The preventive effect of N-nitro L-arginine methyl ester in experimentally induced myringosclerosis

Objective

The purpose of this study was to investigate the antiinflammatory and antifibrotic effects of N-nitro l-arginine methyl ester (l-NAME) in experimentally induced myringosclerosis.

Methods

Twenty Wistar albino rats were bilaterally myringotomized and divided randomly into four groups, each including five rats. Group I received no treatment, Group II was treated with topical saline solution, Group III received topical l-NAME and Group IV received intraperitoneally administered l-NAME. After 2 weeks, the tympanic membranes were examined and scored by otomicroscopy regarding the extent of the myringosclerosis. Then the tympanic membranes were harvested and evaluated histopathologically by light microscopy. The intensity of inflammation and degree of myringosclerosis were evaluated, the mean thickness of tympanic membranes were also measured.

Results

The tympanic membranes of Groups I and II showed extensive myringosclerosis in contrast to those of Groups III and IV which had significantly less or no changes (p < 0.05). The inflammation and fibroblastic activity of the lamina propria in the tympanic membranes of Groups III and IV were found to be significantly less pronounced (p < 0.05). The tympanic membranes were found to be significantly thicker in Groups I and II when compared with Groups III and IV (p < 0.05).

Conclusion

Our results showed that both topical and intraperitoneal applications of l-NAME supressed inflammation, reduced fibroblastic proliferation and decreased the formation of myringosclerosis in myringotomized rat tympanic membranes.     

Otitis media with effusion: Recurrence after tympanostomy tube extrusion

Objective

The incidence rate of recurrence of otitis media with effusion (OME) in children after tympanostomy tube extrusion and the relationship between recurrence and tube retention time was investigated. Also relationship between recurrence rate and initial age of tube insertion was analysed.

Study Design

A retrospective case series of patients who had tympanostomy tube insertion.

Methods

A total of 91 children (169 ears) were reviewed. Ears of children divided into three groups according to retention time of tympanostomy tubes. Group I: tympanostomy tube retention time less than 6 months. Group II: tympanostomy tube retention time 6 months to 12 months. Group III: tympanostomy tube retention time 12 months or more.

Results

OME recurrence rate after tube extrusion was 20.7% in the study. The longer the tympanostomy tube retention time was the lower was the recurrence rate of OME. The comparison of the three groups indicated that recurrence rates were higher in group I (36.54%), than in group II (17.74%) and in group III (9.1%). There were statistically significant differences in recurrence rates between group I and group III, and between group I and II (p < 0.05, p < 0.05). However, the difference in recurrence rates between group II and group III was statistically not significant (p > 0.05). In the preschool age group and school age group, the recurrence rates were 5.5% and 15.4%, respectively. There was no significant difference between these two groups (p > 0.05). OME recurrence was observed in 9.9% of males and in 11% of females. There was no significant difference in recurrence rates between males and females (p > 0.05).

Conclusion

After extrusion of tympanostomy tube, children should be followed-up regularly for recurrence of OME. The shorter the retention time of tympanostomy tubes was the higher was the recurrence rate. For the treatment of OME the ideal type of tubes should have the lowest complication and recurrence rates. Further studies are needed to ascertain the relationship between the incidence of OME and optimal tympanostomy tubes duration of tube stay in tympanic membrane. Therefore, new studies with larger series are necessary to investigate the correlation between the recurrence rates and different tympanostomy tubes after extrusion of tubes.     

The effect of topical adrenaline on the development of myringosclerosis after tympanostomy tube insertion

OBJECTIVE: To determine the effect of topical adrenaline application after myringotomy and before tympanostomy tube placement on the development of myringosclerosis. STUDY DESIGN: A prospective, randomized, double-blind study, with each patient acting as his or her own control. Ethical approval and full parental consent were obtained. SETTING: Department of Otorhinolaryngology-Head and Neck Surgery in a university teaching hospital. PATIENTS: Fifty children satisfying inclusion and exclusion criteria for first-time tympanostomy tube insertion. THERAPEUTIC INTERVENTION: Myringotomy followed by adrenaline application to incision before tympanostomy tube insertion. Control contralateral ear received saline application after myringotomy. Follow-up examination was done 14 to 21 days after surgery and again after 1 year by a single blinded surgeon. MAIN OUTCOME MEASURE: Comparison of myringosclerosis between adrenaline-treated ears and matched control ears. RESULTS: No difference was found in early morbidity between the two groups of ears. Myringosclerosis after 1 year was not found to have been significantly affected by adrenaline application (p = 0.2) CONCLUSION: The use of adrenaline on the myringotomy site before tympanostomy tube placement was not found to influence early postoperative morbidity or the later development of myringosclerosis.     

Sex distribution in children with tympanosclerosis after insertion of a tympanostomy tube

Tympanostomy tube insertion is an accepted treatment for otitis media with effusion in children. Several clinical studies have shown that tube insertion may cause myringosclerosis. During the period 1988 to 1997 we treated 533 ears from 311 children who had otitis media with effusion by inserting tympanostomy tubes. Most of these (431 ears from 251 children) were re-examined in 1998 and sex and occurrence of myringosclerosis at the tube insertion site were noted. Myringosclerosis was observed in 31% of ears of girls treated with tubes, whereas in boys 71% of ears showed myringosclerosis. This difference between sexes may indicate a genetic predisposition such as that seen in atherosclerosis. Received: 8 May 2000 / Accepted: 29 September 2000     

Long-term follow-up of otitis media with effusion in children: Comparisons between a ventilation tube group and a non-ventilation tube group

Objective

The objective of this study was to investigate the long-term outcomes in children with otitis media with effusion who received either medical treatment or ventilation tubes.

Methods

We retrospectively analyzed the medical records of 89 bilateral cases of otitis media with effusion in children who were recommended to receive ventilation tube insertion and were followed up for more than 5 years. Tympanic membrane was inspected by otoscopic examination. Hearing was evaluated with pure tone audiometry. The mean duration of follow-up was 8.4 years (range, 5.2–15.7 years). Twenty-three children were treated without surgery, while 22 were treated once by ventilation tube insertion and 44 were treated more than once by ventilation tube insertion.

Results

At the fifth year of follow-up, both groups of children who underwent ventilation tube insertion had more frequent tympanic membrane abnormalities than the medication group (8.7% in those treated without surgery, 72.7% in those treated once by ventilation tube insertion, and 88.6% in those treated more than once by ventilation tube insertion). Common tympanic membrane abnormalities were retraction (27.0%) and tympanosclerotic plaque (23.6%), regardless of the treatment modality. At the fifth year follow-up, the average air-conduction threshold was 10.0 dB (± 6.5 dB) in patients treated without surgery, 15.9 dB (± 11.2 dB) in patients treated once by ventilation tube insertion, and 17.8 dB (± 7.6 dB) in those treated more than once by ventilation tube insertion. The audiological difference was significant when we compared the hearing level of children treated by medication without surgery to the two ventilation tube groups.

Conclusion

Though ventilation tube insertion can resolve hearing loss quickly, there were more tympanic membrane abnormalities and a decline in hearing levels in our ventilation tube insertion group vs. the observation group measured 5 years later. Physicians should therefore be cautious when applying a ventilation tube in patients with otitis media with effusion and should explain the risks to patients who are a candidate for repeated ventilation tube insertion.     

When should retained Paparella type I tympanostomy tubes be removed in asymptomatic children?

Objectives

Tympanostomy tubes are routinely used for the treatment of otitis media with effusion (OME). There is no definite consensus on the optimal length of the intubation period and the timing of tube removal. This study was designed to determine the appropriate time for tympanostomy tube removal in asymptomatic patients of preschool age.

Methods

A retrospective study was conducted in 336 patients (478 ears) under the age of 7 years old who underwent tympanostomy tube insertion or removal from January 2006 to September 2010 at our institution. The information gathered from chart review included patients’ age at the time of tube insertion, duration of intubation, and the presence of complications, such as tube site infection and persistent tympanic membrane perforation. Logistic regression, chi-square test and Fisher's exact test were used to determine the statistical significance of observations.

Results

The spontaneous extrusion rate of tympanostomy tubes was about 90% at 18 months and showed a plateau after 18 months. The OME recurrence rate decreased after 12 months of intubation, and complications such as tube site infection and persistent tympanic membrane perforation increased after 15 months of intubation.

Conclusion

Tympanostomy tubes removed before 12 months showed a high possibility of recurrence. Removal after 15 months showed an increased possibility of complications. Spontaneous extrusion seldom occurred after 18 months. From these findings, we concluded that asymptomatically retained tympanostomy tubes are recommended to remove when a tube is retained for more than 18 months.     

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.     

Shepard grommet tympanostomy tube complications in children with chronic otitis media with effusion

The objective of this study was to determine tympanostomy tube complications in children with chronic otitis media with effusion who were treated with Shepard grommet tympanostomy tube insertion. This tube type was selected as it is the most commonly used one in our clinic. The medical records of 162 ears of 87 children (52 male and 35 female) were reviewed retrospectively. The children were between 3 to 16 years old (mean age = 8.1 ± 3.1). The patients were followed up 6–66 months (mean 23.3 ± 14.9 months) after tympanostomy tube insertion. We reviewed age, sex, time to tube extrusion and complications. In all patients the indication for surgery was chronic middle ear effusion. Otorrhea occurred in nine ears (5.6%). Granulation tissue was seen in two ears (1.2%). Complications after tympanostomy tube extrusion included myringosclerosis (34.6%), persistent perforation (5.6%), atrophy (23.5%), retraction (16.7%) and medial displacement of tubes (1.2%). The average extrusion time was 8.5 ± 4.6 months (range 1–24) for Shepard grommet tympanostomy tubes. Complications of tympanostomy tube insertion are common. Myringosclerosis, tympanic membrane atrophy and otorrhea are the most frequently appearing complications. But they are generally insignificant and cosmetic. Consequently, in the majority of these complications there is no need for any management.     

Strategies to prevent biofilm-based tympanostomy tube infections

Objective

To review the potential contributory role of biofilms to post-tympanstomy tube otorrhea and plugging as well as the available interventions currently utilized to prevent biofilm formation on tympanostomy tubes.

Data sources

A literature review was performed utilizing the MEDLINE/Pubmed database from 1980 to 2013.

Review methods

Electronic database was searched with combinations of keywords “biofilm”, “tympanostomy tube”, “ventilation tube”, and “post-tympanostomy tube otorrhea”.

Results

Two of the most common sequelae that occur after tympanostomy tube insertion are otorrhea and tube occlusion. There is an increased evidence supporting a role for biofilms in the pathogenesis of otitis media. In this review, we have shown a multitude of novel approaches for prevention of biofilm associated sequelae of otitis media with effusion. These interventions include (i) changing the inherent composition of the tube itself, (ii) coating the tubes with antibiotics, polymers, plant extracts, or other biofilm-resistant materials, (iii) tubal impregnation with antimicrobial compounds, and (iv) surface alterations of the tube by ion-bombardment or surface ionization.

Conclusion

Currently, there is not one type of tympanostomy tube in which bacteria will not adhere. The challenges of treating chronic post-tympanostomy tube otorrhea and tube occlusion indicate the need for further research in optimization of tympanostomy tube design in addition to development of novel therapies.     

Laryngeal dysfunction and oral hygiene: Any relation?

Objective

The purpose of this study is to establish a relation between poor oral hygiene and laryngeal dysfunction.

Methods

43 adult patients were divided into two groups according to caries activity and oral hygiene. 18 patients with oral hygiene index score (OHI-S) 0-1 were grouped as the control group (good oral hygiene). 25 patients with OHI-S 2-3 were grouped as the study group (poor oral hygiene). Larygostroboscopic examination, aerodynamic measures by defining maximum phonation time (MPT) and s/z ratio and the pitch level measurements were done.Patients with gastroesophageal reflux disease (GERD), laryngopharyngeal reflux (LPR), previously confirmed laryngeal diseases or pathologies, systemic other diseases, or smokers were excluded from this study.

Results

The average MPT values of the study group were found to be statistically very significantly lower than those of the control group (p < 0.01). In the stroboscopic findings, the proportion of normal closure levels were meaningfully higher in the control group than in the study group (p < 0.05). The supraglottic involvement was found statistically meaningfully higher in the study group than in the control group (p < 0.05). The proportion of normal closure phase incidences were meaningfully higher in the control group than in the study group (p < 0.05).

Conclusion

So, our findings of high glottic closure impairment, supraglottic involvement and low MPT scores in the poor oral hygiene group correlate with LPR findings such as muscle tension dysphonia. Poor oral hygiene may aggravate potential LPR in people.     

Modulation of somatosensory abilities and the feeling of ear fullness in patients with acute sensorineural hearing loss

Objective

Patients with acute sensorineural hearing loss (ASNHL) often complain of a feeling of ear fullness (FEF) that is similar to the sensation experienced during barometric pressure changes. This suggests that modulation of somatosensory abilities may relate to the manifestation of FEF, whereas it cannot simply be assumed that somatosensory abilities would be directly affected by ASNHL. To examine this possible relationship, we estimated somatosensory abilities of the tympanic membrane, and investigated the relationship between them and the manifestation of FEF.

Methods

To estimate somatosensory abilities of the tympanic membrane, 83 new patients demonstrating unilateral sudden deafness were studied. The air pressure was loaded through an exclusive device on the external auditory canals in order to measure the minimum change in air pressure sensed by the subjects. The minimum pressure was defined as the minimum sensory threshold for air pressure loading (MSTAP; daPa). We estimated patient's somatosensory abilities and inquired about their experiences with FEF at the first medical examination (point 1) and at the time a steady audiogram was obtained (point 2). We also estimated MSTAP in 65 volunteers (130 ears) with no history of ear diseases and compared their MSTAP with that of sudden deafness patients.

Results

MSTAP values (−64.0 ± 32.2 daPa, 60.5 ± 26.0 daPa) on the affected side with both negative pressure and positive pressure measured at point 1 were significantly higher than those (−40.7 ± 15.0 daPa, 40.0 ± 12.7 daPa) obtained at point 2 in all sudden deafness patients (p = 0.0001, p = 0.0001). There was no difference between MSTAP values (−39.6 ± 10.7 daPa, 39.9 ± 11.4 daPa) in normal subjects and those obtained at point 2 in all sudden deafness patients. On the other hand, significant differences of MSTAP with negative pressures between the affected and unaffected sides at point 1 were seen in 32 patients, and manifestation of FEF showed an insignificant association in these 32 patients (p < 0.05).

Conclusion

Modulation of somatosensory abilities in ASNHL seemed to be the best possible explanation for results, suggesting that a rise in MSTAP may somehow be associated with FEF. Although it cannot be verified by result of the current study, consideration of the previous literature suggests that the phenomenon may be caused by cross-modality of hearing and somatosensory abilities.     

Mucosal expression of ENaC and AQP in experimental otitis media induced by Eustachian tube obstruction

Objective

We investigated the expression of the epithelial sodium channel (ENaC) and aquaporins (AQPs) in the middle ear mucosa of a rat model of otitis media with effusion caused by surgical obstruction of the Eustachian tube.

Methods

Sixty-four rats were randomly assigned to either undergo unilateral Eustachian tube obstruction (groups 1, 2, and 3) or to undergo no procedure (control group). Bony Eustachian tubes were approached through ventral incisions and obstructed with electrocautery. On days 14, 28, and 56, the ears were evaluated, and the rats were sacrificed for otoscopic evaluation and real-time RT-PCR. Immunohistochemistry was done for ENaC-α and AQP-1.

Results

The level of ENaC-α expression decreased 0.28- and 0.73-fold at 2 and 4 weeks, respectively, but increased 1.48-fold at 8 weeks (p < 0.05). The change in ENaC-β expression at 2 weeks was insignificant. However, the level of ENaC-β expression increased 3.17- and 7.85-fold at 4 and 8 weeks, respectively (p < 0.05). The level of ENaC-γ expression increased 1.51-, 4.82- and 14.79-fold at 2, 4 and 8 weeks, respectively (p < 0.05). The level of AQP-1 expression decreased 0.10- and 0.04-fold at 4 and 8 weeks, respectively (p < 0.05). The change in AQP4 expression at 4 and 8 weeks was insignificant (p > 0.05). The pattern of immunoreactivity of ENaC-α and AQP-1 was similar with that of gene expression.

Conclusion

The experimental methods provoked reproducible otitis media with effusion. This model is well suited for studies of middle ear homeostasis during disease pathogenesis. Middle ear mucosa homeostasis is altered significantly by ETO, and the subunits of AQP proteins show a characteristic expression pattern over time.     

Changes in caloric responses after temporal bone surgery with posterior tympanotomy

Objective

To elucidate the role of facial recess bony plate in the thermal transmission route from external auditory canal to lateral semicircular canal during caloric stimulation test, we performed the test on patients before and after removal of the plate, i.e. posterior tympanotomy. In the present study, we adopted facial nerve decompression (FND) as posterior tympanotomy without surgery-induced inner ear damages and cochlear implantation (CI) as posterior tympanotomy with surgery-induced inner ear damages.

Methods

Between 1999 and 2003, we performed FND on 19 patients with unilateral facial nerve paresis due to Bell’s palsy (n = 7), Ramsay-Hunt syndrome (n = 7) or facial nerve trauma (n = 5) at Osaka Rosai Hospital. We also performed CI on 34 patients with bilateral deafness at Osaka University Hospital. To examine effects of FND or CI on caloric responses in vestibular periphery, caloric stimulation (30 °C cold water and 44 °C hot water) with ENG was performed twice, just before and 6 months after surgery in each subject. The caloric-induced nystagmus was recorded by using ENG under dark and open-eyes situation to calculate the maximum slow phase eye velocity.

Results

In cases of FND (n = 19), there were significant decreases between pre- and post-operative 30 °C responses (t-test: p = 0.049 < 0.05). There were no significant differences between pre- and post-operative 44 °C responses (t-test: p = 0.467 > 0.05). In cases of CI (n = 34), there were significant changes between pre and post-operative responses in both temperatures (t-test: p < 0.0001 in 30 °C; p = 0.011 < 0.05 in 44 °C).

Conclusion

The insertion of electrodes during CI did some damages to vestibular peripheral function and reduced both hot and cold caloric responses according to the results of CI. However, the procedure during posterior tympanotomy could also decrease caloric responses especially in cold stimulation according to the results of FND. Therefore, we should consider the effect of structural change in temporal bone on the thermal transmission in case of evaluation of vestibular peripheral function by using caloric stimulation test.     

The Korean version of the Sniffin' stick (KVSS) test and its validity in comparison with the cross-cultural smell identification test (CC-SIT)

Objective

The Korean Version of the Sniffin’ stick (KVSS) is the first olfactory test for Koreans. Although we adopted the Sniffin’ Stick, we modified it to make it more suitable for Koreans. KVSS I is a screening test, and KVSS II a more comprehensive test. The aims of this study were to apply the KVSS test and assess its clinical validity and reliability in comparison to CC-SIT.

Methods

One hundred and seventy-four healthy volunteers and 206 patients with subjective decreased olfaction participated. Each participant was tested with both the CC-SIT and KVSS tests and then the correlation between these two tests was analyzed.

Results

The correlation between CC-SIT and KVSS I was 0.720 (p < 0.01) and 0.714 between the CC-SIT and KVSS II total scores (p < 0.01). When the degree of olfaction based on the KVSS I was used, the mean CC-SIT score was 8.6±1.8 for normosmia, 7.3±2.2 for hyposmia, and 4.2±2.3 for anosmia. When the KVSS II total was applied, the mean CC-SIT score was 8.4±1.8 for normosmia, 7.3±2.0 for hyposmia, and 3.7±2.0 for anosmia. The means of the three group differed significantly in both cases (p < 0.01).

Conclusion

Thus, the KVSS test demonstrates validity and reliability for Korean in comparison with CC-SIT.     

Late complications of radiotherapy for nasopharyngeal carcinoma

Objective

To evaluate and assemble late complications of radiotherapy in cases of nasopharyngeal cancer.

Methods

From October 2003 to January 2005, a prospective cohort study was done in a tertiary center, Chiang Mai University Hospital. Two hundred patients were evaluated for late complication according to the RTOG/EORTC late radiation morbidity scoring criteria.

Results

Of 200 patients, 131 were male (65.5%) and 69 female (34.5%). The mean age was 49.7 ± 13.5 years (11–78). The mean pre- and post-treatment body mass indexes (BMI) were 22.5 ± 4 (15–35.6), and 19.8 ± 3.2 (12.9–34.5; P < 0.05). Mean post-radiation period was 3.6 ± 3.4 years (0.3–18.6 years). The radiation dosage ranged from 60 to 76 Gy (mean 69 Gy). Most of the patients (92%) had undifferentiated (50.5%) and poorly differentiated (41.5%) squamous cell carcinoma. Eighty-eight percent of the patients were in Stage III and IV. Chemotherapy was given to 145 patients (72.5%). The mean post-radiation period in the added chemotherapy group was lower than the group treated with radiation alone (2.9 ± 2.7 years vs. 5.4 ± 4.4 years, P < .05). The most common complication was dryness of mouth (97.5%); followed by hearing impairment (inner ear 82.5%). Added chemotherapy increased the complication severity significantly for the skin (P < 0.05). The mean number of complications was 6.3 ± 2.2 (range from 1 to 12).

Conclusion

In this study, every patient had a more or less adverse reaction to radiation. Doctors need to be aware of these complications in order to prevent serious ones and to improve the patients’ quality of life in the long term.     

Long-term results of open cordectomy for the treatment of T1a glottic laryngeal carcinoma

Objective

To assess the long-term results and prognostic factors in patients who have undergone open cordectomy (OC) for the treatment of T_1a glottic laryngeal carcinoma.

Methods

One hundred four epidermoid cancer patients operated from January 1989 through December 1999 were included in the study. Clinical parameters, postoperative complications, and postoperative stay were retrospectively evaluated in all cases.

Results

Mean survival for the patients included in the study was 61.5 ± 24.8 months after the date of operation (range: 11–121 months). Ninety-four patients did not have recurrent tumor (90.4%). Local, regional and distant recurrence were linked with a statistical negative impact on survival rates (p < 0.05). Only sero-hematoma was significantly related to local recurrence (p < 0.05), whereas the remainder complications did not. None of the complications was associated with neck recurrence or distant metastasis (p > 0.05).

Conclusions

Open cordectomy is nowadays a valid technique for the surgical treatment of T_1a glottic laryngeal carcinoma. Its results are comparable with those of other more recent techniques.     

Determination of optimum dosage of intraoperative single dose dexamethasone in pediatric tonsillectomy and adenotonsillectomy

Objective

Our objective is to determine the optimum dosage of intraoperative single dose dexamethasone and its effect upon postoperative morbidity in pediatric tonsillectomy and adenotonsillectomy patients.

Study design and methods

Totally 150 pediatric patients whom underwent adenotonsillectomy or tonsillectomy surgery are offered to participate in this study at otorhinolaryngology clinic between 2002 and 2003. 150 patients are divided into three randomized groups, each composed of fifty patients. Anesthesia protocol is standardized in each group and 0.2 mg/kg intraoperative dexamethasone is given to first group, 0.7 mg/kg (maximum dose 25 mg) intraoperative dexamethasone is given to second group and third group is accepted as control group without giving any intravenous dexamethasone. Each group is compared for postoperative nausea, vomiting and tolerability to take oral foods within first 24 h with the same questionnaire.

Results

There is significantly higher ratio of postoperative nausea and vomiting within first 24 h in group III (80%) when compared with group I (8%) (p: 0.001; p < 0.01) and group II (4%) (p: 0.001; p < 0.01). Also there is significantly higher ratio of patient's tolerability to take oral semisolid/solid foods within postoperative first 24 h in group II (94%) when compared with group I (58%) (p: 0.001; p < 0.01) and group III (12%) (p: 0.001; p < 0.01). We didn’t encounter any side effect of dexamethasone in group I and II.

Conclusions

We thought that 0.7 mg/kg dosage of IV dexamethasone is much a preferable choice depending of its effectiveness on decreasing postoperative morbidity rather than 0.2 mg/kg dosage and beside to this advantage we didn’t encounter any side effects.     

An anatomically sound surgical simulation model for myringotomy and tympanostomy tube insertion

Objective

Myringotomy and tympanostomy tube insertion (MT) is a common surgical procedure. Although surgical simulation has proven to be an effective training tool, an anatomically sound simulation model for MT is lacking. We developed such a model and assessed its impact on the operating room performance of senior medical students.

Study design

Prospective randomized trial.

Methods

A randomized single-blind controlled study of simulation training with the MT model versus no simulation training. Each participant was randomized to either the simulation model group or control group, after performing an initial MT procedure. Within two weeks of the first procedure, the students performed a second MT. All procedures were performed on real patients and rated with a Global Rating Scale by two attending otolaryngologists. Time to complete the MT was also recorded.

Results

Twenty-four senior medical students were enrolled. Control and intervention groups did not differ at baseline on their Global Rating Scale score or time to complete the MT procedure. Following simulation training, the study group received significantly higher scores (P = .005) and performed the MT procedure in significantly less time (P = .034). The control group did not improve their performance scores (P > .05) or the time to complete the procedure (P > .05).

Conclusion

Our surgical simulation model shows promise for being a valuable teaching tool for MT for senior medical students. Such anatomically appropriate physical simulators may benefit teaching of junior trainees.     

Pathogenic role of tonsillar lymphocytes in associated with HSP60/65 in Pustulosis Palmaris et Plantaris

Objective

We aimed to define role of tonsillar lymphocytes (TL) and immune cross-reactivity between bacterial-HSP65 and human-HSP60 in Pustulosis palmaris et plantaris (PPP), an intractable chronic disease characterized with pustules and cornification of palms and soles.

Methods

Two sets of crossover trials were designed by employing SCID mice model. In the first trial, mice were transplanted with tonsillar lymphocytes and skin-grafts from PPP patients (TL group). In the second trial, mice were transplanted with tonsillar lymphocytes from PPP patients and injected with recombinant human HSP60. Control groups were designed for each step. Comparisons were performed for immunologic analyses including infiltration of CD4+ lymphocytes in skin-grafts by immunostaining, and levels of anti-HSP65-IgG and cytokines in mice sera by enzyme-linked immunosorbent assay (ELISA).

Results

In TL group, infiltration of CD4+ lymphocytes in skin-grafts were significantly higher than mice transplanted with blood lymphocytes (p < 0.05), while anti-HSP65-IgG levels in sera showed non-significant tendency to increase in the TL group. CD4+ cells and anti-HSP65-IgG levels were also well-correlated with each other in TL group (p < 0.01). Besides, anti-HSP65-IgG levels were significantly correlated with cytokine levels (IL-6, IFN-γ) in mice sera (p < 0.01). We found strong expression of HSP60 in PPP lesions. Finally, HSP60-stimulation in mice transplanted with TL from PPP patients induced significantly higher anti-HSP65-IgG levels in serum compared to control groups including mice without HSP60-stimulation or peripheral blood lymphocytes-transplanted mice or transplanted with TL from control patients (p < 0.05).

Conclusion

Our results indicate the pathogenic role of TL and immune cross-reaction between human-HSP60 and bacterial-HSP65 in PPP.     

Outcomes of tympanostomy tube placement in children with Down syndrome—A retrospective review

Objectives

Tympanostomy tubes are commonly used for treatment of chronic otitis media with effusion (COME) or recurrent acute otitis media (RAOM) in patients with Down syndrome, but hearing outcomes in this population have been mixed, and complications appear to be common. We aim to characterize outcomes and complications associated with tympanostomy tube placement in this population.

Methods

Retrospective review. All patients with Down syndrome presenting to a tertiary academic pediatric otolaryngology practice over a ten year period from 2002 to 2012 who received tympanostomy tubes for COME, RAOM, or hearing loss were reviewed.

Results

Long term follow up data was obtained in 102 patients, with average follow up 4.7 years. COME was the primary indication for tube placement in 100/102 (98%). Less than half of these patients (44%) initially failed their newborn hearing screen. Post operative hearing was found to be normal or near normal for the better hearing ear in 85/99 (85.9%), and normal to near normal in bilateral ears in 71/99 (71%). A majority (63.7%) of patients required two or more sets of tubes during the follow up period. Long term complications were common and were significantly increased if the patient required three or more sets of tubes, including chronic perforation (36.6% vs 8.2%, p < 0.001), atelectasis (29.3% vs 1.6%, p < 0.0001), and cholesteatoma (14.6% vs 0%, p = 0.003).

Conclusions

COME is a frequent problem in Down syndrome, and the majority of patients will require two or more sets of tubes during their childhood and achieve normal postoperative hearing. Long term complications of otitis media appear to be more common in this population and appear to correlate with increasing number of tubes placed. More investigation is required to determine optimal treatment strategies for COME in patients with Down syndrome.