The importance of thrombotic risk factors in the development of idiopathic sudden hearing loss.

Impaired cochlear blood circulation has been suggested to cause sudden hearing loss. In this study, the role of factor V 1691 G-A (FV 1691 G-A), prothrombin 20210 G-A (PT 20210 G-A), methylene tetrahydrofolate reductase 677 C-T (MTHFR 677 C-T), factor V 4070 A-G (FV 4070 A-G), endothelial cell protein C receptor (EPCR) gene 23-bp insertion, and plasminogen activator inhibitor-1 (PAI-1) 4G/5G mutation was assessed. Fifty-three patients with idiopathic sudden sensorineural hearing loss and 80 individuals comprising the control group were included in this study. The frequency for FV 1691 A was 6.2% in the patient group and 3.7% in the control group, PT 20210 G-A was 1.2% in the patient group and 1.9% in the control group, and FV 4070 A-G was 7.5% in the patient group and 11.3% in the control group. The frequency of MTHFR 677 C-T was significantly higher in the patient group than in the control group, with a P value of .03. PAI-1-675 4G/5G polymorphism was found to be 71.2% and 69.8%, in the control group and the patient group, respectively. The EPCR 23-bp insertion was 0% in the control group and was found in 3 patients (3.7%), which needs further study.

Saccular cyst in an infant: an unusual cause of life-threatening stridor and its surgical treatment.

Saccular cysts in infants are rare lesions of the larynx and may result in respiratory obstruction and severe dyspnea. Herein we present a case of saccular cyst in a three-month-old infant. She was presented with severe stridor and respiratory distress. She had been followed with the diagnosis of tracheomalacia for three months elsewhere. Direct laryngoscopy of the larynx revealed a saccular cyst. Stridor disappeared shortly after surgical excision of the supraglottic saccular cyst under direct laryngoscopy. No complication or recurrence was seen in the 12-month follow-up period. Saccular cysts in infants are rare lesions and should be kept in mind in the differential diagnosis of stridor in infants.

Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect.

Acute bacterial meningitis is a potentially life-threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. Patients with head injury have the highest risk of acquiring recurrent bacterial meningitis, followed by patients with a congenital anatomic lesion of the skull or duramater, such as meningomyelocele. The underlying cause is a transdural communication between the meningeal space and paranasal sinuses or skin. The first attack of meningitis may occur several weeks to 12 years after the head injury. In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement deficiency. We report a 14-year-old boy, who suffered from recurrent Streptococcus pneumoniae meningitis due to a well-defined defect at the ethmoid roof after a head trauma.

Radiofrequency for the treatment of vasomotor rhinitis.

OBJECTIVES: We assessed the efficacy of submucosal application of radiofrequency to the inferior turbinate for the treatment of vasomotor rhinitis. PATIENTS AND METHODS: Twenty patients with vasomotor rhinitis (9 males, 11 females; mean age 29.2 years; range 20 to 40 years) were treated with radiofrequency applied to the inferior turbinate. Symptoms such as nasal obstruction, sneezing, and watery nasal discharge were graded with the use of a visual analog scale (VAS) before, and on days 1, 3, 7, 30, 60, 90, and 180 after the treatment. RESULTS: The severity of symptoms began to decrease following the first week after the application. Maximum relief was achieved between 30 to 60 days after the intervention. The highest rate of improvement (85.4%) was reported in sneezing, followed by nasal obstruction (76.4%) and nasal discharge (67.7%). The mean VAS scores showed a significant improvement in all symptoms between 7 to 180 days after the procedure (p<0.05). The rate of patient satisfaction was 90% for the relief of nasal obstruction and sneezing, and 80% for nasal discharge. Complaints about vasomotor rhinitis increased up to a severity near the pretreatment level in eight patients on the 180th postoperative day and the procedure was repeated. CONCLUSION: These findings indicate that radiofrequency may be used as an alternative treatment option in patients with vasomotor rhinitis.

[The value of laryngeal electromyography in the prognosis of vocal cord paralysis]. / Vokal kord paralizilerinin takibinde larenjeal elektromiyografinin önemi.

OBJECTIVES: We investigated the value of laryngeal electromyography (EMG) in monitoring patients with vocal cord paralysis. PATIENTS AND METHODS: Cricothyroid and thyroarytenoid muscles of 40 patients (10 females, 30 males; mean age 32 years; range 18 to 61 years) with vocal cord paralysis were monitored with laryngeal electromyography. The patients were divided into two groups according to time to presentation after symptom onset, i.e. within 1-3 months (group 1; n=14), and after at least 12 months (group 2; n=26). Electromyography was repeated every three months in group 1, and in the third and sixth months in group 2. RESULTS: Initial EMG examinations showed polyphasic reinnervation potentials and partial axonal degeneration in 21 laryngeal nerves in group 1. Recovery was expected in these patients. Repeat EMGs revealed normal findings in 17 laryngeal nerves, yielding a prognostic estimation of 80.9% (17/21). In group 2, none of the patients demonstrated polyphasic potentials or motor unit potentials suggesting reinnervation on admission. The earliest and latest recoveries were observed in the fourth and eleventh months (mean 6.4 months) in group 1, respectively. However, group 2 patients were followed-up for at least 18 months after the onset of their symptoms and none manifested clinical and electrophysiologic improvement. CONCLUSION: Our data suggest that EMG is a useful technique in the estimation of prognosis of patients presenting in the early period of vocal cord paralysis.

[The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia]. / Yutma güçlügü olan hastalarin tanisinda fiberoptik endoskopiyle yutma degerlendirmesi ve modifiye baryumlu yutma testinin etkinlikleri.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow test (MBST) in patients with dysphagia. PATIENTS AND METHODS: Eighty patients with dysphagia were evaluated in three groups consisting of 27 patients with oral, pharyngeal, or esophageal masses; 26 patients with neurogenic dysphagia; and 27 patients with no distinct pathology. All the patients underwent FEES and MBST to examine elevation of the soft palate, nasal regurgitation, pharyngeal residue, penetration, aspiration, and pooling of secretions in the pyriform sinus and vallecula. RESULTS: In neurogenic dysphagia, MBST was more efficacious in detecting aspiration and pooling in the vallecula (p<0.05). Evaluation of the internal anatomy, visualization of masses, and laryngopharyngeal sensory discrimination were only possible with the FEES. On the other hand, evaluation of the elevation of the larynx and the hyoid, the relaxation of the upper esophageal sphincter, and the oral phase of swallowing, and the detection of esophageal pathologies were only possible with the MBST. CONCLUSION: The leading advantages of the two evaluation techniques seem to lie in the detection of aspiration for the FEES, and dynamic evaluation of the oral and esophageal phases of swallowing for the MBST.

Transcanal anterior approach for cystic lesions of the petrous apex.

OBJECTIVE: To investigate the utility of a newly described approach, the transcanal anterior approach that is a modification of the subcochlear approach for the drainage of cystic lesions of the petrous apex. STUDY DESIGN: Prospective temporal bone study. SETTING: Tertiary referral center. MATERIALS: A total of six cadaveric temporal bone specimens (four males) were included. Right ear in four specimens and left ear in two specimens were used. INTERVENTIONS: The approach commenced with postauricular skin incision. After the transsection of the meatal skin, antero-inferior tympanotomy was performed. Anteroinferior canaloplasty localized the carotid canal. As much as 0.5 cm of the vertical segment of the internal carotid artery was skeletonized. After the identification of the artery, petrous apex cells were reached by drilling the cortical bone between the cochlea and the internal carotid artery. An air cell tract was established. Position and length of the tract in two specimens were demonstrated on the 1 mm-cut computerized tomography scans. MAIN OUTCOME MEASURES: Utility of the approach was investigated based on the established criteria: anteroposterior diameter and height of the fenestra of the tract, length of the tract from the cochlea to the deepest point of the tract (depth of the tract), and the injury risk of the internal carotid artery and the cochlea. RESULTS: The mean anteroposterior diameter, the height, and the length were 4.7 +/- 1.05 mm, 3.2 +/- 0.68 mm, and 14.7 +/- 1.1 mm, respectively. Injury did not occur in the cochlea or internal carotid artery in any of the specimens. CONCLUSION: With the subcochlear approach, there is always potential risk of injury to the cochlea, the internal carotid artery, and the jugular bulb. Although this new approach includes a technically challenging stage (exposing the vertical portion of the internal carotid artery), partly exposing the vertical portion of the artery provides a safer approach, which decreases the injury risk for the round window and the jugular bulb. Additionally, measurements show that it is possible to reach a considerable part of the petrous apex cells.

Voice changes after androgen therapy for hypogonadotrophic hypogonadism.

OBJECTIVES/HYPOTHESIS: Males with isolated hypogonadotropic hypogonadism (IHH) fail to undergo normal sexual development, including the lack of masculinization of the larynx. The objective of this study was to measure the mean vocal fundamental frequency (MF0) in IHH patients and determine the impact of androgen treatment. An additional aim was to compare the MF0 between IHH patients and controls. STUDY DESIGN: Prospective observational study. METHODS: Twenty-four patients with IHH were identified along with 30 normal males and females. Voice recordings were obtained on all subjects. Androgen therapy was administered to the IHH patients. The MF0 and serum sex hormone levels were measured before treatment and at intervals during therapy. These results were compared with the pretreatment data within the IHH group. Voice parameters were also compared between the pre- and posttreatment IHH patients and the normal males and females. RESULTS: The MF0 in untreated IHH patients was 229 +/- 41 Hz. This was intermediate between the normal male (150 +/- 22 Hz, P < .001) and normal female patients (256 +/- 29 Hz, P < .01). After treatment, the MF0 in the IHH group decreased to 173 +/- 30 Hz (P < .0001); indeed, their posttreatment MF0 approached that of normal males (P < .08). Serum hormone levels responded to the injected testosterone, but these levels did not directly correlate with MF0. CONCLUSIONS: MF0 in IHH patients is intermediate between normal male and female levels. After treatment with testosterone, these values approach the range of normal males. This prospective study details the impact of androgens on the larynx and vocal function in patients with IHH.

[Results of voice therapy in functional voice disorders]. / Fonksiyonel ses hastaliklarinda ses terapisi sonuçlarimiz.

OBJECTIVES: To determine the efficacy of voice therapy techniques in 37 patients with functional dysphonia. PATIENTS AND METHODS: The patients were divided into three groups according to the type of functional voice disorder, including mutational falsetto (n=16), vocal nodule (n=17), and muscle-tension dysphonia (n=4). All the patients received voice therapy which varied according to the frequency of visits, time, and techniques for the type of functional voice disorder. Voices of the patients were evaluated subjectively by a questionnaire and the GRBAS scale, and objectively by videolaryngostroboscopy and computed voice analysis before and after the therapy. RESULTS: Fifteen patients with mutational falsetto (93%), eight patients with vocal nodules (47%), and all the patients with muscle-tension dysphonia were cured by voice therapy techniques. Vocal nodules were reduced in 35% of the patients and were stable in three patients (18%). CONCLUSION: Successful results can be obtained by voice therapy techniques in functional voice disorders, which are common in otolaryngology practice, causing difficulties in diagnosis and management.

Evaluation of cochlear function in patients with normal hearing and tinnitus: a distortion product otoacoustic emission study.

OBJECTIVES: We investigated cochlear function in normal-hearing patients with tinnitus using distortion product otoacoustic emissions (DPOAE). PATIENTS AND METHODS: The study included 20 normal-hearing patients with tinnitus (13 males, 7 females; mean age 25 years; range 17 to 52 years) and 15 controls (10 males, 5 females; mean age 23 years; range 18 to 27 years) with normal hearing. Both groups underwent routine audiological tests including audiometry and tympanometry. Cubic DPOAEs were recorded from both groups. Signal-to-noise ratios (SNRs) lower than the 10th percentile of the control values were regarded as abnormal or undetectable. RESULTS: Tinnitus was bilateral in seven patients and unilateral in 13 patients. Seven patients with unilateral tinnitus and all patients with bilateral tinnitus had a history of exposure to noise. The mean perceived frequencies for tinnitus were 6.3 kHz and 6.2 kHz in the left and right ears, respectively. Loudness was measured as 8 dB SL in the left ears, and 7 dB SL in the right ears. Compared to unilateral cases, patients with bilateral tinnitus exhibited a higher percentage of abnormal SNRs at most frequencies. Some asymptomatic ears in the patient group had abnormal results. CONCLUSION: These findings show that tinnitus in normal-hearing patients is often associated with varying degrees of cochlear dysfunction. The results also suggest that tinnitus may be regarded as an early manifestation of noise-induced hearing loss in patients with a history of exposure to noise.

Tolosa-Hunt syndrome with heterotopic salivary gland tissue and absence of internal carotid artery.

Tolosa-Hunt syndrome (THS), heterotopic salivary gland and hypoplasia of internal carotid artery (ICA) are all rare entities. We have reported a case of all these three conditions included in a patient. We have postulated that the heterotopic salivary gland tissue might have caused the hypoplasia of ICA and also triggered the THS.

Impact of tumor size on hearing outcome and facial function with the middle fossa approach for acoustic neuroma: a meta-analytic study.

OBJECTIVE: The purpose of this study was to review the English language literature concerning the effect of tumor size on hearing outcome and facial function after the middle fossa approach for acoustic neuroma in a large patient population. MATERIAL AND METHODS: The literature search identified a total of 11 studies reporting hearing outcome and facial function for a given tumor size. There were 1073 and 797 cases available for the analysis of hearing outcome and facial function, respectively. These cases were subdivided based on the way in which tumor size was measured: category 1 considered only the extracanalicular portion of the tumor; and category 2 considered the largest diameter of the tumor. In category 1, hearing and facial results were regrouped based on tumor size as follows: intracanalicular (IC) tumors; 1-9 mm tumors; 10-20 mm tumors; and a combined group of < 0.5 mm tumors, including IC tumors. In category 2, tumors were subdivided into 2 groups: those < 10 mm in diameter; and those 10-20 mm in diameter. In each category, tumor size groups were compared using the chi2 test in terms of the rate of functional hearing preservation and good facial function. RESULTS: In category 1, analysis of the rate of functional hearing preservation showed that IC tumors compared favorably with the 1-9 mm and 10-19 mm tumors (56.9% vs 45.6%, p = 0.016; and 56.9% vs 32.3%, p < 0.001, respectively). The IC tumor group had the best rate of good facial function, followed by the 1-9 mm and 10-19 mm tumors (98.9% vs 93.9%, p = 0.007: and 98.9% vs 85.6%, p < 0.001, respectively). In category 2, rates of functional hearing preservation and good facial function were almost the same for tumors < 10 mm in diameter and those 10-20 mm in diameter (p > 0.05). CONCLUSIONS: The meta-analysis revealed that tumor size is an important variable determining hearing outcome and facial function. Inclusion of the IC portion of a tumor in the tumor size measurement apparently hampered the statistical power of the study, leading to an overestimation of the size of IC tumors.

[The prognostic significance of DNA ploidy in laryngeal cancers]. / Larenks kanserlerinde DNA ploidinin prognostik önemi.

OBJECTIVES: We assessed the relationship between DNA ploidy and histopathologic parameters and its effect on prognosis in patients with squamous cell carcinoma of the larynx. PATIENTS AND METHODS: Surgical sections of 44 patients who were treated for squamous cell carcinoma of the larynx were studied. Image cytometry measurements were performed on nuclear suspensions derived from paraffin-embedded sections to determine DNA ploidy patterns. We investigated the relationship between the DNA ploidy status and localization, stage, differentiation, keratinization, depth of tumoral invasion, lymphocytic infiltration, perineural invasion, infiltration pattern, necrosis, and 5-year and overall survival rates. RESULTS: Aneuploidy and diploidy were diagnosed in 65.9% and 34.1%, respectively. No significant relationships were found between DNA ploidy and stage, localization, differentiation, keratinization, depth of invasion, infiltration pattern, lymphocytic infiltration, necrosis, perineural invasion, and lymph node metastasis (p>0.05). The five-year (p=0.048) and overall (log rank=4.40; p=0.036) survival rates were significantly higher in diploid tumors. The presence of perineural invasion (p=0.004) and depth of the invasion exceeding 9 millimeters (p=0.045) were significant factors adversely influencing the five-year survival rate. The multivariate Cox regression analysis showed that the DNA ploidy status (p=0.042) and the presence of perineural invasion (p=0.009) were independent prognostic variables related to decreased survival. CONCLUSION: Aneuploidy has an adverse effect on the prognosis in squamous cell carcinoma of the larynx.

Evolving acoustic characteristics of the canal wall down cavities due to neo-osteogenesis by periosteal flap.

OBJECTIVE: To determine whether the acoustic properties of the canal wall down cavity would come closer to those of the normal ear canal as the cavity is lined with periosteal flap. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Twenty one subjects who underwent canal wall down mastoidectomy and total ossicular replacement prosthesis tympanoplasty were selected. INTERVENTIONS: Canal wall down cavities were lined with postauricular periosteal flap. The acoustic properties of 21 canal wall down cavities (mastoidectomy ears) and 16 contralateral normal ears (control ears) were measured with a hearing aid fitting system. MAIN OUTCOME MEASURES: Frequency, amplitude, bandwidth, and Q factor of the resonance curve along with the loss in amplitude below 1 kHz were compared in a paired-wise manner between the first and third months and the third and sixth months postoperatively in mastoidectomy ears, and also between mastoidectomy and control ears. RESULTS: In the mastoidectomy ears, the peak resonance frequency and bandwidth significantly increased at the end of the third and six months as the volume of the cavity decreased ( < 0.05). However, the amplitude and Q factor of the resonance curve remained stable. At the end of the first month, all parameters were different in both groups ( < 0.05). At the end of the sixth month, the frequency and bandwidth of the resonance curve in both groups were not different. The mastoidectomy ears had some decibel-amplitude loss below 1 kHz. Only its frequency changed as the cavity became smaller ( < 0.05). CONCLUSIONS: New bone formation facilitated by a periosteal flap in the posterior part of the CWD cavity behind the facial ridge may provide acoustic properties similar to those of the normal ear canal.

The role of zinc in management of tinnitus.

OBJECTIVE: Several therapeutic modalities have been tried in patients with tinnitus. These trials have given rise to unsatisfactory results in most of the patients since the etiology and pathophysiology of tinnitus is unclear. Significant correlation between tinnitus and decreased zinc level and also reduction in severity of tinnitus after zinc therapy has been reported in some clinical studies. The aim of this study is to find out the prevalence of hypozincemia in patients suffering from tinnitus of various origins (presbyacusis, acoustic trauma and ototoxicity) at young and elderly population and to investigate the effect of zinc therapy upon the severity of tinnitus. METHODS: Forty consecutive patients with severe tinnitus were included in this study between April 1998 and May 2000. There were 32 men (80%) and eight women (20%) with an age ranging between 19 and 67 (mean 40.6 years). Eleven patients were over the age of 50. The zinc level was measured in non-diluted serum by flame atomic absorption spectrophotometry (normal values; 50-120 microg/dl) from fasting blood samples. All the patients were given zinc pills 220 mg each, once a day and 2 h before lunch for 2 months. The patients were required to fulfill a tinnitus scoring scale and a handicap questionnaire before and after treatment. The Wilcoxon rank sum test and McNemar test were used for the statistical analysis. RESULTS: Six patients were hypozincemic and seven patients had decreased serum zinc levels. No significant change has been observed in frequency and severity of tinnitus measured by audiologic tests after zinc therapy. Twenty-three (57.5%) of these patients reported some relief of tinnitus in the tinnitus scoring scale but the rate of improvement was minor (P>0.05). Decrease in severity of tinnitus after zinc therapy in elder group was better than the younger ones. CONCLUSION: Our study could not confirm the high incidence of hypozincemia in patients with tinnitus as reported previously. Zinc therapy for 8 weeks presented no promising effect on tinnitus in three groups of patients and the difference between the rate of improvement in severity of tinnitus after zinc intake in patients with normal and low serum zinc level was not significant. Zinc supplement provided relief of tinnitus in some of the elder people who apparently had dietary zinc deficiency.

Frequency specificity of cochlear damage in acute electrical injury: a longitudinal distortion product otoacoustic emission study.

HYPOTHESIS: To understand cochlear dysfunction and the recovery pattern of the cochlea after acute electrical injury. BACKGROUND: The cochlea is believed to be more vulnerable to direct current than to alternating current. However, the damage-and frequency-specific recovery characteristics of the cochlea have not been well described. METHODS: Baseline distortion product otoacoustic emission measurements were taken via transtympanic electrodes from 19 guinea pigs. A 20-Hz alternating current and a positive direct current, both at a 1,000-microA intensity, were applied to 9 and 10 animals, respectively. The measurements were repeated immediately after the application of current and after 10 days. Comparisons were made for both groups individually in signal-to-noise ratios obtained before and immediately after, immediately and 10 days after, and before and 10 days after the application of electrical current. RESULTS: Alternating and direct currents caused a significant depression in signal-to-noise ratio immediately after the application. However, 10 days later, the mean signal-to-noise ratio in the animals subjected to alternating current came significantly close to the baseline value, particularly between the frequencies of 2,211 and 3,717 Hz. By contrast, the mean signal-to-noise ratio in the animals subjected to direct current remained significantly depressed throughout all frequencies except for 2,211 Hz. CONCLUSION: Baseline distortion product otoacoustic emission measurements enabled cochlear function to be monitored in a frequency-specific manner after electrical injury. The functional damages were quantitatively close to each other for both types of currents at a given intensity. Nevertheless, recovery was more apparent in the animals exposed to alternating current than in those exposed to direct current. Recovery was also better in the midfrequency region than in higher frequencies. It is hypothesized that the reason for the difference in recovery in both groups was the net charge left by direct current.

Electrophoretic evaluation of nasal discharge in patients with allergic rhinitis and vasomotor rhinitis.

BACKGROUND: Allergic rhinitis and vasomotor rhinitis are two common diseases that have similar symptoms and physical findings. This study was designed to assess the efficacy of electrophoretic analysis of nasal discharge for the differential diagnosis of allergic rhinitis and vasomotor rhinitis. METHODS: Two different groups of patients with allergic rhinitis (n = 18) and with vasomotor rhinitis (n = 18) diagnosed by current methods and 10 healthy subjects as a control group were included in this study. Component analyses of proteins in nasal wash were made by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. RESULTS: The mean levels of total protein, 66-kDa proteins and 26-kDa proteins (277.2 +/- 9 microg/mL, 114.5 +/- 9 microg/mL, and 67.0 +/- 4 microg/mL, respectively), in nasal washing samples of patients with allergic rhinitis were found to be higher than in the samples, (222.0 +/- 6 microg/mL, 65.6 +/- 6 microg/mL, and 42.9 +/- 4 microg/mL respectively) obtained from patients with vasomotor rhinitis. The control group showed the lowest rate of these proteins (167.8 +/- 7 microg/mL 34.3 +/- 3 microg/mL, and 25.0 +/- 3 microg/mL, respectively). The differences between mean levels of these proteins in all groups were statistically significant (p < 0.05). CONCLUSIONS: These findings indicate that electrophoretic analysis of nasal discharge can be used for the diagnosis of allergic rhinitis and vasomotor rhinitis. However, further studies are needed to standardize the technique of nasal wash and to determine the range of proteins in nasal secretions that will confirm the diagnosis.

Tumor necrosis factor-alpha and interleukin-1beta levels in recurrent and persistent otitis media with effusion.

OBJECTIVE: Based on interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha levels in effusions, our goals were to specify either recurrent or persistent otitis media with effusion (OME) is a mid stage in the development of chronic disease and to identify the factors that have an influence on cytokine levels. STUDY DESIGN: Samples from groups with recurrent (n = 15) and persistent (n = 39) OME were assayed for IL-1beta and TNF-alpha. Children were also grouped with respect to age, sex, quality of effusion, and the presence of pharyngeal adenoid tissue. SETTING: Tertiary referral center. RESULTS: In recurrent and persistent OME groups, IL-1beta was higher than TNF-alpha (P < 0.01). IL-beta was higher in recurrent OME than in persistent OME (P < 0.05). CONCLUSION: Recurrent OME seems to be closer to the chronic stage of the disease relative to persistent OME in terms of higher IL-1beta levels. Each exacerbation of acute disease in recurrent otitis media is likely to be mediated by IL-1beta. SIGNIFICANCE: We were able to clarify that recurrent OME is a stage that occurs before chronic OME. Therefore, the prevention of acute attacks in recurrent disease would also impede long-term damage to the middle ear.