The Effect of Nasal Septal Deviation on the Postoperative Hearing Results of Patients With Tympanosclerosis.

OBJECTIVE: The main aim is to discuss the effect of nasal septal deviation on the postoperative hearing results of patients with tympanosclerosis. MATERIAL AND METHODS: We analyzed the hearing results of patients with tympanosclerosis who were operated on in a tertiary center. Pure tone audiometric results were compared according to the existence of nasal septal deviation. RESULTS: This study included 48 patients with unilateral tympanosclerosis disease. Moderate or severe septal deviation had no significant effect on postoperative hearing results. CONCLUSION: The nasal septal deviation as the only pathologic factor in patients with tympanosclerosis did not have a deteriorating effect after surgery.

Use of Mesna in the treatment of ossicular chain fixation related to tympanosclerosis; prospective, clinical study.

OBJECTIVE: Mesna is a thiol compound effective in the connective tissue, which is used for its chemical dissector, mucolytic, mucosal damage preventive and antioxidant effects. The aim of this study was to investigate Mesna's effects in easy dissection in type 4 tympanosclerosis cases and in the prevention of formation of new sclerotic plaques. METHODS: 11 patients were included in the study. All patients were in the Wielinga Kerr type 4 class of tympanosclerosis. All patients were administered a 100% concentration of Mesna in the middle ear during tympanosclerosis surgery. All patients underwent audiological evaluation before and 20 months after the operation. Air-conduction thresholds, bone-conduction thresholds and air-bone difference were statistically compared. RESULTS: The patients were followed-up for a mean 20.48 ± 2.37 months. The mean preoperative air-conduction threshold of the patients was 58.09 ± 9.73 dB and the mean postoperative air-conduction threshold was 34.63 ± 15.46 dB and there was a significant difference. The mean preoperative bone-conduction threshold of the patients was 16.27 ± 5.47 dB and the mean postoperative bone-conduction threshold was 14.72 ± 6.11 dB and there was a significant difference. The mean preoperative air-bone gap of the patients was 41.81 ± 10.51, and the mean postoperative air-bone gap was 19.90 ± 12.48, and the difference was statistically significant. CONCLUSION: Mesna prevented hearing loss related to type 4 tympanosclerosis and prevented the formation of new sclerotic structures in our follow-up period. We believe that this effect is due to the chemical dissector and antioxidant effects of Mesna.

Effect of Enoxaparin Sodium on Experimentally-Induced Myringosclerosis in Rats.

OBJECTIVE: To evaluate the effectiveness of enoxaparin sodium (ES) on experimentally-induced myringosclerosis in rats. MATERIALS AND METHODS: Twenty Wistar albino-type rats weighing up to 250-300 g each were randomized into four groups containing five rats each and were then bilaterally myringotomized. The control group (n=5) received intratympanic serum physiologic injections, whereas ES2 (n=5), ES4 (n=5), and ES6 groups (n=5) received intratympanic ES of 2000 IU, 4000 IU, and 6000 IU, respectively, for 10 days after myringotomy. Rats were sacrificed at 60 days after intratympanic application and were then prepared for histopathologic evaluation. RESULTS: As for tympanic membrane hyaline degeneration, there were statistically significant differences among the control, ES2, ES4, and ES6 groups (p<0.05). As for fibrosis formation on tympanic membranes, a statistically significant difference was observed among the control and study groups; however, although not statistically significant, the formation of fibrosis was slowed down in the ES2 and ES4 groups compared with the control group. The control and study groups did not show any significant difference for calcification, hyperemia, and tympanic membrane thickening (p>0.05). CONCLUSION: Although our study and control groups comprised limited number of animals, and only one parameter demonstrated a statistically significant difference between the groups, ES may have an ameliorating effect on myringosclerosis induced by myringotomy in the tympanic membranes of rats. ES proved to be effective in the prevention of hyaline disc formation. Further studies should be conducted for better understanding of the effects of low-molecular-weight heparin (LMWH) (i.e., enoxaparin) on myringosclerosis.

The effect of stapes fixation on hearing results in tympanosclerosis treated by mobilization.

We aimed to investigate the effect of stapes fixation on hearing results in patients who underwent mobilization surgery due to tympanosclerosis (TS). Seventy-nine patients were retrospectively analyzed and divided into two groups. Forty-four (55.7%) patients with mobile stapes were classified as group 1, and 35 (44.3%) patients with fixed stapes were classified as group 2. Improvement of the air-bone gap (ABG) to become less than 20 dB and the pure-tone average (PTA) by at least 10 dB postoperatively were accepted as success criteria. The PTA and ABG levels were significantly improved in both groups. The pre- and post-operative PTAs were 46.57 ± 15.55 and 25.84 ± 15.47 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative PTAs were 55.64 ± 12.69 and 36.20 ± 14.47 dB, respectively, in group 2 (p = 0.001). The pre- and post-operative ABG levels were 35.36 ± 10.53 and 16.91 ± 8.54 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative ABG levels were 41.68 ± 8.78 and 22.20 ± 10.03 dB, respectively, in group 2 (p = 0.001). A gain ≥10-dB in the PTA in groups 1 and 2 was found in 34 (77.2 %) and 23 (65.7%) patients, respectively, and the difference between the groups was not significant (p = 0.684). The post-operative AGB in groups 1 and 2 was less than 20 dB in 32 (72.7%) and 21 (60%) patients, respectively, and the difference between the groups was not significant (p = 0.733). No significant negative effect of stapes fixation on post-operative hearing results in TS was detected. Successful results can be obtained with a mobilization procedure, even if the stapes is fixed.

Combining use of captopril and losartan attenuates the progress of Streptococcus pneumoniae-induced tympanosclerosis through the suppression of TGF-ß1 expression.

OBJECTIVES: In this study, using an Streptococcus pneumoniae-induced tympanosclerosis (TS) model, we explored the effects of captopril and losartan in the treatment of TS and the possible mechanisms. STUDY DESIGN: A prospective experimental animal study. METHODS: We set up the TS models in both guinea pig and wistar rat by inoculation of type-3 Streptococcus pneumoniae microorganisms and then treated the animals with the combining use of captopril and losartan. Otomicroscopy was employed to observe the development of TS. Auditory brainstem response was used to test the hearing function of animals. Hematoxylin-eosin and von Kossa staining were performed to determine the morphological changes and calcium depositions. The protein expressions of transforming growth factor ß1 (TGF-ß1) were assessed by western blot and immunohistochemistry staining, and the mRNA level of TGF-ß1 was measured by quantitative reverse transcription- polymerase chain reaction. RESULTS: The combining use of captopril and losartan attenuated TS responses in terms of a decrease in the TS incidence and the ABR threshold, a reduction of hyalinization and calcification in the middle ear mucosa and the thickness of the mucosa. In addition, the TGF-ß1 expression was decreased at both protein and mRNA levels. CONCLUSION: Our data indicate, for the first time, that the combining use of captopril and losartan obviously attenuates TS progress through inhibiting the overexpressing of TGF-ß1.

[Destrution of ossicular chain and it's impact on hearing of patients with tympanosclerosis].

OBJECTIVE: To study the destruction ossicular chain's impact on hearing of patients with tympanosclerosis. METHOD: A retrospective review was conducted in 115 patients with tympanosclerosis, all patients were divided into 3 groups, including normal ossicular chain structure (A group), fixed ossicular chain(B group), and interrupted ossicular chain (C group). The audiological feature of the patients were compared between the 3 group. RESULT: Difference were significant for PTA, 0.5, 1.0, 2.0, 4.0 kHz air conduction threshold between 3 group (P < 0.01). Difference were significant for air bone gap (ABG) between A, B groups and C group (P < 0.01), there was no difference for ABG between A and B group (P > 0.01). Difference were significant for air conduction threshold between 0.5, 1.0 kHz and 2, 4 kHz in A, B groups (P < 0.01), but there was no significant for same data in C group (P > 0.01). Difference were significant for average bone conduction, 1, 2, 4 kHz bone-conduction threshold between A group and B, C group (P < 0.01). The rate of Carhart notch was low and had no difference between 3 group (P > 0.01). CONCLUSION: The ossicular chain was fixed in patients who's PTA > or = (54.31 +/-13.19) dB HL and was interrupted who's PTA > or = (63.90 +/- 20.29) dB HL or ABG > or = (33.23 +/- 8.49) dB HL. The rising shaped curve in air-conduction audiograph may indicate the ossicular chain was fixed,and the smooth shape curve may indicate the ossicular chain was interrupted.