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Objective: To investigate the possible relationship between chronic otitis media with effusion (COME) and Helicobacter pylori (HP)., Patients and Methods: Twenty-five patients (7 girls and 18 boys; age range 2-10 years, mean age 7.8 years) with COME with or without adenotonsillary disease were included in this study. Myringotomy was performed on all patients. Nine patients also underwent adenoidectomy, and 10 patients underwent adenotonsillectomy. The adenoidectomy specimens and middle ear effusions were examined for HP colonization by the Campylobacter-like organism (CLO) test. Adenoidectomy specimens were also evaluated for HP using immunohistochemical (IHC) evaluation. Before surgery, anti-HP immunoglobulin G (IgG) and A (IgA) antibody titres were detected by enzyme-linked immunosorbent assay in the venous blood samples of the patients., Results: The CLO test results were not positive in any of the adenoidectomy specimens and middle ear effusions. IHC examination also revealed that none of the adenoid tissue specimens had a positive HP result. The anti-HP IgG antibody was detected to be positive in eight patients (32%), and IgA antibody was detected in three patients (12%). In three patients (12%), both IgA and IgG antibodies were positive., Conclusion: We were unable to detect the presence of HP in the middle ear effusions and adenoid specimens of children with COME. Owing to the small size of the group in our study, we propose that further studies be carried out with larger study and control groups in an effort to explain the presence of HP in middle ear effusions.

Objective: To assess the relation between mastoid size and attic blockage in COME patients treated with ventilation tube insertion and prognosis regarding tympanometric compliance and computed tomography findings of temporal bones., Material and Methods: Twenty-four ears of 15 patients with chronic otitis media with effusion were selected prospectively. The ages of patients were between 5 and 13 years old and eight of them were females. All patient received medical treatment for 10 days. Ventilation tubes were inserted with or without adenoidectomy or adenotonsillectomy to the unimproved patients. Postoperative compliances were measured on first day, first week, and first month and the tympanometric results were compared each one with others and with mastoid pneumatization degree using computerized tomographic findings., Results: The hearing thresholds were between 23 and 43 dB in left ears and between 22 and 45 dB in right ears. Mastoid pneumatization and aditus were normal and open in three (12.6%); sclerotic and open in eight (33.3%); sclerotic and blocked in 13 patients (54.1%), when the temporal bones assessed by computerized tomography. The mean compliance values of patients elevated postoperatively in regard with time and this increase was significant. There was a significant statistical relation between mastoid pneumatization and compliance of the ears., Conclusion: Tympanometric assessment may be considered as a valuable and cost-effective method rather than CT in the evaluation of aditus blockage and residual soft tissue of the tympanomastoid region.

The hyper-IgE syndrome is a rare, complex immunoregulatory disorder characterized by pruritic dermatitis, recurrent staphylococcus skin abscesses and extremely elevated levels of IgE in serum. In this report, an 8-year-old girl with hyper-IgE syndrome is presented. She had pruritic dermatitis and skin abscesses on her extremities and scalp. Discharge and granulation tissue in right external ear canal were recognized in otorhinolaryngologic examination. Cultures of the suppuration of the external ear canal yielded S. aureus. Biopsy of the lesion was reported as granulation tissue. Local treatment of the ear canal was performed with ear wick soaked with steroid and antibiotic solutions two times per day.

Objectives: We investigated the etiologic causes and the value of nasal endoscopy in adult onset otitis media with effusion (OME)., Patients and Methods: The study included 50 patients with adult-onset OME (28 males, 22 females; mean age 46 years; range 18 to 41 years). Pneumatic otoscopy, otomicroscopy, pure-tone audiometry and tympanometry were performed in all patients. The nasal cavity and the nasopharynx were examined by nasal endoscopy. Skin prick tests were performed and serum specific IgE levels were determined in all patients. Computed tomography scans of the nasal cavity, paranasal sinuses, nasopharynx, and the skull base were obtained when indicated., Results: Adult-onset OME was bilateral in 24 patients. Allergy was detected in three patients. Four patients had marked septal deviation. Mucopurulent discharge in the middle meatus was observed in 20 patients and polypoid tissue in the lateral nasal wall in two patients. Mucoid and purulent discharge and edema were observed at the orifice of the eustachian tube in 13 patients and 10 patients, respectively. Biopsies obtained from nasopharyngeal masses revealed squamous cell carcinoma in one patient and lymphoid hyperplasia in four patients., Conclusion: We concluded that nasal endoscopy was a reliable method in the investigation of etiologic factors in adult-onset OME.

Objectives: We assessed the causes of failure in patients who underwent open cavity mastoidectomy., Patients and Methods: Of sixty-three patients who had undergone open cavity mastoidectomy for chronic otitis media, 11 patients (7 females, 4 males; mean age 35.2 years; range 8 to 59 years) required revision mastoidectomy. Membrane repair was accomplished with the use of temporal muscle fascia and tragal cartilage; ossicular reconstruction was performed by the interposition of incus and TORP. The mean follow-up was 13.1 months (range 6 months to 2 years)., Results: The involved ear was the right in seven and the left in four patients. None of the patients, but one with nasal allergy had any immune or systemic diseases. In all patients cavity epithelialization was completed in a mean of 1.6 months (range 1 to 3 months). The indications for revision included residual cholesteatoma in three patients, inadequate meatoplasty and lowering of the facial ridge in four patients, patent tuba and serous discharge in two patients, and tympanic membrane perforation and granulation tissue in the hypotympanum and mastoid apex in two patients., Conclusion: The incidence of revision mastoidectomy may be decreased when a safe open cavity is obtained through lowering the facial bridge down to the level of the facial nerve, adequate meatoplasty, and by a complete exenteration of all the mastoid cells.

Myringosclerosis (MyS) is a common sequela of acute and chronic otitis media and ventilation tube treatment of serous otitis media. We aimed to study the effect of topical administration of N -acetylcysteine (NAC) on MyS by assessment of otomicroscopic evaluation, lipid peroxidation and nitric oxide (NO) (nitrite/nitrate) levels in experimental myringotomized rat tympanic membrane. Thirty adult rats were used and the upper posterior quadrant of the tympanic membranes of rats was myringotomized. Thereafter, they were divided into four groups. Group I received no treatment, group II was treated with saline, groups III and IV were treated with topical NAC (0.1 ml of 6 and 12 mg ml−1, respectively). The levels of nitrite/nitrate and malondialdehyde (MDA) were measured in serum samples. In the otomicroscopic evaluation, non-treated and saline treated ears (controls) showed extensive occurrence of myringosclerotic plaques. Groups III and IV showed fewer occurrences of sclerotic plaques. There was no significant difference between groups III and IV regarding the development of MyS. The development of myringosclerotic lesion was found to be significantly different between NAC treated groups (III and IV) and the control groups (I and II). The levels of nitrite/nitrate of both groups III and IV were significantly lower than the control groups. The levels of MDA of these groups were also significantly lower than the control group. The relationship between groups III and IV was not statistically significant for the levels of nitrite/nitrate and MDA. We conclude that the topical treatment of NAC reduces the levels of MDA and NO products in rats. These results suggest that topical NAC application may be useful for the prevention of MyS. [Copyright &y& Elsevier]