Evaluation of ethanolamine oleate sclerotherapy on the submandibular glands of canines as a potential therapy for sialorrhea.

BACKGROUND: Sialorrhea can have major negative effects on the physical and social well-being. Sclerotherapy may be useful in patients with sialorrhea by decreasing the amount of saliva production. The aim of this study was to test the effect of ethanolamine oleate (EO) in an experimental model as a preliminary step for its application in humans. METHODS: Histopathological and morphometric analysis of submandibular glands from thirteen dogs was preformed. A total of 25 glands were injected with 1ml of 2.5% EO (n=5), 1ml of 5% EO (n=5), 5ml of 2.5% EO (n=5) and 5ml of 5% EO (n=5). Five glands were used as control. RESULTS: EO significantly induced a dose dependent scaring of the gland ending in lobular transformation (salivary gland cirrhosis). Morphometric measurements showed that 1ml of 2.5% or 5% EO significantly induced fibrosis compared to normal glands (p=0.014 and 0.021, respectively). Fibrosis significantly increased and was more apparent when a dose of 5ml of 2.5% EO or 5% EO were injected [by semi-quantitative evaluation (p=0.016 and 0.002, respectively) and morphometric measurements (p=0.016 and 0.008, respectively)]. This scarring effect was significantly associated with reduction of area of acinar cells when a dose of 1ml-5%, 5ml-2.5% or 5ml-5% EO were applied (p=0.03. 0.012 and 0.004, respectively). Moreover, ductal injury was only significant when a dose of 5ml of 5% EO was used (p=0.034). This dose and concentration (i.e. 5ml-5% EO) had a significant synergetic effect [p=0.0119]. CONCLUSION: In this model, treatment with EO proved to permanently reduce the acinar area through induction of progressive, irreversible and dose dependant scarring (medical sialoadenectomy).

Eustachian tube obstruction: new technique for treatment.

The function of the eustachian tube is ventilation of the middle ear to equilibrate air pressure in the middle ear with atmospheric pressure. Obstruction of the middle ear produces a negative pressure in the middle ear due to absorption of the oxygen from the middle ear cavity, often leading to otalgia. This study was done on 30 patients complaining of otalgia. They were 16 males and 14 females. They were found to have eustachian tube obstruction by examination, and negative middle ear pressure by tympanometry. All patients were treated with a mixture of equal amounts of nitrous oxide and oxygen under pressure for 30 minutes. Tympanometry was carried out immediately after discontinuation of the gas and again after 1 hour. The treatment appeared to be successful in 94% of patients as demonstrated by the absence of complaint and by tympanometric measurements.