Extending Myringotomy Patency with Topical Everolimus in Rats.

BACKGROUND: Everolimus is an immunosuppressant agent that has antiproliferative properties and negative effects on wound healing. The effect of everolimus use to delay the closure time of myringotomy is not known. OBJECTIVES: The aim of the study was to evaluate the impact of topical everolimus on myringotomy patency and to investigate its histopathologic effects on the tympanic membrane. MATERIAL AND METHODS: Twenty Sprague-Dawley rats were bilaterally myringotomized with a myringotomy knife. Gelfoam soaked in 0.05% everolimus in a microemulsion formulation was applied to the right myringotomy site of the rats for 10 min (the everolimus group). The myringotomy sites of the left ears were treated with sterile saline topically (the control group). The tympanic membranes were routinely examined otomicroscopically every other day for 31 days. The membranes were then harvested and evaluated histologically after 31 days. RESULTS: All tympanic membranes were closed by the 15(th) day in the control group, while in the everolimus group the myringotomy remained open in five rats (25%) on day 31. The mean durations of myringotomy patency in the everolimus group and control group were 20.90 ± 7.85 and 10.10 ± 3.14 days, respectively. The difference was found to be statistically significant (p < 0.01). In the histopathological examination of the tympanic membranes, there was less fibrosis and less inflammation in the everolimus group than in the control group (p < 0.01). CONCLUSIONS: Topical everolimus application is effective in extending myringotomy patency in rat tympanic membranes. Inflammatory reactions and fibrosis in the lamina propria were observed to be significantly less when topical everolimus was used.

Vocal fold paresis accompanying vocal fold polyps.

The aim of this study was to evaluate patients with vocal fold polyps using laryngeal electromyography (LEMG) for the presence of vocal fold paresis and to compare transnasal fiberoptic and rigid stroboscopic findings between polyp patients with normal LEMG and with vocal fold paresis. Thirty-five patients with a vocal fold polyp underwent transnasal fiberoptic laryngoscopy, rigid laryngostroboscopy, and LEMG. The findings were compared between the LEMG-confirmed vocal fold paresis patients and the normal LEMG patients. LEMG resulted in a diagnosis of unilateral or bilateral vocal fold paresis in 17 of 35 patients (48.6 %). More men than women with vocal fold polyps had vocal fold paresis (p < 0.05). The vocal fold paresis group had higher presence of axial rotation and hypomobility of vocal folds, higher asymmetry of vertical height of vocal folds, and less presence of longitudinal stretch of vocal folds (p < 0.05). Medial-lateral compression of the false vocal folds and anterior-posterior approximation of the larynx did not show any difference between the groups. No significant difference was found in vibratory wave characteristics between the groups through rigid laryngostroboscopy. Vocal fold paresis was present in almost half of the patients with vocal fold polyps. Paresis can only be accurately diagnosed with LEMG. Transnasal fiberoptic laryngoscopic examination is helpful to recognize vocal fold paresis in vocal fold polyp patients, while stroboscopic examination is not useful to identify it in vocal fold polyp patients.

Videolaryngostroboscopy versus microlaryngoscopy for the diagnosis of benign vocal cord lesions: a prospective clinical study.

The aim of this study is to prospectively compare rigid videolaryngostroboscopy with microlaryngoscopy for the diagnosis of benign vocal cord lesions. Eighty-five adult patients with benign vocal cord lesions were evaluated with videolaryngostroboscopy and later underwent microlaryngoscopy. During microlaryngoscopy, systematic examination of the glottis was conducted, including careful inspection and meticulous palpation of the vocal cords from anterior commissure to arytenoids. Preoperative and intraoperative diagnoses were analyzed. One hundred and forty-one lesions were diagnosed preoperatively with rigid videolaryngostroboscopy in 85 patients. Microlaryngoscopy revealed a total of 199 lesions in these patients, demonstrating a 41.1 % higher diagnostic yield. Forty-five (77.6 %) of the 58 additional lesions involved structural abnormalities, including sulcus vocalis, microwebs, vascular ectasia, mucosal bridges, and anterior web. The preoperative diagnosis was consistent with the postoperative diagnosis in only 29 patients (34.2 %). For the rest of the patients (n = 56, 65.8 %), the preoperative diagnosis was either changed, or new lesions were identified during microlaryngoscopy. Intraoperative diagnosis of benign vocal cord lesions differs significantly from preoperative diagnosis, regarding both the type and number of lesions present. A large proportion of patients diagnosed with videolaryngostroboscopy have additional lesions, particularly structural abnormalities. Precise inspection and palpation of vocal cords are thus essential during microlaryngoscopy.

Injectable tissue-engineered cartilage using commercially available fibrin glue.

OBJECTIVES/HYPOTHESIS: To achieve injectable tissue-engineered cartilage using a commercially available fibrin sealant, and to determine the most suitable fibrin glue concentration, cartilage source, and cultured chondrocyte concentration. STUDY DESIGN: Animal research. METHODS: A total of 28 immunocompetent New Zealand white rabbits were divided into four groups. The cultured chondrocytes from different anatomical sources carried in fibrin glue with and without aprotinin in different concentrations of fibrinogen and thrombin (Tisseell), were injected into forehead and interocular regions of the rabbits. The new tissue formation was harvested at 8 weeks and analyzed through gross and histological analysis. RESULTS: The new tissue formations were found in round, elliptical, and flat forms. The mean value of Tisseell and cell suspension was 0.8 cc in all of the rabbits' injection regions, but the mean volume of the samples in which immature cartilage matrix and mature cartilage was 0.1 cc. In the 20 of the 55 injection regions of rabbits (36, 36%), mature and/or immature cartilage formation were observed. We observed inflammatory reactions, abscess formation, and foreign body reactions around the new cartilage tissue of tissue-engineered cartilage. The comparison of results using different cartilage sources, chondrocyte concentrations, or different fibrin glue concentrations did not show any significant difference. CONCLUSIONS: We observed that changing the concentrations of ingredients of commercially available fibrin glue, the source of the cartilage, or the cultured chondrocyte concentration did not have significant effect on neocartilage formation.

Everolimus-coated tympanostomy tube on rat tympanic membrane.

OBJECTIVES: Everolimus is an immunosuppressant and an antiproliferative macrolide agent which is used for coronary stent coating for local inhibition of in-stent restenosis. The aim of this study was to evaluate the effect of everolimus-coated tympanostomy tubes in rat tympanic membrane. STUDY DESIGN: Prospective controlled animal study. MATERIALS AND METHODS: Twenty-one Sprague-Dawley rats were included in the study. They were bilaterally myringotomized. An everolimus-coated fluoroplastic tympanostomy tube was inserted into one ear of each of the rats (everolimus-coated TT Group; n=21) and a standard fluoroplastic tympanostomy tube was applied to the contralateral ear of the same rats (Standard TT Group; n=21). Tympanic membranes and tubes were routinely examined otomicroscopically every other day for two months. Then the membranes were harvested and evaluated histologically. RESULTS: In everolimus-coated tubes, the tube obstruction was found to be significantly lower than in standard tubes (p<0.05). The tube extrusion rate was less for everolimus-coated tubes than for standard tubes, but no statistically significant difference was observed between the two tubes. There was no statistically significant difference in the incidence of otorrhea between two tubes. Histopathological examination under light microscope revealed that everolimus-coated tubes resulted in less fibrosis and less inflammation in tympanic membranes than standard tubes (p<0.01). CONCLUSION: The study shows the potential role of everolimus-coating of tympanostomy tubes in reducing tube obstruction. In addition, inflammatory reaction and fibrosis were observed to be significantly less with these tubes.

Long-term complications of polyethylene glycol injection to the face.

Currently, filling, smoothing, or recontouring the face through the use of injectable fillers is one of the most popular forms of cosmetic surgery. Because these materials promise a more youthful appearance without anesthesia in a noninvasive way, various fillers have been used widely in different parts of the world. However, most of these fillers have not been approved by the Food and Drug Administration, and their applications might cause unpleasant disfiguring complications. This report describes a case of foreign body granuloma in the cheeks secondary to polyethylene glycol injection and shows the possible complications associated with the use of facial fillers.