Bożena Skotnicka

Lymphocyte subpopulations in middle ear effusions: flow cytometry analysis.

Objective: The aim of this study was to identify lymphocyte subpopulations in middle ear effusions, peripheral blood, and adenoids in children suffering from otitis media with effusion. Setting: Tertiary referral center. Patients: Thirty-three children (55 ears) undergoing myringotomy for otitis media with effusion. Methods: CD3+, CD4+, CD8+, CD19+, and natural killer cell populations were investigated in middle ear effusion, peripheral blood, and adenoids using a three-color monoclonal antibody and flow cytometry method for quantitative estimation. Results: T cells (CD3+) are dominating lymphocytes in middle ear effusion. Among T lymphocytes, the majority are those of the helper type (CD4+). The dominating isoform among CD4+ lymphocytes are memory cells (CD4+CD45RO+); among CD8+ lymphocytes, naive cells (CD8+CD45RA+). The percentage of CD4+ cells, CD8+ cells, and the CD4+/CD8+ ratio was significantly higher in middle ear effusions than in blood. The percentage of memory CD4+ lymphocytes and naive CD8+ lymphocytes was significantly lower in the middle ear effusion. Lymphocyte subsets were compared between 22 pairs of effusions from each patient. The percentage of each type of cell did not differ significantly. Conclusion: The results of this study indicate local regulation of the lymphocyte profile in middle ear effusions and the same phase of immune response in two ears of the same patient.

Chosen factors of T and B cell apoptosis in hypertrophic adenoid in children with otitis media with effusion.

Evaluation of lymphocyte homeostasis within the chronically inflamed adenoid, closely related to the functioning of the immune system, may have a role in qualifying children for adenoidectomy. Apoptosis is a major process maintaining balance between tonsillar lymphocytes. The Fas receptor and Bcl-2 protein family which show pro-apoptotic and anti-apoptotic actions are of particular significance in apoptosis induction. Adenoid excised due to hypertrophy with or without chronic otitis media with effusion was used as study material. Flow cytometry was used to assess the percentages of apoptotic lymphocytes and CD4(+), CD8(+), CD19(+) cells with CD95(+) antigen and Bcl-2 protein in the group of children who underwent adenoidectomy due to adenoid hypertrophy and accompanying otitis media with effusion. The percentages of CD4(+)Bcl-2(+), CD8(+)Bcl-2(+) and CD19(+)Bcl-2(+) lymphocytes in the group of children with adenoid hypertrophy and acute otitis media were lower as compared to the reference group. However, the percentages of CD4(+), CD8(+) and CD19(+) cells with CD95(+) antigen were higher in the study group comparing to the reference group. The tendency of reduced percentages of T and B lymphocytes with Bcl-2 expression and elevated percentages of these cells with CD95(+) expression within the adenoid may reflect local immunity disorders.

Myringoplastyka u dzieci – czynniki wpływające na wynik leczenia chirurgicznego ☆

Summary Objective Myringoplasty is successfully performed in children since many years. However still considerable controversy surrounds the subject of proper timing of surgery and other factors influencing the success rate. The aim of this study was to assess the results of myringoplasty in children and to determine which factors influence the postoperative results. Material and methods Retrospective study of the anatomic and functional results of 82 consecutive myringoplasties performed in children between 1996–2004. Seventy one children (mean age 13 ± 2,9 years, range 6,4–18 years) who had undergone myringoplasty because of central perforation or retraction pocket in the pars tensa were evaluated. All of the children underwent myringoplasy using endaural or post-auricular approach and underlay technique. Temporalis fascia, perichondrim or cartilage were used as a graft material. The results were assessed on the basis of otoscopic and audiometric examination pre and postoperatively. Following factors have been analyzed to assess their influence on the success rate: age, size and site of perforation, status of the operated ear (dry/discharging), status of the contralateral ear. Results Closure of the perforation was achieved in 91,5% of children. A good anatomic outcome was observed in 87,8%. The Air Bone Gap between 0–20 dB was observed in 95,6% of patients. Age below 10 years was found to significantly affect the results of surgery. The rate of success was lower in cases with pathological process in the contralateral ear but the difference was not statistically significant. Conclusions Myringoplasty with underlay grafting of the fascia temporalis or perichondrium gives good anatomic and functional results in children. The results are significantly worst in children below 10 years of age. Pathological changes in the contralateral ear influence the risk of an abnormal postoperative tympanic membrane.

Production of cytokines by mononuclear cells of hypertrophic adenoids in children with otitis media with effusion

Hypertrophic adenoids with otitis media with effusion is a common infectious disease and present a serious otological problem in children. Cytokines, potent inflammatory mediators, play important role in the initiation of immunological response in otitis media. Adenoids excised due to hypertrophy with or without chronic otitis media with effusion were used to isolate mononuclear cells. Secretion of cytokines by non-stimulated and PHA-stimulated cells was determined by specific ELISAs. We found a significant increase in the production of IL-5 and TNF-a secreted by adenoidal cells of children with otitis media with effusion compared to group with hypertrophic adenoids. No differences were found in the secretion of IL-8, IL-6, and IL-10 between these two groups of patients. Our results suggest a difference between the immunological responses in the course of hypertrophic adenoids with otitis media as compared to hypertrophic adenoids.

Trwałe następstwa wysiękowego zapalenia ucha w wieku dziecięcym

Summary Introduction Otitis media with effusion is the most common cause of hearing loss in children and myringotomy with tympanostomy tube insertion is recommended procedure to deal with the problem. The objective of the present study was to determine the results of treatment, incidence and prevalence of middle ear sequelae and hearing results among children with chronic otitis media with effusion who received standard treatment with tympanostomy tubes. Material and methods The group of 97 patients treated by tympanostomy tubes insertion in the years 1999–2001 was reevaluated after mean period of follow up 7.3 years. At the control examination videootoscopy and audiologic examinations were performed. Audiological assessment consisted of tympanometry and pure-tone thresholds of air and bone conduction. Results Recurrent otitis media with effusion requiring tube insertion occurred during follow up period in 23.7% of patients. At the control examination 16.5% of children had an ongoing otitis media or ventilation tube in place or tympanic membrane perforation. Most common tympanic membrane abnormality were focal atrophy (67.2% of ears) and myringosclerosis (39.5%) followed by retraction pockets of pars flaccida (29.9%) and tensa (9.6%). Mean pure-tone audiometric threshold were significantly higher in ears with tympanic membrane abnormality by the difference did not excide 5dB HL in ears with focal atrophy and myringosclerosis and 6.5 dB HL in ears with retraction pockets. Conclusions As the percentage of recurrences after tympanostomy tubes insertion are not uncommon prolonged period of follow up of those children is recommended. Although ventilation tubes have proven very effective in improving hearing in short term, they have not proven effective in preventing long-term sequelae of tympanic membrane and some degree of hearing loss. The decision about surgical treatment should be taken cautiously taking into account the chance of spontaneous resolution.INTRODUCTION Otitis media with effusion is the most common cause of hearing loss in children and myringotomy with tympanostomy tube insertion is recommended procedure to deal with the problem. The objective of the present study was to determine the results of treatment, incidence and prevalence of middle ear sequelae and hearing results among children with chronic otitis media with effusion who received standard treatment with tympanostomy tubes. MATERIAL AND METHODS The group of 97 patients treated by tympanostomy tubes insertion in the years 1999-2001 was reevaluated after mean period of follow up 7.3 years. At the control examination videootoscopy and audiologic examinations were performed. Audiological assessment consisted of tympanometry and pure-tone thresholds of air and bone conduction. RESULTS Recurrent otitis media with effusion requiring tube insertion occurred during follow up period in 23.7% of patients. At the control examination 16.5% of children had an ongoing otitis media or ventilation tube in place or tympanic membrane perforation. Most common tympanic membrane abnormality were focal atrophy (67.2% of ears) and myringosclerosis (39.5%) followed by retraction pockets of pars flaccida (29.9%) and tensa (9.6%). Mean pure-tone audiometric threshold were significantly higher in ears with tympanic membrane abnormality by the difference did not excide 5dB HL in ears with focal atrophy and myringosclerosis and 6.5 dB HL in ears with retraction pockets. CONCLUSIONS As the percentage of recurrences after tympanostomy tubes insertion are not uncommon prolonged period of follow up of those children is recommended. Although ventilation tubes have proven very effective in improving hearing in short term, they have not proven effective in preventing long-term sequelae of tympanic membrane and some degree of hearing loss. The decision about surgical treatment should be taken cautiously taking into account the chance of spontaneous resolution.

Zastosowanie rynometrii akustycznej w ocenie przerostu migdałka gardłowego oraz skuteczności zabiegu adenoidectomii

Summary Introduction Adenoid hypertrophy is a problem of more than 1/3 of children and is the predominant reason of otolaryngology consultations in this population. Diagnosis and surgical qualification are based on physical examination and other methods introduced more than 100 years ago. Development of endoscopic techniques has been found this method to be a gold standard in adenoid assessment up to date. However, the method is difficult to performed in some young patient because of their invasiveness. Acoustic assessment of nosopharyngs seems to be a new promising method. The aim of the study Were an assessment of nasal obstruction due to adenoid hypertrophy in group of patients referring to adenoidectomy and an objective evaluation of changes in the volume of the nasopharynx after adenoidectomy. Material and methods The examination was carried on the group of 30 patients aged 5–10 y.o. with adenoid hypertrophy admitted for adenoidectomy. The control group consisted of 10 children free of otolaryngological problems. All studied individuals had acoustic rhinometry performed and additionally, endoscopic method such as rhynofiberoscopy and endoscopy of nasopharyngs were introduced in the patients group. Results The study showed that children with adenoid hypertrophy have statistically significant reduction of nasopharyngeal volume (NPV) vs control group. Adenoidectomy increases the NPV parameter and makes it equal to control group. Conclusions The acoustic rhynometry seems to be a promising method in assessment of nasopharyngeal volume. This and further studies may help to reduce the number of „unnecessary” adenoidectomies, by making standards for NPV in different group of age.

Powikłania zapaleń ucha środkowego u dzieci w dobie antybiotykoterapii

Summary Otogenic complications in children occur most commonly secondarily to acute otitis media. Intratemporal complications are predominant and mastoiditis is most frequently seen. Meningitis in the course of acute otitis media is the most common intracranial complication. Complications of chronic otitis media are rare today, but can be more difficult to diagnose, because antibiotics may mask symptoms and change clinical presentation. Antibiotic use, however, has not completely eradicated the otogenic complications and ENT doctors should remember about this possibility.

Ocena odsetka limfocytów CD19+CD5+ w przerosłych migdałkach gardłowych u dzieci chorych na wysiękowe zapalenie ucha środkowego☆☆☆

Summary Introduction Otitis media with effusion and hypertrophied adenoid are still common diseases in childhood. Adenoid has particular meaning to develop of immunological response to inflammations in upper respiratory inclusive middle ear. The origin CD19+CD5+ B cells remains controversial. The differentiation response to ligation of CD5 resulting in apoptosis or proliferation lymphocytes. The aim of this study was compare the percentage of CD19+CD5+ lymphocytes in hypertrophied adenoid tissue at children with otitis media with effusion to comparative group without inflammatory state in middle ear. Material and methods We tested 37 children in examine group with hypertrophied adenoid and otitis media with effusion (OME), and 32 children in comparative group only with hypertrophied adenoid (HA). We also divided both groups into two groups, above 5 and over 5 years old. We made the research by flow cytometry method. We used anty-CD19 and anty-CD5 monoclonal antibodies to examinations. Results In this study we showed significantly higher percentage of the CD19+CD5+ lymphocytes at children with examined group (OME 22.12 ± 4.31%) than in comparative group (HA 19.16 ± 4.32%), p Conclusions The significant higher percentage of B lymphocytes with expressions of CD5+ receptor in hypertrophied adenoid tissue at children with otitis media with effusion are important to develop of early immunological response to inflammatory state in middle ear.

Wideoendoskopowa ocena funkcji gardłowego ujścia trąbki słuchowej u dzieci z chorobami ucha środkowego

Summary Eustachian tube (ET) dysfunction play an important role in the development, persistence and recurrence of otitis media with effusion (OME) and chronic otitis. Evaluation of the type of obstruction in the cartilaginous portion of ET is important for decision concerning methods of treatment and prognosis of surgical outcome. The aim of this study was to identify characteristics of dynamic function of the pharyngeal orifice of ET in children with OME and chronic otitis by video endoscopy. Transnasal endoscopic examination of the nasopharyngeal opening of ET during swallowing was performed on 21 children – 13 with OME, 8 with chronic otitis. Video recording were made for dynamic slow-motion analysis of ET dilation and closing processes. Most cases of ET dysfunction in children were obstrucive (81%), associated with mucosal oedema and hyperplasia. Dynamic type of dysfunction is caused by the reduced movement of the tensor veli palatini. Dynamic video analysis is useful in the identify type of ET dysfunction in children. Obstructive dysfuntion need diagnostic procedures for chronic infection, nasopharyngeal reflux and alergic diseases.

Expression of Toll-like receptors on peripheral blood white cells in acute otitis media.

OBJECTIVE From 10 to 15% of children suffer from recurrent acute otitis media (AOM). An association between polymorphism in TLRs and their co-receptor CD14 with otitis media proneness has been described in children. Moreover, the experiments on animal models have shown that TLRs and their signaling molecules are critical for timely resolution of bacterial otitis. AIM The aim of this study was to determine the expression of TLR1, TLR2 and TLR4 on lymphocytes, monocytes and granulocytes in peripheral blood in children with recurrent or persistent AOM. METHODS The study was performed on a group of 25 children hospitalized for recurrent AOM, failures of previous treatments and/or acute mastoiditis. The results were compared to the control group of healthy children at the same age. The expression of TLRs on peripheral blood white cells was measured by flow cytometric analysis. The results were expressed as mean fluorescence intensity (MFI). The statistical analysis was performed using the Mann-Whitney U test. RESULTS The highest expression of TLR was found on monocytes, the lowest on lymphocytes in both groups of children (AOM and the control one). The expression of TLR1 was the lowest and expression of TLR4 was the highest on all examined cells. The expression of all examined TLRs on monocytes was significantly higher in the AOM group. CONCLUSIONS Peripheral blood monocytes are characterized by increased expression of TLRs in the course of recurrent AOM.