inflammatory responses to hydroxyapatite implants in middle ear in rats

Objective To study local inflammatory response after implantation of hydroxyapatite synthetic ossicular prosthesis. Methods Hydroxyapatite gantries were implanted in the bulla in 32 rats. Sham surgical procedures were performed in 10 rats as the control. Animals were sacrificed at 1 to 300 days after surgery. Bulla sections, stained with HE and Mallory's azan, were examined for numbers and percentages of various inflammatory cell types. Results Slightly more inflammatory reaction was seen in animals with the implant than in the controls, mostly during the early stage following the implantation procedure. Few inflammatory cells were observed at later times. There were satisfactory fibrosis in both implanted and control ears. Conclusion The results indicate that hydroxyapatite synthetic prosthesis is a biocompatible implantation material in the middle ear. Nonetheless, the presence of inflammatory reaction immediately following implantation implies that control of infection is important in the early times after the implantation procedure.     

Epidemiological analysis of patients cure in frame of emergency in ORL clinic in Warsaw, stepińiska 15/21 in 1996

Study the epidemiological and clinical features of patients attending the emergency in the Clinic during 12 months to think whether the emergency is still needed as a one of method of curing. 4892 patients attended the emergency. Parameters analyzed were: age, sex, hour and day of arrival, place of living, initial signs, hospitalization and surgical services. The most frequent reasons for coming to the emergency were: ear disease (32.2%--middle ear otitis), nose disease (662 patients), bleeding nose (559 patients). The most frequent reason for hospitalization were swallowed foreign body (16.5%), tumor of the larynx and pharynx (16%), vestibulary nerve (12.9%). Emergency is an important sector of hospital activity, with a mean 55 per day (week-days), 87 per day (week-end and out of job days). The majority men disease were facial traumas, women were disease of vestibulary nerve, sudden hearing loss. However, 33% of the consultation in the emergency apper to be real medical emergencies, others could be appropriately provided by a general practitioner.     

Guided surgery in a subtemporal approach in CPA tumors?

BACKGROUND: Computer assisted surgery (CAS) permits the visualization of hidden bony covered structures invisible for the human eye with radiological 3d data sets. The surgeon might be able to orientate anatomically during surgery without having to prepare the according landmarks. This would mean less surgical traumatization and a shorter and smaller operation corridor. METHOD: We determined the use of CAS in a quality assurance analysis with the subtemporal approach in 8 patients with supra-meatal tumors type A of the cerebellopontine angle. Various navigation systems and methods for referencing for the registration of the patients' heads were used. The question was whether it is possible intraoperatively without preparation of known anatomical landmarks to define the borders of an optimal positioned temporary bone cap and to identify the bony covered inner auditory canal and its neuronal structures without orienting neurostimulation. RESULT: It was possible with CAS to assess intraoperatively the borders of a temporary bone cap above the cranially positioned mastoid cell. However, the objective inaccuracy of 2 to 28 mm observed during surgery did not allow a secure identification of the inner auditory canal. CONCLUSIONS: CAS with the subtemporal approach cannot replace the conventional preparation of known anatomical landmarks nor neurostimulation to identify neural structures, due to the expected high inaccuracy with the non-invasive referencing systems that are available today.     

Expressionsmuster für nichtviral transfiziertes gfp in der Cochlea der Maus in vitro und in vivo

Background

Diseases of the inner ear such as presbycusis, tinnitus, sudden hearing loss, and vertigo affect many patients, but so far there are no specific therapy options. Gene therapy might become a potential modality of treatment. Viral vectors are standard in animal models to date. Future considerations, however, call for a further evaluation of non-viral transfection methods.

Material and methods

The non-viral transfection agents Metafectene^TM, Superfect^TM, Effectene^TM, and Mirus TransIT^TM were incubated with a plasmid coding for GFP. In vivo, the plasmid-agent mix was injected via the membrane of the round window, and 48 h later the inner ear was perfused, harvested, decalcified, and histologically evaluated for GFP expression.

Results

Cationic lipids (Metafectene^TM) and dendrimers (Superfect^TM) were able to transfect cells in the area of the organ of Corti and lead to GFP expression. The polyamine (Mirus TransIT^TM) did show expression of GFP in the area of Rosenthal’s canal and in the area of the inner hair cell. The combination of a non-liposomal lipid with a DNA condensing component (Effectene?) did not show transfection of the organ of Corti. In the area of the spiral ganglia cells, GFP expression was seen with all the transfection agents.

Conclusions

Non-viral transfection agents are able to introduce a reporter gene in cells of the inner ear in vitro and in vivo. There are, however, differences in the efficiency of the transfection. They might be an alternative in gene therapy of the inner ear. Further investigations to elucidate their potential are needed.     

Interferon-α action in cytokine profile in eosinophilic nasal polyp cultures

IntroductionChronic rhinosinusitis is currently classified into two types: chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps. In the West, approximately 80% of chronic rhinosinusitis with nasal polyps cases are characterized by a predominantly eosinophilic cell infiltrate and a Th2 cytokine pattern.ObjectiveTo evaluate the effect of Interferon-α on cytokine levels of the eosinophilic nasal polyp cell culture supernatant.MethodsCell cultures were performed based on nasal polypoid tissue samples collected from 13 patients with eosinophilic chronic rhinosinusitis with nasal polyps. Polyps were considered eosinophilic according to the histopathological examination. Cell cultures were stimulated with 3000 IU of interferon-α. Before and after the stimulus, concentrations of Interferon-γ, tumor necrosis factor αand IL 2, 4, 6 and 10, using cytometric bead array, were assessed.ResultsCell samples from eosinophilic nasal polyps from 13 patients were included in the study. Twenty-four hours after interferon-α stimulation, eosinophilic nasal polyp culture supernatants showed significantly decreased IL-4 concentrations and increase in interferon-γ, IL-10 and IL-6 concentrations compared to controls. There were no significant differences in tumor necrosis factor -α and IL-2 concentrations.ConclusionWe demonstrated that interferon-α in vitro alters the pattern of cytokines in cell cultures of eosinophilic nasal polyps. Analysis of these alterations suggests that interferon-α promotes a rebalancing of inflammatory profiles in cell cultures, favoring the expression of Th1 and regulatory cytokines over Th2 cytokines.     

Otolaryngology manpower in Canada: a crisis in the making?

Physician manpower issues have been of interest to Canadians and government officials for several decades. Since the first otolaryngology manpower survey was completed by Dr. Percy Ireland in 1962, there have been progressive declines in the physician-to-population ratio across Canada from 1 in 42 000 in 1962 to approximately 1 in 75 000 in 2000. The expected increase in our population over the next decade, the cutbacks in medical school enrollment, and an aging population will compound this problem. The system is in crisis, and this country is desperately in need of more otolaryngologists.     

Tonsillektomie in Hypotension?

Zusammenfassung Es werden Normtonsillektomien unter Verwendung von Adrenalin mit Mandelausschälungen, die unter Hexamethoniumwirkung durchgeführt wurden, verglichen. Auf die nicht unwesentliche rolle psychischer Faktoren bei der Blutdruckgestaltung intra operationem wird hingewiesen. Eine ausreichende Blutarmut läßt sich bei Verwendung von 2,5 mg Hexamethonium intramuskulär pro kg Körpeergewicht erzielen. Es ist wünschenscwert, den Blutdruck auf Werte, die bei etwa 60–50 mm Hg liegen, zu senken. Vorteile des Verfahrens sind die zumeist geringe Blutung während der Operaation sowie fast trockene Wundverhältnisse nach beendeter Tonsillektomie bei häufig geringer Gewebsreaktion und unter dem Durchschnitt liegenden postoperativen Beschwerden. Nachteilig wirken sich der größere technische Aufwand und ein durch die Hirnanoxie hervorgerufener inkonstanter, aber nicht immer unerheblicher Würg- und Brechreiz aus.Mit 8 TextabbildungenHerrn Prof. Dr.Tonndorf zum 70. Geburtstage gewidmet.     

Acetylcholine-induced calcium oscillation in isolated outer hair cells in guinea pig

Objective This study is to explore the relationship between acetylcholine(ACh)-induced calcium release from intracellular Ca2 stores and function of outer hair cell(OHC) motors, in an attempt to elucidate the mechanism of OHC electromotility at resting state. Methods OHCs were isolated from adult guinea pig (200-300 g) cochlea and loaded with Fluo-3/AM. The cells were treated with ACh/dHBSS, ACh/HBSS, dHBSS only or HBSS only. Intracellular [Ca2 ]i variations in cells under the four treatments were observed using an Ar-Kr laser scan confocal microscope. Results [Ca2 ]i oscillations were recorded in five OHCs treated with ACh/dHBSS but not in other cells. This is the first time that Ach-excited [Ca2 ]i oscillations are reported in guinea pig OHCs independent of extracellular calcium. Conclusions ACh-excited [Ca2 ]i oscillations in OHCs originates from intracellular calcium release and may play a crucial role in maintaining active mechanical motility of the OHC at resting and modulating OHC electromotility.     

Is discordance in TEOAE and AABR outcomes predictable in newborns?

Objective

To determine the perinatal predictors of discordant screening outcomes based on a two-stage screening protocol with transient-evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR).

Methods

A cross-sectional study of infants tested with TEOAE and AABR under a hospital-based universal newborn hearing screening program in Lagos, Nigeria. Maternal and infant factors associated with discordant TEOAE and AABR outcomes were determined with multivariable logistic regression analyses adjusting for potential confounding factors.

Results

Of the 4718 infants enrolled under the program 1745 (36.9%) completed both TEOAE and AABR. Of this group, 1060 (60.7%) passed both TEOAE and AABR (“true-negatives”); 92 (5.3%) failed both TEOAE and AABR (“true-positive”); 571 (32.7%) failed TEOAE but passed AABR (“false-positives”) while 22 (1.3%) passed TEOAE but failed AABR (“false-negatives”). Infants with false-positives were likely to be admitted into well-baby nursery (p = 0.001), belong to mothers who attended antenatal care (p = 0.010) or who delivered vaginally (p < 0.001) compared to infants with true-negatives while infants with true-positives were also more likely to be delivered vaginally (p = 0.002) or admitted into well-baby nursery (p = 0.035) compared to infants with false-negatives. Infants with true-positives were significantly more likely to be delivered vaginally (p < 0.001) and have severe hyperbilirubinemia (p = 0.045) compared with infants with true-negatives. No association was observed between false-negatives and true-negatives. Antenatal care status, mode of delivery and nursery type were useful predictors of discordant outcomes among all infants undergoing screening (c-statistic = 0.73).

Conclusions

Given the available screening technologies, discordant TEOAE and AABR may be inevitable for some categories of hearing loss among apparently healthy newborns whose mothers received prenatal care. The potential limitations of perinatal morbidities as basis of targeted screening for such cases therefore merit further consideration.     

Detection of viral DNA in the endolymphatic sac in Ménière's disease by in situ hybridization

The main purpose of this study is to search for a viral etiology in Ménière's disease by examining the presence or absence of herpes family virus DNA in the endolymphatic sac (ES) using the in situ hybridization method. This was a prospective study with the ES from 10 patients with Ménière's disease and from 7 control cases without any pre-mortem ear diseases except a case of acoustic tumor. These 10 patients underwent the ES surgery. The presence of herpes family virus DNA, such as herpes simplex virus types 1 and 2 (HSV1&2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV) and human cytomegalovirus (CMV), was examined using the in situ hybridization method. Serum antibody titers against these viruses just before the ES surgery were studied in these patients. Of the 10 specimens from the patients with Ménière's disease, 7 were positive for VZV, 4 for EBV, 1 for CMV and none for HSV1&2, although the serum antibody titers against these viruses did not show any significant elevation in these patients just before the ES surgery. This result suggests that the viral DNA in the ES is inactive and is present in a latent form. From the statistical analysis, it can be postulated that VZV infection in early childhood may reach the ES and play a role in the pathogenesis of Ménière's disease (p = 0.0235). The double infection with both VZV and EBV tended to be another candidate for the pathogenesis of Ménière's disease (p = 0.0557).     

Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?

Objective

Evaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas.

Laryngeal microsurgery in materials of Woiewódzki ENT department in Kalisz

Basing on literature and own experience authors have presented possibilities and advantages this method. During 1994-1997 3239 patients were hospitalized, 249 because of larynx diseases. 88 (35.34%) from them were operated by Kleinssaser tool kit with control by surgical microscope. Between these patients in histological examination were found in 30 patients--changes of hypertrophy, in 23 patients--polypus vocal fold, in 17 patients cancer of larynx--early shape, in 12 patients--vocal nodulus and 2 patients--Reincke oedema, 2--laryngeal papillomas and 2--cysts of larynx. Patients with cancer of larynx were treated by partial laryngectomy. Other patients had return full function of larynx.     

Does mucosal remodeling in chronic rhinosinusitis result in irreversible mucosal disease?

Mucosal remodeling in the sinuses is a recently described phenomenon in which the mucosa undergoes potentially irreversible changes as a result of ongoing underlying inflammatory processes. Research into remodeling that occurs in the bronchial airways in asthmatic patients has led to modification of asthma treatment guidelines. However, remodeling in the sinuses has still not led to changes in current medical or surgical management of chronic rhinosinusitis. Upper airway remodeling constitutes a new area of research that poses many unanswered clinical questions and may potentially alter the management of patients with severe chronic rhinosinusitis.     

The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland

Hearing loss is one of the most prevalent chronic conditions affecting the health of the aged. It is typically medically non-treatable, and hearing aid (HA) use remains the treatment of choice. However, only 15–30% of older adults with hearing impairment possess an HA. Many of them never use it. The purpose of our study was to investigate the use of provided HAs and reasons for the non-use of HAs. This population-based survey was set in the city of Kuopio in eastern Finland. A total of 601 people aged 75 years or older participated in this study. A geriatrician and a trained nurse examined the subjects. Their functional and cognitive capacity was evaluated. A questionnaire about participants socioeconomic characteristics and the use of HAs were included in the study protocol. The subjects who had an HA were assigned to three groups on the basis of HA use: full-time users, part-time users and non-users. Inquiries were made about the subjective reasons for the non-use of HAs. An HA had been prescribed earlier to 16.6% of the study group. Fourteen percent of the females and 23% of the males had been provided with an HA. The HA owners were older than persons who had not been provided with an HA. Twenty-five percent of the HA owners were non-users, and 55% were full-time users. A decline in cognitive or functional capacity and low income explained the non-use of HAs. The most common subjective reasons for the non-use of HAs were that the use did not help at all (10/24), the HA was broken (4/24) or it was too complicated to use (5/24). The non-use of HAs is still common among the aged. Elderly people who have been provided with an HA and who have a cognitive or functional decline are at risk to be a non-user of an HA. Therefore, they need special attention in counseling.     

A national series of 244 sinonasal cancers in Finland in 1990–2004

Sinonasal cancer is still a somewhat controversial entity because most series are single-center studies. The aim of this study was to give more accurate and generalisable information about treatment of the neck and prognosis of sinonasal cancer. Retrospective, population-based, multicentre study. Altogether 244 patients diagnosed in 1990–2004 were evaluated. The 3- and 5-year disease-specific survival (DSS) rates after treatment with curative intent were 68 and 57%, respectively. Regional status at the time of the diagnosis (P < 0.001, log rank) and local recurrence (P = 0.02, log rank) during the follow-up had a statistically significant effect on DSS. Initially 13% of the patients were diagnosed with neck metastasis. The proportion of regional recurrences during the follow-up was 9%, but it did not have a statistically significant impact on DSS (P = 0.68, log rank). Histopathology had no statistically significant impact on survival in this material of 244 patients. In conclusion, routine elective neck treatment of all sinonasal cancer patients is not recommended, but the importance of the treatment of the primary location is emphasised.     

The Use of Nasendoscopy in Assessing Velopharyngeal Function in Case Received Pharyngeal Flap

纤维鼻内窥镜可以在不干扰腭咽部活动的情况下，如实提供其在发音状态下的清晰图像。与侧位X线透视不同，借助鼻内窥镜，检查者能从腭咽口的上方检查腭帆与咽侧壁、咽后壁的互相接触部位，从而了解不同发音状态下腭咽口的整体情况，尤其是能观察侧位X线透视不能揭示的侧方裂隙的部位及大小，为治疗提供参考。因此，越来越多的言语病理学家与耳鼻喉科学家合作，将其应用于对腭咽功能的评估。本文对该项检查的适应症，操作要领及注意事项、报告书写等作了详细介绍，认为发口腔音时出现持续性过度鼻音及鼻漏气的患者均应接受鼻内窥镜检查，检查时镜体应自中鼻道插入，深度不能超过10cm，检查中所用的言语测试材料应多样化，以便全面了解患者的腭咽功能。对于检查结果的描述，作者推荐了IWG建立的分级标准；文中还采用图解方式强调了应用鼻内窥镜诊治腭咽关闭不全患者的价值(咽瓣成形后仍关闭不全者，软腭麻痹者，癌症术后腭咽部大面积缺损及不可修复的腭裂患者)，指出鼻内窥镜检查不仅有助于了解腭咽口裂隙的部位，大小及构型，而且有助于指导设计、安装赝体。对于腭咽功能不全患者，应用鼻内窥镜评估其腭咽功能，同时结合口腔检查、感知评估及X线透视，必将有助于制定更为合理的治疗方案。