Lukáš Školoudík

Cytology of the nasal mucosa after total laryngectomy

Conclusion: This study demonstrates morphological changes in the nasal mucosa as a consequence of functional changes of the nasal cavity after total laryngectomy (TLE). Objective: Observation of the changes of the nasal mucosa in patients after TLE. Patients and methods: A cohort observational study contained 30 patients after TLE. These patients underwent nasal endoscopy and cytological and microbiological examination of the nasal mucosa. The control group comprised 30 patients. Results: In patients who underwent TLE, morphological changes occurred in the nasal mucosa. The hyperplasia of the cells in the basal zone was the most remarkable change after TLE. The difference was statistically significant (p=0.0002) in comparison with the control group. No statistically significant difference was shown in the incidence of squamous cell metaplasia. The inflammatory changes in the nasal mucosa were found in only 10% of patients after TLE; in comparison with the control group the statistically significant decrease was proven (p=0.003). The presence of bacteria in the nasal mucosa without any signs of inflammation was demonstrated in 27% of the patients who underwent TLE. That finding was not seen in the control group. The statistically significant difference was demonstrated (p=0.0046).

Risk factors for recurrent laryngeal nerve palsy after thyroidectomy

This study investigates the incidence of temporary and permanent recurrent laryngeal nerve palsy (RLNP) and possible risk factors for patients with different types of thyroid gland diseases. 1224 consecutive patients who underwent thyroidectomy for treatment of various thyroid diseases between the years 2001–2005. The rates of RLNP were evaluated. The surgeon and type of thyroid gland disorder were recognised as possible risk factors for RLNP. The incidence of temporary/permanent RLNP for the whole group was 4.5/0.8%. The rates of temporary RLNP for groups, classified as multinodular goitre, Graves’ disease, thyroid cancer or Hashimoto’s disease were 4.3%, 4.3%, 5.2% and 5.7%, respectively. The rates of permanent RLNP for the same groups were 0.4%, 0.9%, 1.6% and 1.9%, respectively. The frequency of temporary RLNP for individual surgeons ranges from 2.8 to 7.0% and the rates of permanent RLNP is between 0–3.1%. There was no relationship between the surgeon’s experience (the number of procedures performed) and RLNP rates. Total thyroidectomy is a safe procedure associated with a low incidence of RLNP not only for benign multinodular goitre, but also for Graves’disease, thyroid cancer and Hashimoto’s disease. The rates of RLNP among individual surgeons are acceptable with small inter-individual differences.

Human Multipotent Mesenchymal Stromal Cells in the Treatment of Postoperative Temporal Bone Defect: An Animal Model.

Canal wall down mastoidectomy is one of the most effective treatments for cholesteatoma. However, it results in anatomical changes in the external and middle ear with a negative impact on the patients quality of life. To provide complete closure of the mastoid cavity and normalize the anatomy of the middle and external ear, we used human multipotent mesenchymal stromal cells (hMSCs), GMP grade, in a guinea pig model. A method for preparing a biomaterial composed of hMSCs, hydroxyapatite, and tissue glue was developed. Animals from the treated group were implanted with biomaterial composed of hydroxyapatite and hMSCs, while animals in the control group received hydroxyapatite alone. When compared to controls, the group implanted with hMSCs showed a significantly higher ratio of new bone formation (p = 0.00174), as well as a significantly higher volume percentage of new immature bone (p = 0.00166). Our results proved a beneficial effect of hMSCs on temporal bone formation and provided a promising tool to improve the quality of life of patients after canal wall down mastoidectomy by hMSC implantation.

Multipotent mesenchymal stromal cells in otorhinolaryngology.

Multipotent mesenchymal stromal cells (MSCs) are primitive cells capable of restoring damaged mesenchyme and with the ability to differentiate into mature cells of bone, cartilage, muscle, fat, nerve or fibrous tissues. MSCs are therefore good candidates for applications in regenerative medicine and cell based therapy. They regenerate through self-renewal, differentiational capacity, immune modulation and secretion of bioactive molecules. Authors present a review of MSCs applications in otorhinolaryngology. The major interest is focused on phonosurgery, sensorineural deafness and reconstruction of large tissue defects with bone, cartilage or soft tissue replacement. Current evidence of MSCs treatment efficacy in otorhinolaryngology is based on animal models. The true impact on clinical treatment will not be known until clinical studies prove functional outcomes in human medicine.

Mechanical treatment and autoclaving of middle ear ossicles from cholesteatomatous ears

Aim of the study: The authors present a prospective histomorphological study of middle ear ossicles, harvested from cholesteatomous ears, to evaluate for presence of residual cholesteatoma after mechanical treatment and short-time autoclaving.Materials and methodsSixty ossicles were used as specimens in this study. The ossicles were grouped as follows: Group A — ossicles stripped and burred using a fine diamond burr under microscopic control. Group B — ossicles autoclaved for 4 min at 134°C after mechanical burring under microscopic control.ResultsIn group A, 30 ossicles were histologicaly examined after mechanical treatment. The residual disease was found in one badly eroded ossicle. In group B, 30 ossicles were histologicaly examined after mechanical treatment and autoclaving. That treatment eliminated cholesteatoma in all cases. The difference of results in these two treatment methods was not statistically significant.ConclusionAuthors recommend using mechanical cleaning in cases of mildly eroded ossicles. In cases of badly eroded ossicles authors recommend to either apply a combination of mechanical and autoclaving treatment. The study proved that 4 minutes of autoclaving at 134°C after mechanical cleaning provides safe bone autografts.

Autoclaving of the middle ear ossicles in an animal experimental model

Abstract Conclusion: Autoclaving the ossicles for 4 min at 134°C impacts superficial devitalization and elimination of the squamous epithelium on the surface of the ossicles. Bone maintains the integrity, firmness, and lamellar structure and ossicles are integrated into the middle ear without any adverse reactions. Objective: Sixteen guinea pigs were used to explore the effect of autoclaving on middle ear ossicles. Methods: Harvested incudomallear complex was autoclaved for 4 min at 134°C and implanted back into the middle ear cavity. Exploration of the middle ear was carried out 30 days after implantation. Results were compared with a control group of 16 non-autoclaved ossicles. Results: Autoclaved ossicles maintained their integrity, firmness, shape, and lamellar structure with Haversian systems. Autoclaving substantially decreased the vitality of the ossicles. The middle ear mucosa overgrew on the ossicular surface. No adverse reactions of soft tissue against ossicles occurred. Although the autoclaved ossicles were implanted with tympanic membrane (squamous epithelium) the histological examination did not demonstrate any residuum of squamous epithelium. In the control group we proved the presence of squamous epithelium on the manubrium surface in all cases; all ossicles were vital without signs of ostitis.

Adenoid hypertrophy affects screening for primary ciliary dyskinesia using nasal nitric oxide

AIM In patients with primary ciliary dyskinesia (PCD), the release of nitric oxide (NO) is extremely low by epithelia of the nasopharynx and sinuses. Measurement of nasal NO (nNO) is recommended as a screening test for PCD. The study aimed to evaluate if adenoids affects nNO and may deteriorate the performance of the test. METHODS In 48 nonallergic patients between 5 and 18 years of age with chronic symptoms of nasal obstruction and indications for adenoidectomy, the measurements of nNO by chemiluminescence analyser and nasal patency by active anterior rhinomanometry were performed both before and after adenoidectomy. Adenoidal tissue size was graded during surgery under general anaesthesia using transoral endoscopy. RESULTS Patients were stratified into groups with adenoids grades 1, 2 and 3 (<1/3, 1/3-2/3 and > 2/3 of the choana and post-nasal space covered by adenoids). Before adenoidectomy, the median of nNO decreased with the increasing grade of adenoids (920, 663, and 491 ppb, P < 0.05). The rhinomanometry results were comparable and showed no correlation with nNO. Seven patients (14.6%) were incorrectly classified to have PCD based on a subthreshold value of the volume flow of nNO (FnNO < 77 nL/min). Following adenoidectomy, nNO of the grade 3 patients increased by 107 ppb (P < 0.05) and no differences were found between groups (P = 0.40). All patients had the postadenoidectomy FnNO >77 nL/min. CONCLUSIONS nNO and FnNO are reduced in nonallergic children with obstructive adenoids. Adenoid hypertrophy can potentially cause a false positive result of the test for PCD.

Histological Changes of the Middle Ear Ossicles Harvested during Cholesteatoma Surgery

BACKGROUND In the cholesteatoma surgery ossicles can be replaced to reconstruct middle ear function. It is important that these ossicles are free of squamous epithelium, to prevent residual disease. This study focuses on the histological findings of the malleus and incus harvested during cholesteatoma surgery. MATERIALS AND METHODS Eighty middle ears ossicles were examined in vivo and histologically to consider the relationship of cholesteatoma to ossicles, grade of bone destruction and invasion of cholesteatoma to deeper layers of bone. RESULTS Serious ossicular destruction was observed more frequently in incus compared to malleus (p=0.0065). Difference of ossicles destruction between children and adults was not significant (p=0.3032). Deep invasion of cholesteatoma into the vascular spaces or inner core of the bone was not observed. CONCLUSIONS Autograft ossicles from cholesteatomatous ears should not necessarily be rejected for reconstruction of the ossicular chain. Regarding the histological finding, the authors suggest mechanical cleaning of the ossicle surface to eliminate residual disease.

Optic neuritis and paranasal sinus diseases

The relationship of sinusitis and paranasal sinus mucoceles to optic neuritis (ON) remains a challenge for both the otolaryngologist and the ophthalmologist. Currently, ON is assumed to be a rare complication of paranasal sinus diseases. Three new cases of ON associated with paranasal sinus diseases are described. We postulate different pathophysiologic mechanisms of ON in our three patients: compression of optic nerve due to sphenoid mucocele in the first patient; extension of bacterial infection to the optic nerve in the second patient; and invasion of aspergillosis to the orbital apex in the third patient. We assume that the complete recovery of the patient’s vision in the second case resulted from surgery, which had been performed immediately. A timely operation could possibly have prevented permanent blindness in cases 1 and 3 as well. Optic neuritis can occasionally be a complication of bacterial and mycotic sinusitis or paranasal sinus mucoceles, especially if located in the sphenoid sinus and posterior ethmoids. The evaluation of paranasal sinuses using imaging techniques is necessary to diagnose the problem, and immediate surgery can prevent permanent sequelae in indicated cases.