Introduction. Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines (TNFα, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after severe trauma. Materials and Methods. Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a level 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratios were assessed at admission, 24, 48, and 72 h. SIRS, SIRS with hypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death. Results. Ninety-nine patients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with higher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion, and HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and death. Low TNFα/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death. Conclusions. Pro- and anti-inflammatory responses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially IL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death.

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INTRODUCTION: Endoscopic surgery has gained notoriety among otologists in recent decades thanks to the enhancement of potential surgical methods and to the significant volume of scientific publications on the subject. AIM: The present literature review was carried out in order to assess endoscopic ear surgery research available in the literature, its main surgical indications, as well as advantages and disadvantages. METHODS: The present literature review was based on the term Endoscopic Ear Surgery; 385 articles were selected as its basis. RESULTS: 326 (84.6%) of the 385 selected articles were published in 2011, 37 (9.6%) of them were published between 2001 and 2010, and 22 (5.8%) up to 2000. According to these articles, 17664 endoscopic ear surgeries have already been performed, either as entire surgical procedures or just for microscopic assistance purposes. Tympanoplasty accounts for the largest number of ear surgeries, it is followed by cholesteatoma surgeries (either via transcanal tympanoplasty or mastoidectomy). Endoscopic surgery advantages include reduced cholesteatoma recurrence, less mastoidectomy procedures, shorter operating room time and costs, less postoperative pain, better visualization of middle ear structures, minimally invasive procedures and less second-look surgeries. Its disadvantages include required healthy external auditory canal, single-handed surgical procedures and thermal effects of endoscopy. CONCLUSIONS: Endoscopic ear surgery has been acknowledged as a promising surgical method by otolaryngologists. Although it has faced some resistance from surgeons who have previously mastered micro-ear surgery, this surgical method has already been regarded as a point of no return.