Production and Characterization of Chitooligosaccharides: Evaluation of Acute Toxicity, Healing, and Anti-Inflammatory Actions.

The search for promising biomolecules such as chitooligosaccharides (COS) has increased due to the need for healing products that act efficiently, avoiding complications resulting from exacerbated inflammation. Therefore, this study aimed to produce COS in two stages of hydrolysis using chitosanases derived from Bacillus toyonensis. Additionally, this study aimed to structurally characterize the COS via mass spectrometry, to analyze their biocompatibility in acute toxicity models in vivo, to evaluate their healing action in a cell migration model in vitro, to analyze the anti-inflammatory activity in in vivo models of xylol-induced ear edema and zymosan-induced air pouch, and to assess the wound repair action in vivo. The structural characterization process pointed out the presence of hexamers. The in vitro and in vivo biocompatibility of COS was reaffirmed. The COS stimulated the fibroblast migration. In the in vivo inflammatory assays, COS showed an antiedematogenic response and significant reductions in leukocyte migration, cytokine release, and protein exudate. The COS healing effect in vivo was confirmed by the significant wound reduction after seven days of the experiment. These results indicated that the presence of hexamers influences the COS biological properties, which have potential uses in the pharmaceutical field due to their healing and anti-inflammatory action.

Facial cutaneous necrosis associated with suspected levamisole toxicity from tainted cocaine abuse.

OBJECTIVE: This study aimed to illustrate the otorhinolaryngologic manifestations of levamisole toxicity and illuminate the features of this diagnosis. METHODS: We describe a case of a known cocaine abuser with suspected levamisole toxicity who developed cutaneous necrosis of the cheeks, earlobes, nose, upper and lower lip, and the midline hard palate. We also review the existing clinical literature about this emerging phenomenon. RESULTS: Levamisole is a common adulterant in cocaine distributed in the United States and has been reported to cause microvascular thrombosis and vasculitis with resultant skin necrosis in cocaine abusers. The distribution of skin findings characteristically involves the cheeks, earlobes, nose, lips, and hard palate and responds variably to cessation of cocaine use. In its most severe cases, immune suppression and/or surgical debridement may be required. CONCLUSION: Levamisole toxicity can frequently involve the ears, nose, and throat tissues. Otorhinolaryngologists should recognize these manifestations to expeditiously diagnose and manage this condition. Failure to do so promptly can lead to complications that may necessitate reconstructive or amputation surgery.

[Bilateral bisphosphonate-associated osteonecrosis of the external ear canal : a rare case]. / Beidseitige bisphosphonatassoziierte Osteonekrose des Gehörgangs : Ein seltener Fall.

Osteonecrosis of the mandible is a well-known and dreaded complication after the administration of bisphosphonates. Only a few cases of bisphosphonate-associated osteonecrosis of the external ear canal have been described. Especially after long-lasting bisphosphonate therapy, for example in patients with multiple myeloma, an ulceration of the floor of the bony external auditory canal should be treated surgically and be distinguished from radioosteonecrosis, malignant external otitis, or carcinoma of the external ear.

Krazy Glue® in the ear: A case report of child abuse.

Krazy Glue® or cyanoacrylate glue is an acrylic resin that polymerizes in less than a minute when in contact with moisture or water. We present a case of a one month old referred to our tertiary pediatric otolaryngology clinic from an outside emergency department with a history of application of cyanoacrylate glue in the external ear canals. This report presents the management of this case along with the medical and legal outcomes surrounding this case of child abuse.

Minocycline-induced hyperpigmentation of tympanic membrane, sclera, teeth, and pinna.

A 40-year-old woman was referred by her primary care physician for evaluation after a routine physical exam revealed bilateral brownish pigmentation of the tympanic membrane. Head and neck examination in the otolaryngology clinic revealed bluish hue of both sclera, teeth, and portions of her pinnae. A hearing test revealed bilateral mild sensorineural hearing loss. The patient had a history of taking minocycline for 14 years, and the hyperpigmentation that she had is known to be a rare complication of prolonged minocycline use. However, to our knowledge, this is the first case showing photographic evidence of minocycline-induced tympanic membrane hyperpigmentation. Minocycline-induced hyperpigmentation should be considered when a patient presents with brown or blue discoloration of the tympanic membrane.

Suture materials in otoplasty.

From my experiences in 101 otoplasties of the Mustardé type, the buried suture materials have shown individual variations, as regards granuloma and slippage complications. As a result, I now prefer 4/0 clear nylon for reconstruction of the anti-helix, 3/0 white Mersilene for concha-mastoidal fixation, and 4/0 chromic or subcuticular Vicryl for skin closure.

Experimental production of cholesteatoma in rabbits by using non-irritants (skin tolerants).

The application of various skin tolerant substances to the postero-superior and antero-inferior aspects of the external auditory canal of the rabbit, with an intact ear drum and middle ear, produced cholesteatomas in the skin of the auditory canal and in the tympanic membrane, particularly in the pars flaccida. At the antero-inferior insertion of the tympanic membrane, however, cholesteatoma growth could not be induced in these animal experiments. In severe diffuse otitis externa, secondary to the operative closure of the external auditory canal, cholesteatomas also develop preferentially in the pars flaccida. The relatively thick, loose intermediate layer of connective tissue allows a rapid expansion of epithelial ridges, thus favouring the formation of cholesteatoma in this region.

The ototoxic effect of intratympanic terbinafine applied in the middle ear of rats.

BACKGROUND: Otomycosis is defined as an infection of the external ear canal with fungal agents. The treatment of the disease is cleansing and drying of the external ear canal, identification and treatment of any predisposing factors and application of topical antifungal agents. Terbinafine is used as an antifungal agent to treat otomycosis. We proposed to investigate the probable ototoxic effect of terbinafine solution on auditory brain stem response (ABR) and distortion product otoacoustic emission (DPOAE) when applied intratympanically in the middle ear of rats. METHODS: The experiment was performed on 30 female Wistar albino rats. Thirty animals were divided into three groups of 10 animals each. 1% terbinafine solution was administered to the first group (group T). The second group (group G) was administered 40 mg/ml gentamicin solution (ototoxic control). The third group (group S) was administered saline solution (negative control). Baseline DPOAE measurements and ABR testing from the left ears were obtained from the animals in all groups under general anesthesia. Ear solutions were applied in the middle ear intratympanically with a dental needle. Treatment was initiated after baseline measurements and repeated once every two days for fifteen days. RESULTS: Pre and post-treatment DPOAE responses for all tested frequencies of group T and Group S showed no statistically significant difference. However, the group G demonstrated a significant change in ABR thresholds and DPOAE responses. CONCLUSIONS: Terbinafine solution is a broad spectrum antifungal agent effective in the treatment of otomycosis. The present study demonstrated that its direct administration in the middle ear of rats does not affect inner ear function as measured by ABR and DPOAE responses.

Feeling blue? Minocycline-induced staining of the teeth, oral mucosa, sclerae and ears - a case report.

Minocycline is a broad-spectrum antibiotic belonging to the tetracycline family, often prescribed in infective skin conditions such as acne and rosacea. Minocycline-induced staining of the sclerae, ears, oral mucosa and teeth are rare but troublesome conditions. If patients already have concerns about their appearance due to an unsightly skin condition, careful consideration ought to be given to using minocycline as it could worsen the status quo, should potentially irreversible blue staining occur. This report describes one case and highlights some of the other dangers of long-term minocycline use which may present themselves to dentists.

Imatinib-associated hyperpigmentation of the palate in post-HSCT patient.

Pigmentation of the oral mucosa can indicate a wide range of lesions or conditions. Some drugs are associated with pigmented lesions of oral cavity. Imatinib mesylate (Gleevec(®)) is a protein inhibitor used in the management of several hematological malignancies associated with dermatological side effects, like hyperpigmentation. We report the case of a 38-year-old male post-HSCT patient who had been using imatinib mesylate for over 5 years and presented with blue pigmentation on the hard palate, the left side of the nose and both ear lobes. The differential diagnosis of hyperpigmented lesions in the oral mucosa is also presented.

[Drug side-effects in ORL practice (author's transl)]. / Nebenwirkungen von Medikamenten im Hals-Nasen-Ohrenbereich.

Drug side-effects as opposed to toxic effects are defined and the specific side-effects of drugs used in otorhinolaryngology are then discussed. Drug induced changes in the ear, nose, throat, mouth, salivary glands and thyroid are listed. Only the most common and most important effects are discussed in detail. Some of the less commonly encountered side-effects have only been reported in a single patient and the mechanism involved is therefore uncertain. A good history is often valuable for reaching the correct diagnosis. It is also important for the physician to know the exact mechanism of a drug's action before prescribing it and to also inform the patient of the possible side-effects when these are relatively common.

Cervical necrotizing fasciitis.

Necrotizing fasciitis is a severe soft tissue infection that results in necrosis of the fasciae and subcutaneous tissues; the infection can quickly prove fatal. Although involvement of the head and neck is rare, causes are usually odontogenic or pharyngeal but can also be insect bites, local trauma, burns or surgery. We present a clinical case of a 31-year-old Italian woman with cervical necrotizing fasciitis having an uncommon presentation. While under treatment, the patient's husband was admitted for necrotizing fasciitis of the medial fasciae of his left leg subsequent to an insect sting. The causes, diagnosis and treatment of necrotizing fasciitis are reviewed.