Microbiome and Culture Based Analysis of Chronic Rhinosinusitis Compared to Healthy Sinus Mucosa

The role of bacteria in chronic rhinosinusitis (CRS) is still not well understood. Whole microbiome analysis adds new aspects to our current understanding that is mainly based on isolated bacteria. It is still unclear how the results of microbiome analysis and the classical culture based approaches interrelate. To address this, middle meatus swabs and tissue samples were obtained during sinus surgery in 5 patients with CRS with nasal polyps (CRSwNP), 5 patients with diffuse CRS without nasal polyps (CRSsNP), 5 patients with unilateral purulent maxillary CRS (upm CRS) and 3 patients with healthy sinus mucosa. Swabs were cultured, and associated bacteria were identified. Additionally, parts of each tissue sample also underwent culture approaches, and in parallel DNA was extracted for 16S rRNA gene amplicon-based microbiome analysis. From tissue samples 4.2 ± 1.2 distinct species per patient were cultured, from swabs 5.4 ± 1.6. The most frequently cultured species from the swabs were Propionibacterium acnes, Staphylococcus epidermidis, Corynebacterium spp. and Staphylococcus aureus. The 16S-RNA gene analysis revealed no clear differentiation of the bacterial community of healthy compared to CRS samples of unilateral purulent maxillary CRS and CRSwNP. However, the bacterial community of CRSsNP differed significantly from the healthy controls. In the CRSsNP samples Flavobacterium, Pseudomonas, Pedobacter, Porphyromonas, Stenotrophomonas, and Brevundimonas were significantly enriched compared to the healthy controls. Species isolated from culture did not generally correspond with the most abundant genera in microbiome analysis. Only Fusobacteria, Parvimonas, and Prevotella found in 2 unilateral purulent maxillary CRS samples by the cultivation dependent approach were also found in the cultivation independent approach in high abundance, suggesting a classic infectious pathogenesis of odontogenic origin in these two specific cases. Alterations of the bacterial community might be a more crucial factor for the development of CRSsNP compared to CRSwNP. Further studies are needed to investigate the relation between bacterial community characteristics and the development of CRSsNP.

[Inpatient vs. outpatient costs analysis of septumplasty in Germany]

The septumplasty is realized inpatient and outpatient in different countries. Caused by the pressure of reduction of expenses there is the question of the economic benefit if done outpatient in Germany. A comparison of the inpatient and outpatient gratification will be done. There is a yearly potential of cost reduction of 180 million euro, if the operation would be done as an outpatient procedure. From the hospital view actual there is no economical recommendation doing an outpatient septumplasty caused by the poor outpatient remuneration. That's why an adjustment of the outpatient remuneration should be done. Actual there is no medical or economical recommendation doing the septumplasty as an outpatient procedere.

Conservative management of post-intubation tracheal tears-report of three cases

Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.

Distribution of circulating natural killer cells and T lymphocytes in head and neck squamous cell carcinoma

OBJECTIVE

Natural killer (NK) cells are capable of eliminating malignantly transformed cells without prior sensitization. In contrast to NK-cells, T lymphocytes possess antitumourous activity that is restricted to major histocompatibility complex (MHC) recognition. The aim of this study was to determine the causes of the different distributions of these cell types in the peripheral blood of patients with head and neck squamous cell carcinomas (HNSCC).

METHODS

A cohort of 105 subjects was divided into three clinical groups: non-treated HNSCC patients, treated relapse-free HNSCC patients and healthy control subjects. Peripheral blood mononuclear cells (PBMC) were isolated from venous blood, subsets were depleted, flow cytometric counts were made and subsequently correlation analyses with clinical parameters were performed.

RESULTS

Treated relapse-free HNSCC patients have a significantly increased mean proportion of NK-cells in PBMC of 26.39% (p<0.001), whereas T lymphocytes and natural killer-T-(NKT) cells of treated patients have a significantly decreased mean proportion in PBMC of 55.15% (p<0.05) at least 12 months after treatment. This inverse redistribution of these two subsets is reflected in a significantly increased mean NK/T-ratio of 0.54 (p<0.05) in treated patients. The NK/T-ratio correlates with the systemic invasiveness of the type of therapy patients undergo and is highest after surgery with adjuvant radiochemotherapy (0.64, rs=0.334, p<0.01). This appears to be a post-therapeutic long-term effect in treated patients, as they had a mean relapse-free period until venous puncture of 47.9 months in our study. We also demonstrated age-dependent changes in the peripheral distribution of T- and NK-cells.

CONCLUSION

These findings reveal new aspects in understanding tumour biology and interactions with the cellular immune system which provide novel starting points for further research.

Taste function after stapes surgery

OBJECTIVE

A manipulation of chorda tympani nerve (CTN) is frequently necessary during the surgical therapy of stapedial ankylosis. The aim of this study was to re-assess the taste function before and after stapes surgery in patients with unilateral stapes ankylosis.

METHODS

Eighteen patients (14 female and 4 male) with unilateral stapedial ankylosis were included. Taste and olfactory function were measured preoperatively, 3 days and 3 months after surgery by questionnaire, chemical taste test, electrogustometry, and Sniffin'Sticks. The patients who reported deterioration in taste and revealed pathological taste test results were re-investigated 8-12 months after surgery. Postoperatively 11 patients were treated intravenously for 3 days for inner ear protection with 1g of cortisone. The gustatory and olfactory results were compared with age and sex specific normative data.

RESULTS

A significant transient decrease of gustatory measurement values was found on the ipsilateral two thirds of the anterior tongue. 12 out of 17 patients whose CTN was slightly manipulated during stapes surgery reported tongue sensations, such as numbness or gustatory blindness of the ipsilateral tongue side. The measures of chemical taste test significantly decrease in lateralized taste test on the ipsilateral side and in whole mouth testing. There was no significant increase of the EGM measures at the ipslateral tongue. In 11 of 12 patients with symptoms, complaints recovered within one year after surgery completely. The factor "cortisone" did not have a significant effect on the taste test results after surgery.

CONCLUSION

In conclusion, even after minor CTN manipulation the rate of postoperative taste disorders or tongue symptoms after stapes surgery is high. The symptoms appear to be transient. Therefore CTN should be preserved in stapes surgery after mild trauma of the CTN. Transient taste alteration should be mentioned prior to stapes surgery.

Effect of the stapedotomy technique on early post-operative hearing results--Preliminary results

OBJECTIVE

To compare three stapedotomy modalities used to fenestrate the stapes footplate in patients with primary otosclerosis.

MATERIALS

The non-randomized and unblinded one-center study included 48 patients with primary otosclerosis who underwent stapes surgery between May 2008 and April 2009. The patients were divided into three groups (single shot and two-shot CO(2) laser stapedotomy, perforator) depending on the modality used for stapedotomy. Bone conduction (BC) and air conduction (AC) thresholds, air-bone gap (ABG), and the difference between mean pre-operative and 2- to 3-week post-operative BC thresholds were analyzed.

RESULTS

The temporary BC deterioration was most pronounced at 6 and 8kHz after 2-shot laser stapedotomy. A significant drop in AC or BC was not found in any of our 48 patients. Age, high-dose cortisone therapy, and 'preoperative hearing' did not influence the post-operative hearing results.

CONCLUSION

Even though the number of patients presented here was small and statistical analysis was limited, the study showed a trend toward worse BC thresholds at 6 and 8kHz after a second shot CO(2) application. Whenever possible, treatment should avoid a second laser shot on the already opened inner ear with the laser parameters used for the initial shot.