Gastroesophageal reflux disease and tympanoplasty surgical outcome: is there a relationship?

OBJECTIVE: To investigate the possible clinical relationship between gastroesophageal reflux disease and the type one tympanoplasty surgical outcomes of adults with chronic otitis media, by using a simple, cost-effective, reliable questionnaire and physical findings. METHODS: Fifty-two of 147 patients undergoing type one tympanoplasty were studied. Gastroesophageal reflux disease symptoms were evaluated using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease questionnaire. Laryngoscopic physical findings of laryngopharyngeal reflux were evaluated using the Reflux Finding Score. A successful outcome was defined as an intact tympanic membrane. Correlations between the two assessment tool results and the patient's surgical success were calculated. RESULTS: The gastroesophageal reflux disease questionnaire score was significantly higher in patients with unsuccessful tympanic membrane closure (group one) than in patients with successful closure (group two) (p < 0.05). The Reflux Finding Score was also significantly higher in group one than group two (p < 0.05). There was a significant positive relationship between the gastroesophageal reflux disease questionnaire score and the Reflux Finding Score (p < 0.01). CONCLUSION: Gastroesophageal reflux disease may be a significant prognostic factor for tympanoplasty failure. Therefore, reflux investigation may be important during the treatment of chronic otitis media, and positive cases may need reflux treatment as well as ear disease treatment.

Improvement in quality of life by adenotonsillectomy in children with adenotonsillar disease.

OBJECTIVES: To evaluate the effect of adenotonsillectomy on quality of life of children with adenotonsillar disease and to evaluate the basal differences and post-surgical changes of life quality in children with different disease severity. STUDY DESIGN: Prospective, case - controlled study. SETTING: Tertiary referral center. PARTICIPANTS AND MAIN OUTCOME MEASURES: Preoperative and postoperative quality of life of 40 children with adenotonsillar disease were determined by pedsQL™, and disease severity was assessed in terms of a score obtained by tonsil and adenoid health status instrument (TAHSI). These children comprised the study group. Median of scores of study group was 31. Twenty-one children with a score less than 31 comprised the study subgroup I, while 19 children with a score bigger than 31 comprised the study subgroup II. Thirty normal children comprised the control group. Comparisons of data obtained from affected and healthy children and their parents were made. RESULTS: The mean preoperative physical, emotional, social, school and total quality of life scores of the study group were 64.81, 49.62, 76.37, 66.62 and 64.41; postoperatively 83.67, 75.75, 85.75, 87.25, 83.18; and control group were 82.21, 77.50, 92.50, 90.50, 85.40, respectively. There was highly statistically significant difference between all preoperative and postoperative scores of the study group. There was highly statistically significant difference between all preoperative scores of the study and control group. There was no statistically significant difference in preoperative and postoperative scores between the study subgroups. The improvement after surgery was not statistically significant between mild and severe group except for emotional scale. CONCLUSION: Children with adenotonsillar disease showed significant improvements in disease-specific and global quality of life after adenotonsillectomy as measured by TAHSI and PedsQL. Preoperative and postoperative life quality does not differ according to severity of the disease. The improvement provided by adenotonsillectomy in the children with mild disease is statistically not different from the severely affected children in overall life quality.

Effect of nasolacrimal duct obstruction on nasal mucociliary transport.

BACKGROUND: Most patients with nasolacrimal duct obstruction have dry, crusty nasal mucosa. Mucociliary clearance is modulated by the amount and biochemical composition of nasal mucus. Nasolacrimal duct obstruction disturbs the drainage of tears into the nasal cavity. OBJECTIVE: We examined the effect of nasolacrimal duct obstruction on the mucociliary transport of nasal mucosa, by comparing saccharine test results for epiphora patients versus healthy volunteers. STUDY DESIGN: Prospective, randomised, clinical trial. METHODS: Eight patients with bilateral epiphora and 10 patients with unilateral epiphora were included in the study group. Complete nasolacrimal duct obstruction was demonstrated by studying irrigation of the nasolacrimal system, and by fluorescein dye study. The control group comprised 20 healthy volunteers. Mucociliary transport was assessed by the saccharine test in both the study and control groups. The saccharine transit times of 26 impaired nasal cavities were compared with those of 20 healthy nasal cavities of controls. Also, the saccharine transit times of the healthy nasal cavities of the 10 patients with unilateral epiphora were compared with those of their diseased sides, and also with those of healthy volunteers. RESULTS: The saccharine transit times of the epiphora patients were statistically significantly greater than those of the control group. Also, there was a statistically significant difference in saccharine transit times, comparing the healthy and impaired nasal cavities of patients with unilateral epiphora. CONCLUSION: Nasolacrimal duct obstruction has a negative effect on nasal mucociliary clearance. This may be related to changes in the amount and biochemical composition of nasal mucus.