Predictive value of P wave parameters, indices, and a novel electrocardiographic marker for silent cerebral infarction and future cerebrovascular events.

BACKGROUND: Silent cerebral infarction (SCI) is a neuronal injury without a clinically apparent stroke or transient ischaemic attack. Left atrial cardiomyopathy is closely associated with SCI. P wave changes in the electrocardiogram (ECG) provide significant information about the development of atrial cardiomyopathy. This study evaluated the role of P wave parameters and indices and a novel ECG parameter in predicting SCI, future cerebrovascular events, and atrial fibrillation/flutter. MATERIALS AND METHODS: A total of 272 patients were retrospectively screened and divided into two groups according to SCI. Cerebrovascular events and atrial fibrillation/flutter were defined as the study's outcomes. P wave parameters, indices, and a novel ECG parameter called the P wave ratio (PWR) were calculated from ECGs, and the relationship between SCI and outcomes was investigated. RESULTS: The maximum P wave duration (PWD), P wave dispersion (PWdisp), PWD measured from the D2 lead (PWDD2), P wave peak time measured from the D2 lead (PWPTD2), PWPT measured from the V1 lead (PWPTV1), and P wave terminal force (PWTFV1) were significantly longer in the SCI group. Both partial and advanced inter atrial block (IAB) were significantly high in the SCI group. The novel parameter P wave ratio (PWR) was significantly longer in the SCI group (0.55 ± 0.08 vs. 0.46 ± 0.09; p < 0.001). In multivariate regression analysis, PWdisp (OR: 1.101, p < 0.001), PWPTD2 (OR: 1.095, p = 0.017), and PWR (OR: 1.231, p < 0.001) were found to be independent predictors of SCI. Cox regression analysis revealed that the PWR (HR 1.077; 95% CI 1.029-1.128; p = 0.001) was associated with cerebrovascular events and atrial fibrillation/flutter. CONCLUSION: In our study, we observed that PWR could be a valuable parameter for predicting SCI and future cerebrovascular events.

The histopathological and electrophysiological effects of thymoquinone and methylprednisolone in a rabbit traumatic facial nerve paralysis model.

OBJECTIVE: We aimed to determine the effects of methylprednisolone and thymoquinone on nerve healing in a traumatic facial nerve paralysis animal model. SUBJECTS AND METHODS: Twenty-four rabbits were randomly divided into 4 groups: group I: control group received no medication and no trauma; group II: sham group received no medication after facial nerve trauma group III: 5mg/kg/day thymoquinone administered; group IV: 1mg/kg/day methylprednisolone administered. An initial electrophysiological assessment was performed in all the animals. The buccal branch of the facial nerve was then clipped to form a traumatic facial paralysis model. The drugs were administered for two weeks once a day. At the end of the second month, the electrophysiological assessments were performed and the distal part of the traumatic facial nerve were dissected and examined under light microscopy. RESULTS: Best nerve regeneration was observed in the control and the thymoquinone groups, respectively, whereas the weakest regeneration was determined in the sham group. Thymoquinone and methylprednisolone significantly increased nerve recovery, as measured by histopathological scores and electrophysiological assessment. In the thymoquinone group, due to postoperative amplitude, axon diameter and thickness of myelin sheath values were significantly further increased nerve regeneration compared to that of the methylprednisolone group and these values were close to those of the values of the control group. CONCLUSION: Thymoquinone was slightly better than methylprednisolone for functional nerve recovery. The neuroprotective effect of thymoquinone was attributed to its antioxidant and anti-inflammatory effects. Thymoquinone can have a new treatment option to ameliorate the nerve injury.

Comparison of Histopathological Effects of Thymoquinone and Local Nasal Corticosteroids in Allergic Rhinitis in a Rabbit Model.

BACKGROUND/AIMS: In this study, we aimed to evaluate the histopathological effects of thymoquinone treatment of the nasal mucosa in a rabbit model of allergic rhinitis, and we compared its effects with those of nasal mometasone furoate. METHODS: A total of 24 male New Zealand rabbits were used. The animals were randomly assigned to one of four groups. Group 1 received no treatment, while group 2 underwent ovalbumin (OVA) sensitization only. Group 3 was the study group; after OVA sensitization, the rabbits were treated with intranasal thymoquinone. The group 4 rabbits received mometasone furoate for 7 days after OVA sensitization. Mucosal structures were stained with hematoxylin and eosin, while toluidine blue was used to stain mast cells. Apoptosis was evaluated using a TUNEL assay. RESULTS: In the positive control groups, including the thymoquinone and intranasal mometasone furoate groups, intraepithelial and submucosal inflammation and goblet cell hypertrophy were significantly decreased compared to group 2 (p < 0.001). The cilial structure was normal, as was the chondrocyte structure in both treatment groups. CONCLUSION: This is the first study to evaluate the histopathological effects of thymoquinone in an allergic rhinitis model. Thymoquinone reduced allergic inflammation and may be valuable for treating allergic rhinitis. However, additional studies are needed.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis.

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

The Effects of Superficial Musculoaponeurotic System Flap on the Development of Frey's Syndrome and Cosmetic Outcomes After Superficial Parotidectomy.

OBJECTIVE: To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey's syndrome (FS) and cosmetic satisfaction. METHODS: In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor's starch-iodine test for FS. For the evaluation of the cosmetic results, the patient's satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area. RESULTS: Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor's starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05). CONCLUSION: According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.

Is Middle Ear Pressure Effected by Nasal Packings after Septoplasty?

OBJECTIVE: To investigate the effects of different types of nasal packings on middle ear pressure in patients undergoing septoplasty. MATERIALS AND METHODS: Sixty patients who were suffering from nasal obstruction and who had to undergo septoplasty because of nasal septal deviation were included in the study. After the septoplasty, Merocel packings and internal nasal splints were intraoperatively applied in thirty patients each. Middle ear pressure was evaluated by tympanometry. Tympanometric peak pressures were used for this aim. Acoustic impedance measurements were performed in both ears, and the average values of the two ears were calculated. Tympanometric measurements were performed for patients during the preoperative period and on the 2(nd) and 5(th) postoperative days. RESULTS: There were 30 (5 females, 25 males; average age 23 years) patients in the internal nasal splint group and 30 (8 females, 22 males; average age 26 years) patients in the anterior Merocel packing group. When the values obtained by acoustic impedancemetry before the operation and on the postoperative 5(th) day were compared, there was no statistically significant difference between the groups. The middle ear pressure significantly decreased in the anterior Merocel packing group compared with that in the internal nasal splint group. The intragroup comparison of the acoustic impedance measurements of the internal nasal splint group revealed no significant difference between the preoperative acoustic impedance values and the values obtained on the postoperative 2(nd) day. CONCLUSION: Cannulated silicone intranasal splints are better in terms of patient comfort after an intranasal surgery without effecting eustachian tube function.

Evaluation of outer hair cell function and medial olivocochlear efferent system in patients with type II diabetes mellitus.

AIM: This study was designed to investigate the function of outer hair cells and medial olivocochlear efferents in type II diabetes mellitus (DM). MATERIALS AND METHODS: There were 50 patients with type II DM and 51 age- and sex-matched healthy controls included in the study. Both groups were compared in terms of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and contralateral suppression of TEOAE. RESULTS: Pure tone thresholds of the patients with type II DM were significantly higher than in the controls (P < 0.05). The TEOAE amplitudes at 1 kHz and at 1.5, 2, 3, 4, and 6 kHz signal-to-noise ratio amplitudes on DPOAE testing were significantly lower in the patients than controls (P < 0.05). There was no significant difference between the type II DM and control groups regarding contralateral suppression test results of TEOAEs. CONCLUSION: Type II DM seems to impact the auditory system at the cochlear level by affecting the functions of outer hair cells, and it results in elevation of the thresholds on audiometry and a decrease in the amplitudes of otoacoustic emissions.

Evaluation of hearing loss in patients with Graves' disease.

Hearing loss has commonly been reported in association with thyroid disorders and during treatment with propylthiouracil. The relationship between hyperthyroidism and the auditory system has not been previously investigated. The aim of this cross-sectional, case-control study was to investigate hearing loss in patients with Graves' disease (GD). The study population consisted of patients with newly diagnosed GD and healthy controls. Pure tone audiometry at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz, along with immittance measures including tympanometry and acoustic reflex tests, were performed in all participants. Twenty-two GD patients and 22 healthy controls consented to inclusion in the study. The differences between groups with regards to age and gender distribution were statistically insignificant (P = 0.567 and P = 0.757, respectively). The hearing thresholds of right and left ears were also similar in both groups (P > 0.05). When single-ear evaluations were taken into account (total of 44 ears for both groups), hearing thresholds in the GD group were significantly higher than healthy controls at all frequencies (P < 0.05). Following testing at the designated frequencies, the only significant effect of thyrotoxicosis was observed with frequencies of 4000 and 8000 Hz. The odds ratio for having hearing loss at a frequency of 8000 HZ associated with GD was 14.97 (95% confidence interval 4.03-55.64). In patients with GD, right and left pure tone audiometric findings at a frequency of 8000 Hz correlated positively with FT3, FT4 and negatively with TSH. Our results are highly suggestive of a decrease in hearing ability in patients with GD, particularly at high frequencies. Further studies are needed to help elucidate the mechanisms behind hearing loss which develops in association with GD.

The effect of oral isotretinoin (13-cis retinoic acid) on hearing systems in patients with acne vulgaris: a prospective study.

Isotretinoin is widely used in the treatment of extensive and nodulocystic acne. The objective of this prospective study was to investigate whether oral isotretinoin could affect the hearing system. Thirty-eight patients with acne vulgaris (76 ears) who were diagnosed and treated at the Department of Dermatology were included in the current study. Study evaluation visits were performed at baseline and at Weeks 1, 2 and 3. Pure-tone averages (PTAs) of air conduction thresholds at 250 Hz (PTA1); 500, 1000, and 2000 Hz (PTA2); 4000, 8000, and 10,000 Hz (PTA3); and 12,500, 16,000, 18,000 and 20,000 Hz (PTA4) for each ear were calculated separately. Assessment of the efficacy was based on the audiometric findings. Compared with pre-treatment evaluation, the PTAs of patients were found to be significantly different at the first week for PTA2 (P = 0.033) and PTA3 (P = 0.001), at the second week for PTA1 (P = 0.036), and at the third week for PTA4 (P = 0.002). Our results suggest that the oral isotretinoin (13-cis retinoic acid), which is a derivative of retinol (vitamin A), improved the hearing level of the patients in all audiometric frequencies in a short-period follow-up.

Investigation of hearing in patients with allergic rhinitis.

The aim of the current study is to investigate hearing function in patients with allergic rhinitis. Fifty-eight patients with positive skin prick test (Group 1) (116 ears) and 31 subjects with negative skin prick test (62 ears) as group 2 were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 8000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in both groups. There was statistically significant difference between pure-tone threshold of the group 1 and group 2 at 8000 Hz (p< 0.05). Based on our study, the patients with allergic rhinitis had better hearing than the control group at 8000 Hz.

Bilateral acquired external auditory canal stenosis with squamous papilloma: a case report.

Acquired external auditory canal (EAC) stenosis is described as resulting from a number of different causes such as infection, trauma, neoplasia, inflammation and radiotherapy. Human papilloma virus (HPV) type 6, a deoxyribonucleic acid (DNA) virus, is considered to cause squamous papilloma of the EAC. In this article, we report a case of a 56-year-old male with warty lesions in the left external ear and a totally stenotic right external ear which had similar lesions one year before the involvement of his left ear. On computed tomography of the temporal bone, there was soft tissue obstruction of the right EAC, and thickening in the skin of the left EAC. The middle ear structures were normal on both sides. Biopsy was performed from the lesion in the left ear, and revealed squamous papilloma. We presented this case because squamous papilloma related bilateral acquired EAC stenosis is a rare entity.

Audiological findings in celiac disease.

OBJECTIVE: Celiac disease (CD) is a gluten-triggered immune enteropathy caused by a genetic predisposition. Recent papers suggest that CD is increasingly recognized by extraintestinal findings. The aim of this study was to investigate the effect of CD on hearing pathway including the olivocochlear efferent system in children. METHODS: Forty-one pediatric CD patients and 31 controls were included in the study. Both groups were evaluated with audiometry, tympanometry, transiently evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and contralateral suppression of the TEOAE. RESULTS: The threshold at 250 Hz of the patients with CD was significantly higher (p < 0.05 in CD compared to control group, p < 0.0001). The signal to noise ratio (SNR) amplitudes in DPOAE testing and the SNR amplitudes with and without contralateral acoustic stimulus in TEOAE testing were significantly lower at 1,000 Hz in the CD compared to the control group. There was no significant difference between the CD and the control group regarding contralateral suppression amplitudes. CONCLUSION: CD seems to have an important impact on the auditory system, and results in an elevation of the thresholds at 250 Hz on audiometry and a decrease in the amplitudes of DPOAE and linear TEOAE at 1,000 Hz in children.

Sensorineural hearing loss in pediatric celiac patients.

OBJECTIVE: Celiac disease (CD) is an immune-mediated chronic inflammatory gluten-dependent intestinal disease affecting 0.5-1% of the general population worldwide. CD is underdiagnosed even with sophisticated health care; approximately 10% of people affected by CD are now diagnosed. The recognition of the atypical extra-intestinal manifestations, including neurological disorders increased the diagnosis of CD. At present, no data are available on the presence of sensorineural hearing loss in pediatric CD patients. The aim of this study was to determine the incidence and severity of sensorineural hearing loss (SNHL) in different frequencies in pediatric CD patients. METHODS: A sample of 32 biopsies and serologically proven newly diagnosed pediatric CD patients (CD group) (64 ears) and 32 sex and age-matched healthy subjects (64 ears) as control group (C group) were included in this study. Anthropometric measurements, physical examinations including ear nose and throat and pure-tone audiometry at frequencies 250-8000 Hz were performed in all subjects in both groups. Slight/mild SNHL was defined as a loss of detection of sound within the 16-40 dB range. The mean age of patient and control group was 11.9 and 11.3, respectively (p>0.05). RESULTS: In CD group, sensorineural hearing loss was found in 13 (40.6%) patients (group A) as it was bilateral in six and unilateral in seven patients. In control group (group C), slight/mild SNHL was found in one (3.1%) subject. The frequency of hearing loss was significantly higher in CD group than in group C (p<0.001). CONCLUSION: The present study showed a higher prevalence of sensory neural hearing loss in pediatric celiac patients than in healthy controls, suggesting an association between CD and SNHL. The findings of this study suggest that hearing impairment should be searched in newly diagnosed pediatric CD patients. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data and to search the immunological processes which could be the basis of the association between CD and SNHL.

Evaluation of cochlear involvement by distortion product otoacoustic emission in Behçet's disease.

OBJECTIVE: The aim of this study was to investigate cochlear involvement in patients with Behçet's disease. MATERIALS AND METHODS: Twenty-six Behçet's disease patients (52 ears) and 24 sex and age-matched healthy control subjects (48 ears) were included in the study. Pure-tone audiometry at frequencies 250, 500, 1000, 2000, 4000, 6000 Hz, immittance measures including tympanometry and acoustic reflex testing and DPOAE (distortion product otoacoustic emission) testing were performed in the patients and controls. RESULTS: A sensorineural hearing loss was found in eight patients (30.7%) as it was bilateral in five and unilateral in three patients. Although no typical audiometric configuration was found, one patient had a flat type audiogram, and the others had a high frequency hearing loss. The DPOAE responses of the patients and controls were significantly different in all frequencies (p<0.05). CONCLUSION: These results indicate that cochlea is affected by damage of outer hair cells in Behçet's disease.

Expression of histamine receptors (H(1), H(2), and H(3)) in the rabbit endolymphatic sac: an immunohistochemical study.

OBJECTIVE: The endolymphatic sac (ES) is part of the membranous labyrinth of the inner ear. Its central role in immunologic activity within the inner ear has been confirmed by numerous studies. The aim of this study was to investigate the expression of histamine receptors (H(1), H(2), H(3)) in the rabbit ES. METHODS: A total of 10 healthy male New Zealand white rabbits weighing 2 to 3 kg were used in the experiments. For immunohistochemical studies, immunostaining was performed according to the avidin-biotin-peroxidase complex technique. RESULTS: Serial sections of the ES of rabbits revealed the presence of H(1), H(2), and H(3) receptor immunoreactivity. Immunoreactive cells for all H(1), H(2), and H(3) were found in the epithelial and subepithelial layers of the duct and the proximal ES. In conclusion, this study showed the immunohistochemical localization of H(1), H(2), and H(3) receptors in the ES of rabbits. These receptors may be important in the homeostasis of the inner ear. In addition, they may be target receptors in the medical treatment of inner ear disorders such as endolymphatic hydrops.

An alternative model for stapedectomy training in residency program: sheep cadaver ear.

To determine the usefulness of sheep cadaver ear as a complementary model for training of stapedectomy at residency programs, 2 of our 4 year residents were included in the study and each operated 20 sheep ears. All routine steps of stapedectomy operation were performed, and their success and complication scores were recorded. Performance of residents for stapedectomy and teflon piston placement in sheep ears were evaluated by the authors. Success of both residents improved progressively. Success and complications were impressively better in the second 10 ears than the initial 10 for each resident. Both residents had better outcomes in last 10 ears. Sheep cadaver ear is an excellent model for stapedectomy training in residency and helps to improve surgical skills. We offer sheep cadaver ear training model especially in the countries where obtaining human cadaver temporal bone is difficult.

[Unusual distant metastasis of larynx carcinoma: a case report]. / Larenks kanserinde sik görülmeyen uzak metastaz: Olgu sunumu.

Although distant metastasis from larynx carcinoma is more common in the late stages, it may sometimes occur in the initial period of the disease. The tumor spread may be by a lymphatic or nonlymphatic route. A 40-year-old male patient presented with complaints of hoarseness and shortness of breath. Indirect laryngoscopic examination showed a vegetable mass extending from the left laryngeal side of the epiglottis to the left vocal cord. Level 3 lymphadenopathies were noted in the jugular region. Biopsy result revealed epidermoid carcinoma. Magnetic resonance imaging performed due to complaints of back pain and foot numbness demonstrated aggressive spinal cord metastases. The patient died on the tenth day of hospitalization.

Endoscopic transnasal sphenoidotomy with or without ethmoidectomy.

OBJECTIVES: We evaluated endoscopic transnasal sphenoidotomy (ETNS) with or without ethmoidectomy in patients with inflammatory sphenoid sinus disease (ISSD). PATIENTS AND METHODS: A retrospective review was conducted in 42 patients (17 males, 25 females; mean age 41 years; range 17 to 67 years) who underwent ETNS with (n=37) or without (n=5) ethmoidectomy for ISSD. The disase was staged according to our staging system based on computed tomography findings. RESULTS: Postnasal drainage was the most common symptom (n=37, 88.1%). Chronic rhinosinusitis was accompanied by sinonasal polyps in 25 patients (59.5%). Five patients (11.9%) had isolated sphenoid disease and 16 patients (38.1%) had unilateral disease. Five patients (11.9%) had stage 1, 15 patients (35.7%) had stage 2, and 22 patients (52.4%) had stage 3 disease. Surgery involved 68 sides. Ethmoidectomy was used in 63 sides of 37 patients, eight of whom required a supplementary procedure. At least one complication was seen in eight patients (19%), including severe perioperative hemorrhage (n=2), early postoperative hemorrhage (n=2), minor injuries to the lamina papyracea (n=4), and synechiae (n=5). CONCLUSION: In patients with isolated ISSD, the direct approach to the sphenoid sinus by ETNS without ethmoidectomy is a favorable technique, whereas ETNS with ethmoidectomy is necessary for patients with concurrent disease in other paranasal sinuses.

Evaluation of hearing and cochlear function by DPOAE and audiometric tests in patients with ankylosing spondilitis.

The aim of this study was to investigate cochlear functions in patients with ankylosing spondilitis (AS). Prospective, case control study. Twenty-eight AS patients (56 ears) and 25 healthy control subjects (50 ears) were included in the study. Pure-tone audiometry at 250, 500, 1,000, 2,000, 4,000, 6,000 Hz and immittance measures including tympanometry and acoustic reflex and DPOAEs (Distortion Product Otoacoustic Emission) testing were performed in the patients and controls. Pure-tone audiometry findings of the patients and controls were significantly different in all frequencies (P < 0.05). Sensorineural hearing loss was found in 10 patients (35%) that was bilateral in seven and unilateral in three patients. On DPOAE testing, there was no statistically significant difference between the levels of noise floor of the patients and controls (P > 0.05). However, the DPOAE responses of the patients and controls were significantly different in 3,000, 4,000, 5,000 and 6,000 Hz frequencies (P < 0.05). There is a damage of outer hair cells in patients with AS, and damaged outer hair cell regions mostly corresponds to the basal and mid-portions of the cochlea.

Investigation of Helicobacter pylori in the middle ear of the patients with chronic otitis media by CLO test and 14C urea breath test.

OBJECTIVE: The aim of this study was to investigate the presence of Helicobacter pylori by CLO test in the middle ear of the patients with chronic otitis media. We also investigated the relationship between H. pylori in the stomach and in the middle ear by 14C urea breath test (14C UBT) for the possible source of this bacterium. STUDY DESIGN: A prospective controlled clinical study. METHODS: Tissue samples were obtained from the middle ear mucosa of 41 patients undergoing ear surgery for chronic suppurative otitis media and placed in the CLO test kit. C UBT was performed in 24 patients and 20 normal subjects. RESULTS: The CLO test results were positive in 22 patients (53.6%). Results of 14C UBT that was performed in 24 patients were positive in 19 patients (79.1%) and were positive in 6 control subjects (30%). CONCLUSION: Fifty-three percent of the middle ear mucosae obtained from 41 patients with chronic otitis media were shown to be positive for H. pylori, and although our results suggest that the source of this bacterium is the stomach, further clinical studies are needed.