Hyaluronic Acid Gel as Middle Ear and External Auditory Canal Packing Material in Tympanoplasty.

OBJECTIVE: This study aims to evaluate the effect of hyaluronic acid gel (HAG) on tympanic membrane (TM) graft success rate and audiometric outcomes in patients with large TM perforations during tympanoplasty. STUDY DESIGN: A single-blinded randomized controlled trial. SETTING: Tertiary hospital. METHODS: In the study, we performed tympanoplasty via postauricular approach on 488 ears and compared 2 groups: the control group (n = 247) with absorbable gelatin sponge packing and the HAG group (n = 241) with HAG packing in both the middle ear and medial 2/3 of the external auditory canal. We compared the graft success rates and postoperative audiometric outcomes between the 2 groups. RESULTS: In a study of 488 ears (HAG group = 241, control group = 247), the HAG group had a higher graft success rate of 96.7% (233/241 ears) compared to the control group's 91.5% (226/247 ears; P = .015). No significant difference was observed between HAG and control in postoperative ABG closure within 20 dB (HAG: 66.8% or 161 ears; control: 59.1% or 146 ears; P = .078). There were no significant differences in improvements, compared to their preoperative condition, in mean bone conduction (HAG: -0.1 ± 6.5; control: 1.3 ± 7.6), air conduction (HAG: 8.7 ± 12.1; control: 9.7 ± 13.1), air-bone gap (HAG: 8.8 ± 10.6; control: 8.4 ± 12.0), and speech reception threshold (HAG: 9.4 ± 11.8; control: 9.2 ± 13.5) between the control and HAG groups (two one-sided T test, P < .001). CONCLUSION: In tympanoplasty, HAG packing in the middle ear and external auditory canal yields higher graft success rates than absorbable gelatin sponge, while audiometric outcomes are similar for both the HAG and absorbable gelatin sponge packing cohorts.

Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study.

OBJECTIVE: This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. METHODS: A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. RESULTS: Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). CONCLUSION: Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.

Is pre-operative audiometry a reliable predictor of ossicular chain condition?

OBJECTIVE: Investigation of ossicular chain (OC) status before surgery is important for preoperative patient consultation. This research aimed to investigate the relationship between pre-operative audiometric values and intra-operative OC condition in a relatively large population of chronic otitis media (COM) surgeries. METHODS: In this descriptive-analytic cross-sectional study, we evaluated 694 patients who underwent COM surgeries. We analyzed pre-operative audiometric data and intraoperative findings including ossicular anatomy, ossicular mobility, and the condition of middle ear mucosa. RESULTS: The optimal cut-off values of pre-operative speech reception threshold (SRT), mean air-conduction (AC), and mean air-bone gap (ABG) for predicting OC discontinuity were 37.5 dB, 37.2 dB, and 28.4 dB, respectively. For the prediction of OC fixation, the optimal cut-off points of SRT, mean AC, and mean ABG were 37.5 dB, 40.3 dB, and 32.8 dB, respectively. The computing of Cohen's d (95 % confidence interval) demonstrated the greater mean ABG in ears with OC discontinuity in comparison with ears with normal ossicles in all types of pathologies. There was a descending trend of Cohen's d from cholesteatoma to tympanosclerosis and then to granulation tissue and hypertrophic mucosa. There was a substantial relation between the type of pathology and OC status (P < 0.001). Ears with tympanosclerosis plaque had the most fixed OC among all types of pathologies (40 ears, 30.8 %), and ears with no pathology had the most normal OC (135 ears, 83.3 %). CONCLUSIONS: The results supported the view that pre-operative hearing is a key determining factor for the prediction of OC status.

Non-carcinogenic and cumulative risk assessment of exposure of kitchen workers in restaurants and local residents in the vicinity of polycyclic aromatic hydrocarbons.

Polycyclic aromatic hydrocarbons (PAHs) are often formed when organic substances do not burn completely. This study evaluates the non-carcinogenic and cumulative risks associated with PAHs levels by testing blood and urine samples in kitchen workers and residents near restaurants in Shiraz, Iran. Metabolites of PAH in the urine samples as well as clinical parameters in the blood samples were measured. The non-carcinogenic and cumulative risk assessments from exposure of the study groups to PAH metabolites were also evaluated. The highest average concentrations of PAH metabolites were related to kitchen workers (2126.7 ng/g creatinine (ng/g cr)). The metabolites of 1-Hydroxypyrene (1-OHP) and 9-Phenanthrene (9-OHPhe) had the highest and lowest mean concentrations, respectively. A direct correlation was observed between the levels of PAH metabolites with malondialdehyde (MDA) and total antioxidation capacity (TAC) levels (p < 0.05). Hazard Index (HIi) was obtained less than one (HIi < 1), indicating low-risk negative health impacts on the target groups. Nevertheless, conducting more studies to determine the health status of these people is quite evident.

Comparison of partial vs. total ossicular chain reconstruction using titanium prosthesis: a retrospective cohort study.

PURPOSE: Comparison of the hearing outcomes of titanium partial ossicular replacement prosthesis (PORP) vs. titanium total ossicular replacement prosthesis (TORP) with footplate shoe (Omega Connector) in second stage ossicular chain reconstruction surgeries. METHODS: In this retrospective cohort study in a tertiary hospital, we compared the hearing outcomes in 248 patients who had undergone ossicular chain reconstruction with titanium prostheses PORP (n = 115) vs. TORP (n = 133) from August 2017 to June 2021. Pre-and post-operative audiometric data were assessed. RESULTS: In general, we found that there were no significant differences between PORP and TORP groups in gains of BC (P = 0.080), AC (P = 0.454), ABG (P = 0.928), SRT (P = 0.065), and SDS (P = 0.363). There were no significant differences in terms of ABG gain between the two groups. Regarding ABG gains frequency-specific analysis in the ears with pre-operative conductive hearing loss, there were no significant differences between low-frequencies (P = 0.260) and high-frequencies (P = 0.973) between the two groups. CONCLUSION: To sum up, this research provided additional evidence with respect to hearing outcomes after staged ossicular chain reconstruction with PORP and TORP. The practical application of our study is that TORP with footplate shoe (Omega Connector) is comparable with PORP in staged ossiculoplasty.

Health risk assessment of polycyclic aromatic hydrocarbons in individuals living near restaurants: a cross-sectional study in Shiraz, Iran.

Polycyclic aromatic hydrocarbons (PAHs) are persistent toxic substances that have ubiquitous presence in water, air, soil, and sediment environments, posing serious environmental risks. The present study aimed to investigate the concentrations of urinary PAHs and their health effects in individuals living near restaurants via a health risk assessment analysis. This cross-sectional study was performed on 57 people living near restaurants and 30 individuals as the control group. Five urinary metabolites of PAHs were monitored. In order to evaluate the effects of the urinary metabolites of PAHs on Malondialdehyde (MDA) concentration, Total Anti-oxidation Capacity (TAC) in urine samples, and C-Reactive Protein (CRP) in serum samples, regression model was used by considering the effects of the possible confounding factors. Non-carcinogenic health risk was calculated, as well. The median concentration of urinary PAHs was 1196.70 and 627.54 ng/g creatinine in the people living near restaurants and the control group, respectively. Among the metabolites, the lowest and highest mean concentrations were related to 9-OHPhe and 1-OHP, respectively in the two study groups. Moreover, PAHs were significantly associated with MDA level and TAC (p < 0.05). Hazard Quotient (HQ) and Hazard Index (HI) were less than 1. Long-term studies are required to determine the actual health effects by identifying the sources of PAHs emission and to find ways to decrease the production of these compounds.

Application of posterior canal skin flap for the repair of large tympanic membrane perforations.

Objective: Many methods have been described for the repair of the tympanic membrane, but there is no general consensus as to the standard method. The aim of this study was to evaluate the effect of the inferior base posterior canal skin flap on the graft success rate in large tympanic membrane perforations. Methods: After the post-auricular incision, the posterior canal skin flap with inferior pedicle was created by two vertical and one horizontal incisions. Then the flap was rotated over the temporalis fascia graft. The graft success rate and postoperation hearing test results were evaluated in 52 patients who suffered from large tympanic membrane perforations. Results: We achieved a 92.3% total graft success rate with about 9 dB improvement in speech reception threshold (SRT). Conclusion: The rotational inferior base posterior canal skin flap tympanoplasty technique is simple, fast, safe, and effective for the repair of subtotal tympanic membrane perforations.

Is it Effective and Cost-saving to Send all Tonsillectomy Specimens for Histopathological Examinations?

INTRODUCTION: The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens. MATERIALS AND METHODS: In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services. RESULTS: Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively. CONCLUSIONS: According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.

Evaluating hearing results in stapedotomy: Comparison of fluoroplastic Causse loop piston and Matrix prosthesis.

OBJECTIVE: We carried out this research to assess and compare post-stapedotomy hearing results of Matrix titanium prosthesis with a Teflon piston prosthesis, specifically the fluoroplastic (Teflon) Causse loop piston prosthesis in patients who suffered from otosclerosis. METHODOLOGY: In this retrospective study, Causse loop piston prosthesis was used in 81 ears, and the Matrix prosthesis was applied in 44 ears. For pairwise matching with Matrix prosthesis, 44 out of 81 Causse loop piston-treated ears were selected based on preoperative audiometric data. Then, postoperative audiometric results of these two groups were compared. The main outcomes were pure tone audiometric results and air-bone gap (ABG) closure before and after the surgery. Incidence of postoperative sensorineural hearing loss was also evaluated and compared between the two groups. RESULTS: The results revealed no significant difference in improvement of speech reception threshold, mean air conduction, bone conduction gain, ABG closure, and incidence of postoperative sensorineural hearing loss at the frequencies of 0.5-4 kHz between the two groups. However, performance of Matrix prosthesis was better in ABG closure at a frequency of 250 Hz. CONCLUSION: Herein, similar postoperative improvement was achieved at the frequencies of 0.5-4 kHz; nevertheless, Matrix provided better ABG closure at frequency of 250 Hz in short term. LEVEL OF EVIDENCE: 4.

Comparison of celecoxib and acetaminophen for pain relief in pediatric day case tonsillectomy: A randomized double-blind study.

OBJECTIVE: Post-tonsillectomy pain is a common morbidity in children. The aim of this study was to compare the efficacy of celecoxib with acetaminophen on pain relief in pediatric day-case tonsillectomy. METHODS: We compared the analgesic effect of celecoxib (99 patients) with acetaminophen (100 patients) for the management of post-tonsillectomy pain. Post-tonsillectomy pain score was evaluated three times a day for 7 days. In addition, the incidence of post-tonsillectomy bleeding and the rate of patients who returned to regular diet were evaluated. RESULTS: In the first day, we observed lower mean pain score in the celecoxib group, than the acetaminophen group (P = 0.013). The overall pain score in other days was not significantly different between the two groups. In the celecoxib group, more patients resumed regular amount of oral intake within the first 3 days. Also, the rate of post-tonsillectomy bleeding in the two groups was not statistically different. CONCLUSION: We recommend celecoxib as a more suitable choice than acetaminophen for post-tonsillectomy pain management in the first day and resuming regular diet within 3 days.Level of Evidence: 1b.

Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy.

OBJECTIVE: To prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used. METHODS: In this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome. RESULTS: The time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow-ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported. CONCLUSION: Silicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy. LEVEL OF EVIDENCE: 4.

Comparison of Titanium versus Polycel as Partial Ossicular Replacement Prosthesis: A Randomized Clinical Trial.

INTRODUCTION: Each type of prosthesis for ossiculoplasty has its advantages and disadvantages, and the choice of the best material has been a matter of various studies. The present study aimed to make a comparison between the hearing outcomes of partial ossicular replacement prosthesis (PORP) using titanium versus Polycel prosthesis. MATERIAL AND METHODS: A total of 106 patients undergoing PORP as a second stage ossiculoplasty were analyzed in this study. Following that, they were randomly assigned to two groups of titanium (n=54) and Polycel (n=52) prosthesis. Subsequently, pre-and post-operative audiometric data were assessed based on the aim of the study. RESULTS: In general, the post-operative air-bone gap within 20 dB was given to 63.5% and 55.6% of all ears in the Polycel and titanium groups, respectively, indicating a non-significant difference (P=0.407). Finally, no SNHL was observed in the groups. CONCLUSION: Overall, the hearing outcomes and the success rate of PORP are comparable between titanium and Polycel prostheses. Therefore, the selection of these prostheses could be based on the surgeons' preferences, availability, and cost.

Comparison of hearing outcomes in stapedotomy with fat and Hyaluronic acid gel as a sealing material: a prospective double-blind randomized clinical trial.

PURPOSE: In the literature on stapes surgery, various materials have been used to seal the vestibulotomy. To date, there are only a few published randomized clinical trials with focus on hearing outcomes, using different sealing materials. Hence, the aim of this study was to compare hearing outcomes when using fat or Hyaluronic acid gel (HAG) to seal the stapedotomy. METHODS: The present double-blind, prospective, randomized clinical trial was conducted on ears undergoing stapedotomy in Dasthgheib Hospital, a referral otology center in Southern Iran, and Dena private hospital, Shiraz Iran. A total of 150 primary stapedotomies were evaluated, and sealing material was fat in 77 ears and HAG in 73. RESULTS: 60 (77.9%) of the fat group ears and 63 (86.3%) of the HAG group ears obtained postoperative air-bone gap (ABG) within 20 dB, but the difference was not significant (p = 0.182). CONCLUSION: As a sealing material in stapedotomy, HAG is comparable with fat in terms of hearing outcomes. Therefore, HAG is recommended as a safe sealing material in stapedotomy.

The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding.

PURPOSE: Pain and hemorrhage are common morbidities after tonsillectomy. Although many studies have focused on post-tonsillectomy pain, inadequate researches are available on wound healing. Hence, there is a definite need for a novel technique to facilitate the healing process and thereby improving the post-tonsillectomy recovery. METHODS: This prospective and randomized study was conducted on 60 adult patients who underwent tonsillectomy. They were divided into two groups of control and amniotic membrane (AM). Human amniotic membrane was applied over the tonsillar bed as a biologic dressing. Post-tonsillectomy pain and bleeding were evaluated. Also, the healing rate was assessed on days 5, 10 and 15 post-operatively. RESULTS: The pain score in the AM group was lower than that in the control group during the first week after surgery (P < 0.0001). Moreover, the AM group returned faster to their normal diet in comparison with the control group (P < 0.0001). With respect to the healing rate, there were no significant differences between the groups on day 5 (P > 0.05), whereas a significant difference was seen on days 10 and 15 post-surgery (P < 0.0001). There was no significant difference between the two groups in terms of post-operative bleeding (P ≅ 1). CONCLUSION: We observed that the use of AM graft as a biologic dressing might be beneficial in reducing post-operative pain and promoting the wound healing process. The results represent a further step toward developing a new technique for coverage of tonsillar fossa with sheeting or wearing grafts.

The effect of anterior tab flap technique on graft success rate in large tympanic membrane perforation.

PURPOSE: Questions have been raised about the effectiveness of myringoplasty techniques for the large tympanic membrane perforation. Various surgical approaches have been recommended to achieve a satisfactory graft success rate in large tympanic membrane perforations. Consequently, there is a growing body of literature that recognizes this controversial topic in otology. The aim of the present research was to investigate the graft success rate in the anterior tab flap technique in ears with large tympanic membrane perforations. METHODS: In this retrospective study, we analyzed 157 ears (belong to 157 patients) which underwent tympanoplasty, intact canal wall mastoidectomy or canal wall down mastoidectomy with anterior tab flap method. Our primary outcome was graft success rate. RESULTS: We achieved a graft success rate of 89.8% (141 ears from a total of 157 ears) by the usage of anterior tab flap method. CONCLUSION: We suggest anterior tab flap as a safe and effective surgical technique for large tympanic membrane perforations.

Prophylactic Antibiotic Practices in Common Otologic Surgeries in Iran.

INTRODUCTION: Rational surgical antibiotic prophylaxis is suggested for some selected surgical processes. However, inappropriate utilization of antimicrobial prophylaxis reduces benefits and increases costs and risks, such as antibiotic resistance. This study aimed to evaluate the current practice of antibiotics prescribed by surgeons in common otologic surgeries. MATERIALS AND METHODS: This cross-sectional study was conducted among otolaryngologists with at least 5 years of experience in common otologic surgeries (tympanoplasty, tympanomastoidectomy, stapes, or middle ear exploration (MEE) surgeries). A total of 257 otolaryngologists filled a checklist about their selected regimen and timing of antibiotic(s) administration. RESULTS: The rates of antibiotic prophylaxis prescription in dry and wet ears in tympanoplasty were 7.4% and 87.1% (preoperative), 40.9% and 47% (intraoperative), 88.3% and 98% (postoperative); in tympanomastoidectomy with no cholesteatoma were 7.1% and 97.8% (preoperative), 39.6% and 50.9% (intraoperative), 93.7% and 99.6% (postoperative); in tympanomastoidectomy with cholesteatoma were 14% and 98.3% (preoperative), 45.4% and 51.9% (intraoperative), 98.3% and 99.6% (postoperative), respectively, and in stapes or MEE surgeries were 6.4% (preoperative), 41.7% (intraoperative) and 73.1% (postoperative), respectively. There were no significant differences in the rates of prescribing intraoperative prophylaxis between wet and dry ears, except in tympanomastoidectomy without cholesteatoma. Overall, the most prescribed antibiotics were cephazolin, cephlexin, and ciprofloxacin drop. CONCLUSION: The results of this study revealed the inappropriate administration and timing of antibiotic prophylaxis regarding current literature evidence. Despite the lack of evidence on the potential role of antibiotic prophylaxis in clean-contaminated and contaminated ears, a significant number of surgeons prescribed prophylactic antibiotics in tympanoplasty and tympanomastoidectomy without cholesteatoma.

An Update of Helicobacter pylori Prevalence and Associated Risk Factors in Southern Iran: A Population-Based Study.

BACKGROUND: The childhood period is considered to be the primary period for acquisition of the Helicobacter pylori. The high prevalence rates from developing countries are associated with gastric cancer. A decreasing trend of its prevalence has been reported from different parts of the world. Determining the prevalence rate could be important in choosing preventive strategies. This study aimed to determine the prevalence of H. pylori among a group of children from southern Iran to provide an update on the current status of the disease. METHODS: This is a cross-sectional population-based study conducted in Shiraz, southern Iran, from January 2014 to December 2015. Four groups including neonates, children aged 6 months to 3 years, 10- and 15-year-old children were included. Multi-monoclonal stool antibody test was used for diagnosis. RESULTS: Among 436 participants, 24.8% (95% CI: 20.8-29.1) had a positive test for H. pylori: 25% in neonates (95% CI: 16.2-36.1), 22% in children aged 6 months to 3 years (95% CI: 15.2-30.2), 19.5% in the 10-year-old (95% CI: 12.3-29.4), and 29.2% in 15-year-old children (95% CI: 21-39). Sex, age, number of siblings, owning a pet, parents' smoking status, parental education, residential area, birth weight, and feeding status were not found to be statistically significant predictors of H. pylori antigen positivity (P > 0.05). CONCLUSION: The prevalence of H. pylori was estimated to be low in southern Iran in comparison with previous reports or other developing countries. Preventive strategies with respect to low prevalence rates may be considered in the childhood period.

The effectiveness of a preoperative multi-component non-pharmacologic preparation on post-tonsillectomy pain: A randomized controlled clinical trial.

INTRODUCTION: Tonsillectomy is a painful operation and some studies have suggested that preoperative non-pharmacologic preparations may decrease postoperative pain. In this randomized clinical trial study, we decided to determine which is more effective in the post-tonsillectomy pain; an informative booklet or a costly, time consuming, sophisticated, and multi-component preparation program. MATERIALS AND METHODS: Patients were randomly assigned into two groups. In the booklet group, children and their parents only received an informative booklet as routine information preparation. On the other hand, in the multi-component group; in addition to receiving the same booklet, children and their parents received our multi-component pre-operative preparation program. The following items were included in the package: preoperative tour in the ward, an educational DVD, and therapeutic play intervention. All patients were observed at least for 8 h as a day case or ambulatory tonsillectomy. The pain score was recorded according to the visual analog scale for seven days. Finally, the post-tonsillectomy pain scores were compared in the two groups. The multi-component group included 121 children and booklet group 120. RESULTS: Minimum and maximum age was 9 and 12 years. Regarding post-tonsillectomy pain, we found no significant difference between the multi-component group and the booklet group. CONCLUSION: Our data revealed that a new concept which is more cost-effective and concise booklet is as effective as costly and sophisticated methods in post-tonsillectomy pain among 9-12 years old children.

Comparison between Fluoroplastic and Platinum/Titanium Piston in Stapedotomy: A Prospective, Randomized Clinical Study.

OBJECTIVES: The objective of this study was to compare hearing results of fluoroplastic (Teflon) Causse Loop Piston with platinum/titanium (Big Easy) Piston in patients who underwent stapedotomy due to otosclerosis. MATERIALS AND METHODS: In this prospective randomized clinical trial study, Causse Loop Piston prosthesis was used in 76 ears and the Big Easy Piston prosthesis in 72 ears. The main outcomes were preoperative and postoperative pure tone audiometry and air-bone gap (ABG). RESULTS: Postoperative ABG closure was not significantly different between both groups. However, the Causse Loop Piston resulted in a significant improvement of the air conduction (AC) in frequencies of 250, 500, and 1,000 Hz. In addition, the improvement of speech reception threshold (SRT) was significantly higher in Causse Loop Piston group. CONCLUSION: We achieved similar postoperative ABG closure in short-term with both prostheses. However, at low frequencies, AC gain was higher in Causse Loop Piston group. In addition, patients in this group yielded better SRT.