Historical use of x-rays: treatment of inner ear infections and prevention of deafness.

PURPOSE: This article provides an historical assessment of the role of radiotherapy in the treatment of inner ear infections. MATERIALS AND METHODS: The research utilized a literature-based evaluation of the use of x-rays during the first half of the 20th century on the treatment of otitis media (OM), mastoiditis, and cervical adenitis and their impact on the occurrence of deafness. RESULTS: X-Rays were consistently found to be effective as a treatment modality at relatively low doses, in the range of 10-20% of the skin erythema dose, rapidly reducing inflammation, and accelerating the healing process. The mechanistic basis of the clinical successes, while addressed by contemporary researchers, is evaluated in the present article in light of current molecular biology advances, which indicate that clinically effective low doses of ionizing radiation act via the creation of an anti-inflammatory phenotype in highly inflamed tissue. CONCLUSIONS: X-Ray treatment of OM, mastoiditis, and cervical adenitis was widely accepted in the first half of the 20th century by clinicians as an effective treatment when administered within an appropriate dosage range.

Radio-tympano-sinu-orthesis with 186Re-colloid: a new treatment modality for chronic otitis media and paranasal mucositis.

UNLABELLED: This preliminary treatment trial was performed to evaluate the safety and clinical efficacy of intracavitary therapy with (186)Re-colloid in patients with recurrent otitis media and paranasal sinusitis, resistant to pharmacotherapy and surgical treatment. METHODS: Thirty-nine applications of 5-35 MBq (186)Re-colloid into the tympanon and the paranasal sinuses were performed in 6 patients. Biodistribution and biokinetics were studied by gamma-camera imaging. Clinical success was documented 6-20 mo after therapy by each patient's self-evaluation and by rhinootologic follow-up, using a 4-step score. RESULTS: No harmful side effects were seen. There was good-to-excellent clinical improvement with a score of +1.44 +/- 0.5 by each patient's self-evaluation and by physicians scoring of +0.81 +/- 0.9 with only negligible extracranial tracer deposition. CONCLUSION: This novel treatment option using intracavitary application of (186)Re-colloid in chronic otitis media and sinusitis is safe and effective. The term "radio-tympano-sinu-orthesis" might be proposed analogously to the well-known radiosynoviorthesis.

A mortality follow-up study of WW II submariners who received nasopharyngeal radium irradiation treatment.

BACKGROUND: During World War II, large numbers of submarine trainees received nasopharyngeal radium irradiation therapy to treat aerotitis media or middle ear barotrauma. METHODS: Using a life table and the Cox proportional hazards model, mortality risk of 1, 214 submariners believed to have received treatment for aerotitis media was compared to 3,176 "untreated" submariners. RESULTS: "Treated" submariners had a significant increased mortality risk for all causes (odds ratio (OR) = 1.32; 95% confidence interval (CI) = 1. 14-1.53) and circulatory diseases (OR = 1.51; 95% CI = 1.20-1.90), and a non-significant increased mortality risk of head and neck cancer (OR = 1.40; 95% CI = 0.54-3.58). CONCLUSIONS: While the excess risk was not statistically significant by conventional standards, the finding does suggest that those who received NP radium irradiation therapy may be at increased risk of death due to head and neck cancers. Due to the lack of data the role of risk factors other than radium exposure cannot be assessed.

Estimates of numbers of civilians treated with nasopharyngeal radium irradiation in the United States.

Nasopharyngeal radium irradiation was used 35 to 50 years ago for treatment of hearing loss, chronic ear infections, asthma, and other conditions. I reviewed the medical literature for published articles on the nonmilitary use of nasopharyngeal radium irradiation. Four years have minimum documented numbers of radium applicators in use (1946, 600; 1948, 1000; 1958, 2000; 1961, 2000). Two levels of physician use were assumed, a high estimate of 25 patients per week and a low estimate of 5 patients per week. It was assumed that physicians used the applicators 50 weeks per year. Typical treatments involved two applicators at a time (one for each nostril) for three sessions. Using a formula reflecting the number of applicators in use, the number of patients a physician would treat in a week, the number of weeks in a year an applicator would be used, and the number of applicators and sessions per patient, I then estimated the number of children who might have been treated. This estimate is that approximately 500,000 to 2.5 million persons might have been treated with nasopharyngeal radium. Because the lack of documentation for numerous parts of the equation required that I make a large number of assumptions, this estimate should be considered a rough approximation of the number of civilians treated.

[Low-intensity laser irradiation in otorhinolaryngology]. / Nizkoénergeticheskoe lazernoe izluchenie v otorinolaringologii.

Low-intensity laser irradiation is a modality widely practiced in otorhinolaryngology. Basing on extensive personal experience and literature data the authors provide ENT specialists with relevant techniques and parameters of the radiation for different otorhinolaryngological diseases.

Roentgen therapy for infections: an historical review.

Radiation was used extensively for the treatment of all types of infections before the advent of antibiotics. Although this mode of therapy is now in disrepute, radiation therapists of that era were firm believers in the ability of radiation to cure infections. A review of the literature suggests, but certainly does not prove, that low-dose local radiation, in the range of 75 to 300 roentgens, is an effective treatment modality for a wide variety of infections. Two then-prevailing rationales held that the effect was due either to radiation damage to the immune cells, causing stimulation of the immune response, or to the increase in local inflammation with resultant increased blood flow. Modern research has been limited but provides support for both arguments. Although there are no present indications for using radiation as therapy for infectious disease, a reasonable argument can be made from the available data that radiation is effective for the treatment of localized infections. The mechanisms of low-dose radiation as a treatment for infections remain unclear. The known and probable long-term sequelae of low-dose local irradiation preclude its common use for this condition. Nevertheless, it is hoped that this review will stimulate investigations into this relatively unexplored area of radiobiology.

[Curietherapy of the Eustachian tube using Ir-192 in chronic otitis of tubal origin]. / Plésiocuriethérapie de la trompe d'Eustache par iridium 192 dans les otites chroniques d'origine tubaire.

Failure of chronic otitis surgery, especially tympanoplasty, are mainly related to Eustachian tube dysfunction. A new technique of anti-inflammatory irradiation of the Eustachian tube was designed in 1985 in Créteil to improve the Eustachian tube function. The Eustachian tube is catheterized during the tympanoplasty using a plastic tube, 1.6 mm in diameter; this tube is closed at the external end. The other end of the tube is open and goes through the opposite nasal cavity. The plastic tube is loaded 24 h later with a 4.5 cm long irridium 192 wire to deliver a dose of 3 Gy on the reference isodose, 4 mm in diameter, in approximately 3 h. The tube is then gently withdrawn through the nasal cavity. Seventy-four patients, 16 years old or more, took part in the study. The method was performed successfully in 62 patients. Fifty-six patients were followed up; mean follow-up was more than 20 months. The follow-up assessment included otoscopy, audiometry, impedancemetry and residual Rinne measurement. Otoscopy results were adequate in 86% of patients. Hearing was improved in 44% of patients. Impedancemetry was adequate in 70% of patients and residual Rinne lower than 20 dB in 56%. These results are better if compared with those of a series of 30 tympanoplasties performed without intracavitary irradiation in 1984: the tympanoplasty failure rate then was 73%. In conclusion, this new procedure proved to be safe and simple and led to an improvement of the functional results of complex tympanoplasty.

Mortality after nasopharyngeal radium irradiation for eustachian tube dysfunction.

Cause-specific mortality of 2,510 persons treated before 1965 by nasopharyngeal radium irradiation (average exposure, 1,200 mg/min), followed to 1985, was compared to that of 2,199 nonexposed comparison subjects. No excess was found for the exposed group in overall mortality, cancer mortality, or in mortality of cancer of specific sites. A marginal excess (p = .07) of malignancies of the lymphatic and hematopoietic system was noted in exposed males only. Only one brain cancer (0.2 per 10(4) person-years) was identified in the exposed group, and two (10.3 per 10(4) person-years) in the nonexposed group.

[Effect of low-energy laser irradiation on the functional state of the acoustic analyzer (experimental study)]. / Vliianie izlucheniia nizkoenergeticheskogo lazera na funktsional'noe sostoianie slukhovogo analizatora (eksperimental'noe issledovanie).

The acoustic function of guinea-pigs (in terms of ERA) before and after middle ear laser treatment (LHe-75, radiation intensity 15-17 mW, total dose 63 J/cm2, number of exposures 14) was investigated. The experiment was carried out using three groups of animals. Group 1 included healthy young animals. Group 2 consisted of adult animals with no signs of otitis media suppurativa. Group 3 involved adult guinea-pigs with chronic suppurative otitis media. After laser treatment all the animals showed increase of amplitudes of all ERA peaks, specifically of the first peak, an increase of the A1/A4 ratio, and an insignificant shortening of L1 at low sound intensities in group 1 and group 2 animals. This may suggest a greater excitation of the first component of the acoustic system. The group 3 animals exhibited a greater L1; this indicates that laser therapy of an untreated cavity during chronic otitis media may aggravate the pathological process. This pathology requires pretreatment of the middle ear cavity and laser therapy in combination with other therapeutic measures. None of the treated animals showed changes of the second time interval, whereas the third time interval (central time of conduction) became shorter, particularly on the side exposed to laser treatment. Our findings demonstrated differences in responses of adult and young animals to laser treatment (distinct shortening of the central time of conduction in those latter) which obviously needs further study.

[Curietherapy of the eustachian tube with Ir-192]. / Curiethérapie de la trompe d'Eustache par Ir 192.

An essential success factor for tympanoplasties is effective aeration of middle ear, lack of tubular permeability being a factor for failure. The anti-inflammatory effect of curietherapy with Iridium 192 introduced into the tube during middle ear surgery was studied in 38 patients. Tubular dysfunction was evaluated by clinical and manometric examinations. During operation, a sealed plastic tube 1.6 mm in diameter was introduced into the Eustachian tube, an Iridium wire inserted on the following day, and a dose of 1.5 and 3 Gy applied to two groups respectively. Tubular function was assessed as normal or almost normal in 61% of cases. Results were compared with a group of 30 patients not receiving curietherapy.

Adenoid cystic carcinoma of the nasopharynx after previous adenoid irradiation.

In 1978, Pratt challenged the otolaryngology community to identify an incidence of malignancy in individuals who have previously received radium therapy to the nasopharyngeal lymphoid tissues. This case report is a direct response to that quest and presents a well documented adenoid cystic carcinoma evolving 23 years after radium applicator treatment to the fossa of Rosenmuller. Although a cause-and-effect relationship cannot be scientifically proven, the case history raises several important questions concerning the stimulating effects of radiation on the later onset of frank malignancy.

Radiation therapy of the nasopharynx: a 30 year view.

A 15 to 30 year follow-up study has been made of radium therapy to the nasopharynx for Eustachian tube obstruction and serous otitis, with a review of the relevant literature. No malignancies or other complications have been seen or recorded. Objective evaluation leads to the conclusion that this is a safe, effective treatment modality. In spite of this it has been discontinued because of public fear and pressure. A judgement reached for this reason, ignoring scientific medical facts, contains the seeds of decline of quality and effectiveness of medical care.