Does topical N-acetylcysteine application after myringotomy cause severe otorrhea?

Yıl 2007, Cilt: 17 Sayı: 1, 22 - 25, 12.01.2007

Arif Şanlı Mehmet Eken Cenk Evren Günay Ateş H. Mustafa Paksoy

Öz

Objectives: The effect of topical N-acetylcysteine NAC application was investigated on the healing of acute experimental tympanic membrane perforations.Materials and Methods: Twenty guinea pigs were used in this study. Under intraperitoneal ketamine anesthesia, incisional myringotomies were per-formed in the posterosuperior quadrant of the tympanic membranes with a straight otologic hook. The diameter of the perforations was approximate-ly 2 mm. Perforations in both ears were treated with freshly prepared sponges soaked in either 0.1 mİ 0.9% NaCI solution 10 control animals or 0.6 mg/0.1 mİ NAC 10 animals for three consecutive days. AH the tympanic membranes were examined by otomicroscopy on the third, fifth, seventh, and ninth days.Results: İn the control group, ali the perforations were completely closed at the end of nine days. During the same period, only 40% of the perforations were completely closed in the NAC group. The remaining ears exhibited otorrhea by the third day. Conclusion: N-acetylcysteine may cause severe otorrhea in the healing process of tympanic membrane perforations. Further studies including histopathological examinations are required to eluci-date this condition.

Anahtar Kelimeler

Acetylcysteine, ear, middle/surgery, middle ear ventilation, tympanoplasty

Miringotomi sonras› uygulanan topikal N-asetilsistein ciddi otore sebebi midir?

Öz

Amaç: Akut, deneysel, travmatik timpan membranperforasyonlarının iyileşmesinde N-asetilsistein kullanımının etkileri incelendi.Gereç ve Yöntem: Çalışmada 20 hayvan guineapig kullanıldı. İntraperitoneal ketamin anestezisi altında, düz otolojik hook yardımıyla timpan membranların posterosuperior kadranlarına insizyonel miringotomi yapıldı. Perforasyonların çapı yaklaşık 2 mmidi. Kobaylar iki gruba ayrıldı. Kontrol grubuna 10hayvan, 20 kulak 0.1 ml %0.09 NaCl emdirilmişspongostanlar, çalışma grubuna ise 0.6 mg/0.1 mlN-asetilsistein emdirilmiş sponglar her gün değiştirilerek üç gün boyunca dış kulak yolundan perforasyon üzerine yerleştirildi. Her iki grubun timpanmembranları 3, 5, 7 ve 9. günlerde kulak mikroskobu ile değerlendirildi.Bulgular: Kontrol grubundaki perforasyonların tamamının dokuzuncu günde kapandığı izlendi. Nasetilsistein uygulanan grupta perforasyonların ancak %40’ı kapandı, geri kalan kulakların tümündeüçüncü günden itibaren otore izlendi.Sonuç: Timpan membran perforasyonlarının iyileşmesinde N-asetilsistein kullanımı yoğun otore sebebi olabilir. Bu konuyla ilgili histopatolojik incelemeleri de içeren daha kapsamlı çalışmalar gerekmektedir

Anahtar Kelimeler

Asetilsistein, orta kulak/cerrahi, orta kulak ventilasyonu, timpanoplasti.

Kaynakça

• Johnson AP, Smallman LA, Kent SE. The mechanism of healing of tympanic membrane perforations. A two- dimensional histological study in guinea pigs. Acta Otolaryngol 1990;109:406-15.
• Davidson BJ, Morris MS. The perforated tympanic membrane. Am Fam Physician 1992;45:1777-82.
• Kent SE, Rhys-Evans PH. Thermal myringotomy in guinea pigs. J Laryngol Otol 1987;101:103-15.
• Johnson A, Hawke M. The function of migratory epi- dermis in the healing of tympanic membrane perfora- tions in guinea-pig. A photographic study. Acta Otolaryngol 1987;103:81-6.
• Rivas Lacarte MP, Casasin T, Pumarola F, Alonso A. An alternative treatment for the reduction of tympan- ic membrane perforations: sodium hyaluronate. A double blind study. Acta Otolaryngol 1990;110:110-4.
• Turley EA, Bowman P, Kytryk MA. Effects of hyaluronate and hyaluronate binding proteins on cell motile and contact behaviour. J Cell Sci 1985;78:133-45.
• O’Daniel TG, Petitjean M, Jones SC, Zogg J, Martinez SA, Nolph MB, et al. Epidermal growth factor binding and action on tympanic membranes. Ann Otol Rhinol Laryngol 1990;99:80-4.
• Mondain M, Ryan A. Epidermal growth factor and basic fibroblast growth factor are induced in guinea- pig tympanic membrane following traumatic perfora- tion. Acta Otolaryngol 1995;115:50-4.
• Somers T, Goovaerts G, Schelfhout L, Peeters S, Govaerts PJ, Offeciers E. Growth factors in tympanic membrane perforations. Am J Otol 1998;19:428-34.
• Ozcan C, Polat G, Gorur K, Talas DU, Bagdatoglu O, Cinel I. The effect of local administration of N-acetyl- cysteine in perforated rat tympanic membrane: an experimental study in myringosclerosis. Pharmacol Res 2002;45:5-9.
• Felding JU, Rasmussen JB, Lildholdt T. Gas composi- tion of the normal and the ventilated middle ear cavi- ty. Scand J Clin Lab Invest Suppl 1987;186:31-41.
• Sade J, Luntz M. Dynamic measurement of gas com- position in the middle ear. II: Steady state values. Acta Otolaryngol 1993;113:353-7.
• Heffner JE, Repine JE. Pulmonary strategies of antiox- idant defense. Am Rev Respir Dis 1989;140:531-54.
• Butler AR, Flitney FW, Williams DL. NO, nitrosonium ions, nitroxide ions, nitrosothiols and iron-nitrosyls in biology: a chemist’s perspective. Trends Pharmacol Sci 1995;16:18-22.
• Lipton SA. Distinctive chemistries of no-related species. Neurochem Int 1996;29:111-4.
• Kampf C, Roomans GM. Effects of hypochlorite on cultured respiratory epithelial cells. Free Radic Res 2001;34:499-511.
• Pepperl S, Dorger M, Ringel F, Kupatt C, Krombach F. Hyperoxia upregulates the NO pathway in alveolar macrophages in vitro: role of AP-1 and NF-kappaB. Am J Physiol Lung Cell Mol Physiol 2001;280:L905-13.
• Ovesen T, Paaske PB, Elbroend O. Local application of N-acetylcysteine in secretory otitis media in rabbits. Clin Otolaryngol Allied Sci 1992;17:327-31.
• Kharazmi A, Nielsen H, Schiotz PO. N-acetylcysteine inhibits human neutrophil and monocyte chemotaxis and oxidative metabolism. Int J Immunopharmacol 1988;10:39-46.
• Aldavood SJ, Behyar R, Sarchahi AA, Rad MA, Noroozian I, Ghamsari SM, et al. Effect of acetylcys- teine on experimental corneal wounds in dogs. Ophthalmic Res 2003;35:319-23.
• Ovesen T, Paaske P, Ledet T, Elbrond O. Immunohistochemical quantitation of collagen types I, II, IV and V in the ventilated and non-ventilated rabbit middle ear with otitis media with effusion. Eur Arch Otorhinolaryngol 1994;251:137-42.
• Ovesen T, Felding JU, Tommerup B, Schousboe LP, Petersen CG. Effect of N-acetylcysteine on the inci- dence of recurrence of otitis media with effusion and re-insertion of ventilation tubes. Acta Otolaryngol Suppl 2000;543:79-81.