A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty

OBJECTIVES

The aim of this study was to evaluate the effects of smoking and other prognostic factors on long-term surgical outcome and hearing results in myringoplasty.

DESIGN

Retrospective cohort.

SETTING

Tertiary medical centre.

PARTICIPANTS

Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Ataturk Training and Research Hospital, using the chi-squared test, Fisher's exact test, t-test and multiple logistic regression statistical analysis.

MAIN OUTCOME MEASURES

The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients' files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day.

RESULTS

The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non-smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8).

CONCLUSIONS

A non-smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.

Viability of crushed and diced cartilage grafts wrapped in oxidized regenerated cellulose and esterified hyaluronic acid: an experimental study

OBJECTIVES

The objective of this study was to investigate the viability of diced/crushed cartilage grafts wrapped in esterified hyaluronic acid (HYAFF) and oxidized regenerated cellulose (Surgicel) with respect to macroscopic and microscopic parameters.

STUDY DESIGN

Experimental study.

METHODS

A total of 10 New Zealand rabbits were acquired for the study. Cartilage grafts were harvested from both ears, with the ventral and dorsal perichondrial layers dissected off. There were six comparison groups in this experimental study: 1) bare, diced cartilage, 2) diced cartilage wrapped in Surgicel, 3) diced cartilage wrapped in HYAFF, 4) bare, crushed cartilage, 5) crushed cartilage wrapped in Surgicel, 6) crushed cartilage wrapped in HYAFF. Six cartilage grafts were inserted into the six subcutaneous pockets of the same animal. All the rabbits were sacrificed at the end of 2 months, the samples were collected, and the total specimen was examined histopathologically. The sections were stained with hematoxylin-eosin and Masson trichrome stain and examined under light microscopy.

RESULTS

There was a significant difference among the bare, diced cartilage, the Surgicel, and the HYAFF groups with respect to fibrosis, chronic inflammation, cartilage mass, and vascularization. A significant difference was observed among the bare, crushed cartilage, Surgicel, and HYAFF groups with respect to fibrosis, chronic inflammation, and cartilage mass. There was no significant difference among the three groups regarding vascularization.

CONCLUSIONS

This study suggests that wrapping cartilage grafts with Surgicel grossly reduces cartilage viability and the regeneration potential of the chondrocytes, leading to fibrosis formation. On the other hand, hyaluronic acid promotes cartilage integrity and survival, thus increasing clinical predictability and avoiding the need for overcorrection.

Prevalence of Otitis Media with Effusion among Primary School Children in Eastern Black Sea, in Turkey and the Effect of Smoking in the Development of Otitis Media with Effusion

The aim of this study was to determine the prevalence of otitis media with effusion (OME) in primary school children in Rize (Eastern Black Sea Region) and the impact of tobacco smoke exposure in the development of OME in primary school children. This study involved a total of 2960 children who appeal for ENT examination to our department at Rize Training and Research Hospital between November 2007 and April 2009. All children were evaluated with regard to OME and exposure to cigarette smoke. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed with OME by otoscopic examination. The association between the children diagnosed as OME and exposure to cigarette smoke was evaluated. The prevalence of OME in this study was 9.86% (292/2960). Exposure to cigarette smoke was a statistically significant factor in development of OME (P < 0.0001). Environmental factors such as smoking are important in the development of OME. To prevent delayed diagnosis or development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of OME.

The Perioperative Utilization of Sleep Monitoring Applications on Smart Phones in Habitual Snorers With Isolated Inferior Turbinate Hypertrophy

The aim of this study is to investigate the novel use of sleep monitoring applications in simple snorers undergoing concha radiofrequency surgery and to compare and correlate the pre- and postoperative symptoms of these patients using the Nasal Obstruction Symptom Evaluation (NOSE) scale. In this retrospective analysis, we have selected 18 consecutive patients with no comorbid sleep or medical disorders suffering from chronic nasal blockage and habitual snoring due to isolated submucous inferior turbinate hyperplasia. After a median follow-up of 8.3 months, the NOSE scale and snoring sound intensity levels monitored by the smart phone application showed statistically significant improvements after the surgical procedure ( P < .05), and we also detected a positive correlation between the levels of snoring percentage and the total NOSE scores ( P < .05). We hypothesize that sleep monitoring applications could be easily used as portable monitors for basic home sleep studies in conjunction with a comprehensive sleep evaluation. Alternatively, such applications may simply be used for objective monitoring of the postoperative success of surgical interventions in the upper respiratory tract region such as concha reduction surgeries as presented herein.

Pleomorphic adenoma of the upper lip

We present a rare case of pleomorphic adenoma in the upper lip region, with erosion of the maxillary bone and distortion of the facial appearance. A 20-year-old man presented with a painless mass on his upper lip, which had gradually increased in size over a period of 2 years. Computed tomography demonstrated a 30 mm × 28 mm enhancing mass in the upper lip region with no invasion to the surrounding tissues. Erosion of the maxillary bone posterior to this lesion was noted. The lesion was excised completely with a wedge of mucosa overlying the tumoral mass, accompanied with abdominal fat grafting to prevent labial asymmetry. Histological examination confirmed the diagnosis of a minor salivary gland pleomorphic adenoma in the upper lip. The pathology, clinical manifestations, and treatment of intraoral pleomorphic adenomas are reviewed.

Changing trends in otorhinolaryngology publishing

The aim of this study is to compare the changes in impact factors and citation numbers of Open Access (OA) vs subscription-based (SB) journals between 1999 and 2016 and to explore the changing trends in ORL publishing. All data extracted from SCImago Journal and Country ranking (SJR) website have been used as input for statistical analysis. The chi-square test of independency was applied in order to understand whether the ratio of number of OA journals of ORL category have dramatically changed between years 1999 and 2016. Also, the years and impact factors of journals belonging to the OA and SB journals have been graphed separately and the changes of annual SJR ranks of both journal types have been compared using one-way Z-test. There was a significant difference as the proportion of OA Journals were not equal to the proportion of SB Journals throughout the years 1999 and 2016, and it showed the tendency to increase greater compared to SB Journals (p < 0.01). Although the overall level of impact factors of SB journals was generally high, by comparing two regression models, it was obvious that the level of increase of the impact factors of OA journals were significantly higher (p < 0.01). When choosing where to publish, it is important to consider the journal’s visibility, cost of publication, IF or SJR of the journal and speed of publication as well as changing trends in medical publishing nourished by the Web of Science.

Does intratympanic xylitol administration have ototoxic effects in a mouse ear model?

OBJECTIVE

To research the ototoxicity of xylitol after intratympanic injection in mice ear model.

METHODS

24 female mice Balb/c mice (48 ears) included in the study. The mice were divided into 4 groups as 6 mice were found (12 ears) in each group. Solutions of 0.9% NaCl solution (Group A), 155 mg/ml (Group B), 310 mg/ml (Group C) and 620 mg/ml (Group D) xylitol, were applied into the middle ear cavity. Microscopic ear examination and auditory brainstem response test were done for each mouse before application of xylitol and on the 1st, 3rd and 10th day of injection.

RESULTS

There are some statistically significant alterations found in the threshold values at 8000, 12000, 16000, 24000 Hz frequencies when each group were compared in itself on day 0, 1,3 and 10, which were independent from the increasing dosage.

CONCLUSION

According to our findings intratympanic xylitol injection does not have any ototoxic effect in the inner ear. To evaluate the effects of xylitol more clinical studies are need to carried out.