Have you ever packed the nose without thinking seriously about use of prophylactic antibiotics? This paper from UK (Biswax & Mal, Acta Oto-Laryngologica, 2009; 129: 179
181) did not observe any difference in bacterial colonization between the packed and non-packed sides of nose.  Well you may , if you like, dismiss it as “applicable to temperate climate, but not to the tropics” if you like!

January 15  2009

Vol 9 No 3

Otorhinolaryngology news

In this issue

· Vestibular Hair Cells regeneration…?

· Nose Packing 7 Antibiotics…?

· Mastoid obliteration, FGF & Ca2PO3..?

· Case of The week

Journal Watch: Reconstruction of Auricular cartilage using tissue-engineering techniques; Rotter, Steiner & Scheithauer, 2009

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 Till 2009,

 Biodun

Already, numerous options are available for obliteration of open mastoid cavity following CWD procedures. These include the use of materials both biological (bone pate, fats, cartilage) and alloplastic (hydroxyapatite, etc) each with one limitation or the other. This paper from Japan (Kakigi, Taguchi & Takeda, Auris Nasus Larynx Volume 36, Issue 1, February 2009, Pages 15-19 ) is a preliminary report of a study evaluating the use of yet newer technique - calcium phosphate bone paste admixed with fibroblast growth factor - said to make up for shortcomings observed with the earlier used materials

Abstract: 

Objectives

To describe mastoid obliteration using a calcium phosphate paste with an artificial dermis soaked with basic fibroblast growth factor (b-FGF) and the usefulness of this procedure.

Methods

Ten ears that underwent a canal wall-down mastoidectomy were treated with calcium phosphate paste. The cases consisted of four patients with mastoid cavity problem, four with middle ear cholesteatoma, one with adhesive otitis media, and one with external auditory canal cholesteatoma. The post-operative follow-up period was 19.9 months on average (ranging from 13 to 23 months). First, the canal wall-down mastoidectomy was performed. Then, the calcium phosphate paste was used to fill up to the facial ridge posteriorly and the horizontal segment of the facial canal superiorly. The surface of the paste was covered with an artificial dermis soaked with b-FGF.

Results

Following calcium phosphate paste treatment, all open cavities were decreased in volume and epithelized within 2 months.

Conclusion

Calcium phosphate paste appears effective for mastoid obliteration. Using an artificial dermis soaked with b-FGF appears to prevent exposure of the paste to the skin of the external auditory meatus. However, the number of the patients is too small to draw any conclusion.

Abstract: Whereas most epithelial tissues turn-over and regenerate after a traumatic lesion, this restorative ability is diminished in the sensory epithelia of the inner ear; it is absent in the cochlea and exists only in a limited capacity in the vestibular epithelium. The extent of regeneration in vestibular hair cells has been characterized for several mammalian species including guinea pig, rat, and chinchilla, but not yet in mouse. As the fundamental model species for investigating hereditary disease, the mouse can be studied using a wide variety of genetic and molecular tools. To design a mouse model for vestibular hair cell regeneration research, an aminoglycoside-induced method of complete hair cell elimination was developed in our lab and applied to the murine utricle. Loss of utricular hair cells was observed using scanning electron microscopy, and corroborated by a loss of fluorescent signal in utricles from transgenic mice with GFP-positive hair cells. Regenerative capability was characterized at several time points up to six months following insult. Using scanning electron microscopy, we observed that as early as two weeks after insult, a few immature hair cells, demonstrating the characteristic immature morphology indicative of regeneration, could be seen in the utricle. As time progressed, larger numbers of immature hair cells could be seen along with some mature cells resembling surface morphology of type II hair cells. By six months post-lesion, numerous regenerated hair cells were present in the utricle, however, neither their number nor their appearance was normal. A BrdU assay suggested that at least some of the regeneration of mouse vestibular hair cells involved mitosis. Our results demonstrate that the vestibular sensory epithelium in mice can spontaneously regenerate, elucidate the time course of this process, and identify involvement of mitosis in some cases. These data establish a road map of the murine vestibular regenerative process, which can be used for elucidating the molecular events that govern this process.

© Copyright Dr 'Biodun Olusesi,  2005 - 2009

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Abstract:

Conclusion. This pilot study did not show an advantage of the routine use of prophylactic antibiotics for spontaneous

epistaxis treated by nasal packing. Objective. The purpose of this study was to investigate the value of the use of prophylactic antibiotics in spontaneous epistaxis cases treated with anterior nasal packing. Subjects and methods. Over a period of 6 months, all cases of epistaxis managed with anterior nasal packing were studied prospectively. After pack removal, swabs from the packed and the non-packed sides of the nasal cavity were cultured to detect any difference in the bacterial growth pattern between the two sides. All these cases were clinically evaluated to detect any infection secondary to the anterior nasal packing. Results. We did not observe infection in any of the cases before or after removal of the anterior nasal pack. The bacterial growth profile of packed and non-packed sides of the nose did not differ significantly.