CT and MRI in the Preoperative Planning of Balloon Dilation of the Eustachian Tube: Literature Review.

Balloon dilatation of the Eustachian tube (BET) is a surgical treatment method for Eustachian tube dysfunction (ETD), which relieves the symptoms in the majority of cases. However, there are potential intraoperative risks associated with BET; the decision-making process with regard to indications for BET is not standardized up to date. The objective of this study was to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative planning of BET. The literature review is based on a database search performed in August 2022. BET is classified into transtympanic and nasopharyngeal. CT of the temporal bone provides good visualization of the site of obstruction, which allows to choose the adequate approach. Transtympanic approach is associated with risks of internal carotid artery damage due to possible carotid canal anomalies. This risk can be prevented with preoperative CT scan of the temporal bone. In case of nasopharyngeal BET, there is no sufficient data considering risks of possible artery damage, although CT can provide accurate measurements of ET. MRI is useful for differential diagnosis of conditions imitating ETD, such as endolymphatic hydrops and nasopharyngeal carcinoma. Thus, it is feasible to perform CT and MRI before BET to personalize the management of ETD patients.

Eosinophilic Otitis Media: Modern Aspects of Pathogenesis, Clinical Features, Diagnosis and Treatment.

Eosinophilic otitis media (EOM) is an inflammatory chronic disease of the middle ear, characterized by the presence of a particularly viscous effusion with a high content of protein toxins of eosinophilic origin in the middle ear cavity. The pathology has relationship with bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. EOM is characterized by a sluggish course, a tendency to relapse, which can lead to a gradual hearing decrease up to complete deafness. In this paper, we reviewed the international literature with special attention to pathogenesis and treatment management.

Stem cell therapy for vocal fold regeneration after scarring: a review of experimental approaches.

This review aims at becoming a guide which will help to plan the experimental design and to choose adequate methods to assess the outcomes when testing cell-based products in the treatment of the damaged vocal folds. The requirements to preclinical trials of cell-based products remain rather hazy and dictated by the country regulations. Most parameters like the way the cells are administered, selection of the cell source, selection of a carrier, and design of in vivo studies are decided upon by each research team and may differ essentially between studies. The review covers the methodological aspects of preclinical studies such as experimental models, characterization of cell products, assessment of the study outcome using molecular, morphological and immunohistochemical analyses, as well as measuring the tissue physical properties. The unified recommendations to perform preclinical trials could significantly facilitate the translation of cell-based products into the clinical practice.

Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations?

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which recurrent abdominal pain is associated with defecation or a change in bowel habits (constipation, diarrhea, or both), and it is often accompanied by symptoms of abdominal bloating and distension. IBS is an important health care issue because it negatively affects the quality of life of patients and places a considerable financial burden on health care systems. Despite extensive research, the etiology and underlying pathophysiology of IBS remain incompletely understood. Proposed mechanisms involved in its pathogenesis include increased intestinal permeability, changes in the immune system, visceral hypersensitivity, impaired gut motility, and emotional disorders. Recently, accumulating evidence has highlighted the important role of the gut microbiota in the development of IBS. Microbial dysbiosis within the gut is thought to contribute to all aspects of its multifactorial pathogenesis. The last few decades have also seen an increasing interest in the impact of antibiotics on the gut microbiota. Moreover, antibiotics have been suggested to play a role in the development of IBS. Extensive research has established that antibacterial therapy induces remarkable shifts in the bacterial community composition that are quite similar to those observed in IBS. This suggestion is further supported by data from cohort and case-control studies, indicating that antibiotic treatment is associated with an increased risk of IBS. This paper summarizes the main findings on this issue and contributes to a deeper understanding of the link between antibiotic use and the development of IBS.

Chronic tympanic membrane perforation: Histopathological evidence of the experimental model.

OBJECTIVES: This study aims to compare the effectiveness of three different models of chronic tympanic membrane perforations. MATERIALS: The experimental study included 18 male chinchillas, divided into 3 equal groups. Group 1 perforations were performed with infolding technique myringotomy. Laser myringotomy was performed for perforation creation in Group 2. Group 3 perforations were performed with infolding myringotomy combined with ventilation tube insertion. At the end of the follow-up period, which lasts 8 weeks, all tympanic membranes with patent perforations were examined histologically. RESULTS: Although, the mean perforation patency in Group 2 was significantly higher than in Group 1 (5 vs. 2.4 weeks, p < 0.01), both of them failed in creation of chronic perforation according to time parameters. Group 3 demonstrated the longest mean perforation patency among investigated models (8 weeks). In Group 3, histological examination of perforations, which were considered to be chronic, revealed, that stratified squamous epithelium continued from the lateral surface around the perforation edge to join with the medial mucosal layer of TM. CONCLUSION: Our findings demonstrated that the combination of infolding technique and ventilation tube insertion seems to be a potential candidate for an effective animal model of tympanic membrane perforation. Further large-scale studies are required to verify our promising results.

Infrared Laser Effect on Healthy and Ossified Costal Cartilage: The Development of Stable Load-Bearing Autoimplants.

BACKGROUND AND OBJECTIVE: The laser-induced stress relaxation provides new prospects to obtain stable long fragments of costal cartilage for autoimplantation avoiding the risk of spontaneous deformation and poor engraftment. However, the age-related alterations of cartilage may sufficiently influence its interaction with infrared (IR) laser radiation and disrupt the effectiveness and safety of the technique. The aim of the work is to study the influence of the structural quality of costal cartilage on its interaction with IR laser and efficiency of obtaining of curved implants for trachea surgery. STUDY DESIGN/MATERIALS AND METHODS: Healthy costal cartilage was taken from pigs and human. Ossified costal cartilage was taken from humans of age 65 ± 7. The cartilage slices with a mean thickness of 3 mm were mechanically curved and processed to stress relaxation by laser irradiation with the wavelength 1.56 µm. The structure and mineral content were studied by X-ray microtomography and element analysis. The optical measurements included the study of the propagation of IR radiation, speckle interferometry, and IR radiometry. RESULTS: The aged cartilage demonstrates a high level of heterogeneity in structure and properties and decreased water content. The presence of dense inclusions consisting of amorphous calcined volumes makes the tissue more fragile and less elastic. The IR radiation propagation intensity for aged cartilage is at least twice higher than that for healthy cartilage. The thermal-induced motion of scatterers in aged cartilage is slower. X-ray microtomography showed the cartilage-like and the bone-like structures within the ossified samples. CONCLUSIONS: The main challenge for laser reshaping of aged cartilage is the presence of ossifications. However, the new stable curvature can be obtained with adjustment of laser power. To obtain the satisfying stable curvature of an implant the ossified volumes should be avoided The laser-induced stress-relaxation mechanism for aged cartilage can be particularly different from that of healthy tissue and the optimal laser regimes should be specified. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Collagen fibrillar structures in vocal fold scarring and repair using stem cell therapy: a detailed histological, immunohistochemical and atomic force microscopy study.

Regenerative medicine opens new opportunities in the repair of cicatricial lesions of the vocal folds. Here, we present a thorough morphological study, with the focus on the collagen structures in the mucosa of the vocal folds, dedicated to the effects of stem cells on the vocal folds repair after cicatricial lesions. We used a conventional experimental model of a mature scar of the rabbit vocal folds, which was surgically excised with a simultaneous implantation of autologous bone marrow-derived mesenchymal stem cells (MSC) into the defect. The restoration of the vocal folds was studied 3 months postimplantation of stem cells and 6 months after the first surgery. The collagen structure assessment included histology, immunohistochemistry and atomic force microscopy (AFM) studies. According to the data of optical microscopy and AFM, as well as to immunohistochemical analysis, MSC implantation into the vocal fold defect leads not only to the general reduction of scarring, normal ratio of collagens type I and type III, but also to a more complete restoration of architecture and ultrastructure of collagen fibres in the mucosa, as compared to the control. The collagen structures in the scar tissue in the vocal folds with implanted MSC are more similar to those in the normal mucosa of the vocal folds than to those of the untreated scars. AFM has proven to be an instrumental technique in the assessment of the ultrastructure restoration in such studies. LAY DESCRIPTION: Regenerative medicine opens new opportunities in the repair of the vocal fold scars. Because collagen is a main component in the vocal fold mucosa responsible for the scar formation and repair, we focus on the collagen structures in the mucosa of the vocal folds, using a thorough morphological study based on histology and atomic force microscopy (AFM). Atomic force microscopy is a scanning microscopic technique which allows revealing the internal structure of a tissue with a resolution up to nanometres. We used a conventional experimental model of a mature scar of the rabbit vocal folds, surgically excised and treated with a mesenchymal stem cells transplant. Our morphological study, primarily AFM, explicitly shows that the collagen structures in the scarred vocal folds almost completely restore after the stem cell treatment. Thus, the modern microscopic methods, and especially AFM are instrumental tools for monitoring the repair of the vocal folds scars.

Laser septochondrocorrection.

OBJECTIVE: To present results from a clinical series of patients who underwent office-based laser nasal septal cartilage reshaping. DESIGN: Nonrandomized prospective clinical trial. SETTING: Outpatient university-based otolaryngology clinic. PATIENTS: One hundred ten patients aged 11 to 66 years with symptomatic nasal obstruction due to septal deviation. INTERVENTION: Topical anesthesia (10% lidocaine solution) was applied to the nasal cavity. The septum was then mechanically straightened using a modified nasal speculum, and it was secured in a median position. Laser energy from a holmium:YAG laser was delivered via an optical fiber to the septum along the regions of maximum mechanical stress. Irradiation was delivered through the mucosa. MAIN OUTCOME MEASURES: A subjective survey, rhinoscopy, and rhinomanometry in 110 patients before and after surgery. RESULTS: Eighty-four patients (76%) showed stable improvement in airways and disappearance of the attendant symptoms. The average duration of follow-up was 18 months. CONCLUSIONS: This technique uses local, nondestructive laser irradiation to reshape septal deviations without the use of mucoperichondrial flaps or sedation.