Utility of immunologic parameters in the evaluation of Meniere's disease.

CONCLUSION: Because of the lack of association between a positive test and response to corticosteroid treatment, at present, detection of anti-HSP 70 antibody, tumor necrosis factor (TNF)-alpha, erythrocyte sedimentation rate (ESR), or antinuclear antibody (ANA), does not offer clinically useful information in the treatment of Meniere's disease (MD). OBJECTIVES: The study was designed to investigate the performance of various laboratory tests, including anti-HSP 70, TNF-alpha, ESR, ANA, and anti-phospholipid antibodies, in the diagnosis and treatment response of patients with MD. PATIENTS AND METHODS: Thirty patients who presented with MD and 30 healthy people were selected as study and control groups, respectively. The laboratory panel included the following tests: anti-HSP 70 antibody immunoassay, TNF-alpha, ESR, ANA, and anti-phospholipid antibodies. The study group was given corticosteroid therapy and separated into two groups: the corticosteroid responders and the corticosteroid non-responders. In the follow-up, repeat audiograms were evaluated to determine the response to treatment. RESULTS: TNF-alpha was found at significantly lower titers in the study group when compared with the control group (p<0.05). Anti-HSP 70 was not found in high titers in the study group. ANA positivity in patients with MD was not statistically different from the control group. There was no significant difference in the treatment response for any of the parameters tested.

Utility of anti-HSP 70, TNF-alpha, ESR, antinuclear antibody, and antiphospholipid antibodies in the diagnosis and treatment of sudden sensorineural hearing loss.

OBJECTIVES: To investigate the performance of various laboratory tests used for patients with sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Prospective clinical trial. METHODS: Thirty patients who presented with SSNHL and 30 healthy people with no cochleovestibular disorders were selected as study and control groups. The laboratory panel includes the following tests: anti-HSP 70 antibody immunoassay, tumor necrosis factor-alpha (TNF-alpha), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and antiphospholipid antibodies. The study group was given corticosteroid therapy and separated into two groups: the corticosteroid responders and the corticosteroid nonresponders. In the follow-up, repeat audiograms were evaluated to determine the response to treatment. RESULTS: TNF-alpha was found at lower titers in the study group when compared with the control group in contrast to other studies. Also, anti-HSP 70 was not found in high titers in the study group. ANA and ESR were the two parameters that were significantly more positive in the study group compared with the control group. CONCLUSIONS: Because of the lack of association between a positive test and response to corticosteroid treatment, detection of the anti-HSP 70 antibody, TNF-alpha, ESR, and ANA, at present, do not offer clinically useful information in the treatment of SSNHL. Also, because of the lower titers of TNF-alpha documented in patients with SSNHL, we do not recommend the use of specific TNF-alpha inhibitors in SSNHL.

Helicobacter pylori: a possible association with otitis media with effusion.

OBJECTIVE: Evaluate possible role of Helicobacter Pylori in pathogenesis of otitis media with effusion (OME). STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. STUDY GROUP: Middle ear fluid was aspirated, a biopsy was taken from the promontorium of 22 children with OME. CONTROL GROUP: A small biopsy was taken from the promontorium of 20 children with normal otologic findings. For both groups, 5 mm deep tissue specimens were obtained from tonsil and adenoid. RESULTS: H pylori presence in the middle ear, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group (P<0.05). CONCLUSIONS: This study is the first to grow H pylori in middle ear in OME. Significantly increased colonization by H pylori of the middle ear, and tonsillar and adenoid tissue in patients with OME indicates that the bacteria might be involved in the pathogenesis of OME. EBM RATING: A-1b.

Investigation of surface changes in different types of ventilation tubes using scanning electron microscopy and correlation of findings with clinical follow-up.

OBJECTIVES: Like all biomaterials, ventilation tubes are subject to formation of bacterial biofilm on their surfaces. There might also be surface changes. This increases the risk of complications associated with ventilation tubes. In this study, we examined two groups of ventilation tubes using scanning electron microscopy (SEM) to investigate biofilm growth and surface deformations. METHODS: There were two different types of ventilation tubes used, the first group consisted of 30 silicone tubes and the second group consisted of 16 ionized, processed silicone tubes. The tube samples included those that were either removed or those that were extruded into the ear canal. We investigated the association between scanning electron microscopy findings and the complications that developed during the treatment. RESULTS: As a result of this study, it is found that the ionized, processed silicone tubes are superior to other silicon ventilation tubes in regard to biofilm growth (z=-3.925, p=0.000, <0.0001) and surface deformations (chi(2)=9.120, p=0.003, <0.01). Furthermore, we observed that as the duration of the ventilation tube application increases, bacterial biofilm growth (chi(2)=10.718, p=0.005, <0.01) and surface deformations (z=-2.940, p=0.003, <0.01) increase. We also observed that biofilm growth and occurrence frequency were related to "otorrhea" (chi(2)=10.258, p=0.036, <0.05) and "plugging" (chi(2)=7.952, p=0.019, <0.05) complications. CONCLUSION: In this study, we show that ionized, processed silicone ventilation tubes are more robust to bacterial biofilm growth compared to other silicone ventilation tubes used in this study and that the "otorrhea" and "plugging" complications are reduced with the decrease of bacterial biofilm growth.

Post-operative radiotherapy in advanced laryngeal cancer: effect on local and regional recurrence, distant metastases and second primaries.

This was a retrospective study of patients who did or did not receive post-operative radiotherapy for squamous cell carcinoma of the larynx.The rates of local and regional recurrences, distant metastases and second primaries were evaluated in 236 patients who received radiotherapy following surgery. These rates were evaluated and compared with those from 294 patients treated with surgery alone. Multivariate analysis of irradiated patients revealed that local and regional recurrences were determined independently by tumour (T) and pathologic node (pN) stages (p < 0.05). The distant metastasis rate significantly depended on N stage (p < 0.05). Multiple primary tumours were not significantly affected by any of the factors studied (p > 0.05). Analysis of both irradiated and non-irradiated patients revealed that local and regional recurrence was determined independently by pathologic T (pT) stage, tumour localization, radiation status and pN stages (p < 0.05). The distant metastasis rate significantly depended on N stage and tumour localization (p < 0.05) and the rate of formation of multiple primary tumours was significantly affected by the patient's age and radiation status (p < 0.05). In conclusion irradiation of laryngeal cancer patients independently increases the risk of local and regional recurrence, and also increases the risk of multiple primary tumours while not significantly influencing the risk of distant metastasis. The risk of distant metastasis is affected by determinants of advanced lesions and tumour localization.

Prevention of gentamicin induced ototoxicity by trimetazidine in animal model.

OBJECTIVE: To show the efficacy of intra-peritoneally administered trimetazidine to prevent gentamicin ototoxicity, which is still an important cause of profound deafness among children in different parts of the world. METHODS: Two groups of Swiss albino mice received daily intra-muscular injections of gentamicin for 30 days. One of the groups received trimetazidine intra peritoneally in addition to the gentamicin. Auditory thresholds of the animals were measured by evoked brain stem response at the beginning and the end of the study. Results were compared to the results of the control group, which received intra peritoneal saline injections. RESULTS: Both groups receiving gentamicin injections had significant auditory threshold shifts, but in the group receiving additional trimetazidine, the threshold shift was not statistically significant when compared to control group. Threshold shift in gentamicin group significantly differed from that of the control group (p=0.0001) and gentamicin+trimetazidine group (p=0.0001), on the other hand there was no statistically significant difference between control group and trimetazidine+gentamicin group (p=0.102). CONCLUSION: Gentamicin ototoxicity can be prevented by intra peritoneal trimetazidine injections in animal model. This treatment modality may be a mode of protection from gentamicin ototoxicity in children.

The role of oxidants and antioxidants in otitis media with effusion in children.

OBJECTIVE: Determine the possible role of oxidants and antioxidants in the pathogenesis of otitis media with effusion in children. STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. The study group was made up of children with otitis media with effusion who were to undergo bilateral ventilation tube insertion and adenoidectomy. The control group was comprised of otherwise healthy children. The blood levels of antioxidants (retinol, beta-carotene, alpha-tocopherol, laycopene, ascorbic acid, superoxide dismutase, glutathione peroxidase, GSH) and oxidation products (malondialdehyde) were determined before and 1 month after the operation in the study group and once only in the control group. These substances were also measured in the adenoid tissue and middle ear fluids. RESULTS: In the study group, the blood levels of antioxidants and oxidants before and after the operation were significantly different when compared with the control group (P < 0.05). In the study group, the blood antioxidant levels increased and oxidant levels decreased significantly after the operation (P < 0.05). The levels after the operation never reached those of the control group. CONCLUSIONS AND SIGNIFICANCE: Oxidants and antioxidants played a significant role in the pathogenesis of otitis media with effusion in children. These children are under significant oxidative stress. Insertion of a ventilation tube and adenoidectomy significantly decreased the oxidative stress in these patients, but could not normalize it completely. Additional studies are necessary in the clinical use of antioxidants in otitis media with effusion.

The relationship between tumor thickness and clinical and histopathologic parameters in cancer of the larynx.

OBJECTIVES: We sought to determine the relationship of tumor thickness to clinical and histopathologic parameters in laryngeal cancer. Study design and setting We conducted a retrospective review of laryngectomy specimens of 111 surgically treated T1-3 laryngeal cancer patients for tumor thickness and various histopathologic parameters. RESULTS: Tumor thickness was significantly related to T, N, and clinical stage; pathologic cervical lymph node metastasis; cartilage invasion; microscopic appearance; mode of invasion to surrounding tissues; perineural invasion; and lymphocytic infiltration (P < 0.05). Tumor thickness had significant correlation with T, N, and clinical stage; cervical lymph node metastasis; cartilage invasion; mode of invasion to surrounding tissues; perineural invasion; and lymphocytic infiltration (P < 0.05). Multifactorial statistical analysis showed that cartilage invasion and lymphocytic infiltration significantly determined tumor thickness independently (P < 0.05). CONCLUSION: Tumor thickness is well correlated to most of the reliable clinical and histopathologic parameters, and it is an objective and easy-to-obtain measure. SIGNIFICANCE: Tumor thickness can be used as a reliable histopathological factor and should be measured in every laryngectomy specimen.

Treatment of oroantral fistula:experience with 27 cases.

PURPOSE: To review patients with chronic oroantral and oronasal fistula who underwent surgical correction. MATERIAL AND METHODS: Twenty-seven patients with chronic oroantral and oral fistula who underwent surgical correction in the Hacettepe University Faculty of Medicine Department of Otorhinolaryngology Head and Neck Surgery between 1968 and 2001 were reviewed retrospectively. RESULTS: Local mucosal flaps were used for surgical correction. The underlying factors were tooth extraction in 13 patients (48%), tumor in 5 (18.5%), osteomyelitis in 3 (11%), Caldwell-Luc procedure in 2 (7.5%), trauma in 2 (7.5%), dentiginous cyst in 1(3.7%), and correction of septal perforation in 1 (3.7%). Among the fistulas, 23 were oroantral, 3 were oroantronasal, and 1 was oronasal, respectively. Two patients required revisional repairment. The surgical procedure failed in 1 diabetic patient and 3 patients with prior history of external radiotherapy. CONCLUSION: Tooth extraction was the most common etiologic factor, and malignancy should be excluded in all patients. The outcome may not be satisfactory in patients with systemic disease and in patients with history of radiotherapy. Multiple surgical interventions may be necessary only on rare occasions.

Magnetic resonance imaging versus computed tomography in pre-operative evaluation of cochlear implant candidates with congenital hearing loss.

Recent reports indicate that the cochlear nerve may be absent in some cases of congenital sensorineural hearing loss. The aim of this prospective study was to determine the incidence of cochlear nerve anomaly in cochlear implant candidates with congenital hearing loss using magnetic resonance imaging (MRI). Twenty-seven patients with congenital profound bilateral sensorineural hearing loss who were being evaluated for the cochlear implant procedure were studied. These patients had high-resolution computerized tomography (CT), through the petrous bone in axial sections. MRI examinations consisted of T1 and turbo spin echo (TSE) T2-weighted 3 mm axial images, and additional 3D Fourier Transform T2-weighted TSE sequences obtained on three different planes (axial, perpendicular and parallel to the internal auditory canal (IAC) i.e. oblique sagittal and coronal, respectively) for the purpose of cochlear nerve demonstration. Results showed that all of the 14 patients with normal CT of the temporal bone, had four distinct nerves in the distal part of the IAC on TSE-MRI. Thirteen patients demonstrated various bony malformations of the cochleovestibular system on CT. MRI revealed the absence of the cochleovestibular nerve in four patients where the IAC was very narrow or completely absent on CT. One patient with severe Mondini malformation who had an enlarged IAC demonstrated an isolated absent cochlear nerve.

Use of homograft dehydrated temporal fascia in tympanoplasty.

OBJECTIVE: To investigate the results of myringoplasty operations using homograft dehydrated fascia temporalis (Tutoplast) and compare these with those performed with autograft fascia temporalis. STUDY DESIGN: Prospective cohort. SETTING: University hospital. PATIENTS: Forty-three adult patients (> or =18 years of age) with central, dry perforations of pars tensa with intact ossicular chains. INTERVENTION: Tympanoplasty with an endaural approach and underlay technique was performed. Homograft dehydrated temporal fascia was used in 22 patients, and autograft was used in the remaining 21 patients. MAIN OUTCOME MEASURES: Preoperative and postoperative air-bone gap and speech reception threshold levels and postoperative compliance values of the homograft and autograft groups were compared. RESULTS: Postoperative perforations were encountered in two patients (9.1%) from the homograft group and three patients (14.2%) from the allograft group. Significant postoperative improvements in air-bone gap and speech reception threshold values were detected for both groups (p < 0.05). Although the mean compliance of the tympanic membranes was significantly lower in the homograft group, no statistically significant difference was observed between groups when the postoperative air-bone gap and speech reception threshold values were compared. CONCLUSION: Homograft temporal fascia can be used in tympanoplasty with the same success rate of autograft temporal fascia without impeding hearing. Its main advantages are the reduction in the duration of surgery and the length of preauricular and postauricular incisions. However, the advantages of the dehydrated homograft temporal fascia should be weighed against its cost and risk of transmission of viral and prion-mediated diseases.