Which technique is better for cholesteatoma surgery?

OBJECTIVE: The objective of this study was to evaluate the long-term surgical outcomes and recurrence rates of three surgical techniques that are commonly used for cholesteatoma. PATIENTS AND METHODS: The hospital records of 132 patients with primary cholesteatoma who underwent surgery between January 1996 and December 2006 were evaluated retrospectively. Twelve cases had bilateral disease, and a total of 144 ears were treated. The patients were divided into three groups according to surgical technique: modified radical mastoidectomy (MRM) (n = 48 ears), radical mastoidectomy (RM) (n = 42 ears), and intact canal wall mastoidectomy (ICWM) (n = 54 ears). MRM and RM procedures are canal wall down (CWD) techniques, whereas the ICWM procedure is a canal wall up (CWU) technique. Postoperatively, all patients were followed up yearly for at least 6 years. The otomicroscopic features, cholesteatoma extension, surgical findings, and recurrence rates were compared in the groups. RESULTS: Preoperative otomicroscopic examination showed attic retraction or perforation in 32% of the cases and central perforation in 11%. There was a higher cholesteatoma recurrence rate in the ICWM group than in the MRM and RM groups (p < 0.05), but there was also better hearing gain in the ICWM group (p < 0.05). CONCLUSION: There are several surgical techniques for eradicating cholesteatoma. Our study found that CWD procedures (RM, MRM) were more effective for the eradication of cholesteatoma, but hearing gain was better when a CWU technique was used. The choice of surgical technique should be individually tailored based on the pre-operative imaging and hearing examination findings.

Effects of septoplasty and septal deviation on nasal mucociliary clearance.

To evaluate the effect of septal pathology and surgery on nasal mucociliary clearance. A radioisotope method was used to measure the velocity of nasal mucociliary transport. Nasal mucociliary clearance was measured before and after septal surgery using technetium-99m macroaggregated albumin. Fifteen patients (mean age: 20 +/- 8 years; 11 males, four females) were studied pre-operatively, but scintigraphy could be repeated only in 10 patients, 2 months after surgery. A group of 10 healthy volunteers were also studied. The clearance values obtained from the preoperative period (26.25 +/- 9.45 min) were significantly higher than those of the post-operative period (15.05 +/- 6.35 min). The values obtained of control group (13.30 +/- 3.15 min) were not significantly different from the post-operative values of the patient group. Septal deviation affects the mucociliary activity. It is improved by surgery. This study showed that nasal septal deviation reduced the nasal mucociliary activity, and this can easily evaluated with scintigraphy.

Left ear (right temporal hemisphere) advantage and left temporal hemispheric dysfunction in schizophrenia.

In this study, to investigate the right or left ear advantages in psychiatric patients. the durations of hearing for right and left ears were assessed in 61 psychiatric patients, 26 with schizophrenia, 17 with depressive disorder, 13 with bipolar affective disorder, and 5 with brief psychotic disorder, plus 24 controls. Diagnoses were made on the basis of information provided from clinical interviews and the Structured Clinical Interview for DSM-IV (SCID). Schizophrenia was associated with a left ear advantage, and both depressive disorder and brief psychotic disorder were associated with right ear advantage as well as controls. These results suggest that their schizophrenia may be associated with a left temporal lobe dysfunction.

Levels of soluble intercellular adhesion molecule-1 and total sialic acid in serum of patients with laryngeal cancer.

BACKGROUND: Adhesion molecules have been implicated in tumor progression. In this study, we aimed to investigate serum soluble intercellular adhesion molecule-1 (sICAM-1) and total sialic acid (TSA) levels in laryngeal carcinoma and correlate their levels with the cancer stage. METHOD: The sera from 35 patients with laryngeal cancer (10 at stage II, 12 at stage III and 13 at stage IV) were extracted before treatment. The concentrations of sICAM-1 and TSA were measured by enzyme-linked immunoassay and the thiobarbituric acid method, respectively and compared with those from a healthy control group (n = 34). RESULTS: Mean serum sICAM-1 and TSA levels were found to be higher in the total patient group (the lowest level belonging to stage II) than in the control group (p < 0.001, control versus total patient group). As the stage of the disease increased, higher levels of sICAM-1 and TSA were determined. The correlations between TSA and sICAM-1 became more significant as the stage of the disease increased (r= 0.67, p < 0.05 in stage II, r= 0.86, p < 0.001 in stage III and r = 0.90, p < 0.001 in stage IV). CONCLUSION: These data reveal that the significant correlations between sICAM-1 and TSA in laryngeal cancer, more prominent at advanced stage, might reflect the similar nature of these molecules, which function as adhesion molecules.