Non-cholesteatomatous Chronic Otitis Research Articles

Success Of Cartilage Grafting with Mastoidectomy In Revision Tympanoplasty

Aims and Objectives: Candidates having non-cholesteatomatous chronic otitis media who have failed tympanoplasty in first attempt (graft used conchal or tragal cartilage) is at higher risk of failure in subsequent repair. The adjunctive use of mastoidectomy with cartilage tympanoplasty (tragal or conchal) in these patients has decreased the risk for subsequent failure. Aim of our study is to compare effect of mastoidectomy in revision cartilage tympanoplasty in terms of successful graft uptake, hearing improvement, and prevalence of other complications. The arguments in favor of mastoidectomy include the facts that the open mastoid cavity provides an improved volume and pressure buffer, rids the mastoid of diseased mucosa, and ensures adequate patency of the aditus (14– 16). Although this logic is sound and is supported in the literature, we believe that in many revision cases, reconstruction with a robust material such as cartilage provides the additional stability necessary to allow the middle ear and mastoid to revert naturally to a normalized environment.

Radiological and Audiological Prediction for Ossicular Fixation in Chronic Otitis Media and Tympanic Membrane Perforation.

Recurrent middle-ear infection can lead to ossicular fixation, adversely affecting post-tympanoplasty hearing outcomes. Preoperative prediction of ossicular fixation remains challenging. We aimed to investigate potential predictors of ossicular fixation in patients with chronic otitis media. Retrospective. Tertiary academic medical center. Patients with noncholesteatomatous chronic otitis media and tympanic membrane perforation, without ossicular discontinuities. Diagnostic. The fixation of each ossicle was assessed during tympanoplasty. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of ossicular fixation was evaluated using uni- and multivariable logistic regression analyses. One hundred thirty-five patients were included. Soft-tissue density between the malleus head and the anterior wall (odds ratio, 3.789 [95% confidence interval, 1.177-12.196]; p = 0.0255) and poor development of mastoid cells (16.826 [2.015-134.520]; p = 0.0078) were independent predictors of malleus fixation. In addition, ≥50% tympanic membrane perforation (5.412 [1.908-15.353]; p = 0.0015), poor development of mastoid cells (3.386 [1.039-11.034]; p = 0.0431), and a ≥40-dB preoperative air-bone gap (ABG) at 500 Hz (4.970 [1.732-14.261]; p = 0.0029) were independent predictors of incus fixation. Soft-tissue density surrounding the stapes (18.833 [1.856-191.104]; p = 0.0119) and a ≥40-dB preoperative ABG at 500 Hz (13.452 [1.640-∞]; p = 0.0138) were correlated with stapes fixation. The accurate prediction of ossicular fixation in patients with chronic otitis media based on CT features and the ABG may facilitate decision-making regarding the need for ossiculoplasty, possibly avoiding unnecessary manipulation or overlooking of fixation.

Aural polyps: What's behind them?

Introduction: Polyps in the external auditory canal (EAC) may be present due to inflammation induced by chronic otitis media. In many cases, the type of underlying otitis media is a cholesteatoma. Aim: The aim of this article is to determine the etiology of EAC polyps in patients referred to the Otology Division of a tertiary hospital in south Brazil. Materials and Methods: Cross-sectional study was conducted with a cohort of patients with otologic diseases who were evaluated from July 2001 to December 2020. Patients with unilateral or bilateral aural polyps underwent anamnesis and recorded video-otoscopy and had their online medical chart reviewed. Results: Of the 2432 patients evaluated, 133 (5.4%) had a polyp in the external auditory canal. Of those, 53 were excluded, leaving a final sample of 81 patients (3.3%). Discussion: Middle ear cholesteatoma (MEC) and non-cholesteatomatous chronic otitis media (NCCOM) were responsible for 86.3% of all polyps evaluated and the majority of diagnoses were established through surgery (76.5%). Conclusion: Symptoms associated with polyps and their aspect do not reveal the most probable etiologies making imaging exams, biopsy and surgery necessary steps in aural polyp investigation.

Surgical Outcomes of Revision Operation for Non-Cholesteatomatous Chronic Otitis Media

Background and Objectives The aim of this study was to investigate the surgical outcomes of revision operation due to recurrence of non-cholesteatomatous chronic otitis media (COM) surgery cases.Subjects and Method From 1989 to 2018, 5197 cases of COM surgery were performed at Kangdong and Hallym University Sacred Heart Hospital. Among them, clinical data of 297 subjects who had undergone revision tympanoplasty and/or mastoidectomy for recurrent noncholesteatomatous COM were retrospectively collected from computerized database of middle ear surgery (Korean Otological Society program 2005). Each case was categorized by surgical approaches into canal wall down mastoidectomy (CWDM), canal wall up mastoidectomy (CWUM), or tympanoplasty only groups.Results Tympanoplasty only was performed in 170 cases, CWDM in 74 cases, and CMUM in 53 cases. Postoperative perforation occurred in 9.4% of total cases, and less frequently in CMDM compared with tympanoplasty only (<i>p</i>=0.023), and CMUM (<i>p</i>=0.049), respectively, whereas no differences between tympanoplasty only and CMUM (<i>p</i>=0.930) were found. Postoperative infection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% of total cases, and the success rate of tympanoplasty only was better than that of CMDM (<i>p</i>=0.001), and CMUM (<i>p</i>=0.011). And, that of CMUM was better than that of CMDM (<i>p</i>=0.011).Conclusion The results showed that postoperative perforation occurred less frequently in CMDM than in tympanoplasty only and in CWUM; successful hearing was achieved more frequently in tympanoplasty alone than in the other surgical approaches in recurrent non-cholesteatomatous COM.

MASTOIDECTOMY IN NONCHOLESTEATOMATOUS CHRONIC SUPPTATIVE OTITIS MEDIA

Clinical outcome comparisons across diverse medical procedures are challenging and require considering several variables,including patient characteristics, research design, methodology, and accessible data. In your situation, you’re interested incontrasting the clinical outcomes of patients who had percutaneous transluminal angioplasty (POBA) and percutaneouscoronary intervention (PCI) with stent insertion and had substantial thrombosis burdens. Here are the main pointsof comparison broken down:Objective: to evaluate the effectiveness of the graft after mastoidectomy in non-cholesteatomatous chronic supportiveotitis media and the functional hearing result.Material And Methods: The research was conducted at the ENT (Ear, Nose, and Throat) department of theMardan Medical Complex Teaching Hospital. Study Duration: The study was conducted between June [2015] andJune [2016]. Follow-Up Period: A [24-month] (2-year) follow-up was established as the standard duration to monitorpatient outcomes after the surgery Patient Characteristics: Patient Age: The age range of the patients included in thestudy was between [20] and [50] years. Mean Age: The patients’ average (mean) age was [26.2] years. Gender Distribution Out of the total patients [25] patients (41.66%) were female [35] patients (58%) were male Ear Condition atSurgery Leaking Ears: [15] patients (25%) had ears that were leaking Dry Ears: [45] patients (75%) had dry ears.Results: Graft failure rates in the first and second groups were [30%] and [15%]. At the most recent follow-up,there was a statistically significant difference in the success rates of groups 1 and 2, where four perforations eitherhealed independently or were treated locally.Conclusion: According to this study, mastoidectomy increases the likelihood that the transplant will be effective andthe patient will have functional hearing. However, it also requires more work and comes with risks.Keywords: (Non-cholesteatomatous chronic supportive otitis media), (two tympanoplasties without mastoidectomy),(two mastoidectomies, may signify air-bone gap)

A comprehensive study of oxidative stress in patients with chronic otitis media

Objective: The purpose of this research study was to evaluate dynamic thiol/disulphide homeostasis (TDH) as a novel oxidative stress marker in participants with noncholesteatomatous chronic otitis media (ncCOM) and cholesteatomatous chronic otitis media (cCOM), as well as to investigate lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) markers and compare the results with a healthy control group. Methods: This research was carried out at Harran University Medical Faculty Ear-Nose-Throat Department, between April 2017 and April 2019. This was a prospective controlled trial study including 121 participants, 40 ncCOM, 39 cCOM and 42 healthy controls. Total thiol, native thiol, disulphide levels and LOOH, TAS, TOS levels were measured in plasma of all patients and healthy volunteers. Results: In our study, we found that total thiol, native thiol levels, native thiol/total thiol ratios and TAS levels were significantly lower in cCOM patients compared with the control group (p<0.01). Disulphide/native thiol, disulphide/total thiol ratios, LOOH, TOS and OSI levels were significantly increased in the cCOM group compared with the control group (p<0.01). Conclusion: Oxidative stress (OS) is believed to be one of the underlying reasons for COM pathogenesis. In this research, we analyzed dynamic TDH as a novel OS marker using a novel improved fully automatic colorimetric technique, along with other parameters. This study may shed light on understanding the underlying reasons for the pathogenesis of COM and identify potential targets for antioxidant drug treatment.

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media. AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers. MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing. ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income. ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.

Long-Term Outcomes after Performing Tympanoplasty without Mastoidectomy for Active and Inactive Noncholesteatomatous Chronic Otitis Media

Objective: This study aimed to assess long-term outcomes after performing tympanoplasty without mastoidectomy (TWOM) for active and inactive noncholesteatomatous chronic otitis media (COM) and to estimate the optimal time for surgery. Methods: The patients were placed into an active ear group (group A) and an inactive ear group (group B). All patients were followed up for 5 years after TWOM. Results: Ninety-two cases among 113 achieved dry ears in half a month to 1 month. The tympanic pressure gradually improved 3–6 months after the operation. A total of 69/72 ears achieved dry ears in the active ear group, and 37 ears had effective hearing improvement. In all, 40/41 ears achieved dry ears in the inactive ear group, and 20 ears had effective hearing improvement. There was no difference in the recurrence rate or hearing improvement in the two groups. Conclusion: With good quality control of the surgical treatment of TWOM, there are no differences in long-term outcomes in noncholesteatomatous COM in different chronic infection conditions.

Study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;If the ears have perforation of long standing durations, even without cholesteatomas, they remain infected. Three times as many operations were performed in the United States in 1978 for this disease as were performed for cholesteatoma. The objective of the study was to study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a clinical study of patients presented to outpatient, department of Vijayanagar Institute of Medical Sciences, Bellary during the period of November 2004 to November 2005 with non-cholesteatomatous chronic suppurative otitis media. This study is aimed to study the various ossicular abnormalities encountered in non-cholesteatomatous chronic suppurative otitis media and their reconstruction techniques. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;12 ears (40%) had central and 18 ears (60%) had subtotal perforation. The average hearing loss in patients with isolated erosion of lenticular process of incus was 50.72±6.95 dB. In our study, autologous incus was used for ossicular reconstruction in 14 (46.67%) patients and homologous septal cartilage in 10 (33.33%) cases. Twenty-nine of the 30 cases underwent myringostapediopexy (type IIIb tympanoplasty) with the ossicular graft as short columella between the tympanic membrane graft and the stapes superstructure. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Excellent results were noted only with the autologous incus graft. 28.57% of the total patients with autologous incus graft showed excellent post-operative results. Good results were found for autologous incus, homologous septal cartilage and teflon PORP, with percentage of 28.57, 50 and 25% respectively.&lt;/span&gt;&lt;/p&gt;

Correlation between cognitive functions and central auditory processing in adolescents with non-cholesteatomatous chronic otitis media.

Auditory deprivation associated with early otitis media with effusion has been considered a risk factor for central auditory processing (CAP), as well as for the development of a number of cognitive functions.Objective:To study the neuropsychological functions of attention, working memory and executive function in adolescents with and without non-cholesteatomatous chronic otitis media (NCCOM) and analyze their interrelationships with the behavioral evaluation of CAP.Methods:Sixty-eight adolescents were recruited, 34 were diagnosed with NCCOM (study group - SG), and 34 had no otological history (control group - CG). The Neupsilin Brief Neuropsychological Assessment Instrument was used. CAP was assessed by: Masking Level Difference, Synthetic Sentence Identification, Random Gap Detection Test, Duration Pattern Sequence Test and Dichotic Digits Test.Results:The results of Neupsilin showed lower scores in the study group when compared to the control group on the following tests: digit sequence repetition, ascending digit ordering, auditory sentence span, and phonemic verbal fluency. An association was found between central auditory processing tests and Neupsilin subtests.Conclusion:The effects of NCCOM on attention, memory and executive function related to central auditory processing disorder in adolescents seem to be enhanced by the severity of the disease.

High-frequency conductive hearing loss as a diagnostic test for incomplete ossicular discontinuity in non-cholesteatomatous chronic suppurative otitis media.

Chronic suppurative otitis media, with or without cholesteatoma, may lead to erosion of the ossicles and discontinuity of the ossicular chain. In incomplete ossicular discontinuity (IOD), partial erosion of the ossicles occurs, but some sound transmission is noted throughout the ossicular chain. High-frequency conductive hearing loss (HfCHL) has been considered a hallmark of incomplete ossicular discontinuity. This study aims to evaluate the use of HfCHL as a preoperative predictor of IOD in patients with non-cholesteatomatous chronic suppurative otitis media. The HfCHL test was defined as the preoperative air-bone gap (ABG) at 4 kHz minus the average of the ABG at 0.25 and 0.5 kHz. The test was applied in 328 patients before surgery and compared to intraoperative findings as the gold standard. At surgery, 201 (61.3%) patients had an intact ossicular chain, 44 (13.4%) had a complete ossicular discontinuity, and 83 (25.3%) exhibited an IOD. The best cutoff level was calculated as 10 dB. The HfCHL test to diagnose IOD had a sensitivity of 83% and a specificity of 92% with a post-test probability of 78% and a likelihood ratio of 10.2. We concluded that the HfCHL test is highly effective in predicting IOD in patients with non-cholesteatomatous chronic suppurative otitis media and that it should be used routinely as a screening test prior to surgery.

Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients.

This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air-bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n=73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n=23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p=0.012, 95% CI 1.3-10.3). Complete failure to manage infection significantly differed (p=0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.

Mean Platelet Volume as a Potential Predictor of Cholesteatoma in Children

Cholesteatoma is a chronic inflammatory clinical disorder, and it may cause hearing loss and various complications due to its destructive nature. Mean platelet volume (MPV) is a prothrombotic and proinflammatory marker. The aim of this study is to investigate predictive values of MPV, neutrophil-to-lymphocyte ratio, erythrocyte distribution width, and platelet lymphocyte ratio in cholesteatomatous or noncholesteatomatous pediatric chronic otitis media. In this study, the authors retrospectively analyzed 24 patients with cholesteatomatous chronic otitis media, 9 patients with noncholesteatomatous chronic otitis media, and 36 age- and sex-matched healthy controls. Cholesteatomatous and noncholesteatomatous chronic otitis media groups were compared with each other, and with controls for WBC, MPV, erythrocyte distribution width, neutrophil-to-lymphocyte ratio, and platelet lymphocyte ratio. Mean platelet volume was significantly lower in patients with cholesteatoma (8.17 ± 1.22 fL) compared with the control group (10.42 ± 0.87 fL) (P <0.001). Region of conversion curve analysis showed that the cutoff level of 9.5 fL for MPV was an independent predictor for cholesteatoma with a high sensitivity (86%) and specificity (84%). Cholesteatomatous and noncholesteatomous chronic otitis media patients were similar for other parameters studied. Mean platelet volume may be used as a fast-to-obtain, reliable, and inexpensive marker with a high predictive level to indicate cholesteatoma in children.

Presence of osteoclasts in middle ear cholesteatoma: a study of undecalcified bone sections

Conclusions: Osteoclasts are unlikely to be involved in bone resorption in middle ear cholesteatoma.Objective: The authors searched for osteoclasts in undecalcified bone sections in patients with middle ear cholesteatoma to determine whether and to what extent these cells are involved in this disease.Methods: Twelve patients, eight men and four women, aged 30–87 years, who underwent tympanomastoidectomy were enrolled. Six patients had primary acquired middle ear cholesteatoma (cholesteatoma group) and the other six patients had other otologic diseases including otosclerosis, non-cholesteatomatous chronic otitis media, adhesive otitis media, perilymphatic fistula and ossicular malformation (control group). The scutum bone was collected during surgery, fixed with ethanol, stained with Villanueva bone stain, and embedded in methyl methacrylate. Five-micrometer-thick sections were prepared and examined under a polarizing microscope. Images were analyzed using a semiautomatic graphics system.Results: No osteoclasts were seen in any of the samples in either group. To avoid the risk of under-estimating the presence of osteoclasts, the number of osteoclasts was considered to be <1 in each sample, and the osteoclast density was calculated. The osteoclast densities in both the cholesteatoma and control groups were significantly lower than the sex- and age-matched standard value of the normal iliac cortical bone (p = .028).

Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media

Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management. PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science. A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic. From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit. Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.

Staining in Tympanoplasty: Is Methylene Blue Rational?

ABSTRACT Objective Is there any advantages of using methylene blue in myringoplasty? To compare the results of methylene blue stained temporalis fascia graft with unstained temporalis fascia graft in underlay myringoplasty. Materials and methods In this prospective study, 120 patients of either sex in age group of 15 to 50 years with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited. Patients were initially managed medically to make the ear dry and after that they were operated upon. Sixty patients underwent underlay myringoplasty using methylene blue stained temporalis fascia graft and 60 patients underwent underlay myringoplasty using unstained temporalis fascia graft. Follow-up period was at least 6 months. Results Graft uptake and hearing improvement was comparable in both groups. Although there was 10% higher graft uptake using methylene blue stained temporalis fascia (95%) as compared to unstained temporalis fascia graft (85%), however the difference was not statistically significant (p = 0.5). But there was statistically significant difference in gain in hearing threshold (gain in air-bone gap) in the myringoplasty using methylene blue stained temporalis fascia graft (18 dB ± 7.156) as compared to myringoplasty using unstained temporalis fascia graft (13.7 dB ± 5.70814) (p = 0.04). Conclusion Methylene blue use in myringoplasty allows improved identification of the graft, can be very helpful for trainee residents and reduce the time of a graft placement. Also, methylene blue as an antioxidant and antimicrobial properties, prevents degradation and lysis of fascia graft, improves the overall success rate of graft uptake with no adverse effects. How to cite this article Kathuria B, Dhingra H, Gulia J, Kakkar V, Yadav SPS, Hernot S, Bishnoi S. Staining in Tympanoplasty: Is Methylene Blue Rational? Int J Otorhinolaryngol Clin 2015;7(3):125-131.

Osteoclasts are not activated in middle ear cholesteatoma.

It is unclear whether osteoclasts are present and activated in cholesteatomas. We explored the expression of messenger RNA (mRNA) for osteoclast biomarkers and regulating factors in middle ear cholesteatomas to elucidate the level of osteoclast activity in this disease. Bone powder was collected from 14 patients with cholesteatomatous and noncholesteatomatous chronic otitis media during tympanomastoidectomy, separately from cortical bone of the mastoid (clean bone powder), from bone neighboring cholesteatoma (cholesteatomatous bone powder), and from bone of the air cells and antrum of noncholesteatomatous chronic otitis media patients (noncholesteatomatous bone powder). The samples collected were soaked in TRIzol reagent, and total RNA was extracted and purified by the acid guanidinium thiocyanate-phenol-chloroform method, followed by the use of magnetic bead technology. The sample was then subjected to quantitative reverse transcription polymerase chain reaction for receptor activator of nuclear factor κB (RANK), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CTSK), osteoclast-associated receptor (OSCAR), calcitonin receptor (CALCR), matrix metalloproteinase9 (MMP9), receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin (OPG). There was no significant difference in the expression of TRAP, CTSK, OSCAR, CALCR, MMP9, or OPG among the clean, cholesteatomatous, and noncholesteatomatous bone powder. On the other hand, the expression of RANK and RANKL was significantly lower in the cholesteatomatous bone powder than in the noncholesteatomatous bone powder (P=0.003 and P=0.028, respectively). The RANKL mRNA/OPG mRNA ratio did not differ among the three samples. These results indicate that osteoclasts are unlikely to be activated in cholesteatomas. Bone resorption mechanisms not mediated by osteoclasts may need to be reappraised in cholesteatoma research in future studies.

To evaluate and compare the results of over-underlay graft technique with conventional underlay myringoplasty

Objective: To evaluate the efficacy of over-underlay graft technique of myringoplasty and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Methods: In this prospective study, 40 patients of either sex in the age group of 15–50 years with noncholesteatomatous chronic suppurative otitis media were recruited. The patients were initially managed medically to make the ear dry and after that they were operated upon. Twenty patients underwent conventional underlay myringoplasty and 20 patients underwent over-underlay myringoplasty. The follow-up period was 3 months. Results: Graft uptake and hearing improvement was comparable in both groups. Although the graft uptake was 5% lower in the group which underwent conventional underlay myringoplasty (90%) as compared to over-underlay myringoplasty (95%), however, the difference was not statistically significant (P = 0.5). However, there was statistically significant difference in gain in hearing threshold (gain in A-B gap) in the conventional underlay myringoplasty (14.5 dB ± 7.236) as compared to over-underlay myringoplasty (18.75 dB ± 5.349) (P = 0.04). Conclusion: The over-underlay technique, which is a hybrid of both overlay and underlay technique, allows the advantages of both methods. It improves the graft uptake rate and hearing in subtotal and large perforations.

Sklerotik mastoid kemiğe sahip kronik otitis medialı hastalarda tip 1 timpanoplasti: Anatomik ve fonksiyonel sonuçlar

Objective: To evaluate success of tympanoplasty type 1 in the treatment of patients with sclerotic mastoid bone. Methods: A retrospective study where 92 patients with non-cholesteatomatous chronic suppurative otitis media were recruited during the period of 2010 to 2012. Patients were managed medically and after dryness of their perforations they were operated upon. Ninety-two patients underwent type 1 tympanoplasty alone without cortical mastoidectomy. Underlay technique with chondroperichondrial graft was performed for all patients. Results: Mean air-bone gap values were estimated and compared. In pre- and postoperative audiograms, air-bone gap values at 500, 1000, 2000 and 4000 Hz frequencies were determined. Pre- and postoperative mean air-bone gap values of the patients were 23.47±4.95 and 11.58±4.77 dB, respectively. Conclusion: Our study emphasizes the fact that overall satisfactory hearing outcome with adequate air-bone closure can be achieved irrespective of cortical mastoidectomy in the surgical treatment of noncomplicated chronic ear diseases.

Comparison of early hearing outcomes of type 2 ossiculoplasty using hydroxyapatite bone cement versus other materials

ObjectivesTo compare the hearing outcomes of type 2 ossiculoplasties for erosion of the long process of the incus according to the reconstruction material used: cartilage, ossicles, hydroxyapatite (HAP) partial ossiculoplasty reconstruction prostheses (PORP), titanium PORP, and HAP cement. Complications related to cement reconstruction were systematically investigated and reported. Material and methodsSeventy patients operated between 2007 and 2011 for non-cholesteatomatous chronic otitis media were included in this study. Mean air-bone gap (500, 1000, 2000 and 4000Hz) was compared preoperatively and 3 months postoperatively according to the reconstruction material used. Postoperative results were classified as good (air-bone gap<10dB), acceptable (air-bone gap 10–20dB) or insufficient (air-bone gap>20dB) and were compared according to the reconstruction material used. ResultsGroups were comparable in terms of preoperative air-bone gap (P>0.05, Anova). The mean postoperative air-bone gap was 14.82±11.52dB in the cartilage group, 13.31±9.03dB in the ossicles group, 22.12±11.95dB in the HAP PORP group, 13.75±11.20dB in the titanium PORP group, and 7.26±8.99dB in the HAP cement group. Statistical analysis showed a significant air-bone gap difference only between HAP PORP and HAP cement groups (P=0.021, Tukey's test). No significant difference was observed between groups when classified by air-bone gap class (P=0.29, Fisher's test). No major complication was reported with HAP cement with a minimum follow-up of 10 months. ConclusionHAP cement provides similar hearing outcomes to autologous material and titanium PORP, and better outcomes than HAP PORP in our patients. These results must be confirmed in a larger series with a longer follow-up.