BACKGROUND:Radiotherapy-related normal tissue injury is clinically important in salvage surgery for hypopharyngeal cancer, but its histopathological features in clinical specimens remain poorly defined. AIMS/OBJECTIVES:To propose a practical descriptive histopathological framework for radiotherapy-related muscle injury using salvage surgical specimens. MATERIAL AND METHODS:We retrospectively examined anterior cervical muscle specimens obtained during salvage total pharyngolaryngectomy after definitive radiotherapy or chemoradiotherapy. Two head and neck surgeons with postgraduate training in pathology independently reviewed H&E-stained sections without reference to treatment exposure and, after discussion, established a four-tier semiquantitative framework based on recurring morphologic patterns. A board-certified head and neck pathologist subsequently reviewed all specimens blinded to treatment exposure and clinical information. No statistical comparison between treatment groups was intended. RESULTS:Thirteen previously irradiated patients and two non-irradiated controls were included. Irradiated muscles showed a spectrum of changes ranging from mild myofiber swelling and atrophy to rupture, fibrosis, necrosis, and scarring. Non-irradiated controls showed preserved muscle architecture. CONCLUSIONS AND SIGNIFICANCE:This study proposes a practical descriptive framework for radiotherapy-related muscle injury in salvage surgery. The grades should be interpreted as predominant morphologic patterns rather than rigid chronological stages or statistically validated treatment-specific categories.
OBJECTIVES:Approximately 30% of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) have poor outcomes despite standardized treatment. Reliable biomarkers for identifying high-risk patients remain insufficiently established. To investigate the clinical significance of systemic inflammatory indices for identifying high-risk patients and to explore their associations with clinicopathological characteristics. METHODS:A total of 99 patients with HPV-associated (p16-positive) OPSCC were included. Systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), were evaluated for their associations with clinical outcomes and clinicopathological characteristics. Their prognostic significance was assessed using Cox proportional hazards regression and Kaplan-Meier survival analyses. RESULTS:Most systemic inflammatory indices were associated with overall survival (OS) in univariate analysis, whereas only NLR was associated with progression-free survival (PFS); furthermore, none remained independently significant in multivariate analyses. Notably, all indices were significantly associated with T classification, whereas associations with N and M classifications were limited. CONCLUSIONS:Systemic inflammatory indices primarily reflected tumor burden rather than serving as independent prognostic determinants in HPV-associated OPSCC. Biomarkers derived from the local tumor immune microenvironment may provide more informative tools for risk stratification and treatment optimization.
BACKGROUND:Informed consent documents often exceed recommended readability levels, potentially compromising patients' decision-making. AIMS/OBJECTIVES:This pilot feasibility study evaluated two large language models (LLMs), ChatGPT-5.2 and Gemini 3 Pro, as tools for generating more comprehensible otolaryngology surgical consent forms, and estimated effect-size parameters for a future trial. MATERIALS AND METHODS:In a prospective, double-blind design, 123 Turkish consent documents (41 procedures × 3 sources: official forms, ChatGPT-5.2 and Gemini 3 Pro) were evaluated. Three independent otolaryngologists rated medical quality on five 5-point criteria; five blinded lay volunteers rated comprehensibility. Two validated Turkish readability indices (Ateşman; Bezirci-Yılmaz) provided objective measurement. Comparisons used linear mixed-effects models. RESULTS:Official forms showed the highest expert-rated quality (4.62 ± 0.35) versus ChatGPT5.2 (3.85 ± 0.48) and Gemini 3 Pro (3.99 ± 0.44; p < 0.001). Gemini forms achieved the highest comprehensibility (4.33 ± 0.42 vs 3.18 ± 0.51 for official forms; p < 0.001). Objective readability mirrored this, with the Ateşman score correlating with comprehensibility (r = 0.81). CONCLUSIONS AND SIGNIFICANCE:Publicly available LLMs, particularly Gemini 3 Pro, can substantially improve consent-form comprehensibility at some cost to medical-accuracy and ethical-legal adequacy; these findings motivate evaluation of a hybrid AI-plus-expert workflow in a future confirmatory trial.
BACKGROUND:Despite rising survival rates and high-quality health data available - no large-scale study has mapped the full Danish Childhood Cancer Survivor population with auditory late effects. AIMS/OBJECTIVES:This study aimed to estimate the prevalence of auditory late effects among Danish children and adolescents diagnosed with cancer in a national register-based study. MATERIALS AND METHODS:Using data from the Danish Cancer Register and the Danish National Patient Register, we identified children diagnosed with cancer before the age of 18 between 2014 and 2024. Statistical analyses including descriptive statistics, chi-square tests, relative risks and trend analysis were performed to explore patterns and potential associations between cancer diagnosis and the development of auditory late effects. RESULTS:The study population consisted of 3075 children with a registration in the Danish Cancer Register. The prevalence of auditory late effects was 5.7%. The risk was higher among younger patients, patients with malignant neoplasms and patients receiving high-dose chemotherapy at a younger age.. CONCLUSION AND SIGNIFICANCE:These findings highlight auditory late effects as a relevant late effect with implications for quality of life. Early identification and monitoring are essential to support developmental outcomes, particularly in younger patients, and to increase awareness in survivorship care.
BACKGROUND:Research on the hearing implant journey in older adults is scarce. AIMS/OBJECTIVES:To conduct a multicenter scoping survey on the clinical routine in the treatment of hearing loss, specifically cochlear implantation, in older adults. MATERIALS AND METHODS:A survey comprising 39 questions on the treatment of hearing loss in older adults was sent to 20 cochlear implant clinics worldwide. RESULTS:Most respondents referred to older adults in the context of cochlear implantation as adults aged 60 years or older with postlingual, mostly progressive hearing loss with different aetiologies. Preoperative assessment in older adults should go beyond standard audiometric tests, including cognitive screening and involving a multidisciplinary team. Significant others and social support play a key role in the rehabilitation process in older adult CI recipients and users. CONCLUSIONS AND SIGNIFICANCE:A guideline for the management of cochlear implantation in older adults is needed.
BACKGROUND:Nasal irrigation is widely recommended for chronic rhinosinusitis and allergic rhinitis, but its effects on the upper-airway microbiome remain unclear. OBJECTIVE:To determine whether 30 days of buffered isotonic saline nasal irrigation alters bacterial diversity in the nasal cavity, nasopharynx, and oral cavity. MATERIAL AND METHODS:Ten volunteers performed twice-daily irrigation for 30 days. Swabs from the nasal cavity, nasopharynx, and posterior tongue were collected at baseline and day 30. Bacterial communities were analysed by 16S rRNA gene sequencing. The primary endpoint was change in nasal Shannon diversity; other microbiome, endoscopic, and correlation analyses were exploratory. RESULTS:Nasal Shannon diversity increased significantly (median [IQR], 1.02 [0.80-1.48] vs 1.50 [1.37-1.66]; p = 0.040), whereas nasopharyngeal and oral diversity did not. Micrococcaceae, Lactobacillus, and Corynebacterium showed directional increases but did not survive FDR correction. Nasal mucosal erythema decreased (p = 0.039). No participant developed acute sinusitis or severe complications; transient mild discomfort occurred in three. CONCLUSIONS AND SIGNIFICANCE:Thirty-day saline nasal irrigation was associated with increased nasal bacterial diversity and reduced mucosal erythema. These single-arm pilot findings are exploratory and warrant validation in larger controlled studies.
ObjectivesTo evaluate the effects of cochlear implantation on speech recognition in noise, sound localization, QoL, and tinnitus in adults with SSD. MATERIAL AND METHODS:This retrospective cohort study with prospective follow-up included 12 adults with SSD who underwent cochlear implantation between 2015 and 2024 at a tertiary referral center. Assessments included the Danish Sentence Test (DAST), sound localization testing, and patient-reported outcome measures. Speech reception thresholds (SRTs), localization accuracy (RMSE), QoL (NCIQ), and tinnitus burden (THI) were evaluated. RESULTS:Cochlear implantation significantly improved speech recognition in the head shadow condition, whereas no significant improvements were observed for binaural squelch or summation. Sound localization accuracy improved significantly. Total NCIQ and THI scores also improved significantly. CONCLUSIONS AND SIGNIFICANCE:Cochlear implantation improved speech recognition in noise, sound localization, quality of life, and tinnitus burden in adults with SSD, supporting its use as an effective treatment option for selected patients.
BACKGROUND:Current olfactory assessment relies on subjective scales or complex objective techniques. A simple, economical objective method is needed. OBJECTIVES:This study evaluated a nasal airflow-based olfactory assessment using eugenol stimulation. MATERIAL AND METHODS:Four hundred and twelve participants underwent VAS scoring, Sniffin' Sticks testing, and nasal airflow assessment with 2.5% eugenol. Correlation, group comparison, cluster analysis, and ROC analysis were performed. A validation cohort (n = 56) and test-retest reliability (n = 30) were also assessed. RESULTS:Velocity change ratio showed weak correlations with discrimination (r=-0.10, p = 0.03), identification (r = 0.09, p = 0.04), and VAS scores (r = 0.05, p = 0.02). The OD group showed lower flow and velocity change ratios than controls (p < 0.001 and p = 0.03). Cluster analysis yielded cut-offs of <4% (flow) and <2.5% (velocity). In the validation cohort, AUC was 0.71 (95% CI: 0.56-0.86), sensitivity 72.7%, specificity 91.7%. Test-retest ICCs were 0.76 and 0.83. CONCLUSIONS:The nasal airflow-based assessment shows weak correlations with established tests and modest diagnostic accuracy. Its simplicity makes it potentially suitable as a screening tool, but it cannot replace comprehensive psychophysical testing.
BACKGROUND:Laryngeal stenosis is a common complication after partial laryngectomy and impairs patients' quality of life. AIMS:This study aimed to identify risk factors for laryngeal stenosis after partial laryngectomy in patients with laryngeal squamous cell carcinoma (LSCC). MATERIAL AND METHODS:A cohort of 511 patients with LSCC who underwent partial laryngectomy from December 2011 to December 2023 was analyzed. Univariate and multivariate analysis were used to analyze the site of tumor, stage, surgery technique and postoperative radiotherapy to identify risk factors for laryngeal stenosis after partial laryngectomy. RESULTS:A total of 70 out of 511 (13.7%) patients developed laryngeal stenosis. In the univariate analysis, surgical technique (p = 0.009) and postoperative radiotherapy (p = 0.023) were significantly associated with laryngeal stenosis. Furthermore, multivariate analysis identified advanced tumor stage (III/IV), tracheohyoidoepiglottopexy (THEP), and postoperative radiotherapy as independent risk factors for laryngeal stenosis. CONCLUSIONS AND SIGNIFICANCE:The surgical technique and postoperative radiotherapy were found to be factors associated with laryngeal stenosis. Furthermore, THEP, advanced tumor stages (III/IV) and postoperative radiotherapy were identified as independent risk factors for laryngeal stenosis following partial laryngectomy in patients with LSCC.
BACKGROUND:The outcomes of pediatric cochlear implantation (CI) in children with epilepsy have not been thoroughly characterized. AIMS/OBJECTIVES:To compare auditory and speech outcomes in pediatric CI recipients with and without epilepsy, and to evaluate whether the presence of epilepsy should contraindicate CI. MATERIALS AND METHODS:This retrospective case-control study included children aged 2-6 years, comprising 23 with epilepsy (cases) and 25 without epilepsy (controls). Outcomes were evaluated using the Categories of Auditory Performance (CAP; scale 0-7) and Speech Intelligibility Rating (SIR; scale 1-5) at 6 and 12 months following implantation. Repeated-measures models with bootstrap validation were employed to account for within-subject correlations. RESULTS:The control group attained significantly higher absolute scores on the CAP and SIR scales (p < 0.001). Nevertheless, the epilepsy group exhibited substantial improvement, particularly with greater relative gains in auditory perception during the second six-month interval. CONCLUSIONS:Epilepsy is associated with reduced postoperative performance; however, it does not preclude substantial benefits from CI. SIGNIFICANCE:Children with epilepsy should not be excluded from cochlear implant candidacy solely on the basis of anticipated lower performance scores.
Background: Mastoid and epitympanic obliteration has become a widely used technique in cholesteatoma surgery to reduce postoperative recurrence. However, recurrent disease still occurs in some patients, and the anatomical sites and mechanisms of recurrence after obliteration remain insufficiently documented.Aims/objectives: To investigate the location of recurrent cholesteatoma using radiological and intraoperative findings and to assess its association with the quality of mastoid and epitympanic obliteration performed during surgery.Material and methods: A retrospective single-center study including 14 patients who underwent surgery for recurrent cholesteatoma from January 2016 to January 2025. All patients had obliteration performed during the initial surgery (canal wall up or down technique) using various materials, mainly S53P4 bioactive glass. Analysis was based on clinical records, CT scans, non-echo-planar diffusion-weighted MRI, and surgical findings.Results: Fourteen patients experienced recurrence after obliteration. All preoperative CT scans showed incomplete obliteration of the epitympanum. Recurrent disease mostly involved the epitympanum (86%), often extending to the mesotympanum or mastoid.Conclusions and significance: Cholesteatoma recurrence after obliteration appears to be associated with incomplete obliteration, particularly of the epitympanum. Complete obliteration, especially of anatomically challenging areas such as the supratubal recess, may play a key role in reducing the risk of recurrence.
BACKGROUND:Hearing preservation (HP) is an important objective in cochlear implantation for patients with residual low-frequency hearing, but its long-term clinical relevance remains uncertain. OBJECTIVE:To evaluate long-term hearing preservation, functional residual hearing, and speech recognition following cochlear implantation. MATERIAL AND METHODS:This retrospective cohort study included 41 adults (42 ears) with a preoperative low-frequency pure-tone average (LFPTA) ≤80 dB HL. Hearing preservation was assessed using the HEARRING and low-frequency threshold shift (dPTA) classifications. Linear mixed-effects models evaluated longitudinal changes in LFPTA and speech recognition, and Kaplan-Meier analysis estimated retention of functional residual hearing. RESULTS:Hearing preservation was frequently achieved according to both classification systems. LFPTA deteriorated by 20.5 dB HL during the first 6 postoperative months and declined by 2.46 dB HL annually thereafter (p = 0.020). Functional residual hearing decreased from 66.7% to 41.7% during follow-up. In contrast, speech recognition improved significantly after implantation (all p < 0.001) and remained stable. Retained functional residual hearing was not associated with superior speech recognition. CONCLUSIONS AND SIGNIFICANCE:Although residual hearing declined progressively, speech recognition remained robust irrespective of retained functional residual hearing. Hearing preservation remains a worthwhile surgical objective but was not associated with improved long-term speech recognition.
BACKGROUND:Cochlear duct length (CDL) varies between individuals and influences cochlear implant (CI) electrode selection, making proper preoperative measurement an important step for optimizing CI outcomes. OBJECTIVES:To measure and report CDL and the cochlear parameters in subjects who underwent temporal bone CT scan in Bahrain. MATERIALS AND METHODS:This retrospective cohort study evaluated temporal bone CT scans obtained between 2010 and 2022 at Governmental Hospitals in Bahrain. One hundred subjects (200 ears) were consecutively selected from the hospital database as DICOM files. Scans with inadequate image quality or absence of thin-section imaging, and those with congenital or acquired temporal bone pathologies were excluded. CDL and main cochlear parameters were measured using OTOPLAN software. RESULTS:Of the 200 ears analyzed, 142 met the inclusion criteria. Mean CDL was 34.8 ± 1.7 mm. Males showed significantly larger cochlear measurements than females, whereas no significant differences were observed between pediatric and adult subjects or between right and left ears. CONCLUSIONS AND SIGNIFICANCE:CDL varies significantly by gender but not by age or side. Differences were also observed between the Bahraini population and certain other geographic populations, highlighting the importance of individualized preoperative CDL measurement to optimize electrode array selection and CI outcomes.
BACKGROUND:Although both microscopic and endoscopic techniques are used in external auditory canal cholesteatoma surgery, their comparative efficacy remains unclear. OBJECTIVE:To compare the outcomes of microscopic and transcanal endoscopic treatments for Naim stage I-III external auditory canal cholesteatoma. METHODS:A retrospective analysis was conducted on patients diagnosed with Naim stage I-III external auditory canal cholesteatoma (EACC) between November 2015 and November 2025. Clinical characteristics were compared between the transcanal endoscopic ear surgery (TEES) group and microscopic ear surgery (MES) group. RESULT:TEES had shorter operative time (46.45 ± 25.61 vs. 65.24 ± 44.98 min) and time to complete epithelialization (28.3 ± 4.7 vs. 45.8 ± 3.2 days) than MES (both p < 0.05). No postoperative cholesteatoma recurrence or EAC stenosis/atresia occurred in TEES. Conversely, MES complications included isolated recurrence (n = 2, 4.4%), isolated EAC stenosis/atresia (n = 1, 2.2%), concurrent recurrence and stenosis (n = 3, 6.7%), and transient facial paralysis (n = 1, 2.2%). CONCLUSION:Surgical management of EACC should be tailored to the extent of the lesion. For Naim stage I-III cases, TEES represents a safe and effective minimally invasive modality.
BACKGROUND:Postoperative complications following middle ear surgery present ongoing challenges despite advances in surgical techniques. A comprehensive analysis of complication patterns, associated risk factors, and their interactions with patient comorbidities is needed to improve patient safety and outcomes. OBJECTIVES:To analyze the incidence, patterns, and risk factors of postoperative complications following middle ear surgery, and to develop a predictive model for complication risk assessment incorporating patient demographics, comorbid conditions, surgical variables, and surgeon experience. MATERIAL AND METHODS:This single-center retrospective cohort study analyzed 200 patients who underwent middle ear surgery between January 2018 and December 2024. Data were collected on demographics (including body mass index and smoking status), comorbidities (hypertension, diabetes mellitus), preoperative conditions, surgical procedures, surgeon experience, and postoperative complications. Risk factors were identified using univariate and multivariate logistic regression analyses. Severity of facial nerve palsy was graded using the House-Brackmann scale, and sensorineural hearing loss was classified as mild, moderate, or severe. RESULTS:A total of 45 patients (22.5%) experienced at least one postoperative complication, yielding 53 complication events (eight patients experienced multiple complications). Early complications (<30 days) occurred in 33 patients (16.5%) and late complications (≥30 days) in 12 patients (6.0%). The most common complications were sensorineural hearing loss (8.5%; mild in 9, moderate in 5, severe in 3), facial nerve paresis (4.5%; all delayed onset; House-Brackmann Grade II in 4, Grade III in 3, Grade IV in 2), surgical site infection (4.0%), and CSF leak (2.5%). Multivariate analysis identified cholesteatoma (OR = 3.24, 95% CI: 1.68-6.25, p < 0.001), surgical duration >180 min (OR = 2.87, 95% CI: 1.42-5.79, p = 0.003), revision surgery (OR = 2.45, 95% CI: 1.23-4.88, p = 0.011), and age ≥60 years (OR = 2.12, 95% CI: 1.08-4.17, p = 0.029) as independent risk factors. Body mass index, smoking status, and comorbidities (hypertension, diabetes mellitus) were analyzed but did not reach statistical significance in multivariate analysis. Surgeon experience (≤5 years) was associated with higher complication rates on univariate analysis (31.8% vs. 17.9%, p = 0.028) but was not retained in the final multivariate model. The predictive model showed good discrimination (AUC = 0.812, 95% CI: 0.751-0.873) with an events-per-variable ratio of 11.25. CONCLUSIONS AND SIGNIFICANCE:Postoperative complications remain significant in middle ear surgery, with cholesteatoma, prolonged surgery, revision procedures, and advanced age as key risk factors. The developed predictive model can aid in preoperative risk stratification and guide enhanced perioperative monitoring for high-risk patients, potentially improving surgical safety and outcomes.
BACKGROUND:The Belfast Rule of Thumb (BRT) is a tool used to estimate subjective hearing improvement based on binaural hearing following middle ear surgery, however, evidence for its association with patient-reported outcomes remains limited. AIMS/OBJECTIVES:To assess the predictive validity of BRT for subjective hearing improvement following ossiculoplasty and to identify additional factors influencing surgical satisfaction. MATERIALS/METHODS:Data were obtained from the Swedish Quality Registry for Ear Surgery. Audiometric results from 340 patients who underwent ossiculoplasty between 2013 and 2019 were analysed in relation to patient‑reported outcome measures. RESULTS:BRT criteria were met by 61.5% of patients, of whom 80.9% reported subjective hearing improvement. The BRT showed a positive predictive value of 80.9% (95% CI, 75.0-85.6), negative predictive value of 59.5% (95% CI, 51.0-67.6), sensitivity of 76.1%, and specificity of 66.1%. Overall, 77.3% of patients were satisfied with surgery. Hearing improvement was the strongest predictor of satisfaction, while postoperative ear discomfort, tinnitus, and water intolerance were the most common adverse factors. CONCLUSION/SIGNIFICANCE:The BRT is a useful tool for preoperative counselling in ossiculoplasty. However, failure to meet its criteria does not preclude meaningful postoperative benefit. Patient satisfaction is influenced by factors beyond hearing improvement, including perioperative care and complications.
BACKGROUND:Benign paroxysmal positional vertigo (BPPV) is highly prevalent in very elderly patients (aged ≥80 years), who present complex comorbidities, atypical manifestations, poor mobility, and high fall risk, leading to diagnostic and therapeutic challenges. Evidence on this population is scarce. AIMS/OBJECTIVES:To clarify clinical features, treatment efficacy, recurrence patterns, and risk factors in very elderly BPPV patients. MATERIAL AND METHODS:Retrospective analysis of 128 very elderly patients with BPPV. RESULTS:Treatment was tolerated by 93.75% (120/128); cure and improvement rates were 93.3% (112/120) and 97.5% (117/120), respectively. The crude recurrence rate was 23.2% (26/112); 76.9% of recurrences were ipsilateral, with 69.2% involving the same canal. Kaplan-Meier estimates, accounting for censored observations, yielded cumulative recurrence rates of 6.3% (95% CI: 1.7%-10.6%) at 1 month, 14.3% (95% CI: 7.6%-20.5%) at 3 months, 18.2% (95% CI: 10.7%-25.1%) at 6 months, and 24.4% (95% CI: 15.3%-32.7%) at 12 months. Multivariable Cox regression identified prior BPPV (HR = 2.416, p = 0.039) and sleep disturbance (HR = 2.448, p = 0.028) as independent predictors. CONCLUSIONS AND SIGNIFICANCE:Very elderly patients (aged ≥80 years) with BPPV show high treatment tolerance and favorable outcomes. Prior BPPV and sleep disturbance are independent predictors of recurrence. Individualized repositioning strategies are recommended.
BACKGROUND:Sleep-related breathing disorders (SRBD) in children are frequently associated with adenoid hypertrophy. A correlation has been identified between SRBD and numerous sleep-related disturbances, such as parasomnias. However, the relationship between SRBD symptoms and parasomnias in children undergoing adenoidectomy remains poorly understood. AIMS:This study was designed to investigate the relationship between SRBD symptoms and parasomnias in children undergoing adenoidectomy. MATERIALS AND METHODS:In this study of 54 pediatric patients with adenoid hypertrophy, sleep symptoms and disturbances were measured via the Pediatric Sleep Questionnaire -Related Breathing Disorder (PSQ-SRBD) and Sleep Disturbance Scale for Children (SDSC) scales. Parasomnias (e.g. enuresis, sleepwalking) were documented through parental reports, followed by correlation analyses and group comparisons between symptomatic and asymptomatic children. RESULTS:Analysis revealed a significant positive relationship between PSQ-SRBD and SDSC scores (r = 0.577, p < 0.001). Children with parasomnia symptoms demonstrated higher PSQ-SRBD and SDSC scores compared to those without parasomnias. Parasomnias were frequently reported among children with prominent SRBD symptoms. CONCLUSIONS AND SIGNIFICANCE:Higher SRBD symptom burden is associated with increased prevalence of parasomnias. Overall, these findings underscore the need for comprehensive evaluation of sleep disturbances in pediatric patients undergoing adenoidectomy.
BACKGROUND:The temporal bone pathology of Meniere's disease was proven to be endolymphatic hydrops. However, the mechanisms surrounding hydrops development and symptom onset in Meniere's disease remain unclear. AIMS/OBJECTIVES:The purpose of this study was to investigate relationships between endolymphatic sac hypoplasia in Meniere's disease and stress hormone vasopressin type-2 receptor (V2R) mRNA expression in endolymphatic sac. MATERIAL AND METHODS:First, we examined temporal bone CT (TBCT) in patients with intractable Meniere's disease before surgery to evaluate endolymphatic sac hypoplasia. Then, we obtained endolymphatic sac tissues during surgery to examine V2R mRNA expression using real-time PCR. RESULTS:All the intractable Meniere's cases were divided into poorly pneumatized retrolabyrinthine air cells PPR group (n = 9) and non PPR group (n = 3) through the TBCT evaluation. V2R mRNA expression were significantly higher in PPR group (n = 9; 31.78 ± 7.54 fold) than non PPR one (n = 3; 4.22 ± 2.61 fold) through the real-time PCR (Welch's t-test: t = 3.45; p = 0.0072). CONCLUSIONS AND SIGNIFICANCE:Several evidences have suggested that functional dysregulation of inner ear fluid homeostasis is associated with endolymphatic hydrops and Meniere's disease. Taken together with the present study, it is suggested that coexistence of endolymphatic sac hypoplasia and V2R mRNA overexpression might determine the affected side of endolymphatic hydrops.
