INTRODUCTION:The aim of the study was to compare hearing results between tympanoplasty with attic wall reconstruction and attic obliteration. MATERIAL AND METHODS:A prospective study included 88 patients who were operated for chronic suppurative otitis media (CSOM) and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Analysis of variance (ANOVA) was conducted to assess the impact of two different techniques of tympanoplasty: attic wall reconstruction and attic wall obliteration on patients' hearing. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Cholesteatoma was found in 54 (61.4%) patients: 31 (35.2%) sinus cholesteatoma, 20 (22.7%) attic cholesteatoma, 3 (3.4%) tensa tympanic cholesteatoma, and 34 cases (38.6%) of CSOM. Lateral attic wall and ossicular chain reconstruction was performed in 33 cases with subsequent attic reconstruction if the long process of the incus and the incudo-stapedial joint were missing. A mixed between-within-subjects analysis of variance showed significant improvement of PTA postoperatively in comparison to preoperative levels: Wilk's Lambda=0.33, F(1,86)=172.1, p<0.001. ANOVA showed significant improvement of ABG postoperatively in comparison to preoperative levels: Wilk's Lambda=0. 23, F(1,86)=286.3, p<0.001. Hearing improvement was measured in both cases, the ABG closure and mean PTA improvement was larger in the attic reconstruction compared to attic obliteration technique. CONCLUSION: Attic wall reconstruction with cartilage provides better postoperative hearing compared to attic obliteration. Attic reconstruction in revision cases for cholesteatoma recurrence is not recommended.Hearing results of tympanoplasty with attic reconstruction vs. obliteration in attic cholesteatoma wall up mastoidectomy for prevention of retraction pocket. Otol Neurotol. 2005 Nov;26 (6):1107-11. 10. Stankovic M. Follow-up of cholesteatoma surgery: open versus closed tympanoplasty. ORL J Otorhinolaryngol Relat Spec. 2007;69(5):299-305
Introduction. The inflammatory mediators play a central role in the pathogenesis of the inflammatory process of the middle ear and cholesteatoma from the aspect of initiating and maintaining the inflammatory response to infection and lesion. The aim of the study was to examine if the presence of acquired cholesteatoma could predict pathomorphological changes of the tympanic cavity mucosa in relation to the control tissue of the inflamed middle ear mucosa and to examine and compare the expression levels of tumor necrosis factor-alpha (TNF-a), interleukin-1 (IL-1) and matrix metalloproteinase 9 (MMP-9) with pathomorphological changes in the middle ear mucosa in chronic otitis media (COM), with and without acquired cholesteatoma (AC). Methods. The immunohistochemical study included 178 patients of both sexes, aged 5 to 75, who underwent microsurgical treatment of COM from 2015 to 2018. Patients were divided into two groups based on the presence or absence of AC of the middle ear: 97 with cholesteatoma (CCOM) and 81 without cholesteatoma (COM). Samples of the perimatrix of AC and inflamed middle ear mucosa were taken intraoperatively. The condition of the tympanic cavity mucosa was examined by otomicroscopy exploration intraoperatively. The expression levels of TNF-a, IL-1 and MMP-9 were determined by immunohistochemical analysis. Results. The difference in the percentage distribution of patients according to the condition of the tympanic cavity mucosa between both groups was statistically significant (p <0.01) where in the COM group the highest frequency was 43.2% of patients with mucosal hypertrophy, and in the CCOM 56.7% with granulations. With highly positive expression of TNF-R2 and IL-1, a higher probability of the presence of mucosal hypertrophy and granulations can be expected, and with highly positive expression of MMP-9 the presence of granulations. Conclusion. Acquired middle ear cholesteatoma is a statistically significant predictor of the occurence of mucosal hypertrophy and granulations in the tympanic cavity in relation to the control tissue of the inflamed middle ear mucosa. The high expression of TNF-R2, IL-1 and MMP-9 shows a statistically significant association with the presence of granulations and mucosal hypertrophy in acquired middle ear cholesteatoma which may have clinical significance in the evaluation and prognosis of the disease.
Transient-evoked otoacoustic emissions are transmitted through the middle ear. The purpose of this study was to investigate the effects of dynamic properties of the transmission system on the measurability of transient otoacoustic emissions. The authors analyzed the presence of transient otoacoustic emissions in 48 children with serous otitis media regarding the tympanogram, presence and type of effusion and pure tone average findings. The results obtained in this research show the predominant absence of transient otoacoustic emissions in patients with type B tympanogram (69.1%) especially if the effusion is mucoid (77.5%) with the hearing loss of 15 decibel hearing level. This research shows that disorders in dynamic characteristics of the middle ear in patients with serous otitis obstruct the transmission of acoustic energy and affect the measurability of transient otoacoustic emissions, especially if the effusion is mucoid and hearing loss of 15 decibel hearing level.
Sazetak. Prikazane su kliničko-epidemiološke karakteristike 221 bolesnika sa dijagnostikovanim malignim tumorom larinksa, koji su liječeni и Klinici za bolesti uha, grla i nosa sa maksilofacijalnom hirurgijom Kliničkog centra и Banjoj Luci и petogodišnjem periodu od 1998. do 2002. godine. Maligni tumor larinksa dominantno je bio zastupljen kod muškaraca (212 bolesnika, 95,92%), dok je oboljelih žena bilo samo 9 (4,08%). Skoro svi pacijenti bili su pušači (220 pacijenata, 99,55). Najveći broj pacijenata bio je starosti od 60 do 80 godina, a najmlađi pacijent je imao samo 23 godine. Kod 218 (98,66%) pacijenata dijagnostikovan je planocelulami karcinom larinksa. U ispitivanom uzorku najveći broj tumora larinksa bio je и stadijumu T3 (111 bolesnika, 50,2%). Od 221 pacijenta sa dijagnostikovanim tumorom larinksa operisano j e 185 (83,71%). Faringokatana fistula, kao najzanačajnija komplikacija nakon totalne laringektomije, javila se kod 17 pacijenata (9,19%).Prikazani rezultati potvrđuju nalaze i iskustva drugih autora da kacinom larinksa zahvata uglavnom stariju populaciju i pušače, kao i da se, uglavnom, dijagnostikuju и kasnom stadijumu.
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