Radiofrequency versus electrocautery for inferior turbinate hypertrophy.

AIM: The aims of this study were to compare radiofrequency tissue reduction (RFTR) and electrocautery (EC) techniques by assessing preoperatively and 8 weeks postoperatively the visual analog scale (VAS), inspiratory peak flowmetry (IPF), and magnetic resonance imaging (MRI) volume measurement of the inferior turbinate and to see whether EC still stands as a valid treatment of inferior turbinate hypertrophy. METHODS: A total of 36 patients were included in the study. An equal number of patients were chosen randomly from 2 groups. Inferior turbinate volumes measured by MRI, IPF, the VAS, and the Sinonasal Outcome Test-20 were used to determine the efficacy of treatment and to compare the 2 groups. RESULTS: Postoperative IPF increase, VAS score decrease, and Sinonasal Outcome Test-20 score decrease were statistically more significant in the EC group, compared with the RFTR group. Although statistically not significant, postoperative inferior turbinate MRI volume decrease was more evident in the EC group when compared with the RFTR group. CONCLUSIONS: Both RFTR and EC techniques could be used as an effective treatment of choice for inferior turbinate hypertrophy, and EC technique is superior to RFTR technique to achieve high efficiency.

Relationships between facial canal dehiscence and other intraoperative findings in chronic otitis media with cholesteatoma.

OBJECTIVE: We investigated the relationship between facial canal dehiscence and intraoperative middle ear and mastoid findings in patients operated on for cholesteatoma. METHODS: We examined retrospectively 334 patients who had been operated on for cholesteatoma in Izmir Katip Celebi University, Ataturk Research and Training Hospital, ENT Clinic, between April 1997 and April 2010. The patients were examined for facial canal dehiscence according to age, gender, side of the ear, surgery type, first or revision surgery, localization of the facial canal dehiscence, spread of the cholesteatoma, with the presence of lateral semi-circular canal (LSCC) fistula and any defect in the ossicle chain, and destruction in the posterior wall of the external auditory canal(EAC). RESULTS: Of the patients, 23.6% had facial canal dehiscence and detected most commonly in the right ear 28.9% and tympanic segment, 83.5%. Facial canal dehiscence was found to be 24.2-fold more common in patients with LSCC fistula and 4.1-fold more common in patients with destruction in the posterior wall of the (EAC). In patients located cholesteatoma in tympanic cavity+antrum and the tympanic cavity+all mastoid cells and with incus and stapes defect, increased incidence of dehiscence. Age, first or revision operation and canal wall down tympanoplasty (CWDT) or canal wall up tympanoplasty (CWUT) did not affect the incidence of dehiscence. CONCLUSIONS: That the likelihood of facial canal dehiscence occurrence is increased in patients with LSSC fistulas, destruction in the posterior wall of the EAC, or a stapes defect is important information for surgeons.

Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury.

OBJECTIVE: To present the results of the traumatic intratemporal facial nerve injury that have undergone facial nerve decompression by using middle cranial fossa (MCF) approach. STUDY DESIGN: A retrospective study SETTING: Tertiary referral center PATIENTS AND METHODS: In this study, 13 patients who developed facial paralysis due to temporal bone trauma and undergone decompression by using MCF approach in Department of Otorhinolaryngology of Izmir Katip Celebi University Research and Training Hospital between January 1993 and December 2012 were presented retrospectively. Patients were assessed in terms of side, etiology, fracture type, House-Brackmann (HB) grade, electroneuronography (ENOG), electromyography (EMG), hearing loss, operation time, and the region of the injury. RESULTS: The fracture was at the right side in 7 (53.8%) and at the left side in 6 patients (46.1%). The type of temporal bone fracture was longitudinal in 6 (46.1%), transverse in 2 (15.3%), and mixed in 5 patients (38.4%). Total axonal degeneration in EMG and ENOG were seen in all patients, who were HB grade 6 at preoperative assessment. Mean operation time was 30 days. The lesion in all patients was at the region of geniculate ganglion. There was conductive hearing loss in 7 patients (53.8%), sensorineural in 4 (30.7%), and mixed in 1 patient (7.6%); hearing was normal in 1 patient (7.6%). Seven patients (53.8%) improved to HB grade 2. CONCLUSION: In the light of the information obtained from HRCT, ENOG, and EMG, we believe that better results can be achieved with facial nerve decompression that is performed before 1 month, and geniculate ganglion region may be better controlled by MCF approach.

Evaluation of the protective effect of α-lipoic acid on cisplatin ototoxicity using distortion-product otoacoustic emission measurements: an experimental animal study.

The aim of our study was to determine the effectiveness of intratympanic α-lipoic acid injection as an otoprotective agent against cisplatin-induced ototoxicity in guinea pigs. Twenty-four adult male albino guinea pigs with normal hearing were divided into 4 groups. The guinea pigs received intraperitoneal cisplatin in group 1, intraperitoneal cisplatin and intratympanic α-lipoic acid in group 2, intratympanic α-lipoic acid in group 3, as well as intraperitoneal cisplatin and intratympanic saline in group 4. Distortion-product otoacoustic emission measurements were obtained for both ears at the following time points: before administration (baseline recording) and on day 3 (72 h later). In group 1 (cisplatin), significant deterioration was observed at all frequencies on day 3 (P < 0.05). In group 2 (cisplatin + α-lipoic acid), deterioration was observed at all frequencies on day 3; however, this deterioration did not reach a statistical significance (P > 0.05). In group 3 (α-lipoic acid), no significant difference was observed between baseline and day 3 (P > 0.05). In group 4 (cisplatin + saline), deterioration was observed at all frequencies on day 3; however, this deterioration did not reach a statistical significance (P > 0.05). Cisplatin-induced hearing loss in the guinea pigs may be limited to some extent by the concomitant use of α-lipoic acid. Dose-dependent changes in the possible effects of α-lipoic acid need further investigation. Future morphologic studies may contribute to expose clearly the protective effect of α-lipoic acid.

Inhibitory effect of N-acetyl cysteine and ascorbic acid on the development of myringosclerosis: an experimental study.

OBJECTIVES: This study investigated the effects of ascorbic acid and N-acetyl cysteine (NAC) antioxidants on the development of myringosclerosis (MS) in an experimental model. METHODS: Myringotomies were performed in the ears of 15 guinea pigs, and Spongostan pieces were placed on the perforated regions of the tympanic membrane. The subjects were divided randomly into three groups and treated with three different solutions on the Spongostan-group 1: (control, 0.9% saline), group 2 (ascorbic acid), and group 3 (NAC). On day 15 after treatment, specimens from the tympanic membranes were obtained and examined via light microscopy. Sclerosis and inflammation scores and the tympanic membrane thicknesses were evaluated. Immunohistochemical methods were used to evaluate the expression of VEGF, TGF-ß, iNOS, and IL1-ß in all groups. RESULTS: Lower sclerosis and inflammation scores and reduced tympanic membrane thicknesses were observed in groups treated with NAC or ascorbic acid compared with the control group. Immunohistochemical studies revealed significantly less expression of VEGF, TGF-ß, and iNOS in groups 2 and 3 compared with group 1. Additionally, IL1-ß expression was significantly less in group 3 than in group 1. Compared with group 1, group 2 animals exhibited reduced inflammation in the lamina propria, fewer active fibroblasts, less leukocyte infiltration, and decreased thickness of the vessels; group 3 animals exhibited decreased numbers of active fibroblasts and collagen fibers in the lamina propria. CONCLUSIONS: Inflammation scores, cellular infiltration, and expression of VEGF, TGF-ß, and iNOS were reduced by ascorbic acid and/or NAC treatments, thereby decreasing MS development. Decreased expression of IL1-ß was observed only in animals treated with NAC.

Searching for the cheese: does ethmoid pneumatization affect the location of the anterior ethmoid artery?

Endoscopic sinus surgery is a widely used technique in otolaryngologic practice. To avoid complications, the locations of important anatomical structures, such as the anterior ethmoid artery (AEA), should be determined preoperatively. We want to evaluate the effect of ethmoid cavity pneumatization on the location of the AEA and to determine consistent landmark(s) for locating the AEA. 524 consecutive patients undergoing sinus CT scans between February and October 2012 were reviewed retrospectively. After the exclusion criteria were applied, 150 CT scans (300 sides) were selected for the study. A statistically significant positive correlation was found between ethmoid pneumatization and the distance of the AEA to the attachment of the inferior turbinate to the lateral nasal wall (Spearman's rho = 0.305; p < 0.001). Likewise, a statistically significant positive correlation was found between ethmoid pneumatization and the distance between the AEA and the frontonasal junction (Spearman's rho = 0.219; p < 0.001). We found that the artery was located mostly between the second and third lamellae [n 211 (71 %) cases]. There was no statistically significant correlation between ethmoid pneumatization and AEA location in terms of the lamellae. Increased ethmoid volume increases the distance of the AEA from the frontonasal junction and the lateral attachment of the inferior turbinate. However, increased pneumatization of the ethmoid cavity did not affect AEA localization in terms of the lamellae. Based on our findings, we suggest that using the lamellae to locate the AEA is reliable.

Soft tissue giant cell tumor of low malignant potential of the neck: a case report and review of the literature.

Giant cell tumor of soft parts is a rare tumor that is clinically and histologically similar to giant cell tumor of the bone. We present a 53-year-old female with a giant cell tumor of low malignant potential arising from the neck. The clinicopathological features and the importance of immunohistochemistry in the differential diagnosis with other giant cell rich tumors was discussed.

Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings.

The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS >7 or RSI >13 was considered reflux positive. Fleiss' kappa (κ) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (κ = 0.078), ventricular obliteration (κ = 0.206), diffuse laryngeal edema (κ = 0.204), and posterior laryngeal hypertrophy (κ = 0.27), intermediate for laryngeal erythema/hyperemia (κ = 0.42) and vocal fold edema (κ = 0.42), and high for thick endolaryngeal mucus (κ = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.

Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results.

CONCLUSIONS: Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique is an effective and durable procedure for the management of patients with bilateral vocal fold immobility. OBJECTIVES: To review the long-term results of bilateral vocal fold immobility in 26 patients treated with vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique over a 6-year period. METHODS: This retrospective study examined patients with a minimum follow-up of 1 year. The main outcome measures used were the modified Medical Research Council (MRC) dyspnoea scale and the assessment of voice quality pre- and postoperatively using the Likert method. RESULTS: The mean follow-up period was 23.77 ± 12.01 months. All patients reported marked symptomatic improvement in dyspnoea (p = 0.0001). The voice quality worsened as expected; however, this difference did not reach a significant level (p = 0.642). Transient microaspiration was noted in seven of the patients and resolved in 1 or 2 days. The procedure was performed for the contralateral vocal fold in one case, due to the loss of suture tension. No patient showed aspiration postoperatively or during follow-up. All patients were regularly followed up for the beginning of movement of the lateralized or contralateral vocal folds in our outpatient clinic.

Postintubation laryngotracheal stenosis: assessing the success of surgery.

OBJECTIVE: This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores. METHODS: The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, Izmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale. RESULTS: The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively. CONCLUSIONS: Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.

Hearing loss effects of administering boric alcohol solution prepared with alcohol in various degrees on guinea pigs (an experimental study).

OBJECTIVE: To investigate the ototoxic effect of boric acid solution prepared with different degree of alcohol. METHODS: This study was performed on 28 young albino guinea pigs. After the animals divided four groups prior to the application of the solution an auditory brainstem response (ABR) test was applied to the each animal under general anesthesia. Their tympanic membranes perforated and test solutions were administrated to the middle ear through the perforation. On 15th day, ABR measurements were carried out and comparison was made with preadministration values. RESULTS: The degrees of hearing loss occurring as a result of the administration of 4% boric alcohol solutions prepared with 60° and 40° alcohol differed significantly (p < 0.001). CONCLUSION: It was established that 4% boric acid solution prepared with 60 alcohol affected hearing in guinea pigs more negatively and an increase in degree of alcohol also increased the ototoxicity of the boric acid solution.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

MRI assessment of internal acoustic canal variations using 3D-FIESTA sequences.

Magnetic resonance imaging (MRI) of the internal acoustic canal is the standard diagnostic tool for a wide range of indications in patients. This study aims to investigate the vascular variations and compression of the cranial nerves (CNs) VII and VIII at the cerebellopontine angle in patients with neuro-otologic symptoms using 3D-fast imaging employing steady-state acquisition (FIESTA) MR imaging. One hundred and eighty-seven patients (374 temporal bones) were examined on a 1.5-T MRI. In addition to conventional MR sequences, a 3D-FIESTA MR imaging was acquired. Magnetic resonance images thus obtained were evaluated with special regard to the presence of vascular contact to the CNs VII and VIII, as well as the presence of the vascular variations of the anterior inferior cerebellar artery (AICA) causing the compression of CNs. The Chi-squared test was used for statistical analysis. No statistically significant differences were found between the presence and absence of the AICA loop and/or vascular contact for the clinical symptoms of patients (P > 0.05). The cisternal and canalicular segments of CNs VII and VIII and adjacent vascular variations are well identified using 3D-FIESTA, especially by determining the relationship of the AICA variations between CNs.

Synovial sarcoma of the infratemporal fossa with intracranial extension.

Synovial sarcomas (SS) account for 7-8% of soft-tissue cancers and 3-5% of all cases with head and neck involvement. Synovial sarcoma of the infratemporal fossa is very rare In this article, we report the fourth case of SS of infratemporal fossa and the first case with intracranial extension via the foramen ovale. A 31-year-old man admitted with a one-year history of intense pain in his right jaw. On physical examination, there was only hyperesthesia over the right mandible side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass in the infratemporal fossa and intracranial extension from the foramen ovale. The mass was surgically removed en bloc. Postoperative pathological examination reported the mass as a biphasic-type synovial sarcoma. The patient who received postoperative chemoradiotherapy had no recurrent disease for one year. The patient is still being followed in our clinic.

Puffed-cheek computed tomography: a dynamic maneuver for imaging oral cavity tumors.

We conducted a prospective study to compare the effectiveness of conventional computed tomography (CT) and puffed-cheek CT in detecting the presence and extension of oral cavity malignant tumors. We enrolled 11 patients--5 men and 6 women, aged 32 to 85 years--who had a primary squamous cell carcinoma of the oral cavity. These tumors were located in the floor of the mouth in 4 patients, in the buccal mucosa in 4, in both the buccal mucosa and retromolar trigone in 2, and in the retromolar trigone only in 1. First, conventional contrast-enhanced axial CT was obtained through the oral cavity and neck in each patient. Next, axial imaging was obtained through the oral cavity while patients inflated their cheeks, pursed their lips, and held their breath. We found that the puffed-cheek CTs provided more information regarding the size and extent of the squamous cell carcinomas than did the conventional CTs. For example, in 8 patients, conventional CT could not differentiate the tumor from the normal mucosal surface, but puffed-cheek images clearly showed the surface of the tumor as distinct from the normal mucosa. More disconcerting was the fact that in the other 3 patients, conventional CTs were evaluated as normal, even though puffed-cheek imaging clearly showed the mass in each case. We conclude that puffed-cheek CT is superior to conventional CT for evaluating the mucosal surfaces of the oral cavity. It provides a clearer and more detailed picture with no downside.

Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes.

OBJECTIVE: The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECT AND METHODS: The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared. RESULTS: The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000). CONCLUSION: Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.

Conquering the castle: a novel technique for the middle fossa approach in facial decompression.

OBJECTIVE: To describe 2 subapproaches of the middle fossa approach: the transillumination method and transection of lines using the foramen spinosum, greater superficial petrosal nerve, and trigeminal impression to locate the malleus head for safe identification and decompression of the geniculate ganglion and facial nerve. STUDY DESIGN: Cadaver study. SETTING: A tertiary university hospital anatomy laboratory. SUBJECTS AND METHODS: The present study was conducted using 7 formalin-fixed cadaver heads (14 sides). A 0° endoscope was introduced into the external ear canal toward the posterosuperior quadrant of the tympanic membrane, after which transillumination was used to locate the malleus head. The brightest point indicated the convergence of the greater superficial petrosal nerve and a line drawn along the superior semicircular canal. An additional line was drawn parallel to the petrous ridge from the foramen spinosum and along the pathway of the greater superficial petrosal nerve. A third line connected the trigeminal impression to the zygomatic root. The area posterior to the intersection of these 2 lines separately with the third line was considered the zone of location of the malleus head. Among 17 patients undergoing surgery for facial paralysis between 1993 and 2011, transillumination was used in 6 patients to identify the malleus head to locate the geniculate ganglion. RESULTS: These techniques were proven to be reliable in locating the malleus head to find the geniculate ganglion in 14 dissected cadaveric temporal bones. CONCLUSION: Two methods of locating the malleus head for facial decompression were defined.

Prevention of cisplatin ototoxicity: Efficacy of micronized flavonoid fraction in a guinea pig model.

OBJECTIVE: To evaluate the effectiveness of micronized flavonoid fraction in preventing cisplatin ototoxicity in a guinea pig model. METHODS: This study was conducted on 23 guinea pigs in the Animal Laboratory of Izmir Atatürk Training and Research Hospital. Animals were divided into three groups: Group 1 consisted of eight animals receiving cisplatin only; Group 2 contained eight animals receiving cisplatin+micronized flavonoid fraction; and Group 3 contained seven animals that received micronized flavonoid fraction only. Their cochlear reserve was evaluated by measuring the distortion product otoacoustic emission on days 0 and 7. RESULTS: In Groups 1 and 2, the intragroup signal-noise ratios were statistically different at all frequencies tested (based on negative ranks, p<0.05). In Group 3, the intragroup signal-noise ratios did not differ significantly at the frequencies tested (p>0.05). Comparison of the three groups showed statistically significant differences among the groups (p<0.05). The post hoc Bonferroni correction showed statistically significant differences among all three groups (p<0.016). The median signal-noise ratio of the three groups tended to increase (z-value was positive for all the frequencies tested; p<0.01). CONCLUSION: Micronized flavonoid fraction (Daflon) is effective against cisplatin-induced ototoxicity in guinea pigs.

[Clear cell mucoepidermoid carcinoma of the parotid gland: a case report]. / Parotis Bezinin Berrak Hücreli Mukoepidermoid Karsinomu: Olgu Sunumu.

Clear cell variant of mucoepidermoid carcinoma of the salivary glands is rare. A 55-year-old male patient with recently growing left parotid mass underwent superficial parotidectomy. Although the dominant component of the tumor was composed of clear cells, mucin containing cells were also present. Histochemically, alcian blue stain supported intracellular mucin positivity. Immunohistochemically, p63 was positive. Based on the morphological, histochemical and immunohistochemical findings, the case was diagnosed as mucoepidermoid carcinoma, clear cell variant.

Increased expression of VEGF, iNOS, IL-1ß, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation.

OBJECTIVE: To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1ß, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure. METHODS: Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1ß, and IL-17 expression. Experimental and control animals were examined using the same protocol. RESULTS: The expression levels of VEGF, iNOS, IL-1ß, and IL-17 differed significantly between the experimental and control groups (p=0.018, p=0.010, p=0.002, and p=0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p=0.132). CONCLUSION: This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1ß, IL-17, and iNOS.