Middle Ear Mucosa Research Articles

Biologics for eosinophilic otitis media: a retrospective case study in a multidisciplinary center.

Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media characterized by eosinophilic accumulation in the middle ear mucosa and effusion. It is refractory to conventional treatments and is strongly associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The diagnostic criteria for EOM were established by IINO in 2011. With the recognition of type 2 inflammatory diseases, the gold standard of treatment is the systemic and topical administration of corticosteroids. Recently, several retrospective studies have demonstrated the efficacy of biologic treatments in EOM. We aimed to share our experience regarding the response of EOM after the use of biologics. This is a retrospective observational analysis including patients with refractory EOM treated with different biologics (benralizumab, omalizumab, mepolizumab, dupilumab) for concomitant severe asthma, urticaria and/or severe uncontrolled CRSwNP from 2011 to 2023. Treatment effectiveness in terms of EOM severity was measured using medical Global Evaluation of Treatment Effectiveness (GETE). We illustrated 4 clinical cases of uncontrolled comorbid EOM and demonstrated the complexity of multidisciplinary medical pathway with good response to biologics. We also observed that response to EOM and CRSwNP does not always follow that of asthma. The results of our small sample were consistent with those found in the literature and showed control of EOM with biologics. We need a larger multicentric sample and methodology to confirm these results and to compare the efficacy of different biologics.

Intra-operative Measurement of Eustachian Tube Orifice, and Its Correlation With Post-operative Surgical Outcome in Chronic Suppurative Otitis Media Patients.

Background Chronic suppurative otitis media (CSOM) is the inflammation of the middle ear mucosa for more than two weeks, resulting in ear discharge. It is associated with hearing loss and the presence of a perforation in the tympanic membrane. Tympanoplasty is performed to place a graft and clear the disease in the middle ear. Despite adequate disease clearance and proper graft placement, graft failure and disease persistence occur due to Eustachian tube (ET) dysfunction. The ET plays a significant role in the ventilation of the middle ear. Hence, this study was conducted to determine the significance of ET size for post-operative graft uptake. Methodology A total of 55 patients with inactive CSOM were included in the study. Their demographic data were recorded. Patients previously operated on for CSOM, cases with traumatic perforation of the tympanic membrane, congenital anomalies (e.g., cleft lip/cleft palate), and atticoantral disease were excluded. Thorough history taking and examination, including otoscopy and examination of the nose, throat, and oropharynx, were conducted. Once the patient was deemed fit for surgery, they underwent tympanoplasty. Intraoperatively, the ET size was measured using the tip of the suction cannulas. They were followed up after three months to assess graft uptake. Results Out of 55 patients included in the study, 42 (76%) had good graft uptake, while 13 (24%) had defects in graft uptake. Graft uptake failed in patients with an ET diameter of <3 mm. Post-operative graft uptake was observed in the majority of patients with a wider ET diameter, ranging between 3 mm and 6 mm, with a statistically significant p-value of 0.00 (0.05), as determined by Pearson's Chi-square test. Conclusion In our study, we found that there is an association between the ET diameter and post-operative graft uptake. Hence, a wider ET may improve middle ear ventilation and play an important role in post-operative graft uptake.

Audiological results of myringoplasty performed by trainee surgeons (ENT residents) under supervision—analytic study

BackgroundMyringoplasty is one of the most common surgeries performed in otology centers, with many factors influencing the success rate, including the size and site of perforation, function of the Eustachian tube, revision surgery, and expertise of the surgeons. It is well established that the perforation closure rate is lower when performed by trainee surgeons than by senior otologists. Myringoplasty performed by trainees tends to pose more iatrogenic trauma to middle ear mucosa, less gentle manipulation of ossicles, and prolonged operation time compared with operations performed by experienced surgeons, all of which might produce more damage to middle ear structures and consequently negatively affect the closure rate of TM and audiological outcome. This study aimed to assess the audiological outcomes of successfully closed perforation myringoplasty performed by a trainee under supervision.MethodsThe study design was an analytic cross-sectional study of 35 patients aged between 6 and 62 years diagnosed with safe TM perforation. All patients had two audiograms, one before surgery and the other 3 months after surgery. The exclusion criteria included any case with cholesteatoma, tumor, tympanosclerosis, or ossicular erosion/fixation because this study aimed to study the sole effect of closing TM perforation without any other confounding factor.ResultsThe results indicate a mean hearing improvement of 12.25 dB of ABG and 10.6 dB of AC thresholds at the four frequencies of 500, 1000, 2000, and 4000 Hz. The mean of the residual ABGs at the four frequencies is 14.2 dB. There were no correlations between the amount of air conduction threshold improvement and age, gender, side of the affected ear, area of perforation, or duration of disease (p > 0.05 for all tests).ConclusionAlthough the rate of perforation closure in myringoplasties performed by trainees is lower than that of experienced surgeons, the audiological outcomes of myringoplasties performed by trainees under supervision were acceptable; however, further research is recommended.

Efficacy of Empirical Co-Amoxiclav Vs Culture Directed Treatment in Chronic Suppurative Otitis Media. A Double Blind Randomized Controlled Trial

Background: Chronic suppurative otitis media (CSOM) is common middle ear inflammatory condition secondary to tympanic membrane perforation and superimposed infection, which causes increased discharge from middle ear mucosa. This is a common condition seen in relatively low socioeconomic status and in younger population. The effective treatment of this disease is essential as un-treated patients often lead to various complications like mastoiditis, facial nerve paralysis, labyrinthitis and abscess formation. A huge number of hearing loss in paediatric population is due to this condition. The treatment of CSOM includes aural toilet, topical antibiotics and in some cases systemic antibiotics. In this study we will compare the results of patients who were given culture sensitivity directed antibiotics with the ones who were given Co-Amoxiclav as an empiric treatment Methodology: A two-year observational cross-sectional study was conducted at PIMS, a total of 396 patients were enrolled and randomly divided into two group i.e., Group A and Group B with 198 patients in each. Group A included those who were given culture specific antibiotics and group B included those who were given Co-Amoxiclav as a part of empiric therapy. Their results were compared after 12 days of treatment in terms of response seen as clean and dried, external auditory canal along with middle ear mucosa. Results: Out of 198 patients in Group A, 177 patients had clean and dried middle ear mucosa which shows success rate of 89.39% and in Group B 170 patients out of 198 (85.85%) showed positive response. Conclusion: Empiric treatment of CSOM (Tubotympanic Type) with co-amoxiclav must be considered as its response is comparable to culture sensitivity directed treatment in terms of clean and dried external auditory canal and middle ear mucosa.

Synchrotron Phase-Contrast Imaging and Cochlear Otosclerosis: A Case Report

Introduction: Otosclerosis is a bone disorder affecting the labyrinthine capsule that leads to conductive and occasionally sensorineural hearing loss. The etiology of otosclerosis remains unknown; factors such as infection, hormones, inflammation, genetics, and autoimmunity have been discussed. Treatment consists primarily of surgical stapes replacement and cochlear implantation. High-resolution computed tomography is routinely used to visualize bone pathology. In the present study, we used synchrotron radiation phase-contrast imaging (SR-PCI) to examine otosclerosis plaques in a temporal bone for the first time. The primary aim was to study their three-dimensional (3D) outline, vascular interrelationships, and connections to the middle ear. Methods: A donated ear from a patient with otosclerosis who had undergone partial stapedectomy with the insertion of a stapes wire prosthesis was investigated using SR-PCI and compared with a control ear. Otosclerotic lesions were 3D rendered using the composite with shading technique. Scalar opacity and color mapping were adjusted to display volume properties with the removal of bones to enhance surfaces. Vascular bone channels were segmented, and the communications between lesions and the middle ear were established. Results: Fenestral, cochlear, meatal, and vestibular lesions were outlined three-dimensionally. Vascular bone channels were found to be frequently connected to the middle ear mucosa, perilabyrinthine air spaces, and facial nerve vessels. Round window lesions partly embedded the cochlear aqueduct which was pathologically narrowed, while the inferior cochlear vein was significantly dilated in its proximal part. Conclusion: Otosclerotic/otospongiotic lesions were imaged for the first time using SR-PCI and 3D rendering. The presence of shunts and abnormal vascular connections to the labyrinth appeared to result in hyper-vascularization, overloading the venous system, and leading to sensorineural hearing loss. We speculate about possible local treatments to alleviate the impact of such critical lesions on the labyrinthine microcirculation.

Dupilumab in the Treatment of Eosinophilic Otitis Media: A Case Report

Eosinophilic otitis media (EOM) differs from classic chronic otitis media as it is a refractory disease with the accumulation of eosinophils in thick mucinous middle ear effusion and mucosa. A 66-year-old male with a history of asthma, chronic sinusitis with polyposis, nasal polyposis, and multiple sets of ventilation tubes was presented to our center for the management of hearing loss and otorrhea. He had a history of consistent otorrhea and hearing loss even with the ventilation tube insertions and medical treatment. Both systemic and intratympanic steroid was administered, but the effect was insignificant and other systemic adverse effects occurred. Finally, the otologic symptoms including hearing loss and otorrhea improved after being given a Dupilumab injection. This case report discusses Dupilumab treatment resulting in remission in a patient suffering from refractory EOM.

A Case of Middle Ear Adenomatous Neuroendocrine Tumors: Proposal of a Staging System

A 49-year-old man visited a local otolaryngology clinic with left hearing loss. He was diagnosed as left middle ear tumor and referred to us. The tumor was protruding from the left tympanic membrane. Computed tomography (CT) revealed thickening of the tympanic membrane, space-occupying lesions in the middle ear cavity and mastoid air cells, and no bone destruction in the left middle ear. Magnetic resonance imaging confirmed the CT findings, and the lesions were hyperintense on T1- and T2-weighted imaging. He was diagnosed as middle ear adenomatous neuroendocrine tumor (MEANT) with a pathological result. The patient underwent postauricular approach and canal wall-down mastoidectomy. The tumor occupied the mastoid air cells and extended into the middle ear mucosa. To prevent perilymphatic fistula, the tumor was excised as extensively as possible, while preserving the tumor around and adjacent to the stapes footplate. MEANT is extremely rare and long-term follow-up is necessary due to be potential for tumor regrowth or recurrence. Herein, we propose a new staging system for MEANT.

Effect of diesel exhaust particles on RANK/RANKL expression in in vivo and in vitro models of middle ear inflammation

ObjectiveIncreasing evidence suggests a link between middle ear inflammation and the development of diesel exhaust particles (DEPs). Chronic middle ear inflammation can lead to bone damage and remodeling. This study aimed to explore the impact of DEPs on the expression of interleukin (IL)-6 and RANKL under conditions of middle ear inflammation. MethodsDEPs were collected by burning fuel in a diesel engine at the Gwangju Institute of Science and Technology. Human middle ear epithelial cells were cultured to 70–80% confluence in culture plates and then treated with DEPs at concentrations of 0, 5, 10, 20, 40, and 80 μg/mL for 24 h. Cell viability was assessed manually. B6.SJL mice, aged 9 weeks, were exposed to DEPs at a concentration of 200 μg/m3 for 1 h daily over a period of 28 days. The expression levels of IL-6, tumor necrosis factor α, RANKL, and RANK were evaluated using hematoxylin and eosin staining and western blot analysis of the harvested middle ear samples. ResultsThe viability of human middle ear epithelial cells was found to decrease in a dose-dependent manner after 24 h. The mRNA expression level of IL-6 exhibited the most significant increase at the 48-h mark. In contrast, the mRNA expression levels of RANKL and RANK showed a marked increase as early as 6 h post-exposure, with both genes subsequently displaying a time-dependent decrease. Histological analysis revealed that the middle ear mucosa was thicker in the group exposed to DEPs compared to the control group. Additionally, the protein expression levels of IL-6 and RANKL were elevated in the DEP-exposed group relative to the normal control group. ConclusionsWe confirmed the expression of osteoclast-related proteins in the mouse middle ear. These results imply that air pollutants might affect RANKL/RANK signaling, which is associated with bone remodeling.

Three-dimensional volumetric analyses of temporal bone pneumatization from early childhood to early adulthood in a South African population.

A debate exists on whether the size of temporal bone pneumatization is a cause or consequence of otitis media (a global disease burden). However, a normal middle-ear mucosa is a prerequisite for normal temporal bone pneumatization. This study investigated the size of temporal bone pneumatization with age and the normal distribution of air cell volume in different stages of human growth postnatally. A three-dimensional computer-based volumetric-rendering technique was performed bilaterally on 248 head/brain and internal acoustic meatus computed tomography images of slice thickness ≤ 0.6 mm consisting of 133 males and 115 females with age range 0-35 years. The average volume of infant (0-2 years) pneumatization was 1920 mm3 with an expected rapid increase to about 4510 mm3 in childhood (6-9 years). The result also showed a significant increase (p < 0.001) in the volume of air cells up to the young adult stage I (19-25 years), followed by a significant decline in young adult stage II (26-35 years). However, the females were observed to experience an earlier increase than males. Also, population differences were observed as the Black South African population group showed a higher increase in volume with age than the White and Indian South African population groups, though the volumes of the latter increased up to young adult stage II. This study concludes that the pneumatization of a healthy temporal bone is expected to continue a linear increase up until at least adult stage I. Termination of temporal bone pneumatization in an individual before this stage could signify pathologic involvement of the middle ear during childhood.

Tympanic Perforations in Children: When to Propose Surgical Closure?

This study aims to analyze the impact of age and other prognostic factors on the success of myringoplasty. A retrospective case series. Pediatric ENT department of a tertiary academic center. Two hundred forty-one children (318 ears) aged 3 to 17 years with tympanic perforation. Myringoplasty performed between 2009 and 2019. The rate of tympanic closure, perforation recurrence, revision surgery, and audiometric gain were collected. The impact of age and anatomical and surgical factors was analyzed for each procedure. With a mean follow-up time of 1 year, the tympanic closure rate was 87.7%, the perforation recurrence rate was 18.6%, and 16.7% of ears required reoperation. The mean air-bone gap decreased from 21 dB preoperatively to 12 dB postoperatively ( p < 0.0001). We did not find different anatomical and audiometric results for our three groups of patients classified according to age. Audiometric results were associated with the location of the perforation, intraoperative inflammation of the middle ear mucosa, and the surgical technique performed. Myringoplasty in children is associated with excellent anatomical and functional results, even in the youngest patients. It can be proposed whatever the child's age if the patients are well selected before giving the indication.

NLRP3 Inflammasome Activation During Acute Negative Pressure Injury in the Middle Ear of Mice.

The present study was conducted to explore the role of the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in mouse otic barotrauma models. Previous studies suggest that the NLRP3 inflammasome plays an important role in the pathogenesis of middle ear disease. However, whether middle ear negative pressure injury underlies NLRP3 inflammasome activation remains unclear. Wild-type and Nlrp3 -/- mice were randomly assigned to control and pressure injury groups, respectively. Pressure loading was performed using a pressure cabin with the pressure level set to 20 kPa higher than that of the ambient atmosphere. This was achieved in approximately 15 seconds and maintained for 10 minutes. Hematoxylin and eosin staining was performed to detect morphological changes of the middle ear mucosa, tissue IL-1β was measured via an enzyme-linked immunosorbent assay, and cleaved caspase-1 was detected by Western blot. We found that the maturation of caspase-1 and IL-1β production in the middle ear significantly increased after otic barotrauma. In Nlrp3 -/- mice, inflammasome activation is downregulated and mucosal hyperplasia is reduced compared with those of wild-type mice during recovery. The NLRP3 inflammasome likely plays an important role in the pathogenesis of otic barotrauma. Controlling activation of the NLRP3 inflammasome may promote middle ear recovery after negative pressure injury.

Autophagy Genes and Otitis Media Outcomes.

Otitis media (OM) is a common cause of hearing loss in children that requires corrective surgery. Various studies have investigated the pathomechanisms and treatment of OM. Autophagy, an essential cellular recycling and elimination mechanism implicated in various diseases, is known to play an important role in the pathogenesis of OM. Here, we conducted a literature review on autophagy in OM, highlighting the relationship between expression patterns of autophagy-related factors and pathophysiological and clinical aspects of OM. We summarized the existing research results on the expression of autophagy-related factors in acute OM (AOM), OM with effusion (OME), chronic OM (COM) with cholesteatoma, and COM without cholesteatoma (CholeOM) in animals and humans. Autophagy-related factors are expressed in the middle ear mucosa or fluid of AOM, effusion of OME, granulation tissue of COM, and cholesteatoma of CholeOM. Among ATGs and other autophagy-related factors, the most extensively studied in relation to the pathogenesis of OM are mTOR, LC3II/I, PI3K, Beclin-1, FLIP, Akt, and Rubicon. Expression of autophagy-related factors is associated with AOM, OME, COM, and CholeOM. Inadequate expression of these factors or a decrease/increase in autophagy responses can result in OM, underscoring the critical role of ATGs and related factors in the pathogenesis of OM.

Intraoperative and postoperative findings in children with myringotomy tubes (MT) undergoing cochlear implantation (CI)

Objective To evaluate and compare children undergoing cochlear implantation (CI) with myringotomy tubes (MT) placed preoperatively or intraoperatively to those without MT . Methods This was a retrospective review of pediatric patients undergoing CI between 2015 to 2020 at a tertiary care pediatric hospital. CI patients with and without MT were reviewed for the following outcomes: intraoperative findings, intraoperative and postoperative complications, and surgical time. Descriptive and bivariable statistical analysis was performed. Results 192 cochlear implant surgeries were included: 116 without MT tubes and 76 with a history of MT. Twenty-six patients had MT present at the time of CI surgery. No statistical difference existed between patients with MT (CI + MT group) and those without MT (CI – MT group) with regard to intraoperative complications (P = 0.760) and intraoperative findings (P = 0.545). MT association with total post-operative complications (GEE) showed no statistical significance (OR 2.45, 95% CI 0.83–7.22, P-value 0.105). CI + MT patients were significantly more likely to have inflamed middle ear mucosa at time of surgery (P = 0.003). CI + MT patients did not have a longer length of surgery compared to the CI – MT group (3.47 h vs 3.3 h, respectively, P = 0.342). Conclusion Our data confirms it is safe to perform CI in ears with myringotomy tubes, although the surgeon should be aware of possibly encountering increased middle ear inflammation during the surgery.

Effectiveness of trichloroacetic acid and trichloroacetic acid with gel foam for closure in patients with central perforation of tympanic membrane—a randomized controlled trial

BackgroundThe tympanic membrane (TM) forms the partition between the external auditory canal and the middle ear. Perforations occur as a result of acute otitis media or traumatic causes which undergoes healing spontaneously over 3 to 4 weeks. Non-surgical methods are successful in the closure of small to medium-sized perforations. Chemicals used for the cauterization of the margins of perforation are trichloroacetic acid and silver nitrate. This study was performed in a total of 90 patients. External auditory canal, tympanic membrane, site and size of perforation, and middle ear mucosa status were assessed followed by pure tone audiometry. One group constituting 45 subjects underwent TCA cauterization under sterile precautions. Another group of 45 subjects underwent the same procedure with TCA cautery and gel foam application for perforation closure. The procedure was repeated once a week for about 6 weeks. The effectiveness of these two procedures was compared between the two groups after a waiting period of 2 weeks.ResultsThe mean age of the study population is 41.84 ± 16.71. Of the 90 study participants, 54.4% (N = 49) were less than 40 years of age, gender, cause, and laterality of perforation were not associated with the outcome whereas the size of the perforation was significantly associated with the closure of TM perforation with chi-square value of 7.028 and P value of 0.008 (< 0.05). Overall, TM closure was achieved in 3.56 applications in TCA with gel foam patching whereas in 6.02 applications with TCA alone.ConclusionTCA cauterization with or without gel foam patching can be performed as a first-line treatment in adults with small to medium-sized perforations.

Efficacy, safety, and tissue penetration of solithromycin in Japanese patients with otorhinolaryngological infections

ObjectiveTo assess the efficacy, safety, and tissue penetration of solithromycin for the treatment of otorhinolaryngological infections, we conducted three studies: a tissue penetration study with patients scheduled to undergo otorhinolaryngological tissue removal, an open-label study comprising patients with otitis media, pharyngitis, laryngitis, and tonsillitis, and a non-inferiority study compared with high-dose cefcapene-pivoxil (CFPN-PI). MethodsTissue penetration study; 17 patients with chronic rhinosinusitis, chronic otitis media, chronic tonsillitis, or palatine tonsillar hypertrophy, who required resection or removal of their tissue, were enrolled. Solithromycin was administered orally, and otorhinolaryngological tissues were collected 3.5–6 h after drug administration; blood was collected within 15 min before and after drug administration. The collected tissues and blood concentrations were measured at a central laboratory. Open-label study; 55 patients who were diagnosed with acute otitis media, laryngopharyngitis, or tonsillitis were enrolled. Solithromycin was administered orally 800 mg on Day 1, while on days 2–7, 400 mg of the drug was administered once daily. The primary endpoint is the clinical response at Test-of-Cure (TOC: 5–10 days after completion) Non-inferiority study; 283 patients with acute rhinosinusitis or acute exacerbation of chronic rhinosinusitis were randomized into either the solithromycin group or CFPN-PI group. Solithromycin was administered 800 mg once daily on Day 1 and 400 mg once daily while on Days 2–7 in solithromycin group, and CFPN-PI was administered 150 mg three times a day while on Days 1–7 in CFPN-PI group. The primary endpoint is the clinical response at TOC. ResultsIn the tissue penetration study, the tissue concentration ratios (tissue concentration/plasma concentration) of solithromycin were 4.19 in the sinonasal mucosa, 1.33 in the middle ear mucosa, and 6.12 in the palatine tonsil tissue. In the open-label study, the efficacy rates at the TOC were 97.0 % for acute otitis media, 100 % for laryngopharyngitis, and 81.8 % for tonsillitis. In the non-inferiority study comprising patients with rhinosinusitis, the efficacy rate at the TOC was 87.7 % for solithromycin and 89.7 % for CFPN-PI. The difference in the efficacy rate (95 % confidence interval) was -2.0 % (-9.4 % to 5.4 %), verifying the non-inferiority of solithromycin to CFPN-PI. The most common adverse events in patients administered solithromycin were diarrhea (20.7 %), nausea and nasopharyngitis (3.6 %,), pharyngitis and elevated hepatic function test results (3.1 %), and abnormal hepatic function (2.1 %). ConclusionBased on the findings, it is suggested that solithromycin is useful for the treatment of otorhinolaryngological infections.

Defining the URCOTEBS System as a Unilateral Radiographic–Stochastic Model for the Complementary States (Health/Disease) of the D-Organ and Middle-Ear Mucosa

The middle ear (ME) is a notoriously complicated anatomic structure, geometrically arranged as irregular interlinked spheroidal and polyhedric cavities dug inside the temporal bone (TB). The bony walls of these cavities are radiopaque and form the bony support for the D-Organ that we have previously defined as corresponding to the epithelium covering the Antrum walls (belonging to the central cavities of the middle ear) and the walls of mastoid and petrous cavities (the peripheral cavities of the ME). The aim of the study is to define an exact method for categorizing a Unilateral Radiographic COnformation of the TEmporal Bone in Schuller’s projection (URCOTEBS) under one of the four defined conformations and using it for practical everyday clinical purposes. The conclusion is that a radiograph in Schuller’s projection is a concrete way of storing precise information on the status (health/disease) of the D-Organ and therefore of the ME mucosa. These data is encoded within the image and we aim to decode and translate them into clinical data. The URCOTEBS results in an overlapping projection of all bony cavities that comprise the General Endo-temporal Bony Cavity Complex onto the same plain (film). This characteristic of classical film imaging constitutes an advantage from the multiple CT sections, as far as our proposed approach goes, because the set of stochastic information is found in the whole of the cavities taken as one on the same image, to which the measurement gauges can be easily applied. The decoding must be performed accordingly, and this occurs much faster with conventional radiography. This image of the TB in Schuller’s projection is a mirror that reflects the status of the ME mucosa, and URCOTEBS encodes the physiological state of the D-Organ. The present work gives, through stochastic methods, the key to decoding this information into clinical language. In ascending order of their projection areas (projection of their Variable Geometry Peripheral Endo-temporal Bony Cavity Complex) we can recognize URCOTEBS_d, URCOTEBS_c, URCOTEBS_b, and URCOTEBS_a. The corresponding Greek letter designates the state of disease for each of these conformations: URCOTEBS_δ, URCOTEBS_γ, URCOTEBS_β, URCOTEBS_α, and the capital letters define their state of health: URCOTEBS_D, URCOTEBS_C, URCOTEBS_B, URCOTEBS_A. URCOTEBS_d is the smallest unilateral radiographic conformation of the TB in Schuller’s projection and is, by definition, a radiographic image of the state of disease of the D-Organ. The probability of disease in URCOTEBS_d is 100%. This radiographic system is readily available and clinically usable.

Study of Mastoid Antral Changes in Tubotympanic Chronic Supportive Otitis Media

Background: Study of mastoid antrum findings in tubotympanic chronic suppurative otitis media Objectives: To study mastoid antrum findings in tubotympanic CSOM and to determine predictors for performing antrostomy. Methodology: 71 patients with tubotympanic CSQM were selected from OPD and IPD. All patients were subjected to investigations like X—ray mastoid (Schuller’s View), pure tone audiometry and Otoendoscopy. All patients were subjected to mastoid exploration (cortical mastoidectomy or antrostomy) with tympanoplasty. Pre-Operative findings on basis of history, examination and investigations were noted along with intra-operative findings of middle ear and mastoid antrum. Findings were tabulated and statistical tests were applied to determine significant predictors. Results: Mastoid antrum was found to be diseased in 21 patients with pathological findings like mucopus, granulations etc. Recurrent URTI, mastoid pneumatization pattern, pre operative middle ear mucosal status on otoendoscopy, degree of hearing loss and ossicular status were significantly associated with diseased antrum (P-value&lt;0.05). Conclusion: Disease can be found in mastoid antrum in tubotympanic CSOM. Mastoid exploration in form of antrostomy should be done in all cases where certain predictors are present. The predictors for performing antrostomy in tubotympanic disease are presence of recurrent URTI on history, sclerotic mastoid on x—ray mastoid (Schuller’s View), unhealthy middle ear mucosa on otoendoscopy, moderate and moderately severe hearing loss on pure tone audiometry and intra-operative ossicular necrosis and immobility.

Clinicopathological Study of Salivary Gland Tumors in Tertiary Care Teaching Hospital

Background: The study “Preoperative predictors of ossicular status in chronic suppurative otitis media” was undertaken in Swami Rama Himalayan University, Dehradun. A total number of 124 patients who underwent “tympanomastoidcetomy” for CSOM were evaluated to correlate the preoperative predictors with intraoperative ossicular status. Materials and Methods: This study was carried out for 12 months period in the Department of Otorhinolaryngology at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. Subjects were recruited from Inpatient Department planned for surgery. Each of the patients selected for the study was subjected to a detailed history and complete ear, nose and throat examination. Site and size of perforation, status of attic, middle ear mucosa status, presence of myringosclerosis, tympanosclerosis, granulations and cholesteatoma were noted in each patient. Degree and type of hearing loss was evaluated via pure tone audiometry. Results: Most of the patients belonged to the age group of less than 40 years, with maximum patients falling in the age group of 21-30 years i.e.,39 (31.45%) patients. The average age of patients was 29.39±10.79 years. Female predominance was seen with male to female ratio being 1:1.33. More cases were from rural areas comprising of 81 (65.3%) cases while 43 (34.6%) resided in urban areas. Ear discharge was the most common presenting complaint seen in 109 cases (87.90%) followed by hearing loss which was present in 100 cases (80.64%). Unilateral ear discharge present in 89 (81.65%) and 20 (18.34%) had bilateral ear discharge. Conclusion: Blood-stained discharge was present in 40 (36.66%) patients out of which 28 (70%) patients had ossicular necrosis. On assessing the amount of ear discharge, highest number of patients had scanty discharge i.e., in 75 (68.80%), out of which 30 (40%) patients had ossicular necrosis. Mucopurulent discharge was seen in highest number of patients i.e., in 68 (62.38%) out of which 30 (44.1%) had ossicular necrosis. Associated symptoms of vertigo were present in 28 patients (22.5%) out of which 16 patients (57.1%) had ossicles necrosed. On findings of otoscopy and otoendoscopy, perforation in pars tensa was seen in 82 patients (66.12%) out of which ossicular necrosis was present in 14 patients (17%). Highest incidence of ossicular necrosis was seen in 4 (4.83%) patients who had perforation involving both pars tensa and pars flaccida.

Ferrostatin-1-loaded thermosensitive nanodelivery system for noise-induced hearing loss treatment

Hearing loss is one of the most difficult sensory disorders to treat because of complicated anatomical and physiological barriers, which result in systemic administration, making it difficult to achieve effective drug concentrations in the inner ear. We recently found that the ferroptosis inhibitor ferrostatin-1 (Fer-1) can alleviate noise-induced hearing loss but large doses and multiple injections are required. Here, a novel Fer-1-loaded thermosensitive nanodelivery system was constructed by combining the advantages of chitosan (CS) and poly(d,l-lactide-co-glycolide acid) (PLGA) nanoparticles (NPs). β-Glycerophosphate disodium (β-GP) was added to the gel to make it temperature-sensitive. This thermosensitive nanodelivery system could be injected into the middle ear, change into a semisolid phase, and stick to the middle ear mucosa. In vivo experiments indicate that the gel prolonged retention for at least 7 d, causing little inflammatory response. In addition, the injection of the gel caused a temporary increase in the hearing threshold, but mice returned to normal hearing within 3 d. Finally, we demonstrated that this Fer-1-loaded thermosensitive nanodelivery system could alleviate noise-induced hearing loss (NIHL) by reducing the loss of outer hair cells (OHCs), inner hair cell (IHC) ribbon synapses, and auditory nerve fibers (ANFs) in a mouse model. Our results demonstrate that intratympanic injection of the Fer-1-loaded thermosensitive nanodelivery system is a safe and effective way to attenuate NIHL, providing a new idea for the treatment of NIHL.

Tracing of Helicobacter pylori in the middle ear and mastoid mucosa of patients under 18 years of age with chronic otitis media (with and without cholesteatomas).

It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media. Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed. We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori. Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.