Analysis of preoperative and peroperative features and postoperative outcomes with neutrophil to lymphocyte ratio, in chronic otitis media surgery,

Neutrophil to lymphocyte ratio was determined to be a new marker for predicting inflammation and it was studied in several cancers, cardiac diseases, gastrointestinal diseases, ear nose and throat diseases in the literature. However analysis of neutrophil to lymphocyte ratio in chronic otitis media was not reported in any study before. Our study aims to retrospectively review preoperative and intraoperative findings and postoperative results with NLR in patients who had surgery for chronic otitis media. We examined the effects of our findings on patients' treatments and success of surgery in chronic otitis media and we expect that our study will lead the way to the further studies in this area. There are two groups in our study as patient and control group. 391 patients who were operated with the diagnosis of chronic otitis media between January 2012 and June 2015 in Bulent Ecevit University Faculty of Medicine, Ear, Nose and Throat Department were analyzed in terms of preoperative and intraoperative variables with neutrophil-lymphocyte ratio and 242 patients whose postoperative results were achieved were analyzed in terms of postoperative results with neutrophil-lymphocyte ratio. As control group, NLR values of 50 patients who were hospitalized and operated in our clinic due to a deviated septum were taken into consideration. Patients who had previous head trauma, patients with intracranial malignancies and malignancies of hearing pathways, patients who have another chronic inflammatory or infectious disease, patients receiving radiotherapy due to head and neck malignancy, patients who have a psychiatric or neurological disease, patients who can not come to the clinic for regular follow-up and patients under 18 years of age were excluded from the study both in the patient and the control group as it may affect their NLR values. Cases in our study were divided in five subgroups as a cholesteatomatous otitis media group, tympanosclerosis group, myringosclerosis group, adhesive otitis media group and chronic otitis media without cholesteatoma group for the diagnosis based on microscopic and operative findings. Preoperative and postoperative NLR values of the patient group and all subgroups were compared with each other and with the control group. Demographic characteristics of the patients such as age and gender, history of the diseases, the effected ear or bilaterality, tympanic membrane perforations in otomciroscopic examination, polyps in external ear canal, the type of the operation, pathologies and anomalies encountered during the operation, intraoperative findings such as the status of the ossiclar chain, the facial nerve and lateral semicircular canal were analyzed in detail and NLR values were compared with each other and the control group. The success of the hearing level and graft membrane of the patients who come to follow-up in the postoperative period was evaluated and NLR values of these patients were compared with each other and the control group. Mean neutrophil value in the control group was found as 4,42 ± 1,22 and mean lymphocyte value in the control group was found as 2 ± 0,65 in our study. Mean NLR value in the control group was 2,45 ± 1,12 in our study. Preoperative mean neutrophil value in the patient group was found as 4,97 ± 1,77 and preoperative mean lymphocyte value in the patient group was found as 2,25 ± 0,63 in our study. Preoperative mean NLR value in the patient group was 2,49 ± 2,07 in our study. Postoperative mean neutrophil value in the patient group was found as 4,71 ± 1,43 and postoperative mean lymphocyte value in the patient group was found as 2,34 ± 0,63 in our study. Postoperative mean NLR value in the patient group was 2,15 ± 0,97 in our study. Decline was observed in the neutrophils, lymphocytes and neutrophils to lymphocytes ratio values in the postoperative periods in our study patient group and these changes were statistically significant (p <0.05). In our study, preoperative and postoperative NLR values of the patient group and all subgropus were calculated higher than the NLR values of the control group, but these values was not statistically significant (p> 0.05). The difference between mean lymphocyte values of the control group and preoperative mean lymphocyte values of the patient group were statistically significant (p = 0.01, p <0.05). NLR is a simple and robust indicator of prognosis in several types of cancers and inflammatory diseases. On the other hand in order to be more useful in the risk stratification of chronic otitis media NLR should be confirmed with prospective controlled studies with larger number of subjects.