Ear candles: a triumph of ignorance over science

Ear candles are hollow tubes coated in wax which are inserted into patients’ ears and then lit at the far end. The procedure is used as a complementary therapy for a wide range of conditions. A critical assessment of the evidence shows that its mode of action is implausible and demonstrably wrong. There are no data to suggest that it is effective for any condition. Furthermore, ear candles havebeen associated with ear injuries. The inescapable conclusion is that ear candles do more harm than good. Their use should be discouraged.

Inhibition of procollagen C-proteinase reduces scar hypertrophy in a rabbit model of cutaneous scarring

Hypertrophic scarring, which results from excessive collagen deposition at sites of dermal wound repair, can be functionally and cosmetically debilitating to the surgical patient. Pharmacological regulation of collagen synthesis and deposition is a direct approach to the control of scar tissue formation. One of the key steps in collagen stabilization is the cleavage of the C-terminal propeptide from the precursor molecule to form collagen fibrils, a reaction catalyzed by procollagen C-proteinase (PCP). We tested the ability of a PCP inhibitor to reduce hypertrophic scar formation in a rabbit ear model. After the placement of four, 7-mm dermal wounds on each ear, New Zealand white rabbits received PCP inhibitor subcutaneously in the left ear at four time points postwounding: days 7, 9, 11, 13 (early treatment; n=20 wounds) or days 11, 13, 15, 17 (late treatment; n=20 wounds). The right ear of each animal served as a control (vehicle alone). Wounds were harvested on postoperative day 28 and scar hypertrophy quantified by measurement of the scar elevation index. Early treatment of wounds with PCP inhibitor did not reduce scar formation compared with controls (p>0.05). However, late treatment resulted in a statistically significant reduction in the scar elevation index (p<0.01). Our results point not only to the potential use of PCP inhibitors to mitigate hypertrophic scarring but also to the temporal importance of drug delivery for antiscarring therapy.

[Replantation of traumatic amputated ears by Mladick procedure: 6 cases]

Traumatic ear amputations are relatively rare. Whenever possible, ear reimplantation should be attempted, however the choice of the surgical procedure must be judicious.

PATIENTS AND METHODS

We present 6 cases of partial ear amputation treated by the pocket technique described by Mladick. The series comprises 5 partial amputations severing less than half of the auricule and 1 subtotal amputation preserving the ear lobule.

RESULTS

Necrosis of the avulsed fragment occurred in the only case of subtotal amputation. In the 5 other cases the revascularisation of the severed part was successful. Morphological results are often very good when the ear is freed from the pocket before 4 weeks. Beyond this delay skin grafting is necessary and inaesthetic scar retraction occurs.

CONCLUSION

The success rate depends on the size and the degree of contusion of the amputated ear. We recommend the Mladick's procedure for reimplantation of fragments less than 1/2 of the auricle with favorable tissue condition. We believe that other procedures described in the literature could offer a good alternative for amputations exceeding half of the ear pavilion.

Effect of extracts from the Chinese and European mole cricket on wound epithelialization and neovascularization: in vivo studies in the hairless mouse ear wound model

Until the end of World War II, oily extracts from the European mole cricket, Gryllotalpa gryllotalpa Linné, were used for treating nonhealing wounds and burns. In traditional Chinese medicine, extracts from the Chinese mole cricket, Gryllotalpa africana Beauvois, have been used to treat boils, abscesses, and ulcers successfully for over two centuries and are still being used today. The aim of this study was twofold: first, to measure the effect mole cricket extracts have on wound epithelialization and neovascularization, and second, to identify the active compounds in the Chinese and German mole cricket extracts. For the first aim, the hairless mouse ear wound model was used. The findings showed that wounds treated with the mole cricket extracts epithelialized significantly faster than control wounds 12.7+/-0.9 and 13.2+/-1.4 days vs. 16.3+/-2.2 days (mean+/-SD, p<0.05), respectively. While the rate of wound neovascularization was significantly increased in the first 3 days postwounding from that point on, the rate in treated wounds was the same as in controls. To identify the active compounds in the mole cricket extracts, the extracts were fractionated and tested in a foreskin basal keratinocyte cell culture assay. In this assay, the migration of keratinocytes is similar to skin cell migration or reepithelialization in a healing wound. Using this method, we found the active compound in the mole cricket extracts to be linoleic acid methyl ester. All other fatty acid structures that were isolated were found to be inactive.

Antifibrogenic effects of liposome-encapsulated IFN-alpha2b cream on skin wounds in a fibrotic rabbit ear model

This study was conducted to assess the ability of a dermal cream containing liposome-encapsulated interferon- alpha2b (IFN-alpha2b) (LIPO+IFN) to improve hypertrophic scarring in open and reepithelialized dermal wounds in a rabbit fibrotic ear model. Full-thickness skin wounds were made in New Zealand white rabbits, and were either left untreated, treated on day 16 postsurgery (open wound), or treated on day 23 postsurgery (reepithelialized wound) with either LIPO+IFN or liposome alone (LIPO). The conditions of the wounds were monitored until day 35 postsurgery, when hypertrophic scar formation reached its peak. Dry wound weight, scar thickness, hypertrophic index (HI), and tissue cellularity of treated and untreated wounded tissue samples were evaluated as an index for scar formation. The results of this study showed that reepithelialized wounds treated with LIPO+IFN and to a lesser extent with LIPO alone were reduced in thickness, HI, and cellularity compared with untreated control wounds or LIPO+IFN-treated open wounds. Dry wound weight was also reduced but not significantly. The findings of this study suggest that LIPO+IFN is more effective than using LIPO alone in reducing the scar formation in a rabbit fibrotic ear model. Further investigation is required to confirm these results.

New quantitative trait loci that regulate wound healing in an intercross progeny from DBA/1J and 129 x 1/SvJ inbred strains of mice

Wound healing/regeneration mouse models are few, and studies performed have mainly utilized crosses between MRL/MPJ (a good healer) and SJL/J (a poor healer) or MRL/lpr (a good healer) and C57BL/6J (a poor healer). Wound healing is a complex trait with many genes involved in the expression of the phenotype. Based on data from previous studies that common and additional quantitative trait loci (QTL) were identified using different crosses of inbred strains of mice for various complex traits, we hypothesized that a new cross would identify common and additional QTL, unique modes of inheritance, and interacting loci, which are responsible for variation in susceptibility to fast wound healing. In this study, we crossed DBA/1J (DBA, a good healer) and 129/SvJ (129, a poor healer) and performed a genome-wide scan using 492 (DBA x 129) F2 mice and 98 markers to identify QTL that regulate wound healing/regeneration. Four QTL on chromosomes 1, 4, 12, and 18 were identified which contributed toward wound healing in F2 mice and accounted for 17.1% of the phenotypic variation in ear punch healing. Surprisingly, locus interactions contributed to 55.7% of the phenotype variation in ear punch healing. In conclusion, we have identified novel QTL and shown that minor interacting loci contribute significantly to wound healing in DBA x 129 mice cross.

Transdermal Sustained-Delivery Oxygen Improves Epithelial Healing in a Rabbit Ear Wound Model

HYPOTHESIS

Transdermal sustained-delivery oxygen therapy improves wound healing.

DESIGN

Experimental study using a well-established rabbit ear model for acute wound healing.

SETTING

Wound-healing research laboratory in a university center.

METHODS

Four full-thickness 7-mm punch wounds were created on each ear of young, female New Zealand white rabbits. Treated ears received transdermal sustained delivery of oxygen via silicone tubing tunneled subcutaneously to a pocket under a semiocclusive dressing. Oxygen production (100% oxygen at 3 mL/h continuously) relied on a small, self-contained device connected to the silicone tubing and secured to the rabbit's back for the duration of the experiment using a body harness. Ears were harvested at each of 2 time points: day 5 and day 8.

RESULTS

Histologic analysis of the wounds showed significantly greater healing at both day 5 and day 8 in response to oxygen therapy. Most significantly, epithelial wound coverage was almost doubled in treated ear wounds when compared with controls.

CONCLUSION

Our results suggest that epithelial wound healing is improved by transdermal sustained-delivery treatment with 100% oxygen.

Prior injury accelerates subsequent wound closure in a mouse model of regeneration

Tissue regeneration and scarless healing involves the complete replacement and functional restoration of damaged organs and tissues. In this study of the "scarless healing" MRL mouse model, we demonstrate that 2-mm diameter through-and-through holes made in the cartilaginous part of previously injured MRL mouse ears are closed more efficiently, and that the regenerative repair response is significantly accelerated compared with unprimed MRL and control "nonhealer" strains of mice. Accelerated healing was detected both locally and distally from the original site of injury indicating the involvement of systemic components such as circulating cell types or soluble factors. Histologically, we observed early differences during the wound repair process (before Day 4 post injury) with accelerated formation of blastema-like structures, epidermal downgrowths, and enhanced epithelium thickening in wound border zones in primed MRL mice versus unprimed MRL mice. Although the mechanism of tissue regeneration remains unclear, the results from this study justify the use of the MRL model for further experimentation directed toward the identification of proteins and cell types capable of stimulating scarless tissue regeneration.

Otologic blast injuries due to the Kenya embassy bombing

Otologic injuries are frequently associated with large blasts. On August 7, 1998, a large truck bomb exploded next to the U.S. Embassy in Nairobi, Kenya. Initial patient findings and care are reviewed. Five months later, an otologic screening and care mission was then sent to comprehensively screen all remaining blast victims on site in Nairobi and to determine degree of persistent injury. Surgical care appropriate for an outpatient environment was provided. Five of 14 tympanic membranes without intervention failed to heal, while 3 of 3 with previous intervention had. Blast injury severity did not correlate to distance from blast epicenter. This may be due to channeling of the blast through the embassy building and an unpredictable pattern of blast overpressure within the building. It is recommended that comprehensive otologic screening be performed after blast events to identify occult injuries and improve outcomes. Early intervention for tympanic membrane perforation (suctioning, eversion of perforations, and paper patch) is recommended.

Rapid, accurate and non-invasive detection of cerebrospinal fluid leakage using combined determination of β-trace protein in secretion and serum

BACKGROUND

beta-Trace protein (Btp) has been proposed as a valuable marker of cerebrospinal fluid (CSF) leakage overcoming the drawbacks of beta-2-transferrin (B-2Tr) determination. However, there is still controversy about the appropriate cut-offs to be used (range 0.35-6 mg/L). The aim of the study was to evaluate cut-offs of Btp determination for detection CSF leakage. Further, we assessed whether the Btp secretion to serum ratio (Btp-sec/ser-ratio) would add diagnostic value.

METHODS

Prospective study in patients with suspected CSF leakage. Quantitative determination of Btp in secretion and serum (Dade-Behring) and qualitative measurement of B-2-Tr in secretion and serum. Results were assessed in view of clinical data. Cut-offs and diagnostic characteristics were determined by ROC analysis.

RESULTS

A total of 176 samples were assessed originating from 105 patients. In 43 samples CSF leakage could be confirmed. Sensitivity of B-2-Tr was 84%, specificity amounted to 100%. The area under the curve (AUC) for Btp-measurement in secretion was 0.98. At a cut-off of 0.68 mg/L, sensitivity was 100% and specificity 91%. At a cut-off of 1.11 mg/L, the specificity was 100% with a sensitivity of 93%. The Btp-sec/ser-ratio has an AUC of 0.99. Combining a 0.68 mg/L cut-off in secretion with a Btp-sec/ser-ratio cut-off of 4.9 reveals a sensitivity of 99% and a specificity of 100%.

CONCLUSIONS

Btp is a rapid and accurate marker for the presence of CSF leakage. Combining measurement of Btp in secretion together with determination of the Btp-sec/ser-ratio enhances the diagnostic characteristics of the Btp assay. Determination of Btp in both serum and secretion is thus recommended.

Ear nose and throat injuries in children

BACKGROUND

This study was carried out to determine types and mechanisms of injuries encountered in Ear, Nose and Throat (ENT) regions of children at two localities of NWFP province of Pakistan.

METHODS

This study was carried out at ENT departments of DHQ Hospital, Swabi and Khyber Teaching Hospital, Peshawar, Pakistan from June 2001 to June 2003. Children up to age 15 years presenting in emergency with ENT injuries or reporting at OPDs were included in the study.

RESULTS

160 children reported with injuries to ENT in this 2 years period. Most of the injuries were in the nasal region (50%) and nasal bone fracture was the commonest (26%). Fall and trauma during playing were the mode of injuries. In children of less than 5 years, the commonest cause of injury was pointed objects in the mouth while in children between 5-10 years the cause was fall. In children of 10-15 years of age the common causes of injury were road traffic accidents (270%) and fall (23 %M).

CONCLUSION

It is concluded that injuries of ENT in children are different than in adults. The mechanism of these injuries is also different.

Barotrauma

Barotrauma is pressure-induced injury. The application of direct pressure to the body may cause trauma, including positive pressure from artificial ventilation. Trauma may also be caused by the effects of pressure changes on gas-containing body spaces, not in communication with the environment. This can include the external ear, the middle ear (and, indirectly, the inner ear), the para-nasal sinuses, the lungs, the gut, and abscess cavities (for example, in the teeth). Gas may penetrate tissues adjoining the affected space (such as the anterior cranial fossa, via the ethmoid sinus), or may embolise via the blood stream. The most severe expression of this is cerebral arterial gas embolism, which may present as a stroke. The management of these problems includes prevention, the use of pressure-equalizing techniques, vasoconstrictor drugs, surgery, and hyperbaric oxygen therapy.

Spallanzani's mouse: a model of restoration and regeneration

The ability to regenerate is thought to be a lost phenotype in mammals, though there are certainly sporadic examples of mammalian regeneration. Our laboratory has identified a strain of mouse, the MRL mouse, which has a unique capacity to heal complex tissue in an epimorphic fashion, i.e., to restore a damaged limb or organ to its normal structure and function. Initial studies using through-and-through ear punches showed rapid full closure of the ear holes with cartilage growth, new hair follicles, and normal tissue architecture reminiscent of regeneration seen in amphibians as opposed to the scarring usually seen in mammals. Since the ear hole closure phenotype is a quantitative trait, this has been used to show-through extensive breeding and backcrossing--that the trait is heritable. Such analysis reveals that there is a complex genetic basis for this trait with multiple loci. One of the major phenotypes of the MRL mouse is a potent remodeling response with the absence or a reduced level of scarring. MRL healing is associated with the upregulation of the metalloproteinases MMP-2 and MMP-9 and the downregulation of their inhibitors TIMP-2 and TIMP-3, both present in inflammatory cells such as neutrophils and macrophages. This model has more recently been extended to the heart. In this case, a cryoinjury to the right ventricle leads to near complete scarless healing in the MRL mouse whereas scarring is seen in the control mouse. In the MRL heart, bromodeoxyuridine uptake by cardiomyocytes filling the wound site can be seen 60 days after injury. This does not occur in the control mouse. Function in the MRL heart, as measured by echocardiography, returns to normal.

[Clinico-audiological characteristics of the patients with acute injury of the ear]

Three hundred patients with an acute injury of the ear were examined. It was found that such injuries inflict damage on various structures of the middle and internal ear. Therefore, it is necessary in such cases to conduct a comprehensive audiological examination of hearing for posttraumatic neurosensory hypoacusis to administer early rehabilitation. Audiology is especially indicated if impairment of labyrinthine windows is suspected.

Types and causes of otorrhea

INTRODUCTION

Otorrhea is a common symptom and sign of patients seeking examination in an ENT Department of a General Hospital. The objective of this review is to assess the cause of otorrhea according to the type of it.

METHODS

Retrospective review of 306 ears discharging some kind of fluid of 296 patients, who appeared in the ENT Department of our Hospital over a 58-month period.

RESULTS

The most common type of otorrhea was the purulent one: 276 ears among 306 discharging ears (90%). The most common cause of purulent otorrhea was otitis externa: 156 ears among 276 ears discharging purulent fluid (56%). The germ most commonly isolated in the cultures of purulent aural discharge was Pseudomonas aeruginosa: 67 isolations of P. aeruginosa among 256 cultures (26%).

CONCLUSIONS

Otomicroscopic examination and accurate culture of purulent discharge are mandatory for the clinician to establish a correct diagnosis and suggest a proper therapy in every case of otorrhea.

Otorhinolaryngological problems occurring within the intensive care unit

OBJECTIVE

An overview of common otorhinolaryngological (ORL) problems and procedures in the intensive care unit (ICU) is presented.

FOCUS

Diagnostic, management, and treatment aspects of some conditions are discussed with emphasis on the potential difficulties encountered in the ICU. Approach recommendations are outlined as well as a list of required basic equipment.

CONCLUSIONS

Otorhinolaryngology should be included in intensive care continuing medical education programs.

Matrix metalloproteinase activity correlates with blastema formation in the regenerating MRL mouse ear hole model

The MRL mouse was proposed as a model of mammalian regeneration because it can close ear holes completely with the restoration of normal tissue. This regeneration process involves the formation of a blastema during healing, the re-appearance of cartilage and hair follicles, and healing without scarring. Such a process requires extensive tissue remodeling. To characterize differences in ear wounding responses between regenerating and nonregenerating mice, we examined and compared the extracellular matrix remodeling and the matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) response in the MRL and C57BL/6 mouse strains after injury. We found a correlation between the MRL's ability to break down the basement membrane, form a blastema, and close ear hole wounds and an inflammatory response with neutrophils and macrophages seen in the ear after injury. These cells were positive for MMP-2 and MMP-9 as well as TIMP-2 and TIMP-3. Clear differences between the MRL and B6 response to injury were seen that could explain the differences in healing and blastema formation in the MRL and lack of it in the B6 mice. This finding was further supported by enzyme activity as determined by gelatin zymography.

Regeneration of the ear after wounding in different mouse strains is dependent on the severity of wound trauma

The replacement and restoration of tissue mass after organ damage or injury in adult higher vertebrates is critical to the architecture and function of the organ. If replacement occurs with scar tissue, this often results in adverse effects on function and growth as well as an undesirable cosmetic appearance. However, certain mammals, such as the MRL/MpJ mouse, have shown a restricted capacity for regeneration, rather than scar tissue formation, after an excisional ear punch wound. To investigate the changes in tissue architecture leading to ear wound closure, initial ear wounding studies with a 2-mm clinical biopsy punch were performed on MRL/MpJ mice, by using C57BL/6 mice as a nonregenerative control strain. In contrast to previously reported studies on mouse ear regeneration, we observed that C57BL/6 mice in fact showed a limited regenerative capacity. One explanation for this difference could be attributed to the method of wounding used; both previous studies on mouse ear regeneration used a thumb punch, whereas our approach was to use a clinical biopsy punch. This approach led us to further investigate whether the severity of trauma applied influenced the rate of wound healing. We, therefore, compared the effects of the sharp clinical biopsy punch with that of a cruder thumb punch, and introduced a third strain of mouse, Balb/c, known to be a slow-healing strain. A new method to quantify ear punch hole closure was developed and a histologic investigation conducted up to 4 months after wounding. Image analysis data showed a reduction in original ear wound area of 85% in MRL/MpJ mice at 4 weeks and of 91.7% over 4 months by using a biopsy punch. In contrast, the crude thumb punch methodology resulted in an increase in wound area of up to 58% in Balb/c ears; thought to be due to increased necrosis of the wound site. All biopsy-punched wound areas plateaued in healing between days 28 and 112. Only 5 of 80 MRL/MpJ mouse ears showed no residual holes macroscopically after 28 days. Histologically, all strains of mice healed their ear wounds in a similar manner involving re-epithelialization, blastema-like formation, dermal extension, blood vessel formation, chondrogenesis, folliculogenesis, and skeletal muscle and fat differentiation. However, all regenerative features were more pronounced and accelerated in MRL/MpJ mice when compared with C57BL/6 and Balb/c biopsy-punched mouse ears.

[Noise level evaluation in acute ear trauma]

Subjective noise in the ears can be defined as a pathological acoustic sensation arising in the ear in different pathology of the acoustic analyzer. To make the treatment of the injury more effective, topical diagnosis of the acoustic analyzer affection is desirable.

The human ear: its role in forensic practice

The human ear has much to offer investigators in relation to many areas of forensic practice including forensic pathology, anthropology, identification and facial reconstruction and yet its full potential is often overlooked. This review paper explores current knowledge related to the human ear drawing attention to those situations where the ear could play a valuable role in a forensic investigation.

Potential anti-inflammatory treatments against cutaneous sulfur mustard injury using the mouse ear vesicant model

In spite of several decades of research, no effective treatment to skin injuries following exposure to sulfur mustard (HD) has yet been found. In the present study, the mouse ear vesicant model was applied to awake mice in order to evaluate the efficiency of potential anti-inflammatory treatments in preventing HD-induced skin damages. Clinical follow-up and histological evaluation were used to characterize the injuries to the skin and to evaluate the efficiency of the drugs that were applied. Thus, the extent of mouse ear oedema and the histopathological changes following a single application of 0.2 or 1 microL of neat HD for 10 min (representing moderate and severe lesions, respectively), were monitored. Typical HD skin lesions were observed including epithelial and dermal damage. The development of the injury in mouse ears was found to be very similar to that reported in human skin. Screening of post-exposure topical steroids and non-steroidal antiinflammatory drugs (NSAIDs) proved that HD-induced inflammation could be diminished significantly as long as the treatment was applied during the early stages following exposure. A combined application of these drugs approved to be particularly effective in reducing inflammation.

Torn earlobe repair

A variety of techniques have been described in the literature to repair torn earlobes. Some of these methods incorporate the reconstruction of the earring hole during earlobe repair, but many authors still recommend repiercing the earlobe at a later time. The present article is a comprehensive review of the published techniques for earlobe repair. Illustrations are provided to facilitate the description of the different methods and helpful recommendations are listed for a surgical approach to torn earlobes.

Angiostatic effects of corticosteroid on wound healing of the rabbit ear

Wound healing is a complex biologic process with initial inflammation, granulation tissue formation, and matrix remodeling. We observed the relation between angiostatic effects and corticosteroid administration time in the rabbit ear chamber. Angiogenesis in the chamber was studied using a microscope-television system. Two experiments were undertaken to represent the systemic and the topical administration of steroids. In experiment 1, 10 mg of triamcinolone acetonide was injected three times intramuscularly (on the day of implantation of the chamber, and the 7th and 14th day after implantation). Vascularization in this group was significantly delayed at the 7th, 14th, and 21st days but no difference from controls was observed in the size and density of vessels after its completion. In experiment 2, 3 mg of triamcinolone acetonide was injected once into the skin adjacent to the chamber on the 10th day after installment of chambers or on the day of installment. In the former group, new vascular growth was delayed until the 21st day after installment. The hemorrhagic zone had narrowed and vascular dilation was observed. In the latter group, endothelial budding was delayed and vascular constriction occurred. New vascular growth was severely delayed and granulation filling of the chamber was not completed. These results suggest not only that the topical administration had the stronger inhibitory effect on neovascularization than the systemic administration but that the effect differed depending on the stage of wound healing. In view of this effect of this steroid, we should pay careful attention to the time when steroids are administered to patients.

Applications of hyperbaric oxygen in otolaryngology head and neck surgery: facial cutaneous flaps

Hyperbaric oxygen therapy is of significant benefit in the setting of an ischemic flap of the head and neck. Mechanistically, hyperbaric oxygen decreases local tissue edema and improves oxygen delivery to compromised tissues. Both capillary and fibroblast in-growth occur at a greater rate with hyperbaric oxygen therapy, and there is an increase in the tensile strength of the wound. Additional indications in the head and neck include traumatic composite amputations, necrotizing soft-tissue infections, and osteoradionecrosis of the facial skeleton.

Effects of nitric oxide synthase inhibitors on vascular hyperpermeability with thermal injury in mice

The role of nitric oxide and related synthase in thermal injury was investigated by using models of experimental burn to evaluate severity from the aspect of vascular permeability. Thermal injuries were produced in the murine right ear by pinching with a pair of preheated tweezers. Immediately thereafter, Evans blue dye was intravenously administered, and the mice injured with burns were sacrificed at various times. The burned ears were collected and hydrolyzed, and the level of extracted dye was measured as an indicator of inflammation. Vascular hyperpermeability was suppressed by the administration of nitric oxide synthase inhibitors. LNAME not only suppressed vascular hyperpermeability in thermal injuries in a dose-dependent manner but was also effective with either prophylactic or therapeutic administration. Although aminoguanidine also suppressed the inflammatory response, it had no effect on the early inflammatory phase. Nitric oxide synthase is well known to have two types of isozymes. Aminoguanidine, an inhibitor specific to inducible nitric oxide synthase, suppressed the late phase 6 h after injury, suggesting that inducible nitric oxide synthase is involved in inflammatory responses of thermal injuries. These results also demonstrated that inducible nitric oxide synthase-like protein stained the burned region immunohistochemically. Therefore, both types of enzymes mediating nitric oxide affect inflammatory responses, i.e., vascular hyperpermeability, and their regulation may lead to the development of new therapy for thermal injuries.

[Barotrauma in diving]

Boyle's law is important for the understanding of the pathophysiology of barotrauma. Barotrauma--any disease or injury due to unequal pressures between a hollow space inside the body and the ambient pressure, or between two spaces within the body; examples include arterial gas embolism, pneumomediastinum, and pneumothorax. It may affect the lungs, the middle ear, the inner ear, the external ear, the eyes, the teeth, the gastrointestinal tract, the skin. Symptoms remain the same whether it all happens during ascent or descent.

Genetic control of the rate of wound healing in mice

There have been few studies of the inheritance of wound healing in mammals. In this study, we demonstrate that inbred strains of mice differ significantly in the rate of wound healing. Of the 20 strains tested, fast healers (MRL/MpJ-Fas(lpr) and LG/J) healed wounds four times faster than slow healers (Balb/cByJ and SJL/J). The genetic basis underlying the difference in the healing capacity was analysed using F2 populations of two different crosses. We show that the wound healing is a polygenically determined quantitative trait with an average estimated heritability of 86%. The modes of gene action in these two crosses are different. In the (MRL/MpJ x SJL/J) cross, genes regulating fast healing in MRL/MpJ mice exhibited additive effects, whereas these effects were suppressed by a dominant repressor gene in CBA/J mice in the (MRL/MpJ-Fas(lpr) x CBA/J) cross. Information gained from this investigation provides insight into further study of molecular mechanisms underlying the rate of wound healing in mammals.

Assessing tinnitus and prospective tinnitus therapeutics using a psychophysical animal model

Subjective tinnitus is a common and often debilitating disorder that is difficult to study because it is a perceptual state without an objective stimulus correlate. Studying tinnitus in humans is further complicated by the heterogeneity of tinnitus quality, severity, and associated hearing loss. As a consequence, the pathophysiology of tinnitus is poorly understood and treatments are often unsuccessful. In the present study, an animal psychophysical model was developed to reflect several features of tinnitus observed in humans. Chronic tinnitus was induced in rats by a single intense unilateral exposure to noise. The tinnitus was measured using a psychophysical procedure, which required the animals to discriminate between auditory test stimuli consisting of tones, noise, and 0 dB. Tinnitus was indicated by a frequency-specific shift in discrimination functions with respect to control subjects not exposed to noise. The psychophysical consequences of the noise exposure were best explained by a tinnitus hypothesis and could not be explained easily by other consequences of noise exposure such as hearing loss. The qualitative features of the tinnitus were determined and related to the duration of noise exposure and the associated cochlear trauma. The tinnitus was found to persist and intensify over 17 months of testing. Finally, the tinnitus was reversibly attenuated by treatment with gabapentin, a GABA agonist. It was concluded that this model reflected several features of human tinnitus, such as its tonality and persistence, and could be useful as a screen for potential therapeutics as well as a tool to help unravel the pathophysiology of the disorder of phantom auditory perception.

[Diagnostic criteria and treatment strategies in traumatic injuries of the ear]

The paper presents the results of examination and treatment of patients with different traumatic injuries of ear structures. The most characteristic injuries were detected in different mechanisms of traumas: mechanical (direct, indirect), altitude-induced, and thermal injuries. Major diagnostic signs of traumatic perilymphatic fistulas were revealed. The efficiency of surgical treatment for different injuries was evaluated. The surgical management of traumatic perilymphatic fistulas was comparatively assessed in different periods following injury. Evidence is provided for that it is expedient to close perilymphatic fistulas in ear injuries as early as possible.

Analysis of gene expression in the wound repair/regeneration process

Wound repair/regeneration is a complex process consisting of three stages: inflammation, tissue regrowth, and remodeling, which together involve the action of hundreds of genes. In order to i) identity and analyze the genes that are expressed at the inflammatory stage of repair (i.e., 24 h after injury) and ii) evaluate the molecular basis of fast-wound repair/regeneration in adult mammals. we examined the expression of 8734 sequence-verified genes in response to ear punch in a fast wound-repair/regeneration strain, MRL/MpJ-Fas(lpr) mice, and a slow-wound-repair strain, C57BL/6J mice. Many differentially expressed genes can be assigned to wound-repairing pathways known to be active during the inflammatory phase. whereas others are involved in pathways not previously associated with wound repair. Many genes of unknown function (ESTs) exhibited a more than twofold increase in MRL/ MpJ-Fas(lpr) or C57BL/6J mice, suggesting that current understanding of the molecular events at the inflammatory stage of repair is still limited. A comparison of the differential expression profiles between MRL/MpJ-Fas(lpr) and C57BL/6J mice suggests that fast-wound-repair in MRL/MpJ-Fas(lpr) mice is mediated by a metabolic shift toward a low inflammatory response and an enhanced tissue repair.

Otitis externa sicca/fibrotising external otitis (FEO) as a complication of Sjögren's syndrome

Sjögren's syndrome (SS) is a condition characterized by sicca symptoms and by autoimmune features. We describe two SS patients with otitis externa fibroticans/sicca. One of these 2 patients developed a lesion of the tympanic membrane making it necessary to perform a tympantomy and meatoplasty. Our findings suggest firstly that the epithelial cell-mediated secretion of lamellar bodies and the production of the permeability barrier are defective in SS. Secondly, local moisturing and/or topical corticosteroid treatment in SS patients with sicca symptoms in the auditory canal could help to avoid reconstructive surgical treatment.

Underwater application of nasal decongestants: method for special operations

A simple method of emergency underwater application of a nasal decongestant in divers to prevent diving-related accidents or even fatalities attributable to sequelae of middle-ear and sinus barotrauma of ascent was evaluated. Eleven military divers had to inject 1 mL of 0.02% methylene blue into a central venous catheter after having inserted the tip between their upper lip and the mask at 1 m depth in a pool. After injection, the head had to be reclined. Blue liquid flowing from a diver's nostril and a "bitter" taste sensation reported immediately after surfacing indicated successful application. All divers were observed to have had blue liquid flowing from the nostril of application, and one diver could not describe the taste. This method of underwater application of nasal decongestants may be useful for emergency prevention in divers, especially during covert operations. Underwater availability of the system in a special kit carried by divers would be required.

Complications and side effects of hyperbaric oxygen therapy

BACKGROUND

Despite ongoing controversy, hyperbaric oxygen (HBO) therapy is frequently administered in various clinical situations. Probably because of the unique atmospheric conditions to which the patient is exposed, there are concerns about the safety aspects of this therapy. Possible complications during HBO therapy include barotraumatic lesions (middle ear, nasal sinuses, inner ear, lung, teeth), oxygen toxicity (central nervous system, lung), confinement anxiety, and ocular effects (myopia, cataract growth).

METHODS

To analyze the medical safety of HBO therapy, this report reviewed complications and side effects of 782 patients treated for various indications with a total of 11,376 HBO therapy sessions within a multiplace chamber. The absolute treatment pressure was 240 or 250 kPa 114 or 15 msw). The compression was performed in a linear manner with 14 to 15 kPa (1.4 to 1.5 msw) x min(-1). All data were gathered prospectively within a special database.

RESULTS

More than 17% of all patients experienced ear pain or discomfort as an expression of problems in equalizing the middle ear pressure. Most episodes were not related to a persistent eustachian tube dysfunction since they only occurred once. Barotraumatic lesions on visual otological examinations (ear microscopy) were verified in 3.8% of all patients. Patients with sensory deficits involving the ear region need special attention, because they seem to be at risk for rupture of the tympanic membrane (three cases documented). A barotrauma of the nasal sinuses occurred rarely and no barotraumatic lesions of the inner ear, lung, or teeth were noted. Oxygen toxicity of the CNS manifested by generalized seizures affected four patients without any recognizable risk factors or prodromes. None of the patients suffered recurrences or sequelae. Regular checks of the blood glucose in diabetics failed to reveal episodes of hypoglycemia as a cause for seizures. Lung function tests of patients undergoing prolonged treatment (average 52.8 sessions) did not deteriorate.

CONCLUSION

Patients scheduled for HBO therapy need a careful pre-examination and monitoring. If safety guidelines are strictly followed, HBO therapy is a modality with an acceptable rate of complications. The predominant complication is represented by pressure equalization problems within the middle ear. Serious complications rarely occur.

[Traumatic and occupational deafness]

The frequency of accidental, traumatic hearing loss is increasing due to a sometimes violently noisy environment and to the development of sports as leisure activities. The diagnosis is based on knowledge of the circumstances of the trauma and on otoscopic examination. Total audiometry localises the damage. Occupational hearing loss forms a special subset of traumatic deafness. This trauma is usually due to intense noise occurring at the work-place. It is of insidious onset, irreversibly progressive and without treatment once under way; Prevention is based on knowledge of the deleterious effects of noise and on the individual factors of the subject at risk.

Reconstruction of the burned nose and ear

Patients who have survived thermal injuries to the face suffer from severe disfigurement. When the nose and ear are involved, the resulting deformities are immediately obvious to all who see the patient. This level of injury results in a self-imposed confinement; the patients never leave their homes. It is therefore important that we plastic surgeons know, understand, and use all options available to improve our patients' appearance and ultimately their mental and physical well being.

[Agents for combined pharmacotherapy in severe trauma to the brain and ENT organs]

Early complex treatment of a critical brain traumas should be aimed not only at men's life and personality saving, but also at their performance' rehabilitation. Complicity and to some degree individual nature of a critical trauma pathogenesis depend on the associative active methods of surgery interference and conservative pharmacotherapy. The article deals with well-practiced means and methods of symptomatic pharmacotherapy at the early and later stages of the brain traumas with vestibular and hearing system injures and with theoretical and clinical base for modern "quick-action adaptogens" usage in addition to psychoneurocorrectors.