Longitudinal follow-up after pediatric myringoplasty: long-term outcome is defined at 12 months.

OBJECTIVES: To determine the true success rate of pediatric myringoplasty. MATERIALS AND METHODS: This retrospective study analyzed 67 pediatric myringoplasties performed at Hyogo College of Medicine between 2000 and 2009. We divided the pediatric population into a younger group (<10 yr old, n = 41) and an older group (≥10 yr old, n = 26). We also compared the pediatric group (n = 67) with a group of adult patients (n = 63) who underwent myringoplasty between 2008 and 2009. RESULTS: In the pediatric group, graft success was achieved in 81% of the cases. The pathologic success rate, which was based on the presence of an intact membrane without adhesion, retraction, or effusion, was 73%. Furthermore, an intact membrane with successful hearing was achieved in 67% of the cases at 12-month follow-up. The graft success rate of the adult group was 90%, and there was no significant difference with the pediatric group. However, when success was defined as pathologic success or pathologic success with hearing improvement, there were significant differences in success rates between pediatric and adults groups (p < 0.05). The success rate of pathologic success with hearing improvement was significantly lower in children with abnormal contralateral ears or poor contralateral air cell development than in children with healthy contralateral ears (p < 0.01) or good contralateral air cell development (p < 0.05). CONCLUSION: These findings suggest that the success of pediatric myringoplasty should be defined as an intact tympanic membrane without evidence of adhesions, retraction, or effusion, together with hearing improvement at the 12-month follow-up.

Trigeminal and taste sensations of the tongue after middle ear surgery.

OBJECTIVE: To establish clinical tests for measurement of trigeminal sensitivity on the human tongue and objectively assess changes in oral trigeminal sensitivity and taste ability after chorda tympani nerve (CTN) injury. STUDY DESIGN: Prospective study. SETTING: University hospital. PATIENTS: One-hundred and twenty-six patients with unilateral middle ear diseases who underwent primary middle ear surgery. MAIN OUTCOMES AND MEASURES: Trigeminal sensation was measured each operated side as well as nonoperated side both before and 14 days after surgery using 3 kinds of tests: Semmes-Weinstein sensory test (SW test), 2-point discrimination test, and the electrostimulator test. Taste function was assessed with electrogustometry (EGM) similarly. RESULTS: The patients which the CTN was not touched (n = 6) showed no differences between preoperative and postoperative thresholds in any tests. In the patients with sectioned CTN (n=30), postoperative thresholds on the operated side were significantly higher than preoperative thresholds on the electrostimulator test, 2-point discrimination test, and EGM. In the patients with manipulated but not sectioned CTN (n = 90), postoperative thresholds were significantly higher than preoperative thresholds on the electrostimulator test and EGM. The patients with manipulated but not sectioned CTN and abnormal EGM postoperative thresholds (n = 48) showed that postoperative thresholds were significantly higher than preoperative thresholds in all tests. CONCLUSION: These findings suggest that the electrostimulator test was most useful to objectively assess small changes of trigeminal sensation among the 3 tests. The finding that trigeminal sensitivity of the tongue deteriorated on the operated side after CTN injury suggests that CTN function affected both taste sensation and trigeminal sensation of the tongue.

[Clinical analysis of 1059 patients with taste disorders].

Taste disorders are caused by several factors, and there have been few reports concerning the clinical course of taste disorders. In this study, patients with taste disorders were classified into 10 groups according to causes, and they were retrospectively studied in terms of therapeutic effects. In total, 1059 patients (412 men and 647 women, mean age: 60.0 years) who complained of taste disorders were reviewed in our clinic. The patients were asked detailed questions about their history of symptoms, and their emotional status was assessed using a self-rating depression scale. In all subjects, taste functions were measured by electrogustometry (EGM) and filter paper disks (FPD). The grades of their symptoms were assessed with a visual analogue scale (VAS). In addition, the levels of serum iron, copper, and zinc were examined. The patients were treated with zinc sulfate, polaprezinc, iron preparation, herbal medicine, and minor tranquilizers according to the factors causing the taste disorders. The most frequent cause was idiopathic taste disorder (192 cases, 18.2%), the second was psychogenic (186 cases, 17.6%), and the third was drug-induced (179 cases, 16.9%). The recovery rate of the symptoms was 64/92 (70.2%) in post-common cold, 31/35 (88.6%) in iron deficiency, and 85/116 (73.3%) in zinc deficiency. In these groups, the rates of recoveries were better than in the other groups. The recovery period in drug-induced taste disorders was approximately twice as long as the recovery period in the other groups. In the patients who were able to start treatment within 6 months from the onset of taste disorder, the recovery rate was significantly higher and the therapeutic period was significantly shorter than in those who had the disorders for more than 6 months (p<0.05, respectively).

Preoperative assessment of taste function in patients with middle ear disease.

OBJECTIVE: To identify differences in taste function among patients with chronic otitis media, cholesteatoma, and noninflammatory disease before middle ear surgery. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary referral hospital. PATIENTS: Two hundred thirty ears underwent primary middle ear surgery from January 2006 to December 2010. The subjects consisted of 84 men and 146 women with ages ranging from 20 to 60 years (mean, 43.9 yr). There were 95 ears with chronic otitis media, 61 ears with pars flaccida retraction-type cholesteatoma, 22 ears with pars tensa retraction-type cholesteatoma, and 52 ears with noninflammatory diseases such as otosclerosis and ossicular anomalies. MAIN OUTCOME MEASURE: The patients underwent taste testing using electrogustometry and the filter paper disk method in the regions controlled by the chorda tympani nerve. RESULTS: None of the patients complained of taste dysfunction before middle ear surgery. Among the 4 groups, the patients with pars tensa retraction-type cholesteatoma displayed the highest electrogustometry threshold. The filter paper disk method did not detect any significant differences among the 4 groups. CONCLUSION: Our findings suggest that the filter paper disk scores of all taste qualities (sweet, salty, sour, and bitter tastes) are not deteriorated preoperatively during chronic inflammation in the middle ear and that taste function is affected most in patients with pars tensa retraction-type cholesteatoma.