mutations was determined by performing restriction digestion and DNA sequencing analysis. RESULTS: Among the 40 middle ear fluid samples, bacteria were detected in 13 middle ear fluid samples. The amounts of IgM, IgA, and IgG were 151.20+/-60.94 ng/mL, 21.59+/-7.96 ng/mL and 11.55+/-16.98 ng/mL, respectively. TLR 2 and 4 were expressed in the middle ear fluid and the expression of TLR 2 was higher than that of TLR 4. However, there was no correlation between the expressions of TLR 2 and 4, and the concentration of immunoglobulin or the presence of bacteria (P>0.05). There ware no mutations of TLR 2 (Arg753Gln, Arg677Trp) and TLR 4 (Asp299Gly, Thr399Ile). CONCLUSION: TLR 2 and 4 were expressed in all the middle ear fluid samples of OME, but the mutations of TLR 2 and 4 were not detected. TLR 2 and 4 may play a vital role in the immunological responses of patients with OME.

The Effectiveness of the Hearing Aid in Hearing Loss with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing aids are commonly used to alleviate the effects of tinnitus. But the investigations for effectiveness of hearing aids on tinnitus gave variable results according to survey methods. We will determine the effects of the hearing aid on the perception of tinnitus using the THI (Tinnitus Handicap Inventory) and investigate the relationships between THI & SADL (Satisfaction with Amplification in Daily Life) scale. SUBJECTS AND METHOD: THI score was assessed at pre-aid time and 4 weeks after fitting with the same inventory prospectively by 36 hearing impaired patients who reported tinnitus. Also, the SADL scale was completed at 4 weeks after fitting. The relationship between SADL score and THI benefit was evaluated. RESULTS: Twenty-two of thirty six patients (61.1%) showed subjective beneficial effect of hearing aid on tinnitus. The use of hearing aid significantly reduced the tinnitus handicap score in all subclasses and total THI. The only positive effect in the subscale of SADL was related to the THI benefit statistically. CONCLUSION: The hearing aid can provide relief from tinnitus associated with hearing loss and improve the subjective satisfaction of fitting.

Relationship between Effusion Bacteria and Concentrations of Immunoglobulin in Effusion Fluid in Recurrent Otitis Media with Effusion Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Upper respiratory infections and host immunity against infection may be important in the pathophysiology of otitis media effusion (OME) in children with as yet undeveloped Eustachian tubes. So, we measured Ig concentrations in effusion fluid and serum, and examined their relationship with the presence of bacteria in effusion fluid, as determined by the conventional culture methods and PCR. SUBJECTS AND METHOD: Middle ear effusion was collected from 61 OME patients who had undergone ventilation tube insertion. Bacteria in effusion fluid were detected by standard bacterial culture and polymerase chain reaction. Middle ear fluid immunoglobulins in the OME prone group and OME non-prone group were evaluated. RESULTS: The level of IgA in the otits media prone group was significantly lower than in the otitis media non-prone group, but there was no significant difference in the level of IgG, IgM between two groups (p<0.05). Bacteria detection rate were 59% in the prone group and 50% in the non-prone group. The level of IgA in the bacterial detection group was signifi-cantly lower than that of the non-detection group (p<0.05). CONCLUSION: These results suggest that IgA seems to be important in the protection of bacterial growth and local immunity in the middle ear and may be related to the chronicity or relapse of OME.

Usefulness of Botulinum Toxin Injection in Rehabilitation of Facial Paralysis: Improving Mouth Angle Asymmetry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A number of surgical procedures exist to improve facial symmetry for patients with facial paralysis. Whereas static symmetry is often improved, dynamic asymmetry frequently persists because of the imbalance of complex coordinated movements of facial expression. The paralyzed face is often distorted by the excessive pull of the normal contralateral face during emotional expression. We report the use of botulinum toxin in patients with facial paralysis to improve lower facial asymmetry by limiting the excessive pull of contralateral face. SUBJECTS AND METHOD: Ten adult patients with unilateral facial paralysis were included in this study. Patients had injections at contralateral facial muscle which were zygomaticus major, levator labii superioris and depressor angularis orii. The effectiveness of the botulinum toxin injections on facial symmerty and patient appreciation of this were assessed by measuring the level difference of both mouth angles and difference in the distance from the midline to both mouth angles before and 1 month after injection. Also patients were asked to fill up the questionnaire about the magnitude of effect and any related side effects of injection at 1 month follow up. RESULTS: Botox injection decreased the level difference of both mouth angle and difference of distance from midline to both mouth angles in patients with unilateral facial paralysis at full-denture smiling. Five of ten patients were reported as moderate to marked improvement in expressive facial asymmetry after botulinum toxin injection into normal lower face. CONCLUSION: Botulinum toxin injection is a useful ancillary technique for improving dynamic facial asymmetry of the paralyzed face.