Oral microbial dysbiosis in patients with oral cavity cancers.

OBJECTIVES: The pathogenesis of oral cavity cancers is complex. We tested the hypothesis that oral microbiota dysbiosis is associated with oral cavity cancer. MATERIALS AND METHODS: Patients with primary oral cavity cancer who met the inclusion and exclusion criteria were included in the study. Matching healthy individuals were recruited as controls. Data on socio-demographic and behavioral factors, self-reported periodontal measures and habits, and current dental status were collected using a structured questionnaire and periodontal chartings. In addition to self-reported oral health measures, each participant received a standard and detailed clinical examination. DNA was extracted from saliva samples from patients and healthy controls. Next-generation sequencing was performed by targeting V3-V4 gene regions of the 16 S rRNA with subsequent bioinformatic analyses. RESULTS: Patients with oral cavity cancers had a lower quality of oral health than healthy controls. Proteobacteria, Aggregatibacter, Haemophilus, and Neisseria decreased, while Firmicutes, Bacteroidetes, Actinobacteria, Lactobacillus, Gemella, and Fusobacteria increased in oral cancer patients. At the species level, C. durum, L. umeaens, N. subflava, A. massiliensis, and V. dispar were significantly lower, while G. haemolysans was significantly increased (p < 0.05). Major periodontopathogens associated with periodontal disease (P. gingivalis and F.nucleatum) increased 6.5- and 2.8-fold, respectively. CONCLUSION: These data suggested that patients with oral cancer had worse oral health conditions and a distinct oral microbiome composition that is affected by personal daily habits and may be associated with the pathogenicity of the disease and interspecies interactions. CLINICAL RELEVANCE: This paper demonstrates the link between oral bacteria and oral cancers, identifying mechanistic interactions between species of oral microbiome.

The Comparison of Inflammatory Markers for the Prediction of Recurrence of the Nasal Polyp After Endoscopic Sinus Surgery.

During the past decade, several inflammation-based periferic prognostic systems have been reported in the field of chronic rhinosinusitis with nasal polyps (CRSwNP). Recently, C-reactive protein (CRP) and albümin ratio (CAR) showed its impact on a large variety of diseases conditions that cause chronic inflammation. We aimed to compare the inflammatory markers in patients with recurrent and non-recurrent nasal polyps and if a significant inflammatory profile is associated with multiple recurrences. The study concerned 144 patients who underwent FESS for CRSwNP from 2012 to 2017 and had a postoperative follow-up longer than 12 months and 120 healthy individuals. We evaluated the impact of the CAR, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, eosinophil-to-lymphocyte ratio (ELR) between patients with and without polyp recurrences and control groups. There was a statistically significant difference in CRP, CAR and ELR values between multiple recurrence group and no-recurrence group (p = 0.02; 0.004; 0.019 respectively), mean eosinophil and CRP values, CAR, NLR and ELR was significantly higher in NP patients than control group (p < 0.001). The receiver operating curve analysis showed CAR and ELR as a potential marker of recurrence of NP (AUC = 0.713 and 0.613, respectively p < 0.001). The cutoff values for were 1.03 for CAR and 0.22 for ELR. The mean CRP, CAR and ELR were significantly higher in patients with CRSwNP whose disease recurred after surgery. CAR may be a potential marker to predict the recurrence before endoscopic sinus surgery as well as ELR in CRSwNP disease.

Effects of nigella sativa oil on allergic rhinitis: an experimental animal study

Abstract Objectives: Nigella sativa oil is known antiallergic and immunomodulatory effects. We aimed to compare this oil with mometasone furoate, a topical steroid, on a rat model in the prevention of allergic rhinitis symptoms. Methods: A total of 28 two-to-four-month-old Wistar Hannover rats weighing 250-350 g were randomly divided into four groups of seven, which included control, allergic rhinitis, mometasone furoate, and Nigella sativa oil groups. Loss of cilia, an increase of goblet cells, vascular proliferation, inflammatory cell count, eosinophil infiltration, and the degree of hypertrophy in chondrocytes were assessed by light microscopy. Results: The frequency of nasal scratching in the Nigella sativa oil group was found to be significantly lower compared with the allergic rhinitis group (p < 0.05). Typical inflammatory changes seen in allergic rhinitis were not detected in the Nigella sativa oil group. No inflammation was observed in 85.7% of both the healthy control group and the Nigella sativa oil group. In addition, no inflammation was observed in 71.4% of the mometasone furoate group, and this difference was found to be significant compared with the control group (p < 0.05). In addition, eosinophil infiltration, cilia loss, chondrocyte hypertrophy, vascular proliferation, and goblet cell increase were found to be significantly decreased in the mometazone furoate and Nigella sativa oil groups compared to the allergic rhinitis group (p < 0.05). Conclusion: According to the findings obtained from this study, we found anti-inflammatory and anti-allergic effects of Nigella sativa oil as equally effective as mometasone furoate in the treatment of experimentaly generated allergic rhinitis. Level of evidence: IV.

Effects of nigella sativa oil on allergic rhinitis: an experimental animal study.

OBJECTIVES: Nigella sativa oil is known antiallergic and immunomodulatory effects. We aimed to compare this oil with mometasone furoate, a topical steroid, on a rat model in the prevention of allergic rhinitis symptoms. METHODS: A total of 28 two-to-four-month-old Wistar Hannover rats weighing 250-350 g were randomly divided into four groups of seven, which included control, allergic rhinitis, mometasone furoate, and Nigella sativa oil groups. Loss of cilia, an increase of goblet cells, vascular proliferation, inflammatory cell count, eosinophil infiltration, and the degree of hypertrophy in chondrocytes were assessed by light microscopy. RESULTS: The frequency of nasal scratching in the Nigella sativa oil group was found to be significantly lower compared with the allergic rhinitis group (p < 0.05). Typical inflammatory changes seen in allergic rhinitis were not detected in the Nigella sativa oil group. No inflammation was observed in 85.7% of both the healthy control group and the Nigella sativa oil group. In addition, no inflammation was observed in 71.4% of the mometasone furoate group, and this difference was found to be significant compared with the control group (p < 0.05). In addition, eosinophil infiltration, cilia loss, chondrocyte hypertrophy, vascular proliferation, and goblet cell increase were found to be significantly decreased in the mometazone furoate and Nigella sativa oil groups compared to the allergic rhinitis group (p < 0.05). CONCLUSION: According to the findings obtained from this study, we found anti-inflammatory and anti-allergic effects of Nigella sativa oil as equally effective as mometasone furoate in the treatment of experimentaly generated allergic rhinitis. LEVEL OF EVIDENCE: IV.

Comparison of preoperative diagnostic accuracy of fine needle aspiration and core needle biopsy in parotid gland neoplasms.

BACKGROUND: Fine needle aspiration (FNA) and core needle biopsy (CNB) are two commonly used approaches for the diagnosis of suspected neoplastic parotid gland lesions. We aimed to compare the diagnostic efficiency of FNA and CNB performed with ultrasound guidance preoperatively for the diagnosis of parotid neoplasms. METHODS: We retrospectively analysed the preoperative specimens of 113 patients (66 FNA, 47 CNB) who underwent surgical excision at our institute between 2014 and 2017. Patient selection was based on lesion type and dimension, preliminary and final pathology, imaging characteristics, clinical course, and treatment data for accurate statistical analysis. The final diagnosis was based on surgery in all of the patients. We compared the diagnostic accuracy of FNA and CNB regarding the correct tissue-specific diagnosis of benign and malignant tumours. The recurrence and complication rates were analysed to determine the safety of each technique. RESULTS: Among the 113 patients, the average follow-up period was 65.4 (50-88) months. Seventy-one patients (62.8%) were males, and the median age was 50 years. The most common type of surgery was superficial parotidectomy (83.2%), and the median tumour size was 30.0 mm. Pleomorphic adenoma was the most frequent neoplasm. The diagnostic rates of preoperative pathological evaluation of FNA and CNB samples were 68.2% and 91.5%, respectively. The sensitivity, specificity, and positive predictive value of FNA for detecting malignant lesions were 40, 100, and 100%, respectively, and those of CNB were 100, 100, and 100%, respectively. Only one complication occurred (haematoma) in the biopsy area after CNB. No recurrences were seen after CNB and FNA during the follow-up period. CONCLUSION: Our findings suggest that the diagnostic ability, sensitivity, and specificity of CNB are excellent compared with those of FNA. The only disadvantage of CNB is the need for experienced staff and good-quality equipment. The complication rates of each technique are very low, and the risk of tumour tract seeding is controversial. CNB should be considered the technique of choice when a nodule is detected in the parotid glands.

Association of Conductive Hearing Loss with the Structural Changes in the Organ of Corti.

OBJECTIVE: The aim of the study was to evaluate the association of conductive hearing loss (CHL) with the structural changes in the organ of Corti. METHODS: Twenty ears of 10 healthy adult Wistar albino rats were included in the study. The right ears (n = 10) of the animals served as controls (group 1), and no surgical intervention was performed in these ears. A tympanic membrane perforation without annulus removal was performed under operative microscope on the left ears (n = 5) in 5 of 10 animals (group 2). A tympanic membrane perforation with annulus removal was performed under operative microscope on the left ears (n = 5) of the remaining 5 animals (group 3). Auditory brainstem response testing was performed in the animals before the interventions. After 3 months, the animals were sacrificed, their temporal bones were removed, and inner ears were investigated using scanning electron microscopy (SEM). The organ of Corti was evaluated from the cochlear base to apex in the modiolar axis, and the parameters were scored semiquantitatively. RESULTS: In group 1, the pre- and post-intervention hearing thresholds were similar (p > 0.05). In group 2, a hearing decrease of at least 5 dB was encountered in all test frequencies (p > 0.05). In group 3, at the frequency range of 2-32 kHz, there was a significant hearing loss after 3 months (p < 0.01). After 3 months, the hearing thresholds in group 2 and 3 were higher than group 1 (p < 0.01). The hearing threshold in group 3 was higher than group 2 (p < 0.01). On SEM evaluation, the general cell morphology and stereocilia of the outer hair cells were preserved in all segments of the cochlea in group 1 with a mean SEM score of 0.2. There was segmental degeneration in the general cell morphology and outer hair cells in group 2 with a mean SEM score of 2.2. There was widespread degeneration in the general cell morphology and outer hair cells in group 3 with a mean SEM score of 3.2. The SEM scores of group 2 and 3 were significantly higher than group 1 (p < 0.05). The SEM scores of group 3 were significantly higher than group 2 (p < 0.05). CONCLUSION: CHL may be associated with an inner ear damage. The severity of damage appears to be associated with severity and duration of CHL. Early correction of CHL is advocated in order to reverse or prevent progression of the inner ear damage, which will enhance the success rates of hearing restoration surgeries. Subjective differences and compliance of the hearing aid users may be due to the impact of CHL on inner ear structures.

Investigation of the effects of thrombocyte-rich plasma, systemic ozone and hyperbaric oxygen treatment on intraoral wound healing in rats: experimental study.

OBJECTIVE: In this study, it was aimed to evaluate and compare biochemical and histopathological effects of platelet-rich plasma (PRP), ozone and hyperbaric oxygen (HBO) on wound healing which was formed experimentally in oral cavity of rats. MATERIALS AND METHODS: In this study, thirty-six Wistar Hannover rats with weight of 250-350 g, fed with standard feeds, were anesthetized to create intraoral wound on the hard palate. Rats were divided into four groups as the following: control group, PRP, HBO and Ozone groups. 0.1 ml of PRP was injected on the wound edges of each rat in the PRP group on days 1, 3 and 7. Each rat in the ozone group was systemically injected with 2.3-3.0 ml ozone gas on the 1st, 3rd and 7th days. The wounds of the rats in the control group were not performed anything. The rats in the HBO group were placed in the HBO pressure chamber and were treated with one session (2 h for each session) of 100% oxygen each day for 7 days. Rats in all groups were killed on the 15th day and the hard palates were excised for histopathological examination. Inflammation severity, neovascularization, fibroblast proliferation, collagen density and epithelization were evaluated. RESULTS: The rate of intense wound closure (epithelialization intensity) was significantly higher in all the three treatment groups, the PRP group was the highest, than in the control group (p < 0.05). Fibroblast proliferation level was higher in PRP group (p < 0.05), followed by ozone, HBO and control groups, respectively. Histologically, inflammation was significantly higher in the control group than the treatment groups (p < 0.05). For the treatment groups; it was lowest in the PRP group, followed by the ozone and HBO groups, respectively. The rates of angiogenesis and collagenization were significantly higher in all the three treatment groups, the PRP group was the highest, than in the control group (p < 0.05). In this study, no significance difference was found between the groups in terms of blood glucose levels (p = 0.21). CONCLUSION: In this study, all three treatment modalities were found to be effective in wound healing, and PRP was found to be more effective than the others.

Role of Peak Nasal Inspiratory Flow for Measuring the Effectiveness of Surgery in Children with Adenoidal Hypertrophy.

Objective Nasal airway obstruction in children is a frequent problem in otolaryngology practice. Adenoidal hypertrophy (AH) is the most common pathology in childhood that requires surgery. Nasal patency can be evaluated by subjective and objective methods. Unlike other methods, peak nasal inspiratory flow (PNIF) is portable and easy to perform. The need for patient compliance is the most important disadvantage of this method. We aimed to analyze the significance of PNIF for measuring the effectiveness of adenoidectomy as well as to compare PNIF with other subjective methods. Methods Two-hundred forty-five (245) patients aged between six and 11 years were evaluated. Seventy-seven (77) of them formed the study group and 168 formed the control group. Pre and post-surgery PNIF measurements, adenoid scores, and simple visual analog scale (sVAS) were recorded. Results The average PNIF value has significantly increased to 70.65 L/min from 33.02 L/min after adenoidectomy (p<0.01). The average PNIF value was 71.66 L/min in control subjects. High PNIF values were significantly correlated with low sVAS and adenoid scores postoperatively in the study group as compared with those of preoperative data (p<0.01). Conclusions PNIF has a satisfying correlation with nasal examination findings and other subjective methods to evaluate nasal obstruction and may provide unique and complementary information helpful for evaluating and improving the effects of adenoidectomy in children.

Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study.

OBJECTIVES: To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. MATERIALS AND METHODS: The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. RESULTS: Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. CONCLUSION: Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Histopathological Effects of Bone Cement on Cartilage Tissue.

INTRODUCTION: Glass ionomer bone cement is frequently applied with cartilage grafts in otology, even as a single unit. OBJECTIVE: This experimental study was performed to investigate the histopathological effects of bone cement on cartilage tissue. METHODS: The study was conducted between January 2018 and April 2018 and used 12 New Zealand White rabbits. The right ears of the rabbits constituted the study group, while the left ears were the controls. Ketac Cem Radiopaque (3 M Germany) was used as glass ionomer cement. Tissue samples from the rabbits were subjected to histopathological analysis to compare acute and chronic inflammation, foreign body reaction, angiogenesis, collagenesis, fibrosis, necrosis, cartilage fracture, osseous metaplasia, and loss of chondrocyte nuclei between the groups. RESULTS: The rates of cartilage fracture (P = 0.044), foreign body reaction (P < 0.001), acute inflammation (P = 0.009), chronic inflammation (P = 0.002), and angiogenesis (P = 0.003) were significantly higher in the study group compared with the controls. The study group showed some degree of necrosis; no necrosis was observed in the control group, but the difference was not statistically significant (P = 0.101). There were no significant differences in fibrosis, collagenesis, osseous metaplasia, or loss of chondrocyte nuclei between the groups. CONCLUSIONS: This study showed that application of bone cement can cause acute and chronic inflammation, foreign body reactions, angiogenesis, and cartilage fractures. Further studies are needed to determine the long-term effects of bone cement on cartilage.

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model / Comparação histopatológica dos efeitos da cicatrização óssea entre as técnicas de osteotomia lateral endonasal e percutânea em modelo de rinoplastia em coelhos

Abstract Introduction: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. Objective: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. Methods: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n = 4), and percutaneous osteotomy (8 bones) in Group 2 (n = 4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. Results: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. Conclusion: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

Resumo Introdução: Nas rinoplastias, a osteotomia lateral é realizada principalmente por via endonasal ou percutânea para correção de deformidades nasais. Ambas as técnicas apresentam vantagens e desvantagens. Objetivo: Comparar os efeitos histopatológicos sobre a cicatrização óssea e estabilidade nasal entre as técnicas de osteotomia endonasal e percutânea em rinoplastia em um modelo animal experimental. Método: Foram incluídos oito coelhos brancos da Nova Zelândia de um ano de idade. Hidrocloreto de xilazina e cetamina intramuscular foram administrados aos coelhos como agentes anestésicos. Osteotomia endonasal (8 ossos) foi realizada no Grupo 1 (n = 4) e osteotomia percutânea (8 ossos) no Grupo 2 (n = 4). Um mês depois, os coelhos foram sacrificados. A cicatrização óssea dos coelhos foi avaliada de acordo com o escore de cicatrização óssea de Huddleston et al. Em ambos os grupos, a integridade do osso nasal foi avaliada subjetivamente. Resultados: No grupo da osteotomia percutânea, observou-se cicatrização óssea de grau 1 em duas amostras (25%), cicatrização óssea de grau 2 em duas amostras (25%), e cicatrização óssea de grau 3 em quatro amostras (50%). No grupo da osteotomia endonasal, observou-se cicatrização óssea de grau 1 em 6 amostras (75%) e a cicatrização óssea de grau 2 foi observada em 2 amostras (25%). No grupo percutâneo, o tecido fibroso foi observado em 2 amostras, enquanto tecido predominantemente fibroso e uma menor quantidade de cartilagem foi observada em 2 e uma quantidade igual de tecido fibroso e cartilagem foi observada em 4 amostras. No grupo endonasal, observou-se tecido fibroso em 6 amostras e tecido predominantemente fibroso com uma menor quantidade de cartilagem em 2 amostras. Em ambos os grupos, quando força manual foi aplicada aos ossos nasais, a mesma resistência foi observada subjetivamente. Conclusão: A técnica de osteotomia lateral percutânea resultou em menor traumatismo ósseo e periosteal e melhor cicatrização óssea em comparação com a técnica de osteotomia endonasal.

Effect of Septoplasty on Cardiopulmonary Functions in the Patients With Nasal Obstruction.

OBJECTIVE: In this study, the authors aimed to investigate whether septoplasty has an effect on cardiopulmonary functions in the patients with nasal obstruction. METHODS: A total of 53 patients with nasal obstruction due to septum deviation were included in the study. All the patients were performed septoplasty operation. Echocardiography and spirometric analysis were performed to assess cardiopulmonary functions before and after the operation (6 months postoperatively). The same evaluation was done for the degree of nasal obstruction by visual analogue scale. The preoperative and postoperative values were compared with each other. RESULTS: Of the total 53 patients, 44 were males (83%) and 9 were female (17%). The mean age was 31.71 ±â€Š9.46. The preoperative and postoperative mean right ventricular volumes were 2.0736 and 2.0906, respectively. The preoperative and postoperative mean left ventricular volumes were 4.4264 and 4.3528, respectively. The preoperative and postoperative mean cardiac septal thicknesses were 0.9642 and 0.9358, respectively. The mean value of preoperative cardiac posterior wall thicknesses was 0.8849, whereas the postoperative value was measured as 0.8340. The preoperative and postoperative mean pulmonary artery pressures were 27.8302 mmHg and 23.6415, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean forced vital capacities (FVC) were 4.3221 and 4.5564, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean 1st second forced expiratory volumes (FEV1) were 3.6698 and 3.8085, respectively, and this was statistically significant (P < 0.001). The mean value of preoperative FEV1/FVC was 84.9811, whereas postoperative mean value was measured as 83.8019 and this was statistically significant (P < 0.001). CONCLUSION: In this study, the authors observed that septoplasty has positive effect on cardiopulmonary functions in the patients with nasal obstruction due to nasal septum deviation. The authors also claim that septoplasty may be a preventive procedure for future pathologies of cardiopulmonary functions.

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model.

INTRODUCTION: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. OBJECTIVE: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. METHODS: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. RESULTS: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. CONCLUSION: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

Histopathology of tympanic membranes from patients with ventilation tubes.

OBJECTIVE: To evaluate the histopathologic changes in tympanic membranes (TMs) with ventilation tubes (VTs). METHODS: In this retrospective human temporal bone study our overall study group included 4 subgroups of TMs from deceased donors as follows: 24 with a history of VT insertion for chronic otitis media with effusion (COME-VT); 5 with a history of VT insertion for Meniere's disease (MD-VT); 33 without a history of VT insertion for chronic otitis media with effusion (COME); and 14 without a history of VT insertion for Meniere's disease (MD). We classified the extent of migration of the outer keratinized squamous epithelium onto the inner surface of TM perforations and noted the presence and location of tympanosclerosis, of atrophy, of perforation, and/or of cholesteatoma formation. RESULTS: Tympanosclerosis occurred in 14/24 TMs in the COME-VT subgroup; 2/5, MD-VT; 7/33, COME; and 0/14, MD. The VT insertion site was mostly in the anteroinferior (63%) quadrant of the TM; tympanosclerosis occurred more frequently in the posteroinferior (42%) and posterosuperior (33%) quadrants. We found no significant correlation between the location of tympanosclerosis and the VT insertion site (P>0.05). Atrophy occurred in 7/24 TMs in the COME-VT subgroup; 3/5, MD-VT; 8/33, COME; and 2/14, MD. We found no significant correlation between the location of atrophy and the VT insertion site; however, atrophy was located mostly in the anteroinferior quadrant (one of the most common VT insertion sites) of the TM. Regarding the ingrowth of keratinized epithelium, the mucocutanous junction was detected at any point at the inner surface of the TM in 50% of the specimens. We observed intratympanic cholesteatoma formation in 2/24 TMs in the COME-VT subgroup. CONCLUSION: TM changes due to VT insertion are more common than previously realized. Meticulous otomicroscopic evaluation of the TM is necessary during tympanomastoidectomies in order to prevent the intratympanic inclusion pearls and squamous epithelial ingrowth to prevent any further cholesteatoma formation.

Can Serum Neutrophil-to-Lymphocyte Ratio Be a Predictive Biomarker to Help Differentiate Active Chronic Otitis Media From Inactive Chronic Otitis Media?

OBJECTIVES: The authors' aim was to investigate whether serum neutrophil to lymphocyte ratio might be used as a predictive biomarker to help differentiate active from inactive chronic otitis media (COM). METHODS: Two hundred fifty-nine patients having inactive COM received tympanoplasty without mastoidectomy and were identified as Group 1. On the other hand, 254 patients having active COM received tympanoplasty with mastoidectomy and were identified as Group 2. Routine hemogram tests were performed preoperatively for both the groups. By performing a chart review, white blood cell count, red blood cell count, hemoglobin, hematocrit, platelet, and mean platelet volume values were compared between the groups in an age-matched and sex-matched manner. RESULTS: A total of 513 COM patients with age range of 7 to 65 years were included in the study. Two hundred seventy-five patients (53.6%) were male, 238 were (46.4%) female. Preoperatively both serum neutrophil and lymphocyte counts were significantly higher in Group 2 (P = 0.015 and P = 0.004, respectively). However, the neutrophil-to-lymphocyte ratios between the groups were not significantly different (P = 0.511). CONCLUSION: No statistically significant differences were identified from preoperative neutrophil-to-lymphocyte ratios between patients having active COM and inactive COM. LEVEL OF EVIDENCE: Level NA.

Extended lateral thoracic fasciocutaneous biosynthetic flap for reconstruction of full-thickness partial external ear defects: an experimental study.

External ear reconstruction is a controversial topic in reconstructive plastic surgery. Here, we prepared a pedicled biosynthetic flap for full-thickness, partial ear defects in rabbits. We operated on six adult female New Zealand rabbits weighing 3-4 kg. The dimensions of the lateral thoracic fasciocutaneous flap were 7 × 6 cm. The flap was elevated based on one of the bilaterally located internal thoracic arteries, which were dissected proximally. The pedicled flap was folded in two, and polypropylene mesh was sandwiched in the middle. The flap was adapted to a defect of 3.5 × 3 cm in diameter. In fact, the defect was created before elevation of the flap. Rabbits were followed up for 4 weeks, at the end of which they were killed and their ears were evaluated histopathologically. The survival rate of the rabbits was 100 %. All pedicled biosynthetic flaps were viable, but one showed partial (20 %) necrosis (1/6) and one was partially detached (1/6). Macroscopic (color, thickness, texture) and histological (polymorphonuclear leukocyte invasion in the skin, subcutaneous tissue, and at the junction between the polypropylene mesh and the flap) features of the flap were compared to the ipsilateral ear. A new technique was developed for partial external ear reconstruction with sufficient inner skeletal support and outer skin lining. Level of evidence Level NA.

Polypropylene mesh for nasal septal perforation repair: an experimental study.

The aim of this study is to determine the effectiveness and biocompatibility of polypropylene mesh for the repair of nasal septal perforations in an animal model on rabbits. A full-thickness nasal septal perforation with a diameter of nearly 10 × 10 mm was created on 12 rabbits, and then the perforation was reconstructed with two different methods. We used mucosal flaps and polypropylene mesh as an interpositional graft in group 1. Only mucosal flaps were used for reconstruction and are identified as group 2. After 4 weeks, we removed the nasal septum of the rabbits and performed histopathological examinations for acute rejection, infection, inflammatory response, fibrosis, and granuloma formation. We found perforation closure rates of 75 and 25 % in groups 1 and 2, respectively. Inflammatory response was seen in all specimens of group 1 (100 %). The inflammatory response was +1 in five of the specimens (62.5 %), +2 in one specimen (12.5 %), and +3 in two specimens (25 %). Mild fibrosis around the mesh was detected in four specimens (50 %), medium-level fibrosis was detected in one (12.5 %), and no fibrosis was detected in three (37.5 %). Severe fibrosis was not seen in any specimens. The foreign-body reaction was limited to a few giant cells, and granuloma formation was seen in two specimens (25 %). The propylene mesh showed excellent biocompatibility with the septal mucosa, and it can, therefore, be used for the repair of septal perforation as an interpositional graft safely.

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.

Surgery of isolated malleus fixation due to tympanosclerosis.

The aim of the present study was to describe our surgical approach for isolated malleus fixation in patients with tympanosclerosis and to analyze the postoperative results. A total of 30 patients presented with isolated malleus fixation were operated. The fixation was reached via canalplasty. Fixated areas were cleaned without damaging the ossicle. Pre- and postoperative audiometric results were evaluated for each patient. Improvement of the pure-tone average (PTA) by at least 10 dB and an air-bone gap (ABG) of less than 20 dB after 12 months of follow-up was accepted to indicate success. The recovery of the postoperative PTA and ABG measurements was significant. Pre- and postoperative PTA was 48.00 ± 11.86 and 24.90 ± 12.45 dB, respectively (p < 0.001). According to PTA measurements, 40-50 dB recovery was achieved in four (13.3 %) patients, 31-40 dB in six (20 %) patients, 21-30 dB in ten (33.3 %) patients, and 11-20 dB in five (16.6 %) patients, with a total success rate of 25/30 (83.2 %). Pre- and postoperative ABG levels were 38.95 ± 9.92 and 16.10 ± 7.79 dB (p < 0.001), respectively. The ABG level was between 0 and 10 dB for 8 (26.6 %) patients, and 11-20 dB for 16 (53.3 %), with a total success rate of 24/30 (80 %). In cases of isolated malleus fixation with tympanosclerosis, performing a canalplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.

Does the use of radiofrequency myringotomy for insertion of a ventilation tube reduce the incidence of myringosclerosis?

The aim of the present study was to determine the rate of myringosclerosis after radiofrequency (RF) myringotomy and ventilation tube (VT) insertion and compare it with that after the incisional myringotomy and VT insertion. Thirty children (60 ears), 2-16 years old (mean age 7.06 ± 2.77 years) who were planned to undergo surgical intervention for bilateral otitis media with effusion (OME), were included in this study. The children were treated by RF myringotomy of the right ear, incisional myringotomy of the left ear, and insertion of VTs into both ears. Both ears were examined intraoperatively for bleeding, and patients were evaluated for myringosclerosis formation with otomicroscopy at the end of the ninth month. Myringosclerosis was observed in 22 of the 60 ears. The overall incidence was 36.6 %. Fifteen (50 %) left ears showed myringosclerosis by otomicroscopy, and seven (23.3 %) right ears showed myringosclerosis. The rate of myringosclerosis of the right ear was significantly lower than that of the left ear (p < 0.05). In addition, intraoperative tympanic membrane bleeding was observed in 24 (40 %) of the 60 ears: 21 (70 %) left ears and three (10 %) right ears were perforated by RF. The tympanic membrane bleeding rate of the right ear was significantly lower than that of the left ear (p < 0.01). The present study is the first to determine the myringosclerosis rate after RF myringotomy and VT insertion. Our results indicate that VT insertion with RF myringotomy decreased the incidence of myringosclerosis.