Searching of serum paraoxanase 1 and carbonic anhydrase 9 enzymes level in chronic otitis media patients' blood sample

The etiopathogenesis of chronic otitis media (COM) and cholesteatoma is still not fully elucidated. Many reasons such as osteoclastic activity, cytokines, chronic inflammation, endotoxin and toxic effects of lipid peroxidation products are blamed for this. It is thought that in these patients, the inflammatory/anti-inflammatory balance is a situation in which inflammatory factors are more active. In our study, we aimed to investigate whether the blood serum levels of Paraoxanase (PON) 1 and Carbonic Anhydrase (CA) 9, which are known to be two antioxidant enzymes, have an effect on the chronicization process of otitis and the formation of cholesteatoma form. We also examined other factors such as comorbidities and septum deviation in COM patients and investigated whether they affected serum enzyme levels. 41 patients between the ages of 18-65, diagnosed with chronic otitis media at the Ear Nose and Throat Clinic, and 39 volunteer healthy individuals without any disease to form the control group were included in the study. Routine audiometric and radiological examinations of COM patients were performed. It was noted that whether the patients had active ear discharge, COM sides, antibiotic usage, septum deviation, comorbidities, sleep quality or presence of cholesteatoma as a result of HRCT. Venous blood was taken from both groups and PON 1 and CA-IX enzyme levels were measured using a Spectrophotometer from the serum obtained after centrifugation. As a result of the statistical analysis, it was seen that serum enzyme levels did not change depending on age and gender in both groups. Serum PON 1 enzyme decreased significantly in the patient group (p<0.001). The median CA-IX enzyme level was also decreased in the patient group compared to the healthy group, but no statistical significance was found. Among the independent variables, serum PON 1 levels were found to be significantly lower in the patient group with septum deviation than in the group without deviation (P = 0.001). Serum PON 1 level and activity were found to be significantly increased in individuals with additional diseases (Diabetus Mellitus, Hypertension, Coronary artery disease, Asthma, Migraine, etc.) (p = 0.033). Both serum PON 1 and CA-IX activity were significantly decreased in patients with COM with cholesteatoma compared to simple COM patients (p<0.001 and p=0.021, respectively). When evaluated, these results show that in COM patients, where chronic inflammation is known to predominate, anti-inflammatory enzymes such as PON 1 and CA-IX may have protective roles in the formation of chronic otitis and the progression of the condition to cholesteatoma, and these clinical pictures may occur with the decrease in the levels of these enzymes. Key Words: Chronic otitis media, Paraoxanase, Carbonic anhydrase