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Magliulo G, Iannella G, Granata G, Ciofalo A, Pasquariello B, Angeletti D, La Marra F, Quinti I. Otologic evaluation of patients with primary antibody deficiency. Eur Arch Otorhinolaryngol 2016; 273:3537-3546. [PMID: 26935054 DOI: 10.1007/s00405-016-3956-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/26/2016] [Indexed: 12/11/2022]
Abstract
Common variable immunodeficiency (CVID) represents the most frequent primary immunodeficiency, often encountered in the ENT clinical practice. The clinical spectrum of CVID is quite broad, but otitis media are certainly among the most common clinical manifestations. This prospective study enrolled 60 patients (34 males, 26 females) with a previous diagnosis of CVID with the aim of performing an otologic evaluation and a more precision characterization of incidence, diagnosis, and treatment of otitis media in this group of patients. In consideration that Eustachian tube dysfunction (ETD) could be the 'primum movens' of otitis media, we wanted to assess whether a Eustachian tube dysfunction was present in these patients. Besides, we propose a possible diagnostic algorithm of middle ear pathologies to use in all cases of primary antibody deficiency patients. Results of our otologic examination showed that: 5 % of patients had chronic suppurative otitis media, 25 % bilateral otitis media with effusion and 10 % reported unilateral OME with associated contralateral ETD. There was bilateral isolated ETD and unilateral isolated ETD in 5 and 15 % of patients, respectively. All patients with unilateral OME had associated contralateral ETD. Finally, 40 % of patients were bilaterally negative at otoscopic examination and all otologic tests.
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Affiliation(s)
- Giuseppe Magliulo
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy.
| | - Giannicola Iannella
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy
| | - Guido Granata
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy.,Department of Molecular Medicine, La Sapienza University, Rome, Italy
| | - Andrea Ciofalo
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy
| | - Benedetta Pasquariello
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy
| | - Diletta Angeletti
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy
| | - Fabiola La Marra
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy.,Department of Molecular Medicine, La Sapienza University, Rome, Italy
| | - Isabella Quinti
- 'Organi di Senso' Department, 'Sapienza' University of Rome, Via Gregorio VII n. 80, 00165, Rome, Italy.,Department of Molecular Medicine, La Sapienza University, Rome, Italy
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Si Y, Zhang ZG, Chen SJ, Zheng YQ, Chen YB, Liu Y, Jiang H, Feng LQ, Huang X. Attenuated TLRs in middle ear mucosa contributes to susceptibility of chronic suppurative otitis media. Hum Immunol 2014; 75:771-6. [PMID: 24882571 DOI: 10.1016/j.humimm.2014.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/18/2014] [Accepted: 05/18/2014] [Indexed: 11/27/2022]
Abstract
The variability in the recovery of otitis media (OM) is not well understood. Recent data have shown a critical role for toll-like receptors (TLRs) in inflammatory responses to bacteria. It remains unclear whether TLRs-mediated mucosal immunity plays a role in the OM recovery. The etiology, pathological profile, expression levels of TLR2, TLR4, TLR5, TLR9 and proinflammatory cytokines were measured in human middle-ear mucosae sampled from three subject groups: non-OM group, chronic otitis-media (COM) group, and chronic suppurative otitis-media (CSOM) group. Of the 72 ears, 86.11% CSOM patients were positive for bacteria. The cellular makeup of the middle ear mucosa differs among the three groups. Mucosae from the CSOM group presented chronic inflammation or suppurative inflammation in the rudimentary stroma, mainly with infiltration of monocytes and macrophages. The mRNA and protein levels of TLR2, TLR4, and TLR5 exhibited no difference between the non-OM and COM groups but were significantly lower in the CSOM group. Conversely, there was no significant difference in the TLR9 level among the three groups. Furthermore, proinflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6 were up-regulated in the CSOM group. This study provides evidence that the variability in clinical otitis media recovery might be associated with the variability in the expression of mucosal TLRs. Reduced TLR levels in the middle-ear mucosa might cause weak host response to bacteria, persistent inflammation and susceptibility to CSOM.
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Affiliation(s)
- Yu Si
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhi Gang Zhang
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
| | - Sui Jun Chen
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yi Qing Zheng
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yu Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yi Liu
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Huaili Jiang
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lian Qiang Feng
- Department of Immunology, Zhongshan School of Medicine, Institute of Human Virology, Sun Yat-sen University, Guangzhou 510080, China; Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
| | - Xi Huang
- Department of Immunology, Zhongshan School of Medicine, Institute of Human Virology, Sun Yat-sen University, Guangzhou 510080, China; Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China.
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Effect of caffeic acid phenethyl ester on myringosclerosis development in the tympanic membrane of rat. Eur Arch Otorhinolaryngol 2013; 272:29-34. [DOI: 10.1007/s00405-013-2832-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 11/18/2013] [Indexed: 10/26/2022]
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Ozdemir T, Cincik H, Dogru S, Cekin IE, Ulubil SA, Gungor A. Efficacy of topical halofuginone in myringotomy patency. Eur Arch Otorhinolaryngol 2010; 267:1701-4. [PMID: 20574743 DOI: 10.1007/s00405-010-1306-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 06/07/2010] [Indexed: 11/26/2022]
Abstract
The objective of the study is to determine whether topical halofuginone (HF) application has an impact on prolonging the time for healing of myringotomy incision, and to investigate histopathologic effects of HF on tympanic membrane (TM) in rat model. Forty rats with normal eardrums were involved in this study. The study group and control group consisted of 30 and 10 rats, respectively. A posterior incision 1 mm in diameter was made on healthy eardrums of the rats. Following incision, gelfoam soaked with HF hydrobromide of 30 mg/dl was applied on the perforation in study group, whereas gelfoam soaked with isotonic saline was applied on the perforation in control group. On days 1, 3, 7, 10, 14, 18, 21, 24, 27, and 30, otoendoscopic evaluation of eardrums under general anesthesia was conducted and perforations were screened. A rat of each group was killed in control days and TMs were dissected to evaluate histopathological changes. The average times for patency of perforation in study and control groups were 21.43 and 7.50 days, respectively. The difference was found to be statistically significant (p < 0.05). Histopathological evaluation revealed that HF reduces hyalinisation and fibrosis in eardrum, when compared with the control group. In conclusion, HF significantly delays closure time of myringotomies in rat model. However, this delay may not be enough for recovery of otitis media with effusion.
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Affiliation(s)
- Taner Ozdemir
- Department of ENT, Gulhane Military Medical Academy, GATA, Haydarpasa Training Hospital, KBB Klinigi, 34668 Kadıköy, Istanbul, Turkey
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John EO, Russell PT, Nam BH, Jinn TH, Jung TT. Concentration of nitric oxide metabolites in middle ear effusion. Int J Pediatr Otorhinolaryngol 2001; 60:55-8. [PMID: 11434954 DOI: 10.1016/s0165-5876(01)00509-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Free radicals such as nitric oxide (NO) seem to be important in the pathogenesis of otitis media with effusion (OME). NO can be quantitated by measuring its metabolites, nitrate (NO(3)(-)) and nitrite (NO(2)(-)). The purpose of this study is to determine the concentrations of NO in human middle ear effusion (MEE). Samples of human MEE were collected at the time of myringotomy and tympanostomy tube insertions. The type of MEE was classified as serous (SOM), mucoid (MOM) or purulent (POM) at the time of surgery. Samples of MEE were assayed for NO metabolites (nitrate and nitrite) with colorimetric assay (Griess method). Concentrations of NO metabolites were highest in MOM followed by SOM and POM. This study suggests that NO is present in human MEE and may play an important role in the pathogenesis of OME.
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Affiliation(s)
- E O John
- Division of Otolaryngology-Head and Neck Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
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Vambutas A, Paparella MM. Tympanoplasty: prudent considerations of silent otitis media and interactions of middle ear and inner ear. Otolaryngol Clin North Am 1999; 32:505-12. [PMID: 10393782 DOI: 10.1016/s0030-6665(05)70148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Otitis media is a common problem, often with simple, minimally invasive solutions; however, a small subset of patients progress to chronic disease despite provision of standard therapies. The flexible approach to tympanoplasty is a prudent consideration for patients with chronic otitis media, especially children. This article discusses the findings and implications of silent otitis media, interactions of the middle ear and inner ear, and obstructive sites in the middle ear cleft. Tympanoplasty by the flexible approach is described in the context of these findings.
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Affiliation(s)
- A Vambutas
- Department of Otolaryngology, Albert Einstein College of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Abstract
Otitis media is an important disease of children and adults and is caused by multiple interrelated factors, including infection, eustachian tube dysfunction, allergy, and barotrauma. This article includes a pertinent review of the literature regarding otitis media. The pathogenesis, classification, and treatment of otitis media in children and adults are also reviewed in this article. Additionally, therapy is discussed with emphasis on the surgical options appropriate at each stage.
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Affiliation(s)
- T T Jung
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California, USA
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Rodrigo C. Prevention of acute otitis media. Clin Microbiol Infect 1997. [DOI: 10.1016/s1198-743x(14)64955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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