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A szelektív epitympanalis dysventilatiós szindróma a cholesteatomaképződés egy új elmélete, melynek leírását a néhány éve megjelent új, minimálinvazív műtéti technika, az endoszkópos fülsebészet (transcanal endoscopic ear surgery) tette lehetővé. Az endoszkópos fülsebészeti részletes anatómiai ismeretek biztosítottak lehetőséget az elméletet magyarázó új patofiziológiai tényező beazonosítására, mely a középfül ventilatiós útjainak elzáródása. Jól működő fülkürt mellett ezen ventilatiós útvonalak elzáródásának következtében kialakulhat a szelektív epitympanalis dysventilatiós szindróma. Célunk volt felhívni a gyakorló fülsebészek figyelmét a kórképre, mivel a megfelelő diagnózis felállítását követően endoszkópos technikával visszafordítható vagy akár megelőzhető a cholesteatomaképződés, a következményes életminőség-rosszabbodást okozó fülváladékozás és vezetéses halláscsökkenés. A szindrómát saját készítésű anatómiai grafikai ábráink által tesszük még inkább átláthatóvá, érthetővé. A jelen közleményben a szerzők a nemzetközi irodalom áttekintése mellett saját esetbemutatásukon keresztül ismertetik a szelektív epitympanalis dysventilatiós szindróma tüneteit, felismerésének fontosságát és endoszkópos fülsebészeti megoldását. Orv Hetil. 2022; 163(36): 1440–1446.

Purpose Single-sided deaf patients following cochlear implantation often compare the sound quality of their implanted ear with normal hearing. The interaural differences can result in dissatisfaction with speech comprehension and reduced time of usage of the speech processor; hence, prolonging auditory adaptation time. The proposed calibration method presented in this study demonstrates how the frequency distribution of the cochlear implant can be set to adequately approximate the pitch perception of the contralateral normal hearing ear towards improving speech intelligibility in a noisy environment. Methods In 12 postlingual single-sided deaf patients, subjective interaural pitch-matching was carried out to determine new central frequencies for the reallocation of the frequency bands of their speech processor (CP910, CP950 or CP1000, Cochlear, Australia). The patients were asked to compare the pitch of the tones presented to their normal hearing ear to the pitch of individual channels of their cochlear implant (CI522 or CI622, Cochlear, Australia). A third-degree polynomial curve was fit to the acquired matching frequencies to create the new frequency allocation table. Audiological measurements (free-field aided thresholds, speech reception thresholds, and monosyllabic word recognition score) in noise, together with a Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire (short version of the original SSQ) results were evaluated prior to the pitch-matching procedure, and again, 2 weeks later. Results The free-field aided thresholds of the patients showed no greater shift than ± 5 dB following the procedure; however, their monosyllabic word recognition score in noise improved significantly (mean − 9.58%, SD 4.98%, matched pairs t test comparison: p 0.001). The results of the SSQ12 questionnaire also showed significant improvement in speech intelligibility, sound localization, and sound quality (mean 0.96 points, SD 0.45 points, matched pairs t test comparison: p 0.001). Conclusions Matching the pitch perception of the implanted cochlea with the sensation of the normal hearing contralateral ear, resulted in significant changes in the quality of hearing in patients with single-sided deafness. It is plausible the procedure can usher positive results in bimodal patients or following sequential bilateral cochlear implantation.

Mastoid obliteration technique combines the advantages of canal wall-up (CWU) and canal wall-down (CWD) approaches in the surgery of chronic suppurative otitis media with cholesteatoma. We aim to demonstrate our experience with mastoid obliteration technique using bone dust and BonAlive® (S53P4) bioactive glass granule in a comparative prospective clinical study.Between 1st of March 2012 and 31st of November 2021, mastoid obliteration surgery was performed in 14 patients using bone dust (7 cases) and BonAlive® granule (7 cases). Prior to these interventions, the patients had undergone more than three ear surgeries (CWU and CWD) generally in both groups. Changes of complaints, audiological results, and changes in quality of life were analysed in both groups, postoperatively.Having performed the mastoid obliteration technique, cochlear damage did not occur in either patient group. Long-term ear discharge and vertigo were occasionally observed after performing obliteration with bone dust. However, these complaints disappeared after a while. Complications were not reported in the case of obliteration with BonAlive®. Outstanding improvement was experienced in both groups.In our practice, mastoid obliteration surgery, using either bone dust or BonAlive® granule, has proved to be a safe and effective method in the management of chronic suppurative otitis media with cholesteatoma, resulting in continuous putrid ear discharge after CWU or CWD tympanoplasty. Obliteration with BonAlive® granule provides several advantages for patients, such as antibacterial effect, osteoconductive effect ensuring frame for bone growth and osteoproductive effect stimulating the ossification. Orv Hetil. 2022; 163(21): 838-845.Bevezetés és célkitűzés: Az otitis media suppurativa chronica cholesteatomatosa sebészetében a mastoidobliterációval végzett megoldás egyesíti a nyitott és a zárt technikával végzett műtétek előnyeit. Összehasonlító prospektív klinikai tanulmányunkban a csontporral és a BonAlive® (S53P4) bioaktív üveggranulátummal végzett mastoidobliterációs műtéteinkkel szerzett tapasztalatainkat összegeztük. Beteganyag és módszerek: 2012. március 1. és 2021. november 31. között 14 felnőtt betegünknél végeztünk mastoidobliterációs műtétet csontporral (7 beteg), illetve BonAlive® granulátummal (7 beteg). A mastoidobliterációt megelőzően a betegek mindkét csoportban átlagosan több mint 3 fülműtéten (nyitott vagy zárt technikájú tympanoplastica) estek át. A műtéteket követően mindkét csoportban elemeztük a panaszok változását, az audiológiai eredmények alakulását és a betegek életminőségében bekövetkezett változásokat. Eredmények: A mastoidobliterációs műtéti megoldás egyik betegcsoportban sem okozott cochlearis károsodást. A csontporral történt obliterációt követően gyakrabban tapasztaltunk elhúzódó fülváladékozást és esetenként szédülést, mely panaszok idővel megszűntek. A BonAlive® granulátummal obliterált esetekben komplikációt nem észleltünk. Mindkét betegcsoportban igen jelentős életminőség-javulást figyeltünk meg. Következtetés: A mastoidobliterációs műtétek – akár csontporral, akár BonAlive® granulátummal végezve – gyakorlatunkban biztonságos és hatásos megoldásnak bizonyultak korábban otitis media suppurativa chronica cholesteatomatosa miatt akár nyitott, akár zárt technikával végzett, állandó bűzös fülváladékozással járó esetekben. A BonAlive® granulátummal végzett obliterációk számos előnnyel járnak a betegek számára: az üveggranulátum antibakteriális hatású, oszteokonduktív hatású (keretet biztosít a csont növekedéséhez), és oszteoproduktív hatást is kivált (stimulálja a csontosodást). Orv Hetil. 2022; 163(21): 838–845.

Összefoglaló. Halláspanasszal számos beteg fordul orvoshoz. A rutinszerűen elvégzett súgottbeszéd-, hangvilla- és tisztahangküszöb-audiometriai vizsgálat alapján vezetéses, sensorineuralis, illetve a kettő együttes fennállása esetén kevert típusú halláscsökkenést különböztetünk meg. Vezetéses halláscsökkenés létrejöhet mind a külső, mind a közép- vagy a belső fül veleszületett vagy szerzett rendellenességei esetén. Amennyiben a stapediusreflex kiváltható, ugyanakkor a betegnél nincs jelen a külső fület, valamint a középfület érintő kórfolyamat, felmerül a harmadikablak-szindróma lehetősége. A kórkép okaként egy, a belső fül csontos tokján „harmadik ablakként” funkcionáló laesio van jelen, amely az ovális ablakon keresztül beérkező hangenergia egy részét elvezeti, mielőtt az a kerek ablakon át kivezetődik a középfülbe. A diagnózis felállítása gyakran nehéz feladat elé állítja a klinikust, melyhez a megfelelő audiológiai, illetve képalkotó vizsgálatok elvégzése elengedhetetlen. Tekintettel arra, hogy a panaszok megszüntetésére számos műtéti módszer került leírásra, közleményünkben átfogó képet adunk a kórkép etiológiájáról, diagnosztikájáról, terápiájáról, valamint bemutatjuk saját kezdeti tapasztalatainkat is 2 eset prezentálásával. Orv Hetil. 2020; 161(46): 1944–1952. Summary. Patients frequently present to the physician with hearing loss. Routine hearing tests include speech field (whisper test), tuning forks and pure tone threshold audiometry, which can identify the presence of sensorineural hearing loss, conductive hearing loss or a combination of both (mixed type). Conductive hearing loss can be a symptom of many different conditions. These include congenital or acquired malformations of the outer, middle and inner ear. If a conductive hearing loss with intact stapedial reflexes are recorded and in the absence of outer or middle ear pathology, then the third window syndrome should be considered. The cause is a bony defect on the otic capsule that acts as a ’third window’, dissipating the incoming sound energy. Without the appropriate audiological and imaging tests, the diagnosis of the condition is challenging in clinical setting. Several surgical techniques have been described to treat the condition. The authors give a comprehensive review of the etiology, diagnosis and treatment of the disease presenting their initial experiences with 2 cases. Orv Hetil. 2020; 161(46): 1944–1952.

Absztrakt: A pars petrosa cholesteatoma egy lassan növekvő, a temporalis csontot roncsoló, elhúzódóan tünetmentes kórkép. A diagnózis felállítása gyakran késlekedik, hiszen ritka volta miatt még a tapasztalt klinikusok sem gondolnak rá időben. A végső diagnózist jellemzően számos eredménytelen középfülsebészeti beavatkozás előzi meg. A modern radiológiai módszerek nemcsak a diagnózist, hanem a betegek hosszú távú követését is lehetővé teszik. Retrospektív klinikai tanulmányunkban a pars petrosa cholesteatomák sikeres műtéti kezelésére kívánjuk felhívni a figyelmet, hazai beteganyagon első alkalommal elemezve a műtéti megoldások eredményességét. Kezdeti tapasztalatainkat a nemzetközi irodalomból nyerhető adatokkal hasonlítottuk össze. 2015 januárja és 2020 januárja között 6 beteget (4 férfi, 2 nő) kezeltünk különböző lokalizációjú pars petrosa cholesteatomával. Valamennyi beteg a cholesteatoma lokalizációjának megfelelő agyalapi sebészeti beavatkozáson esett át. A betegek átlagos követési ideje 2,7 év volt. A betegek átlagéletkora 47 év volt. A leggyakoribb panaszok a halláscsökkenés, gennyes fülfolyás, szédülés, fülzúgás voltak. Egy beteg már a felvételekor a komplett facialis paralysis tüneteit mutatta. A Sanna-féle osztályozás szerint 2-2 betegünk szenvedett supralabyrinthaer, illetve apicalis, 1-1 beteg pedig masszív, illetve infralabyrinthaer pars petrosa cholesteatomában. Komplikáció sem a peri-, sem a posztoperatív időszakban nem fordult elő. Egy betegnél észleltük a residualis betegség radiológiai jeleit. A pars petrosa cholesteatoma diagnózisa és terápiája komoly nehézséget jelent még a tapasztalt klinikusok számára is. A korai diagnózist a nem jellegzetes tünettan ismerete és a modern képalkotó modalitások teszik lehetővé. A sziklacsontot roncsoló patológiás folyamat eltávolítására korszerű agyalapi sebészeti módszerek állnak rendelkezésre. Ezek a műtétek napjainkban kombinálhatók a modern hallásrehabilitációs módszerekkel. Orv Hetil. 2020; 161(43): 1840–1848.

Absztrakt: Az eosinophil otitis media az utóbbi évtizedben került a kutatók és a klinikum látóterébe; jellemzője a középfülben termelődő, eosinophil granulocytákkal telített mucosus, nehezen eltávolítható váladék és az asthma bronchiale, valamint a krónikus rhinosinusitis társulása. A betegség egyelőre kevéssé ismert a klinikumban, emiatt nincsenek információk a pontos előfordulási gyakoriságáról sem. A kórkép nem gyógyítható, de kezelésére beváltak az intratympanalisan használható szteroidkészítmények, melyek azonban csak enyhébb fokú betegség esetén vezetnek eredményre. A súlyosabb gradusú eosinophil otitis media dobüregi granulációs szövet képződésével és idegi halláscsökkenéssel is járhat, ami sebészi eltávolítást és per os szteroidkezelést is igényel. Fontos felhívni a figyelmet a kórkép létezésére, mert a megfelelő diagnózis felállítása után az időben elkezdett kezeléssel elkerülhető lehet az életminőséget rontó fülváladékozás, felülfertőződés és az idegi halláscsökkenés. A jelen közleményben a szerzők a nemzetközi szakirodalom áttekintésén túl saját esetbemutatásokon keresztül demonstrálják a betegség enyhe és súlyos fokú változatának kezelési lépéseit. Orv Hetil. 2020; 161(41): 1769–1775.

Background: Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects. Objectives: Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices. Methods: This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were “chlorine dioxide” AND “oral”, and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I2-tests. Results: 364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457–0.967 vs 0.489– 1.001, respectively) and also in bacterial counts. Conclusion: Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

OBJECTIVE Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. METHODS We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. RESULTS Six nonrandomized cohort studies were eligible. The primary outcomes were ABG 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). CONCLUSIONS Endoscopic stapes surgery is a valid alternative to the microscope. LEVEL OF EVIDENCE 2a Laryngoscope, 130: 2019-2027, 2020.

Background Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty. Objective of review The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty. Type of review We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Search strategy A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics-Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, 'myringoplasty OR (tympanoplasty AND perforation)' into the search query. We applied only a 'human' filter. We excluded non-English studies. Additional records were identified by checking the references of relevant studies. Evaluation method Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome. Results Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82-1.77; I2 = 0.0%), the postoperative hearing results (WMD = -1.13; 95% CI: -2.72-0.45; I2 = 78.1%) and the operation time (WMD = -21.11; 95% CI: -42.60-0.38; I2 = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30-14.76; I2 = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37-32.73; I2 = 0.0%, P = 0.839), when compared with the microscopic approach. Conclusions Based on our meta-analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.

Abstract: Wegener’s granulomatosis – or, in other words, granulomatosis with polyangiitis – is an anti-neutrophil cytoplasmic antibody associated granuloma forming vasculitis, mainly affecting the respiratory tract and the renal system. Otologic manifestations of Wegener’s disease can be otitis media with effusion or chronic silent mastoiditis with conductive hearing loss, but sensorineural hearing loss can also evolve. The diagnosis is based on the clinical appearance as well as the immunoserological and histopathological results. It is of paramount importance to begin a combined immunosuppressive treatment immediately, besides eradicating the otologic manifestations. The intractable cases of chronic otitis media due to Wegener’s granulomatosis are challenging any ear surgeons. Subtotal petrosectomy has proved to be an effective solution in such cases to create a dry ear and to provide a safe surgical field for hearing restoration. The authors reviewed the literature and report a case history to present the modern management of Wegener’s granulomatosis with otologic manifestation. Orv Hetil. 2019; 160(4): 151–157.

Herpes zoster (HZ) causes considerable pain and distress, and γ-Aminobutyric acid (GABA) and its derivatives are assumed to control this, but the available data are inconsistent. This meta-analysis and systematic review aimed to assess the effectiveness of GABA derivatives in the prevention of acute herpetic pain. The metaanalysis was conducted following the PRISMA guidelines using PICO format, registered in PROSPERO number CRD42018095758. PubMed, Web of Science, Ovid, Scopus, and EMBASE databases were searched. Records were included if they were randomized controlled trials of patients undergoing HZ infection, investigating the effect of GABA derivatives versus placebo in the treatment of HZ pain. Eligible trials were evaluated for the risk of bias. Then data were extracted and analysed. The number of patients with observed presence of pain after treatment was used to calculate odds ratio in a random effect model with the DerSimonian-Laird estimator. The I2 statistic was analysed for heterogeneity. The potential risk of bias was measured using Egger’s regression test. The meta-analysis included three randomized controlled trials with a total of 297 patients. The incidence of acute HZ pain events for GABA group was significantly lower compared to placebo group,18/148 vs 44/149, respectively (OR = 0.36; 95% CI = 0.14 to 0.93; Z = 2.11; P = 0.035), Egger’s test yielded P = 0.308. In conclusion, the present meta-analysis demonstrates that GABA derivatives reduce the incidence of acute herpetic pain. However, additional, well-designed randomized clinical trials are needed to determine their dose- and time-dependency regarding this symptom.

We demonstrate a low-volume, stress-free, piezoelectric micro-electromechanical system (MEMS) cantilever array for fully implantable hearing aids. The 12-element spiral-matrix is sensitive to the lower part of audible frequency range (300⁻700 Hz) through the proper resonant frequency of the individual spirals tuned by dimensions of the cantilevers. The obtained high Q-factors (117⁻254) provide high frequency selectivity. The generated open circuit voltage signals could be sufficient for the direct analog conversion of the signals for cochlear multielectrode implants. By comparing different geometries we have also demonstrated that the initial stress, which is derived from silicon-dioxide (SiO2) and aluminum-nitride (AlN) layers, could be drastically reduced simply by the spiral geometry. The results of vibration measurements have shown a good agreement with the calculated resonant frequencies.

Fully implantable, self-powered hearing aids with no external unit could significantly increase the life quality of patients suffering severe hearing loss. This highly demanding concept, however, requires a strongly miniaturized device which is fully implantable in the middle/inner ear and includes the following components: frequency selective microphone or accelerometer, energy harvesting device, speech processor, and cochlear multielectrode. Here we demonstrate a low volume, piezoelectric micro-electromechanical system (MEMS) cantilever array which is sensitive, even in the lower part of the voice frequency range (300–700 Hz). The test array consisting of 16 cantilevers has been fabricated by standard bulk micromachining using a Si-on-Insulator (SOI) wafer and aluminum nitride (AlN) as a complementary metal-oxide-semiconductor (CMOS) and biocompatible piezoelectric material. The low frequency and low device footprint are ensured by Archimedean spiral geometry and Si seismic mass. Experimentally detected resonance frequencies were validated by an analytical model. The generated open circuit voltage (3–10 mV) is sufficient for the direct analog conversion of the signals for cochlear multielectrode implants.

The class of salivary gland tumours is very heterogenous, both in a histopathological and clinical sense. Since they are uncommon lesions, their clinical management is still problematic. Molecular mechanisms underlying the development of these cancer types may be fundamental for the diagnosis, treatment and prognosis of this disease. In this study, the gene expression of nuclear factor-kappa B (NKkB1/p65), c-Jun N-terminal kinase (JNK1) and growth arrest and DNA damage (GADD45A), which all play an important role in inflammatory and cell survival mechanisms, was assessed in benign and malignant neoplasms of the salivary gland. The absolute mRNA content of paraffin embedded samples of salivary gland cancer was determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) using specific primers for NFkB1, GADD45A and JNK1. Expression values (relative to HPRT) were statistically evaluated. Among the detected alterations in gene expression, the only difference reaching statistical significance was in the case of NFkB1 in adenocystic carcinomas (p=0.05). Given the importance of these signalling mechanisms in the biology of tumorigenesis, these results may be implemented in further research and these genes might become targets for innovative diagnostic and therapeutic strategies.

microRNA expression profile analysis provides evaluation of the early stages of carcinogenesis. This study focuses on early alteration of miRNA expression after treatment with different carcinogens.Mice were intraperitoneally injected with one dose of 7,12-dimethylbenz(α)anthracene (DMBA) and N-methyl-N-nitrosourea (MNU). The expression of miRNAs were analyzed 3 and 6 hours after the treatment, using quantitative real-time-polymerase chain reaction.Underexpression of miR-34a and miR-155 were detected in the liver, spleen and kidneys at 3 and 6 hours after MNU treatment. In the lungs and kidneys, the expression of miR-21 was significantly elevated 6 hours after DMBA treatment, while in the liver, MNU induced higher expression levels of miR-21 at 3 and 6 hours compared to treatment with DMBA.The different response of miRNAs to carcinogens emphasizes their possible role as potential epidemiological biomarkers in early phases of environmental tumorigenesis.

Background: There is emerging molecular evidence concerning themodification of miR expression pattern after the treatment with chemopreventive agents. We investigated whether a potential chemopreventive agent called “Procont” deriving from a biological systemhas a positive effect on the DMBA induced dysregulation of let-7a, miR-21 and miR-146amiRNAs.Materials and Methods: CBA/CA H2k inbred micewere fed by Procont for 7 days before the intraperitonealinjection of DMBA. After one weekof the beginning of Procont diet weanalized the let7a, miR-21, miR-146agene expression in vital organs of mice. Results:The Procont feeding significantly decreased all of the investigated miRNA expression compared with either the mice on a normal diet in the control group or mice were exposed to DMBA alone.Conclusion:The results indicate that“Procont” diet has a potential chemopreventiveeffect in mice exposed to DMBA.

7,12-Dimethylbenz(α)anthracene (DMBA) is a carcinogen capable of inducing various types of tumors.We investigated the effect of DMBA on micro-RNA expression in CBA/CA H2(k) inbred mice after 24 hours and one week from exposure.Expression levels of miR-21, miR-146a and let-7a were significantly higher in the vital organs of the mice 24 hours after DMBA exposure compared to those of the controls. On the other hand, a significant down-regulation of the miRNAs was observed seven days after DMBA administration.Based on our data, DMBA has an impact on the expression of miR-21, let-7a and miR-146a genes. The altered micro-RNA expression can be regarded as an early effect of exposure to chemical carcinogens. To our knowledge, this is the first study of miRNA modulation caused by DMBA in non-malignant tissues.

Facial palsy that occurs immediately after middle ear surgery (stapedectomy, stapedotomy, and tympanoplasty) can be a consequence of the local anesthetics and it regresses completely within a few hours. In the case of delayed facial palsy, the alarming symptom occurs several days or even weeks after uneventful surgery. The mechanism of the neural dysfunction is not readily defined. Surgical stress, intraoperative trauma, or laceration of the chorda tympani nerve with a resultant retrograde facial nerve edema can all be provoking etiological factors. A dehiscent bony facial canal or a multiple microporotic fallopian canal (microtrauma or laser effect) can also contribute to the development of this rare phenomenon. The most popular theory related to the explanation of delayed facial palsy at present is the reactivation of dormant viruses. Both the thermal effect of the laser and the elevation of the tympanomeatal flap can reactivate viruses resting inside the ganglion geniculi, facial nerve, or facial nuclei. The authors report the case histories of a 55-year-old female, and a 45-year-old male who presented with a delayed facial palsy following laser stapedotomy. The clinical characteristics, the therapeutic options, and the possibility of prevention are discussed.