Tympanosclerosis: review of literature and incidence among patients with middle-ear infection

Evaluation of aortic stiffness by echocardiography in tympanosclerosis patients

BACKGROUND AND AIMS

Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. This study aimed to determine echocardiographically whether aortic elasticity is impaired in TS-detected patients and to correlate blood inflammatory parameters with TS and aortic elasticity.

METHODS

Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were assigned to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were comparable.

RESULTS

Demographic, clinical, and laboratory parameter differences were insignificant. Hs-CRP, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in the study group than in the control group (P=0.018, P=0.003, P=0.019, respectively). The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; P<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; P=0.001) values than the control group. The AS index was significantly higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; P<0.001).

CONCLUSION

In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, may signify early cardiovascular involvement in TS-developed patients.

Impact of Sclerotic Lesions on the Surgical Outcome of Cholesteatoma

OBJECTIVE

Cholesteatoma is occasionally accompanied by excessive calcification and presumably has different osteogenic dynamics compared to noncholesteatomous chronic otitis media. Cholesteatoma-related sclerotic lesions through the temporal bone can pose manipulatory difficulties, possibly leading to worse surgical outcomes or complications. Therefore, we compared surgical outcomes of cholesteatomas with and without sclerotic lesions.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary academic medical center.

PATIENTS

Consecutive ears with acquired cholesteatomas requiring primary resection between January 2009 and December 2019. The ears followed up for <1 year were excluded.

INTERVENTIONS

Tympanoplasty with/without mastoidectomy.

MAIN OUTCOME MEASURES

Prevalence and location of sclerotic lesion, comorbid fistulae, postoperative air-bone gap, recidivism, and complications.

RESULTS

Overall, 19 (6.4%) of 299 ears had sclerotic lesions. More than two-thirds (68.4%) of sclerotic lesions were located adjacent to the lateral semicircular canal (LSC). Among ears with sclerotic lesions adjacent to the LSC, 46.2% had a comorbid fistula in the LSC. The prevalence of labyrinth fistula was significantly greater in ears with sclerotic lesions (42.1%) than in ears without sclerotic lesions (5.0%) (p < 0.0001, Fisher's exact test). Sensorineural hearing deterioration was significantly higher in ears with sclerotic lesions than in ears without (p = 0.0004, Fisher's exact test). Multivariate logistic regression analysis demonstrated that the presence of sclerotic lesions was a significant prognostic factor for residual disease (odds ratio [95% confidence interval]: 6.820 [2.055-22.633], p = 0.0017).

CONCLUSIONS

Surgeons should be conscious of preoperative identification of sclerotic lesions adjacent to one of the semicircular canals, possibly leading to postoperative sensorineural hearing deterioration or residual cholesteatoma.

A low-cost otoscopy simulator increased confidence in mechanical otoscopy skills and tympanic membrane pathology identification among preclinical medical students during the COVID-19 pandemic

Background: Diagnostic evaluation of otologic diseases often requires otoscopy to visualize the tympanic membrane. The fundamentals of otoscopy include both learning the mechanics of using an otoscope and accurately identifying ear pathologies. During the COVID-19 pandemic, there was limited peer-to-peer physical exam practice for preclinical medical students. We developed a low-cost 3D-printed otoscopy simulator to teach the otoscopic exam to small groups of medical students.  Methods: A modified open-source 3-dimensional (3D) head was printed, and a silicone ear was attached. A user interface was created to display one normal tympanic membrane and four pathologies. Preclinical medical students attended a didactic lecture on common otologic pathologies and on how to perform otoscopy. Students then practiced otoscopy and pathology identification on the simulator in small groups. After the session, students were provided an optional survey to evaluate their confidence in otoscopy skills and pathology identification. Results: A total of 47 out of 134 (35%) medical students completed the survey, of whom 60% reported that training with the 3D printed otoscopy simulator was at least moderately effective in learning the mechanical techniques of otoscopy, and 66% found the simulator to be at least moderately effective in helping them learn to identify pathology. The majority (57%) of students reported that the otoscopy simulator was more effective than practicing otoscopy on their peers. Conclusions: We demonstrate the utility of a novel low-cost 3D printed otoscopy simulator to teach both the mechanical skills and pathology identification necessary in performing an otoscopic exam to preclinical medical students.

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

OBJECTIVES

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.

STUDY DESIGN

Retrospective.

SETTING

Tertiary academic medical center.

PATIENTS

Patients with noncholesteatomatous chronic otitis media and tympanic membrane perforation, without ossicular discontinuities.

INTERVENTIONS

Diagnostic.

MAIN OUTCOME MEASURES

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.

RESULTS

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.

CONCLUSIONS

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.

The Short-Term Effect of Eugenol on the Prevention of Experimentally Induced Myringosclerosis in a Rat Model

Objective:

The aim of our study was to assess the possible short-term effects of topical and oral eugenol on the suppression of experimentally developed myringosclerosis (MS).

Methods:

Four groups of seven male Wistar albino rats were used in the study. The tympanic membranes (TMs) of all subjects were myringotomized, and group 1 was given no treatment (as control group), group 2 received saline, group 3 had received topical eugenol and group 4 received oral eugenol.

Results:

In macroscopic evaluation the control and saline groups showed much more MS compared to the topical and oral eugenol groups which had statistically significantly less changes (p<0.05). Fibrosis and inflammation regarding the lamina propria (LP) of the eardrums of the topical and oral eugenol groups were significantly less than those of the control and saline groups (p<0.001). In microscopic evaluation, TMs were found to be thicker in the control and saline groups (p<0.001).

Conclusion:

Our study showed that the application of topical and oral forms of eugenol reduced fibrosis and prevented the advancement of MS in the LP of the TMs in the short-term. More studies with different extracts are needed to investigate the efficacy of phytotherapeutic agents for preventing MS development following myringotomy.

Reliability of high-resolution CT scan in diagnosis of ossicular tympanosclerosis

OBJECTIVES

To evaluate the reliability of high-resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post-surgical hearing outcome based on comparing radiological and surgical findings.

METHODS

A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air-bone gap (ABG) were compared. A postoperative pure-tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients.

RESULTS

The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo-malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo-malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow-up after 6 months.

CONCLUSIONS

Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

Role of TGF-β1-mediated epithelial-mesenchymal transition in the pathogenesis of tympanosclerosis

The present study aimed to explore the role of TGF-β1-mediated epithelial-mesenchymal transition (EMT) in the pathogenesis of tympanosclerosis. Sprague Dawley rats were injected with inactivated Streptococcus pneumoniae suspension to establish a rat model of tympanosclerosis. The rats were sacrificed 8 weeks after the model was established. H&E and von Kossa staining was used to observe the morphological changes of middle ear mucosa. Western blotting was used to detect the expression of TGF-β1 and EMT-associated proteins in the mucosa samples. Middle ear mucosal epithelial cells of rats were collected to establish a primary culture. The cultured cells were stimulated with TGF-β1 and the expression of EMT-associated proteins was detected by western blotting and immunofluorescence. In addition, the cells were treated with TGF-β receptor type I/II inhibitor and the expression level of EMT-associated proteins was detected by western blotting. Sclerotic lesions appeared on 72.4% of tympanic membranes, and marked inflammation, inflammatory cell infiltration and fibrosis were found in the middle ear mucosa of rat models of tympanosclerosis. In middle ear mucosa of rats with tympanosclerosis, the expression of mesenchymal cell markers increased and that of epithelial cell markers decreased compared with the control group. TGF-β1 stimulated the activation of the EMT pathway in middle ear mucosal epithelial cells, resulting in an increased expression of fibronectin and N-cadherin. In addition, a decreased expression level of EMT-associated proteins was observed when TGF-β1 was inhibited. In conclusion, the present study indicated that TGF-β1-mediated EMT may play an important role in the pathogenesis of tympanosclerosis.

Significance of the middle ear risk index in predicting tympanoplasty success in the elderly

PURPOSE

To evaluate the relationship between middle ear risk index (MERI) score and success of tympanoplasty in elderly (≥ 60 years) compared with young patients (18-59 years) and to investigate the prognostic factors affecting the success of tympanoplasty.

METHODS

Patients were subdivided into three subgroups according to the MERI score as follows: mild (0-3), moderate (4-6), and severe (≥ 7). Ages, perforation sides and location, preoperative and postoperative audiological results, and the graft success of 29 patients aged over 60 years were compared with those of 52 patients aged between 18 and 59 years.

RESULTS

Preoperative and postoperative air conduction, preoperative and postoperative bone conduction, and preoperative and postoperative air-bone gap (ABG) were higher in the older group compared with the younger group (p < 0.05). The hearing gain in the younger group was 12.63 (6.43), and in the older group was 12.66 (7.85), while did not differ significantly between groups (p = 0.689). Results demonstrated that cases with low/moderate score of MERI had a higher graft success rate compared with patients with a high score of MERI (Φ = 0.391; p < 0.001) as well as, patients with low/moderate score of MERI had the lower need for mastoidectomy compared with patients with a high score of MERI (Φ = 0.385; p = 0.001).

CONCLUSION

Low/medium MERI scores were the variables that provided realistic expectations and increased the success of tympanoplasty more precisely before surgery. The surgeon will also be able to design an operation strategy as a case study for elderly patients by doing so.

Analysis of Risk Factors for Myringosclerosis Formation after Ventilation Tube Insertion

BACKGROUND

This study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI).

METHODS

A retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS-. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed.

RESULTS

Myringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS- group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI.

CONCLUSION

Older age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.

Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery

Background/aim

Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM).

Materials and methods

A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department.

Results

The most frequent diagnosis was simple COM (39.9%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6%). The overall hearing success rate was found to be 75.8%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success.

Conclusion

Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared.

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

Pars tensa and tympanicomalleal joint: proposal for a new anatomic classification

PURPOSE

The tympanic membrane (TM) belongs to the ear. Despite its place in the ear anatomy, can we give it also a different anatomic classification? The main objective is to clarify the nature of TM, tympanic bone and malleus to propose a new anatomic classification.

METHODS

This cadaveric study was performed in two human heads and six fresh temporal bones. A study of the temporomandibular joint, external acoustic meatus (EAM), TM and middle ear structures was conducted. A medical literature review englobing anatomy, embryology, histology and phylogeny of the ear was performed and the results were compared with the results of the dissection.

RESULTS

The external ear is constituted by the auricle and the EAM. This last segment is made by a cartilaginous and an osseous portion. The osseous portion of the EAM is constituted mainly by tympanic bone. The external ear is separated from the middle ear by the TM. Inside the middle ear, there are three ossicles: malleus, incus and stapes, which allow the conduction of sound to the cochlea. Based on the anatomic dissection and medical literature review of the tympanic bone, malleus and TM, we propose that these structures are interconnected like a joint, and named it "Tympanicomalleal joint".

CONCLUSIONS

It seems that the TM can be part of a joint that evolved to improve sound transmission and middle ear protection. Thinking TM has part of a joint may help in the development of more efficient reconstructive surgical techniques.

Is there any effect of montelukast on prevention of myringosclerosis after myringotomy in a rat model?

OBJECTIVES

In this study, our aim was to identify the possible effects of montelukast sodium (ML) on the prevention of experimentally induced myringosclerosis.

MATERIALS AND METHODS

Twenty-eight female Wistar albino rats were used and they were divided into four groups randomly. Tympanic membranes (TM) of all animals were perforated and then group 1 received no treatment (control group), group 2 was treated with a topical saline solution, group 3 received topically ML and group 4 received orally ML. On the 15th day, all animals were euthanized. Tympanic membranes were evaluated otomicroscopically and histopathologically.

RESULTS

The histopathological findings, compared against a control and saline groups, showed the topically and orally ML groups had statistically significant differences of degree of myringosclerosis (p < 0.002) and median thickness of the TMs (p < 0.001). Suppression of inflammation was statistically significant only in the oral ML treatment group (p < 0.002).

CONCLUSION

Oral and topically administration of ML reduced myringosclerosis formation in myringotomies rats.

Possible role of Dickkopf-1 protein in the pathogenesis of tympanosclerosis in a rat model

OBJECTIVES

This study aimed to investigate the expression of DKK1 protein in an experimental model of tympanosclerosis and its possible role in the pathogenesis of this disorder.

METHODS

Forty Sprague Dawley rats were included in the study: 20 in the control group (which received no treatment) and 20 in the experimental group (which received an incision to induce tympanosclerosis). Otomicroscopy was performed to observe the development of myringosclerosis. Haematoxylin and eosin staining was performed to observe the morphological changes. Western blot analysis and immunohistochemistry were performed to assess the expression of DKK1 protein.

RESULTS

At day 15, sclerotic lesions were observed in 70 per cent of the tympanic membranes. Inflammatory infiltration and hyaline degeneration markedly appeared in the tympanic membranes and middle-ear mucosa. DKK1 protein was mainly distributed in the cytoplasm of epithelial cells, which were widely distributed in the tympanic membranes and middle-ear mucosa. The expression of DKK1 protein was significantly decreased in the calcified experimental ears.

CONCLUSION

DKK1 protein is involved in the pathogenesis of tympanosclerosis by regulating the Wnt/β-catenin signalling pathway.

Effect of Topical Dexamethasone for Preventing Experimentally Induced Myringosclerosis

Objective

We aimed to examine the effect of topical dexamethasone by otomicroscopic and histologic examinations for preventing myringosclerosis induced by myringotomy in rat tympanic membranes.

Methods

Twenty-one Sprague Dawley rats (42 ears) were randomly divided into the following three groups after otomicroscopic examinations: experimental surgical group (5 rats), control group (8 rats), and study group (8 rats). The rats of all the groups underwent myringotomy in both tympanic membranes. Other than myringotomy, no additional procedure was performed for the rats in the experimental surgical group. In the control group, 0.9% NaCl was applied to the ears, whereas in the study groups, topical dexamethasone was applied to the ears. These applications in the control and study groups were repeated for nine days. On the 10th day of the study, the rat ears of all groups underwent otomicroscopic and histologic examinations. The prevalence and process of myringosclerosis were evaluated by otomicroscopic examination, whereas inflammation, membrane thickness, and myringosclerosis intensity were evaluated by histologic examination.

Results

The growth of myringosclerosis with otomicroscopic examination was lesser in the study group in which topical dexamethasone was applied than the control and the experimental surgical groups. Moreover, it was observed that myringosclerosis effected fewer quadrants in the study group.Histologic examinations revealed that inflammation was significantly lesser in the study group than in the experimental surgical and control groups. The average membrane thickness values were significantly lesser in the study group than in the experimental surgical group. With respect to myringosclerosis growth, no statistically significant difference was observed among all groups, whereas with respect to myringosclerosis intensity, the rat ears in the study group were less severely affected.

Conclusion

Thus, our study results suggest that applying topical dexamethasone after myringotomy has positive effects on limiting the intensity and prevalence of myringosclerosis.

[The prevalence of tympanosclerosis and the effectiveness of its surgical treatment]

The objective of the present study was to characterize the epidemiological variants of tympanosclerosis and the effectiveness of the surgical treatment of the patients presenting with this condition. We have undertaken the analysis of the results of 1965 surgical interventions on the patients suffering from different forms of chronic otitis media (COM) performed during the period from 2009 till 2014 with a view to determining the frequency of tympanosclerosis (TSC). In 542 cases, it proved possible to evaluate the intraoperative findings, stages and methods of reconstructive surgery, the anatomical and functional outcomes and effectiveness of the intervention. At present, the signs of tympanosclerosis are identified in 27.6% of the patients presenting with chronic otitis media including 88.7% and 11.3% suffering from the perforating and non-perforating forms of this pathology, respectively. In 74% of the cases its manifestations are diagnosed in the patients having the tubotympanic form of COM. In 53.3% of the patients TSC foci are responsible for the fixation of the ossicular chain whereas in 46.7% of the cases the auditory ossicles retain mobility. As many as 88.6% of the patients underwent the one-step surgical intervention, 10.7% were managed using two-step surgery, and 0.7% of the patients were given the three-stage treatment. Type I tympanoplasty was performed in 62% of the patients, type III tympanoplasty in 30.4%, and various types of stapedoplasty in 4.6% of the cases. The favourable anatomical and functional outcomes at the first stage of the surgical intervention with the use of the autogenous tissues for tympano- and ossiculoplastic surgery were achieved in 87.9% of the patients on the average (by means of the closure of the tympanic defect in 92.2% and by re-fixation of the selected elements of the ossicular chain in 17.3%of the cases). The anatomical and functional effectiveness of the second-stage surgical intervention was estimated at 93.1%.

Genetic polymorphisms affecting antioxidant enzymes are present in tympanosclerosis patients

BACKGROUND

This study investigated genetic polymorphisms affecting the inducible nitric oxide synthase, superoxide dismutase and catalase enzymes in chronic otitis media patients with and without tympanosclerosis, and the role of genetic susceptibility in the disease aetiology.

METHODS

A total of 162 patients who underwent surgery for chronic otitis media were divided into two study groups: a tympanosclerosis group and a chronic otitis media group. A third, the control, group comprised 188 healthy volunteers. Venous blood samples were evaluated using reverse transcriptase polymerase chain reaction.

RESULTS

There was a significant difference in GG genotype distribution of the -277A>G polymorphism in the NOS2 gene between the tympanosclerosis and control groups (p T) polymorphism in the SOD2 gene (p > 0.05). There were significant differences in the TT genotype distribution of the -21A>T polymorphism in the CAT gene between the tympanosclerosis and control groups, and between the chronic otitis media and control groups (p < 0.05).

CONCLUSION

These results suggest that genetic predisposition may play a role in the aetiopathogenesis of tympanosclerosis.

An Analysis of Surgical Treatment Results of Patients With Tympanosclerosis

OBJECTIVE

The authors aimed to evaluate the intraoperative features and the results of postoperative hearing gain successes of patients with tympanosclerosis who were treated surgically in our clinic.

MATERIAL AND METHODS

A retrospective analysis was conducted on 151 ears with tympanosclerosis of 138 patients who operated because of chronic otitis media or only tympanosclerosis, between January 2007 and June 2014. They were evaluated by appealing complain, complain duration, accompanying systemic disorders, tympanic membrane condition, localization of sclerotic plaque, damage in ossicular chain, existence of cholesteatoma, operation procedure type, hearing reconstruction type, preoperative, and last postoperative audiometric findings in every frequency both bone and air way.

RESULTS

In the group of Wielinga-Kerr Group 3 (isolated stapes fixation), no statistically significant results were found in preoperative and last postoperative audiometric findings in every frequency both bone and air conduction (BC and AC) (P > 0.05). In the Wielinga-Kerr Group some results had significant (P < 0.05) and some results had highly significant (P < 0.001).

CONCLUSIONS

Patients with less impact on ossicular chain and limited localization of sclerotic plaques have better hearing gain. Although surgery is still controversial in tympanosclerosis; it is the most effective treatment till new effective medication is discovered.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

Correlation Between Tympanosclerosis and Helicobacter pylori

Background:

Tympanosclerosis is a condition caused by calcification of tissues in the middle ear mucosa that sometimes results hearing loss. Helicobacter pylori is one of the pathological and etiologic factors in the development of tympanosclerosis.

Objectives:

The purpose of this study was to show the role of H. pylori in the different aspects of chronic suppurative otitis media using the polymerase chain reaction (PCR) technique.

Patients and Methods:

This case-control and cross-sectional study was performed on all patients with chronic otitis media, candidates for surgical operations, in 2013. They were allocated into the case group with tympanosclerosis and the control group without tympanosclerosis. During the surgical operation, biopsy was done from middle ear and the samples were studied to see if they contained H. pylori using the PCR method.

Results:

From a total of 19 patients with tympanosclerosis , 16 cases (84.2%) were H. pylori positive, while in the control group 15 (45.4%) cases out of the 37 cases were H. pylori positive, which showed a significant difference (P = 0.002). Age and gender of the patients, ear dryness and perforation size were not correlated with the presence or absence of H. pylori.

Conclusions:

There is a significant correlation between tympanosclerosis and H. pylori (P = 0.002). This correlation can single out H. pylori as a pathological factor in the development of tympanosclerosis; however, further studies are needed to prove this correlation.

Discerning the differential molecular pathology of proliferative middle ear lesions using Raman spectroscopy

Despite its widespread prevalence, middle ear pathology, especially the development of proliferative lesions, remains largely unexplored and poorly understood. Diagnostic evaluation is still predicated upon a high index of clinical suspicion on otoscopic examination of gross morphologic features. We report the first technique that has the potential to non-invasively identify two key lesions, namely cholesteatoma and myringosclerosis, by providing real-time information of differentially expressed molecules. In addition to revealing signatures consistent with the known pathobiology of these lesions, our observations provide the first evidence of the presence of carbonate- and silicate-substitutions in the calcium phosphate plaques found in myringosclerosis. Collectively, these results demonstrate the potential of Raman spectroscopy to not only provide new understanding of the etiology of these conditions by defining objective molecular markers but also aid in margin assessment to improve surgical outcome.

Tympanoplasty outcomes in elderly patients

OBJECTIVE

To investigate the outcomes of tympanoplasty in elderly (≥60 years) compared with young patients (18-59 years).

MATERIALS AND METHODS

Patients who had been performed type I tympanoplasty between 2009 and 2012 were retrospectively analyzed. Preoperative and postoperative audiological results and the graft success of 42 older patients were compared with those of 72 younger ones.

RESULTS

The mean preoperative air conduction levels were statistically significantly higher in older group (57.4±16.8dB) than younger group (37.3±10.3dB) (p<0.001). Preoperative bone conduction levels were statistically significantly higher in older group (28.5±13.4dB) than in the younger group (12.4±4.8dB) (p<0.001). The mean preoperative and postoperative air-bone gaps were statistically significantly larger in the older group (28.5±11.0dB, 16.4±9.0dB) than in the younger group (24.9±7.7dB, 12.4±8.0dB respectively) (p<0.001). The intragroup comparisons of preoperative and postoperative mean air-bone gaps revealed statistically significant improvements in both groups (p<0.001 for both). Graft success rates and the mean hearing gains were not statistically significantly different between the groups (p=0.225, p=0.786 respectively).

CONCLUSION

Although preoperative and postoperative air and bone conduction levels were worse in the older group, graft take rates and postoperative hearing gain did not differ between the groups. If the physical status is stable tympanoplasty procedure can be recommended for elderly patients.

Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis

OBJECTIVE

This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis.

METHODS

A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air-bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air-bone gap were the main outcome measures.

RESULTS

Mean post-operative air-bone gap was 5.25 dB. Four patients had an air-bone gap of less than 10 dB; the remaining patient had an air-bone of 12.50 dB.

CONCLUSION

Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

The effect of lycopene on experimental myringosclerosis

OBJECTIVES

The aim of this study was to investigate the effect of lycopene on myringosclerosis development using histopathological and immunohistochemical analyses.

METHODS

Fifty-six intact tympanic membranes of 28 guinea pigs were included in the study. Subjects were randomly divided into four groups (n=7/group). Group I (control group) did not receive any treatment after myringotomy. Group II (lycopene treatment after myringotomy) received oral lycopene (once daily at the same time, 10mg/kg, dissolved in water, administered with a catheter). The treatment lasted seven days. Group III (lycopene treatment before and after myringotomy), received lycopene treatment (same dose and route of administration) for seven days. Myringotomy was performed on day 8, and lycopene treatment was initiated immediately, and continued for seven days (same dose and route of administration). Group IV (lycopene treatment before myringotomy) received lycopene treatment one week before myringotomy using the same method and dose for seven days. Myringotomy was performed on day 8. Lycopene was not administered after myringotomy. Fourteen days after myringotomy, myringosclerosis was evaluated automicroscopically and scored. Following decapitation, bulla were removed and immersed in a 10% formaldehyde solution. Sections were cut for histopathological and immunohistochemical examination, and thickness, sclerosis, inflammation, and collagen-IV accumulation were scored semi-quantitatively.

RESULTS

In the present study, the level of myringosclerosis was significantly lower in lycopene-treated groups compared to the control group (p<0.05). In addition, thickness, inflammation, sclerosis, and collagen-IV accumulation were significantly lower in the lycopene-treated groups compared to the control group (p<0.05). The timing of lycopene administration - i.e. before and/or after surgery - did not cause any difference with respect to myringosclerosis development.

CONCLUSION

Lycopene, a strong antioxidant, may represent a good alternative treatment to prevent the development of myringosclerosis.

The effect of stapes fixation on hearing results in tympanosclerosis treated by mobilization

We aimed to investigate the effect of stapes fixation on hearing results in patients who underwent mobilization surgery due to tympanosclerosis (TS). Seventy-nine patients were retrospectively analyzed and divided into two groups. Forty-four (55.7%) patients with mobile stapes were classified as group 1, and 35 (44.3%) patients with fixed stapes were classified as group 2. Improvement of the air-bone gap (ABG) to become less than 20 dB and the pure-tone average (PTA) by at least 10 dB postoperatively were accepted as success criteria. The PTA and ABG levels were significantly improved in both groups. The pre- and post-operative PTAs were 46.57 ± 15.55 and 25.84 ± 15.47 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative PTAs were 55.64 ± 12.69 and 36.20 ± 14.47 dB, respectively, in group 2 (p = 0.001). The pre- and post-operative ABG levels were 35.36 ± 10.53 and 16.91 ± 8.54 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative ABG levels were 41.68 ± 8.78 and 22.20 ± 10.03 dB, respectively, in group 2 (p = 0.001). A gain ≥10-dB in the PTA in groups 1 and 2 was found in 34 (77.2 %) and 23 (65.7%) patients, respectively, and the difference between the groups was not significant (p = 0.684). The post-operative AGB in groups 1 and 2 was less than 20 dB in 32 (72.7%) and 21 (60%) patients, respectively, and the difference between the groups was not significant (p = 0.733). No significant negative effect of stapes fixation on post-operative hearing results in TS was detected. Successful results can be obtained with a mobilization procedure, even if the stapes is fixed.

Altered response of fibroblasts from human tympanosclerotic membrane to interacting mast cells: implication for tissue remodeling

Several lines of evidence suggest that a tympanosclerotic (TMS) lesion often develops secondary to acute and chronic otitis media. Histological findings indicate that fibroblasts and inflammatory cells, including mast cells, play a key role in the tympanosclerotic plaque formation. However, details on the functional characteristics of tympanosclerotic fibroblasts (Fs(TMS)) are scanty. Therefore the aim of our study was to examine the activity of human fibroblasts from tympanosclerotic lesions and to evaluate the influence of stimulated by crosslinking of IgE receptor mast cells (HMC-1(FcɛRI)) on fibroblast functional behavior. We observed that fibroblasts from normal tympanic membrane (Fs(TM)) released less TNF-α, TGF-β1 and IL-6 compared to Fs(TMS). Fs(TMS) but not Fs(TM) upon interaction with HMC-1(FcɛRI) released increased quantities of TNF-α and TGF-β1. Exposing the fibroblast to HMC-1(FcɛRI) cells resulted in an increased synthesis of proteins including collagen. We noted that the COL2A1 transcript level increased ∼5- and ∼12-fold in Fs(TM) and Fs(TMS) co-cultured with HMC-1(FcɛRI), respectively. Both Fs(TM) and Fs(TMS) upon maintenance in the primary culture released significant quantities of matrix metalloproteinase 9 (MMP-9). However, Fs(TMS) released ∼5-fold more MMP-9 activity compared to the Fs(TM) cultures. The mast cell-induced release of TNF-α, TGF-β1 and MMP-9 sustained for a longer time in Fs(TMS) cultures compared to Fs(TM). Concluding, our data strongly indicate that increased fibroblast sensitivity to mast cell stimulation greatly contributes to the excessive fibrosis and pathological remodeling of the tympanic membrane. We postulate that the persistency of the Fs(TMS) activated state could be an important factor in the pathogenesis of tympanosclerosis.

Inhibitory effect of N-acetyl cysteine and ascorbic acid on the development of myringosclerosis: an experimental study

OBJECTIVES

This study investigated the effects of ascorbic acid and N-acetyl cysteine (NAC) antioxidants on the development of myringosclerosis (MS) in an experimental model.

METHODS

Myringotomies were performed in the ears of 15 guinea pigs, and Spongostan pieces were placed on the perforated regions of the tympanic membrane. The subjects were divided randomly into three groups and treated with three different solutions on the Spongostan-group 1: (control, 0.9% saline), group 2 (ascorbic acid), and group 3 (NAC). On day 15 after treatment, specimens from the tympanic membranes were obtained and examined via light microscopy. Sclerosis and inflammation scores and the tympanic membrane thicknesses were evaluated. Immunohistochemical methods were used to evaluate the expression of VEGF, TGF-β, iNOS, and IL1-β in all groups.

RESULTS

Lower sclerosis and inflammation scores and reduced tympanic membrane thicknesses were observed in groups treated with NAC or ascorbic acid compared with the control group. Immunohistochemical studies revealed significantly less expression of VEGF, TGF-β, and iNOS in groups 2 and 3 compared with group 1. Additionally, IL1-β expression was significantly less in group 3 than in group 1. Compared with group 1, group 2 animals exhibited reduced inflammation in the lamina propria, fewer active fibroblasts, less leukocyte infiltration, and decreased thickness of the vessels; group 3 animals exhibited decreased numbers of active fibroblasts and collagen fibers in the lamina propria.

CONCLUSIONS

Inflammation scores, cellular infiltration, and expression of VEGF, TGF-β, and iNOS were reduced by ascorbic acid and/or NAC treatments, thereby decreasing MS development. Decreased expression of IL1-β was observed only in animals treated with NAC.

Morphological alterations in the tympanic membrane affected by tympanosclerosis: ultrastructural study

The ultrastructure of tympanoslerotic tissue, surgically excised from patients, has been studied with particular reference to the morphological changes of the connective tissue components and mineralization. Detailed analysis revealed the combination of degenerative and fibroplastic alterations, especially in the circular fibrous layer of the thickened lamina propria. In the biological material in this study the authors recognized different stages of calcium plaque development with discrete, moderate, and severe degree of mineralization. Extracellular matrix vesicles, with or without calcareous deposits, released by degenerating fibroblasts were prominent. In these biopsies no distinct morphological features of an inflammatory reaction were seen.

[Assessment of Tumor Necrosis Factor alpha gene expression profile in selected structures of middle ear in patients with tympanosclerosis]

AIM OF THE STUDY

Tympanosclerosis is a middle ear disease located in submucous membrane. It leads to the tympanic membrane and ear ossicles fixation which results in severe conductive hearing impairment. The etiology of tympanosclerosis remains unclear. Cytokines play very important role in development of tympanosclerosis. The research aimed to assess gene expression level of pro inflammatory cytokine TNF-α in selected structures of middle ear in patients with chronic otitis media with tympanosclerosis.

METHODOLOGY

The research was performed on middle ear tissues with tympanosclerosis achieved from 30 patients operated on in the Otolaryngology Department of the Medical University of Gdańsk. The control group was formed by tympanic membranes sampled from 17 corpses of patients who died suddenly. Advancement of tympanosclerotic changes were grouped based on Tos classification. The TNF-α gene expression level was measured by real time PCR with specific hydrolysed probes (TaqMan). The gene expression level for TNF-α was correlated with clinical classification of tympanosclerosis.

RESULTS

The level of gene profile expression for TNF-α in selected structures of the middle ear with tympanosclerosis was statistically significant, higher in comparison with the control group. The highest level of expression was observed in group two which is relevant to more advanced tympanosclerosis.

CONCLUSION

Tympanosclerosis is a result of constant inflammatory process and it is modulated by cytokines including TNF-α. The positive correlation between gene expression level of TNF-α and tympanosclerosis could in the future contribute to antiinflammatory, medical treatment of tympanosclerosis.

The effect of stapes mobility on hearing outcome and which procedure to choose in fixed stapes in children tympanosclerosis

OBJECTIVES

Our objective was to evaluate the features of tympanosclerosis in children and to determine the effect of stapes mobility and the type of one-stage operation on hearing outcomes.

MATERIALS AND METHODS

Fifty-one children who were performed different types of single-stage otologic surgery for tympanosclerosis between January 1997 and December 2006 were retrospectively chart reviewed. The children were divided into two groups according to the mobility of ossicular chain, especially the stapes. Stapes fixed group was also evaluated in detail according to the type of surgery that was performed. Patients who had previous ventilation tube insertion, tympanic membrane parasynthesis or any other otologic surgery were excluded from the study. Improvement of the hearing by at least 10 dB and air-bone gap less than 20 dB were accepted as success criteria after 24 months of follow-up period.

RESULTS

The air conduction levels, and the air-bone gap values of both groups were improved significantly after the single-stage operations. Pure tone averages pre- and postoperatively for stapes mobile group were 45.55+/-15.96 and 34.50+/-16.64 dB (p=0.002); and in stapes fixed group these were respectively 43.97+/-13.45 and 33.16+/-12.14 dB (p<0.001). When pre- and postoperative air-bone gap levels were evaluated it was seen that in both groups they were improved more than 10 dB, from 34.10+/-11.37 to 23.05+/-12.32 dB (p=0.002) in stapes mobile group and from 35.29+/-11.65 to 24.48+/-12.50 dB (p<0.001) in stapes fixed group. In stapes fixed group air-bone gap was less than 20 dB in 11 of 23 (47.8%) patients who had mobilization and 3 of 8 (37.5%) patients who had small fenestra stapedotomy operations. Although it was not statistically significant, gain was more than 10 dB only in 2 of 8 (25.0%) patients in the stapedotomy group but 14 of 23 (60.9%) patients in mobilization group (p=0.698 for ABG and p=0.220 for gain). The change in the bone conduction levels were improved 0.75 dB in group 1 and got worse 0.52 dB in group 2 and this was not statistically significant (p=0.239).

CONCLUSIONS

In this study about children, the status of stapes and the place of tympanosclerotic mass had no significant negative effect on hearing improvement. You can perform mobilization in one-stage if you are experienced and have to prefer second-stage surgery if stapes is fixed and stapedectomy is needed.

[Treatment of tympanosclerosis]

Tympanosclerosis is a scarring process with a remarkable variability in its localization within the middle ear. It can lead to conductive hearing loss in many cases. It is usually caused by recurrent chronic inflammation of the middle ear. It is generally accepted that functionally relevant tympanosclerotic findings of the middle ear structures should be treated by surgery. Depending on the extent of the surgical resection, the tympanic membrane and the ossicular chain must be reconstructed individually. In cases of isolated myringosclerosis with no hearing loss, no surgery is required. When the ossicular chain is affected by the sclerosis, sound conduction can often be restored only by interposition of grafts. Stapes footplate fixation can be treated by a stapesplasty. Tympanosclerosis of the oval window combined with other chronic inflammation usually requires two-stage surgery. Tympanosclerotic findings without any clinical symptoms should not be removed. The fitting of conventional or implantable hearing aids is the only treatment if chain reconstruction fails or is impossible.

Histopathological classification of tympanosclerotic plaques

Tympanosclerotic plaques seen in the middle ear and tympanic membrane as a sequelae of otitis media have different characteristics. Tympanosclerotic plaque consistency shows a wide range from soft to hard during surgical excision and can be classified histologically. The aim of this study is to classify surgically excised tympanosclerotic plaques macroscopically and histologically. Seventeen surgically excised tympanosclerotic tissues were examined otomicroscopically and light microscopically. Otomicroscopically, plaques were classified as type I: soft (four cases), type II: moderately hard (six cases) and type III: very hard (seven cases), according to their consistency and surgical detachment feature. Sections prepared from tympanosclerotic tissues were stained with hematoxylin-eosin, Mallory-Azan and von Kossa stains for light microscopic evaluation. In type I tympanosclerotic tissue, fibroblasts and collagen fibers were equally abundant in typical loose connective tissue. A few small calcium crystals were seen. In type II tympanosclerotic tissue, large bundles of collagen fibers, proliferation of fibroblasts and focal calcification points were seen. In type III tympanosclerotic tissue, round shaped condroblast-like cells located in lacunae and intense calcification points were evident. Tympanosclerotic tissues can be classified in respect of their morphological and histological aspects. Histological classification of tympanosclerotic tissue may inform us about the maturation of the tissue, and therefore the grade of the disease. In type I tympanosclerotic disease, even if complete resection of sclerotic tissue is performed, the underlying process may go on and new sclerotic tissue formation can be expected. Type III sclerotic tissue is associated with limited, inactive disease. Progress of the disease and the patient's benefit from surgery can be interpreted according to this classification. However, these results will need to be verified by long-term patient follow-up and comparison of histological classification and clinical audiological symptoms.

Evaluation of plasma fibronectine level as a probable indicator for tympanosclerosis

OBJECTIVES

Wound healing, epithelial regrowth and collagen synthesis are very important factors in the repair of the traumatised tympanic membrane. The aim of the present study was to determine the role of plasma fibronectine in the aetiopathogenesis of tympanosclerosis.

METHODS

This prospective study included 58 patients with and 49 without tympanosclerosis. No inflammation or trauma was noted in either patient group. All patients underwent otoscopic and otomicroscopic examination, and the degree of tympanosclerosis was graded from mild (stage I) to severe (stage III). Following otological examination, blood samples were taken for plasma fibronectine measurement.

RESULTS

Following otoscopic and otomicroscopic examinations, patients' tympanosclerosis was graded as follows: 18 patients were stage I; 29 were stage II; and 11 were stage III. Statistical analyses revealed that the plasma fibronectine concentrations were significantly lower in the study group compared with the control group (p = 0.031). In addition, fibronectine levels were lowest in the patients with severest tympanosclerosis (p = 0.0001 in each comparison).

CONCLUSION

The results of the present study show that serum fibronectine is important in the development and severity of tympanosclerosis.

Tympanosclerosis revisited

Tympanosclerosis is a common clinico-pathological entity encountered by the otosurgeon. Its pathogenesis and optimum management have eluded the otologists since time immemorial. The present study was undertaken to study the incidence of tympanosclerosis amongst patients with chronic suppurative otitis media and to study the correlation between the degree of hearing loss and the site of tympanosclerosis. Audiometric and operative findings of 200 patients of chronic suppurative otitis media were analysed. The incidence of tympanosclerosis was found to be 19% (3d cases out of 200 patients). Most cases of tympanosclerosis had a dry ear on presentation (78.9%). When tympanosclerosis was confined only to the tympanic membrane. 83.3% of the cases had an air-bone-gap less than 40 dB. On the other hand, when tympanosclerosis affected both the tympanic membrane and the middle ear. 75% of the cases had an air-bone-gap more than 40 dB. The hearing loss associated with tympanosclerosis was of the conductive type in the majority of cases. Ossicular mobility was found to be normal in 71.1% of the cases.

Otomicroscopic and histologic findings of induced myringosclerosis in rats: a critical study of an experimental model

Myringosclerosis is characterized by hyaline changes of the lamina propria of the tympanic membrane. Experimental studies have used otomicroscopy or histology to evaluate myringosclerosis in animals, but they do not correlate precisely these two methods.

AIM

The present study evaluates the accuracy of otomicroscopy in the diagnosis of myringosclerosis in rats.

STUDY DESIGN

Experimental.

MATERIAL AND METHOD

Myringosclerosis was induced by transtympanic inoculation of Streptococcus pneumoniae in 25 Wistar rats, which were examined weekly through otomicroscopy and sacrificed after eight weeks for histologic study of their tympanic membranes.

RESULTS

From the comparison of the otomicroscopic data in relation to the histologic findings, we could observe sensibility of 80% and specificity of 75% for the otomicroscopy.

CONCLUSION

Considering the results in this study, otomicroscopy did not represent a good method to evaluate myringosclerosis in this experimental model.

Achados otomicroscópicos e histológicos da miringoesclerose induzida em ratos: estudo crítico de um modelo experimental

A miringoesclerose é caracterizada por hialinização da lâmina própria da membrana timpânica. Trabalhos experimentais têm utilizado a otomicroscopia ou a histologia para estudar a miringoesclerose em animais, porém sem correlacionar precisamente estes dois métodos de avaliação. OBJETIVO: Este estudo procura avaliar a acurácia da otomicroscopia no diagnóstico de miringoesclerose em modelo experimental com ratos. FORMA DE ESTUDO: experimental. MATERIAL E MÉTODO: Foi induzida miringoesclerose por inoculação transtimpânica de Streptococcus pneumoniae em 25 ratos Wistar, que foram examinados quinzenalmente por otomicroscopia e sacrificados após oito semanas, tendo suas membranas timpânicas examinadas por histologia. RESULTADOS: Da confrontação das alterações otomicroscópicas com os achados histológicos, houve uma sensibilidade de 80% e especificidade de 75%. CONCLUSÃO: Pelos resultados obtidos neste estudo, a otomicroscopia não representou um bom método para avaliar a miringoesclerose neste modelo experimental.