[Expression and significance of IFN-γ and IL-4 in the effusion and peripheral blood of chronic otitis media with effusion patients].

OBJECTIVE: To explore the shift of Th2/Th1 type cytokine profiles in middle ear and peripheral blood of chronic otitis media with effusion (COME) patients. METHODS: Middle ear effusions (MEEs) and peripheral bloods were collected from 30 COME patients between April 2011 and July 2012 at Department of Otolaryngology, Beijing Tongren Hospital, Capital Medical University. Peripheral blood samples were collected from 20 healthy controls. The expressions of IFN-γ (Th1 cytokine) and IL-4 (Th2 cytokine) in peripheral blood and middle ear fluid were assessed by flow cytometry and cytometric bead array. The expression levels of cytokines in peripheral blood were compared between patient and control groups. Moreover, the levels of cytokines in the Middle ear fluid and the supernatant of COME patients were also compared. RESULTS: Compared to the control group, the level of IL-4 in peripheral blood of COME patients significantly increased (0.7% ± 0.8% vs 2.4% ± 4.5%, P < 0.05) . The ratio of IFN-γ positive cells/IL-4 positive cells was significantly lower in peripheral blood of COME patients than that of control group (17 ± 13 vs 35 ± 19, P < 0.05) . However, the level of IFN-γ showed no significant difference between two groups (12% ± 8% vs 13% ± 8%, P > 0.05) . The levels of IL-4 and IFN-γ in middle ear fluid and the supernatant of the case group showed no significant difference. CONCLUSIONS: COME may be a Th2 predominant disease. Th1/Th2 imbalance is probably involved in the pathogenesis of COME. The role of the allergic reaction in middle ear microenvironment remains uncertain.

[Survey of quality of life scale for patients with congenital ear malformation].

OBJECTIVE: To explore the congenital ear malformation (CEM)-specific quality of life (QOL) and examine the effects of total ear reconstruction surgery for QOL of CEM patients. METHODS: A self-composed QOL scale was used for 129 patients with congenital external and middle ear malformation. All patients were requested to fill in the QOL scale before and 1 month after ear reconstruction surgery. RESULTS: The level of QOL varied according to the degree of ear malformation. The total QOL score of patients with unilateral and bilateral CEM was 28.5 ± 18.4 and 51.6 ± 23.6, respectively. The total QOL score of patients pre- and post-operation was 21.0 ± 14.0 and 14.2 ± 9.7 respectively. Physiological functions, psychological status and social interactions of the patients were of statistical significance after ear reconstruction surgery compared to that of at pre-operation. CONCLUSION: Congenital ear malformation-specific QOL scale can show sensitively the changes of QOL of CEM patients. And ear reconstruction surgery is beneficial for the patients.

[Vibrant soundbridge implantation (two cases report)].

OBJECTIVE: To investigate the effect of Vibrant Soundbridge (VSB) implantation. METHODS: In accordance with the indications for VSB implantation, surgeries were done for two patients who suffered from either a sensorineural or conductive hearing loss (microtia). Their preoperative auditory thresholds (0.5, 1, 2 and 4 kHz) were 56 dB HL and 61 dB HL. The VSB was turned on and adjusted seven weeks after surgery. RESULTS: Postoperative auditory thresholds of the two patients were improved. Their pure tone thresholds were 32 dB HL and 40 dB HL, and the respective improvement was 24 dB HL and 21 dB HL. There was no facial paralysis, vertigo and tinnitus. CONCLUSION: Patients with a sensorineural or conductive hearing loss may benefit from VSB implantation.

[Development and evaluation of a quality of life scale specific to patients with congenital external and middle ear malformation].

OBJECTIVE: To develop a quality of life scale for patients with congenital external and middle ear malformation, and to explore its reliability and validity. METHODS: The initial quality of life scale for patients with congenital external and middle ear malformation was constructed based on quality of life scales from home and abroad. A total of 140 patients with congenital external and middle ear malformation had been recruited in the study. After pretest and item sifting, the quality of life scale was constructed, and its reliability and validity were evaluated. RESULTS: Eighteen-item quality of life scale for patients with congenital external and middle ear malformation was constructed, which included three parts: physiological function, psychological status and social interaction. The retest reliability was 0.878; split-half reliability coefficient and Cronbach's alpha coefficient were 0.927 and 0.899, respectively. The results of factor analysis showed satisfactory construct validity. The reliability and validity of this scale was consistent with the demands of psychometrics. CONCLUSION: Congenital external and middle ear malformation quality of life scale is believable and effective, which can be used for clinical practice.

[Effects of chronic suppurative otitis media of bone conduction threshold in old patients].

OBJECTIVE: To research the effects of chronic suppurative otitis media on bone conduction threshold in old patients. METHODS: The files of patients with unilateral chronic otitis media were retrospective analyzed, who were all oder than 60 years, who were inpatient in our department since January 2005 to March 2009. Conventional puretone audiometry test was carried out. Bone conduction thresholds were calculated for frequencies of 0.5, 1, 2, and 4 kHz, with comparison between the ear with chronic otitis media and contralateral ear. Thresholds were examined separately for each frequency. RESULTS: The bone conduction threshold for the normal side was lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.01). There were no differences between the groups when analyzed for the presence of cholesteatoma except at 2 kHz frequencies (Z = -1.975, P = 0.048). There were differences between the groups when analyzed for an interruption of the ossicular chain only at 2 kHz frequencies (Z = -2.721, P = 0.007). There were differences between the groups when the duration of middle ear disease was not same at 1 kHz and 2 kHz frequencies (Z value were -2.877, -2.624, P < 0.01, respectively). CONCLUSIONS: This study shows that chronic otitis media can enhance bone conduction threshold for old patients. All measures for early cure should be considered as early as possible in oder patients with chronic otitis media to prevent advance of sensorineural hearing loss.

[Analysis of clinical features and treatment outcomes of patients with tuberculous otitis media and mastoiditis].

OBJECTIVE: To analyze the clinical features and the surgical treatment outcomes of patients with tuberculous otitis media and mastoiditis. METHODS: The medical records of 16 patients (18 ears) with tuberculous otitis media and mastoiditis, who received surgery in Beijing Tongren hospital, were reviewed. RESULTS: The common symptoms were otorrhea and hearing loss, and 3 patients demonstrated severe sensorineural hearing loss. Three patients demonstrated a peripheral-type facial palsy. Temporal bone high resolution CT scans demonstrated the entire tympanum and mastoid air cells were occupied by soft tissue. Eleven patients demonstrated bone destruction and sequestra was found in 7 temporal bones. Contemporary pulmonary tuberculosis were diagnosed in 7 of the 16 patients. Surgical removal of disease lesions in combination with anti-tuberculosis treatment were given to 15 patients. Other than 2 cases of tuberculous otitis media and mastoiditis diagnosed by pre-operational biopsy through the perforated tympanic membrane, the remaining 14 cases were diagnosed intra-operatively or post-operatively. No relapse of tuberculosis in the middle ear and mastoid were found after follow-up for more than 1 year, except for the one case that was lost to follow-up. The 3 cases of facial nerve palsy almost recovered to normal. CONCLUSIONS: Clinicians should suspect tuberculous otitis media and mastoiditis if clinical findings include refractory otorrhea, total occupation of the tympanic cavity and mastoid ari cells by soft tissue, and erosion of the bone or sequestra as shown by CT. A history of tuberculosis should be asked carefully in order to differentiate tuberculous otitis media and mastoiditis. The patients who received surgery and anti-tuberculosis chemotherapy achieved more rapid healing of the ear.

Role of interleukin-10 and transforming growth factor beta 1 in otitis media with effusion.

BACKGROUND: Otitis media with effusion (OME) is a disease with complicated pathogeneses which are not clearly known. Increasing interest has been focused on immunological cells, cytokines and their roles in chronic inflammatory states. This study was designed to disclose the existence and roles of interleukin-10 (IL-10) and transforming growth factor beta1 (TGF-beta1) in the cause of OME in adults, and to investigate the probable role of Foxp3(+)CD4(+)CD25(+) T cells in OME. METHODS: The concentrations of IL-10 and TGF-beta1 in the middle ear effusions (MEEs) and plasmas of 36 adults (45 ears) with OME were measured by means of enzyme linked immunosorbent assay (ELISA). As contrast, the concentrations of IL-10 and TGF-beta1 in the plasma of 30 normal volunteers were measured using the same method. Furthermore, the proportion of Foxp3(+)CD4(+)CD25(+) T cells in CD4(+) T cells of blood was tested by flow cytometry. RESULTS: (1) The concentrations of IL-10 in all MEEs and plasmas of the chronic OME patients were higher than those in patients with acute OME (both P < 0.05), so was TGF-beta1 (both P < 0.01). The concentration of IL-10 in MEEs was significantly higher than that in plasmas, not only in acute OME (P < 0.01), but also in chronic OME (P < 0.01). In chronic OME, the concentration of TGF-beta1 in MEEs had no statistical difference with those in plasmas of the same patients. However, the concentration of TGF-beta1 in plasmas of patients with chronic OME was significantly higher than that in plasmas of normal volunteers (P < 0.01). (2) The concentrations of IL-10 and TGF-beta1 in MEEs of the patients who had been treated more than once were higher than those MEEs of the patients who were treated for the first time, respectively (P < 0.05, P < 0.01). The level of TGF-beta1 in plasmas of the patients who had been treated more than once was higher than in those of the patients who were treated firstly (P < 0.05), while the level of IL-10 in plasmas had no difference. The concentration of IL-10 in mucoid MEEs was higher than those in serous ones (P < 0.05), while TGF-beta1 had no statistical difference between mucoid and serous MEEs (P > 0.05). The concentration of IL-10 in MEEs had a strong correlation with the duration of the illness (r = 0.547, P < 0.01). The same correlation was also found between the concentration of TGF-beta1 in MEEs and the times patients being treated (r = 0.579, P < 0.01). (3) The proportion of Foxp3(+)CD4(+)CD25(+)T/CD4(+) T cells in the blood of chronic OME was not only significantly higher than that in the acute OME (P < 0.01), but also higher than that in normal volunteers (P < 0.01). In chronic OME, there was a correlation between the proportion of Foxp3(+)CD4(+)CD25(+) T/CD4(+) T cells in the blood and the concentration of IL-10 in the plasmas (r = 0.602, P < 0.05). CONCLUSIONS: IL-10 and TGF-beta1, as two important immunoregulatory mediators, participate in middle ear inflammatory response, especially in chronic course of OME in adults. Foxp3(+)CD4(+)CD25(+) T cells may play some immunoregulatory roles in the course of this disease.

[Congenital stenosis of external auditory canal with cholesteatoma and skin fistulae or sinuses].

OBJECTIVE: To investigate the clinical features, differential diagnosis and management of congenital stenosis of external auditory canal (CSEAC) with cholesteatoma. METHODS: The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed. RESULTS: The patients' ages ranged from 4.75 to 22 years (average 12 years). The diameter of the external auditory canal (EAC) was < 2 mm. All 10 ears had a history of postural fistulae or sinuses. Bone erosion of EAC was distinctly shown in high-resolution computed tomography (HRCT) of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up 1 to 3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions improved 20 - 35 dBHL. CONCLUSIONS: In CSEAC with cholesteatoma, the bony wall of EAC is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postural or cervical sinuses. HRCT of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion.

[Long-term results and an analysis of surgically related factors in myringoplasty with sandwich method].

OBJECTIVE: To evaluate the effect of the prognostic factors on long-term surgical outcome in myringoplasty. METHODS: Retrospective cohort 205 patients (223 ears) with sandwich temporal fascia myringoplasty were analyzed using the multiple logistic regression analysis. The charts of inpatients had undergone myringoplasty before at least 2 years between January 1999 and November 2003 at Beijing Tongren Hospital. Postoperative follow-up rate was 78.2%. Their ages ranged from 12 to 65 years (mean = 34. 3 years). Their durations of disease ranged from 1 month to 25 years (mean = 16.07 months). The effect of prognostic factors on myringoplasty were investigated by variables noted from patients' files such as age, sex, causes of disease, duration of disease, period of dry ear of disease, operation types, places of tympanic membrane perforation, size of tympanic membrane perforation, status of middle ear and status of eardrum. RESULTS: There were 11 ears with re-perforation of eardrum at the last follow-up. Successful closure of the tympanic membrane perforation was obtained in 95.1% of the ears (212 ears) with 2 to 5 years follow-up. There were 26 ears with other complications at the last follow-up. Operations were successful in 186 patients. The overall take rate of the myringoplasty was 83.4%. Multiple logistic regression analysis (ward) was subsequently carried out on these prognostic factors on overall take rate of the myringoplasty and yielded the following classification. Relative importance of the predictive variables was as follows: size of tympanic membrane perforation (OR = 1.900), duration of disease (OR = 1.003) and period of dry ear of disease (OR = 0.908). Hearing outcomes: the average air-bone gap improvement was 7.0 dB and the average air conduction improvement was 6.8 dB for all 175 myringoplasty procedures. CONCLUSIONS: A long term follow-up was important. Late atelectatic pocket was a late complication and a cause of failure. A relatively smaller tympanic membrane perforation, a relatively shorter duration of disease and a relatively longer period of dry ear of disease were found to be significant prognostic factors positively influencing the success rate of myringoplasty.

[Long-term surgical results for congenital aural atresia and hearing reconstruction].

OBJECTIVE: To evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery. METHODS: Six hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years. RESULTS: Stenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation. CONCLUSIONS: Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.

[Vestibulotomy about the displaced facial nerve].

OBJECTIVE: To investigate the feasibility of vestibulotomy above the displaced facial nerve. METHODS: From January 2000 to January 2002, eight patients with severe congenital conductive hearing loss underwent the vestibulotomy above displaced facial nerve and reconstruction of the ossicular chain with a total ossicular replacement prosthesis, which all for the congenital middle ear deformity and the facial nerve overhang and concealed the oval window niche or lied inferior to the oval window. In four of eight cases, the facial nerve was transposed in order to access the oval window niche. RESULTS: Hearing of this patients improved 15 dB in 2 ears, 16-25 dB in 3 ears and 26 dB or more in 3 ears. In no case was there a postoperative facial paresis. With 4 months to 28 months follow-up, the postoperative hearing gain was stable. CONCLUSIONS: Vestibulotomy above displacement of the facial nerve allows a final chance of achieving serviceable hearing through surgery. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in otherwise marginal or poor surgical candidates.