Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy

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.

The Role of the Level of Interleukin-33 in the Therapeutic Outcomes of Immunotherapy in Patients with Allergic Rhinitis

Abstract Introduction Allergic rhinitis (AR) affects up to 40% of the population and results in nasal itching, congestion, sneezing, and clear rhinorrhea. Objectives This study aimed to evaluate the changes in the clinical symptoms and in the level of serum interleukin (IL)-33 before and after pollen immunotherapy (IT) in patients with AR. Methods The total symptomscore and the levels of total immunoglobulin E (IgE) and IL-33 were determined in the serum of 10 non-allergic healthy controls and 45 patients with AR who were equally divided into 3 groups: GI (patients did not receive IT), GII (patients had received IT for 6 months) and GIII (patients had received IT for 2 years). Results There was a significantly higher concentration of IgE and IL-33 in the serum of patients with AR than in that of non-allergic patients. Furthermore, serum level of IL-33 decreased significantly after pollen IT. But, there was no significant reduction in the serum level of IL-33 between GII and GIII patients. Conclusion Our results show a clinical improvement associated with a decrease in serum level of IL-33 after pollen IT.

Mucociliary function of the inferior turbinate after radiofrequency tissue volume reduction versus submucosal diathermy "electron microscopic study"

Nasal obstruction is one of the most common chronic presenting symptom encountered by otolaryngologists. In most patients, the cause of nasal obstruction is either septal deviation or turbinate hypertrophy. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestants or corticosteroid [1]. However, surgery is required in some cases and there is a trend toward less invasive than invasive techniques [2]. In order to compare and evaluate radiofrequency tissue volume reduction [RFTVR] and submucosal diathermy [SMD] for treatment of nasal obstruction due to bilateral hypertrophy of the inferior turbinates, 40 patients with bilateral nasal obstruction were divided into 2 groups; 20 patients underwent RFTVR and 20 patients underwent SMD. All 40 patients were followed for 2 months after surgery. Postoperative improvement in nasal breathing after RFTVR was reported for 85% of patients 8 weeks after surgery, while after SMD, improvement was reported for 80% of patients. Rhinomanometric results demonstrated a significant decrease in nasal resistance on both sides after both techniques 6 weeks postoperatively [P < 0.01]. As regard saccharine transit time [STT], in the RFTVR group the mean post operative STT was 10.65 mm, while that in the SMD group was 12.05 min which suggests good preservation of surface mucosa and mucocilinary function in group A than group B patients. Electron microscopic study in both groups showed that in group A patients, RFTVR did not induce any epithelial damage with preservation of ciliated cells and mucociliary function which was markedly better than the SMD technique. In conclusion, both techniques are relatively safe and effective in improving the nasal airway but RFTVR is more superior in preservation of the nasal mucociliary mechanism