Outcomes with gold wire and hydroxyapatite partial ossicular replacement prostheses in type 2 tympanoplasty: a preliminary study.

OBJECTIVES: To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media. METHOD: This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted. RESULTS: The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687). CONCLUSION: The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

Histological analysis of the effects of anti-adhesive haemostatic agents on the middle ear of the guinea pig.

INTRODUCTION: Adhesion formation is a frequent and serious post-operative problem in ENT surgery. This study assessed the effect of two anti-adhesive haemostatic agents on an experimental guinea pig model. MATERIALS AND METHODS: The middle-ear mucosa of 14 guinea pigs was exposed to surgical trauma. After surgery, Arista™ AH was injected into the right middle ear of seven animals, while Ankaferd Blood Stopper was injected into the right middle ear of the other seven animals. The left ears were left untreated and regarded as the control group. The three groups were compared by histological examination at post-operative week 4. RESULTS: In each of the three groups, consolidation of the lamina propria and epithelium mucosae, increments in the number of active fibroblasts, collagen fibrils and inflammatory cells, and increased vascular dilation were observed on haematoxylin and eosin-stained sections, and were more prominent in the control and Ankaferd Blood Stopper groups. Epithelial thickness and capillary vasodilation were significantly lower in the Arista™ AH group compared with the control and Ankaferd Blood Stopper groups (p < 0.008). CONCLUSION: Arista™ AH may prevent the formation of adhesions in middle-ear surgery. Further experimental studies are required to determine its ototoxic potential.

Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study.

OBJECTIVE: To determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. DESIGN: Prospective observational study. SETTING: University Teaching hospital. PARTICIPANTS: One hundred and eight patients were referred from the allergy clinic included in the study. MAIN OUTCOME MEASURES: Predictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. RESULTS: Logistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss κ coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (κ = 0,48, P < 0.001), polypoid degeneration of the inferior turbinate tail (κ = 0.48, P = 0.01), nasal polyps (κ = 0.96, P < 0.001) and nasal septal deviation (κ = 0.65, P = 0.01) showed significant inter-rater agreement. A low κ coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P = 0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (κ = 0.31) and turbinate colour (κ = 0.38) showed no significant inter-rater agreement. CONCLUSIONS: Patient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study.

Serum matrix metalloproteinases and tympanosclerosis.

AIM: To investigate levels of matrix metalloproteinases 2 and 9, and of their tissue inhibitor (i.e. tissue inhibitor matrix metalloproteinase 1), in the serum of patients with tympanosclerosis. MATERIALS AND METHOD: We included 40 patients (age range 13-63 years) who had undergone surgery in the ENT department of Izmir Atatürk Training and Research Hospital between 2002 and 2007. Twenty had uncomplicated chronic otitis media and 20 had tympanosclerosis. We also included as the control group 20 individuals with no history of previous otic complaints or systemic or infectious disease. Serum levels of serum matrix metalloproteinases 2 and 9 and of tissue inhibitor matrix metalloproteinase 1 were measured in all subjects and compared. RESULT: Significantly higher levels of serum matrix metalloproteinases 2 and 9 were found in the tympanosclerosis group, compared with the chronic otitis media and control groups. There was no statistically significant difference in tissue inhibitor matrix metalloproteinase 1 level between the three groups. CONCLUSION: Tympanosclerosis surgery has poor success rates, since the pathological process is still active. We suggest that high levels of matrix metalloproteinases may play a role in the continuation of the disease process.