The optimization of patient management after otosurgical interventions

Unique properties of X-ray fluorescent analysis with synchrotron radiation and classical morphological method allowed to reveal interrelation between the trace elements content and structure of lymph nodes. Belonging of lymph nodes to different regions is defining in formation of a certain microelemental profile and features of the microanatomic organization of lymph nodes. Lymph nodes have different functional specialization with prevalence of immune or drainage function and a certain microelement composition. The inguinal lymph node has active drainage function because of the developed sinus system at the maximum of Mn, Fe, Zn concentration; immune function prevails in a tracheobronchial lymph node at the low content of all trace elements; the mesenteric lymph node has evenly developed drainage and immune functions at the maximum of Cu, Se contents. The content of trace elements is considered as the leading mechanism limitation the structural organization of lymph nodes. Innovative approach helped to reveal formation of lymphoid-microelemental association. Features of this association modify the structural organization of lymph nodes depending on localization (region specifics).

The recently rediscovered meningeal lymphatic system (MLS) opens new insight into pathways of brain clearing and drainage functions that play an important role in neurorehabilitation. The development of breakthrough strategies for augmentation of MLS might be a promising therapeutic target for preventing of neurological diseases. Here we demonstrate photostimulation (PS, 1268 nm) of clearing and drainage function of MLS in healthy male mice. We uncover PS‐mediated increase of the mesenteric lymphatic permeability to fluorescent macrophages via a decrease of expression of tight junction and transendothelial resistance. In sum, our results clearly show PS stimulation of meningeal clearing and drainage functions as well as effects of PS on permeability of the lymphatic endothelium to macrophages. These findings open new strategies for alternative nonpharmacological therapy of brain diseases via PS modulation of lymphatic mechanisms of the homeostasis of central nervous system.

The rapid population growth and urban development in Serang City have significantly increased the incidence of flooding, highlighting the importance of improving urban drainage systems. This research analyzes the influence of priority scale criteria—technical, economic, inundation, socio-cultural, and environmental—on the enhancement of drainage functions in Serang City, with the performance of the Public Works and Housing Agency (DPUPR) as an intervening variable. The study uses a quantitative approach with data collected through expert validation and public surveys, analyzed using Structural Equation Modeling-Partial Least Square (SEM-PLS) and multiple linear regression. The findings reveal that the technical and inundation criteria have the most significant direct influence on drainage function improvement. Moreover, the performance of DPUPR mediates the relationship between priority criteria and the success of drainage improvements. The study proposes alternative strategies based on dominant influencing factors, providing a practical reference for urban infrastructure planning and flood mitigation efforts in Serang City.

An efficient soil water balance model based on hybrid numerical and statistical methods

The article is devoted to the role of the regional lymphatic system of the middle ear, from the point of view of the pathogenesis of the prolonged presence of fluid in the air cavities of the temporal bone with a prolonged course of serous otitis media. The study was carried out in an experiment on a model of exudative otitis media in laboratory animals (20 sexually mature male Wistar rats). Studied the state of regional (superficial, facial, and deep) lymph nodes collecting lymph from the mastoid process, tympanic cavity; external auditory canal, auditory tube. Comparative morphological and morphometric studies of lymph nodes were carried out on the 12th day of experimental otitis media and were assessed according to 19 criteria: total area of the node section, area of the capsule, marginal sinus, cortex, paracortex, medullary sinuses, medullary cords, number and area of primary and secondary lymphoid nodules, area of germinal centers, specific areas of cortical and medullary substance, sinus system, cortical/medullary ratio (C/M index), T- and B-dependent areas. Disorders of lymph outflow in the middle ear area, different nature, and degree of response of regional lymph nodes of different groups to the exudative process were revealed. It is assumed that the restructuring of the structural organization of the nodes, reflecting the inhibition of their protective and drainage functions, can prolong the phenomena of lymphostasis in the area of the primary focus and lead to the protracted course of exudative otitis media in clinical practice.

Introduction: Chronic otitis media (COM) of the mucosal type is an inflammatory process in the middle ear space, persisting for more than 12 weeks, which can result in a nonhealing perforation of the pars tensa. The Eustachian tube function (ETF) is essential for maintaining middle ear ventilation and pressure equilibrium, and its dysfunction can exacerbate the disease. This study aimed to assess the mucociliary clearance of the middle ear by the saccharine test and the ventilatory function by the Toynbee’s test and to evaluate its impact on tympanoplasty outcome. Aim: (1) To assess the ETF in COM – Mucosal type with the Toynbee’s and saccharine tests. (2) To correlate the results of Toynbee’s and saccharine tests with the success of tympanoplasty. Materials and Methods: In this prospective cohort study, the ETF of 54 subjects with COM was evaluated using the Toynbee’s and saccharine tests. The Toynbee’s test was categorized as normal or impaired function. In the saccharine test, saccharin perception time was categorized as normal, partial dysfunction, or gross dysfunction. Postevaluation, these patients underwent tympanoplasty and were followed up for 3 months to assess graft uptake. Results: In our study of 54 patients, the Toynbee’s test was normal in 35 (64.8%) patients and impaired in 19 (35.2%) patients. The saccharine test was normal in 36 (66.7%) patients, partially impaired in 14 (25.9%) patients, and grossly impaired in 4 (7.4%) patients. Overall, 83.3% of patients achieved successful graft uptake, with normal ETF strongly correlating with better outcomes. On further assessment, of those 18 patients with abnormal mucociliary function, nine patients with normal ventilatory function had a successful graft uptake (100%), and six out of nine patients with abnormal ventilatory function had a 66.7% graft rejection. Conclusion: Both Toynbee’s and saccharine tests evaluated the ETF, and a normal finding was critical to graft uptake. Abnormal ventilatory function along with impaired mucociliary clearance capacity of the Eustachian tube significantly reduced the chances of successful graft uptake.

Introduction: Chronic otitis media (COM) is now synonymous with chronic suppurative otitis media, which is not actively used since COM is seldom associated with “the collection of pus.” Acute suppuration of the ear which transcends 6 weeks is considered to be COM which suggests an abnormality of the ear drum. With a prevalence incidence of 1%, Eustachian tube (ET) dysfunction is among the most important factors in the development of COM. Recently, mastoid air cells have been acknowledged as an essential compounding factor for the pathogenesis of middle ear disease. Since ET, mastoid air cell system, and nasopharyngeal mass like adenoids can play a pivotal role in the causation and persistence of COM, the current study will be taken to observe the status of ET, mastoid air cells system, nasopharynx in general, and adenoids in particular in patients of COM. Aim: This study aims to study the status of the mastoid antrum on surgical exploration, the status of ET, and nasopharynx for adenoids in patients of large, subtotal perforation, and posterosuperior retraction pockets (PSRPs). Study Design: This study was an observational, cross-sectional study. Study Setting: All the patients with large, subtotal perforation, and PSRPs visiting the Outpatient Department and Inpatient Department of ENT in Acharya Vinoba Bhave Rural Hospital (AVBRH) between 2022 and 2023 will be studied. Methods: All the selected patients of large, subtotal perforation, and posterosuperior retraction pocket (PSRP) in the age bracket of 15–65 years and satisfying the inclusion criteria will be considered and accrued in this study. We plan to look at a sample size of 50 patients (50 ears). Diagnostic nasal video endoscopy to get insight into ET function, size, and grade of adenoids by grading system given by Cassano et al. and pure-tone audiometry by ALPS AD2000 to know the type and amount of hearing loss will be carried out. Status of the mastoid antrum, the extent of the disease, status of ossicles, and associated abnormalities of temporal bone along with any other incidental findings will be noted intraoperatively. Expected Results: The data will be tabulated, analyzed statistically, and will be discussed in the context of existing research. Conclusion: The purpose of the present study is to help the surgeon have a better insight into the status of the mastoid antrum, ET in cases of large and subtotal perforation, and PSRP and nasopharynx in general with significance to adenoids in patients of COM in rural area.

The Eustachian tube (ET) is responsible for the ventilation, protection, and cleaning of the middle ear. ET dysfunction plays an important role in the pathogenesis of otitis media cases, and thus the treatment and prognosis of these cases is extremely dependent on adequate ET function, which can ultimately affect the success rate of middle ear reconstruction practices. Data research on the ET’s ventilation function is needed to ensure the success of therapy and surgery treatments in the case of Chronic Suppurative Otitis Media (CSOM) patients. This study aims to investigate ET ventilation functioning in benign type CSOM and non-otitis media subjects and to develop another modality to measure ET ventilation functioning in patients with intact and perforated tympanic membranes. A comparative cross-sectional study of 36 benign type CSOM patients and 80 non-otitis media subjects will be conducted using sonotubometry and the rated parameter measurements of ET opening frequency, amplitude and ET opening duration. Malfunctioning ventilation of the ET is more common among benign type CSOM subjects (47%) than among non-otitis media subjects (18.75%). There is a significant difference (p = 0.002) between the ET ventilation functioning of benign type CSOM subjects and non-otitis media subjects—benign type CSOM subjects have rates of malfunctioning ET ventilation that are 3.88 times higher than those of non-otitis media subjects. Patients with benign type CSOM are more likely to experience malfunctioning ET ventilation than are non-otitis media subjects.

Histologic sections of human temporal bone with Eustachian tube attached were examined to investigate the changes that occur in folding of the Eustachian tube (ET) as it develops postnatally. Study of 45 specimens from individuals aged 3 months to 88 years of death, including 5 cases with chronic otitis media (OM) with perforation and 5 with OM with effusion, showed that the folds in the tube decreased significantly as age increased up to 20 years, after which no significant change with age was found. These results suggest that folding in the ET is important to its function in infants and children. Folding provides a relatively greater surface area for the tube, allowing for a greater abundance of ciliated cells, which would promote clearance of the middle ear through the ET. Greater folding might also support the tube's protective function by keeping the lumen narrow.

We investigated the relationship between the Eustachian tube's ventilatory function and the pneumatization of mastoid air cells. In 65 adults (66 ears) with chronic otitis media (COM), ventilatory Eustachian tubal function was evaluated by the inflation-deflation test, while the area of mastoid air cells was measured by the rectangular method on X-ray film. Group I represents good function in both the inflation and deflation tests. Group II represents good function in the inflation test but poor function in the deflation test. Group III represents a poorly functioning Eustachian tube in both tests. The opening pressure in Group III was statistically higher than in Group I and Group II. The area of mastoid air cells in Group I was statistically larger than in Group III. There was no correlation between opening pressure and area of mastoid air cells in COM. Postoperative failure of the tympanic membrane was frequently found in Group III. We discuss the tubal function and pneumatization of mastoid air cells.

Background: Eustachian tube (ET) is a dynamically intricate and poorly accessible structure connecting the nose and the middle ear. Although chronic otitis media (COM) is multifactorial disease, ET dysfunction is an important but overlooked predisposing factor. With newer evidence into the dynamics and prognostic factor in outcome of middle ear surgeries, it has become a focus of research. Our study aims to evaluate the various ET parameters using high-resolution computed tomography (HRCT) scan with multiplanar reconstruction technique. These parameters were compared between the diseased and normal ears to evaluate any association between the ET parameters and middle ear disease. Materials and Methods: It is a retrospective study of 66 HRCTs, with 47 HRCTs of COM and rest were controls. ET parameters including (a) ET-angle, (b) length, (c) pretympanic diameter, and (d) diameter at isthmus are measured accurately using HRCT temporal bone. Results: ET angle was significantly obtuse in COM group (154.81° ± 6.33°) when compared with the controls (149.99° ± 6.24°) with P < 0.001. Similar observation in ET angle was noted in diseased ear (154.54° ± 5.79°) in unilateral COM when compared with contralateral ear (149.56° ± 6.87°) (P = 0.001). ET was longer in COM group (3.44 ± 0.31) when compared with controls (3.4 ± 0.35). Pretympanic diameter and diameter at isthmus were greater in control group. Conclusion: The obtuse ET angle and narrow pretympanic diameter may contribute to the pathogenesis of COM. These measurements may be useful in the assessment of ET function preoperatively and might help in determining the surgical outcome. HRCT of temporal bone with multiplanar reconstruction is an effective tool to measure ET dimensions accurately.

The possibility of infection must always be considered in the postoperative evaluation of patients following middle ear surgery for otitis media-related conditions, since the etiology of otitis media is usually infection. Organisms gain access into the middle ear cavity from the nasopharynx by aspiration, insufflation, or reflux through the Eustachian tube. However, when the tympanic membrane is not intact, contamination of the middle ear cleft from organisms in the external ear canal is also possible. Acute otitis media is usually caused byStreptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and to a lesser extent, Streptococcus pyogenes and Staphylococcus aureus. The same organisms have been isolated from up to 50% of middle ear aspirates from chronic otitis media with effusion (“secretory” otitis media). Beta-lactamase-producing strains of H. influenzae (20%), B. catarrhilis (75%), and S. aureus(50–75%) have recently been identified from acute and chronic middle ear effusions. Pseudomonas aeruginosaor S. aureus or both, are usually cultured from ears with chronic suppurative otitis media and from infected cholesteatoma. Anaerobic bacteria have been also isolated. Recently, Candida albicans has been the offending organism in chronic suppurative otitis media (without cholesteatoma). Antimicrobial treatment is still indicated for children with acute otitis media to eliminate infection/effusion and to prevent suppurative complications. Also, antimicrobial therapy is indicated in selected patients who have otitis media with effusion. Amoxicillin is preferred since it is effective against the common pathogens, but cefaclor is a reasonable alternative, especially when a Beta-lactamase-producing organism is identified or suspected, as are erythromycin with sulfisoxazole and trimethoprim-sulfamethoxazole. For children with frequently recurrent acute infection, antimicrobial prophylaxis is an attractive alternative to surgical intervention. When chronic suppurative otitis media (without cholesteatoma) is caused by P. aeruginosa, parenteral antimicrobial therapy (e.g. carbenicillin) may be successful in eliminating the infection. Myringotomy with or without tympanostomy tube, repair of tympanic membrane defects (myringoplasty/tympanoplasty), tympa- nomastoidectomy, and reconstructive middle ear surgery are per formed to treat and prevent otitis media or its complications or sequelae, and to restore function. Appropriate and adequate antimicrobial therapy may prevent the need for such surgical procedures but, if medical treatment fails, surgery is indicated. Antimicrobial agents for preoperative treatment and perioperative prophylaxis may prevent postoperative complications following surgery for chronic suppurative otitis media and infected cholesteatoma. The success of surgical procedures for otitis media-related conditions should include, among other important outcomes, the rate of postoperative infection. This evaluation cannot be just for the immediate postoperative period but over many years, especially after surgery is performed in children.

ObjectiveTo evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM).MethodsA retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too.ResultsThe mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter).ConclusionsEustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

Background: Chronic suppurative otitis media (CSOM) is still a significant public health problem, especially in developing countries. Eustachian tube dysfunction is one of the factors that influence the occurrence of CSOM. The pathogenesis of acute and chronic otitis media is initiated by negative pressure in the middle ear. One theory of the event of CSOM is the continuum theory. The eustachian tube as one of the factors that influence the occurrence of CSOM has been proven from various studies comparing CSOM patients and the average population and CSOM with and without cholesteatoma. With the advanced technology, CT scan helps diagnose pathological conditions in the ear as a diagnostic tool and evaluation modality. CT scan imaging with a multiplanar reconstruction technique can provide a clear image of the anatomical shape of the Eustachian tube. Objective: This study aims to determine the relationship between the angle and length of the Eustachian tube in the ear with CSOM and the contralateral ear's angle and length. Method: An analytic study with a cross-sectional design involving 30 samples of CSOM patients with the contralateral ear. The measurement of the angle and length of the Eustachian tube using the multiplanar HRCT temporal reconstruction technique. Result: Statistical analysis with paired t-test showed that the Eustachian tube angle was significantly more horizontal in the CSOM ear than the contralateral ear (p<0.05). Eustachian tube length was shorter in CSOM than contralateral (p<0.05). Conclusion: The angle of the eustachian tube in the CSOM ear is smaller (more horizontal) and shorter than the contralateral ear.

Normal middle ear volume indicates the well ventilated middle ear and subsequently the normal function of the Eustachian tube. We carried out preoperative assessment of the middle ear volume by tympanometry and scintigraphic evaluation of Eustachian tube patency in patients with unilateral otitis media. We correlated the middle ear volume and Eustachian tube patency in these patients. Prospective. A total of 58 patients with unilateral otitis media were studied. All patients underwent Eustachian tube scintigraphy. We categorized the patients as Group A with patent Eustachian tube and Group B with blocked Eustachian tube (ET). We assessed the equivalent middle ear volume (VeqME) in all patients and correlated it with ET patency. We also correlated the degree of hearing loss and intraoperative middle ear pathology in two groups. There is strong linear correlation between the ET patency and VeqME of the patients. Degree of hearing loss and the middle ear pathology is also found to be severe in patients with blocked ET and low VeqME. Preoperative assessment of patients with chronic otitis media should include the objective evaluation of middle ear volume and ET patency, as it is the reliable predictor of middle ear pathology.