Ahmet Hamdi KEPEKÇİMD. Otorhinolaryngologist

Assistant ProfessorYeniyüzyıl University (Istanbul, Turkey)

Subject The Diagnostic Value of Mean

Platelet Volume (MPV) and Platelet Distribution Width (PDW) as a Inflammatory Indicator in Patients with Chronic Otitis Media with Effusion

Introduction Chronic otitis media with effusion (COME) is

a clinical situation characterized with an effusion in tympanic cavity exceeding three months without an acute infection.

Platelets have critical role in homeostasis and tissue repair (Polinska et al., 2011). Beside these effects recently it was understood that platelets also have a role in inflammatory process.

MPV (mean platelet volume) and PDW (platelet distribution width) are routine hematologic parameters and these are very practical parameters to understand the platelet activity.

PDW shows the difference in platelet sizes in the circulation. increase of PDW level indicates that there are much more different size of platelets in the circulation and the decrease of PDW indicates that the similar sized old platelets increase in the circulation

MPV: The young platelets with large volume have intense granules in their cytoplasma and enzymatically and metabolically they are much more active (Boos et al., 2007). Since the increase of platelet activation have an important role on developing the inflammatory process it can be used as an indicator of inflammation

Aim In this retrospective study we tried to

investigate whether MPV and PDW could be an inflammatory indicator in patients with chronic otitis media with effusion

Materials and Methods The MPV and PDW parameters were

collected retrospectively from the 149 patient’s files who undergo to ventilation tube insertion operation for chronic otitis media with effusion between December 2009 and December 2015.

Patients with chronic inflammatory diseases, i. e. connective tissue disorders and hemoglobinopathies were excluded from the study.

These parameters analysed statistically with the MPV and PDW levels of the control group including 151 healthy subjects The blood samples were collected in sterile tubes containing constant amount of anticoagulant and analysed in several minutes with ABX Micros automatic hematologic analyzer (ABX Micros: HORIBA, California, USA) .

Ethics committee approval was received for this study from the local hospital ethics board (no: 01.03.2016/18).

Statistical Analysis Data were analyzed with the computer software

SPSS for Windows (SPSS for Windows, Version 21. 0, SPSS Inc, USA). To compare the groups for the categorized variables, t - test was used; Mann - Whitney U test was used for the quantitative variables. In all cases, P values of < 0. 05 were considered.

Results

Our study group including 149 patients and control group including 151 subjects, The mean age of the study group was 6, 75±2, 67( the minimum age 2 and maximum age 16) and the mean age of control group was 6, 69±3, 66. The study group including 65 female and 85 male patients, the control group including 68 female and 83 male subjects.

F: female; M: male COME: chronic otitis media with effusion;

Come Group (n=149) Control Group (n=151) P value a

Age(years) 6, 75±2, 67 6, 69±3, 66 , 601

Gender, F/M, n(%) 65 (43, 6%) / 84 (56, 4%) 68 (45, 0%) / 83 (55, 0%) , 806

The parameters of gender, age and hematologic findings of both the study and the control group

COME: chronic otitis media with effusion; WBC: white blood cell count; RBC: red blood cell count; Hb: hemoglobin; Hct: hematocrit; PLT: platelets; MPV: mean platelet volume.  PDW: platelet distribution width. a: Statistical analysis was performed with the Mann-Whitney U-test

Come Group (n=149) Control Group (n=151) P value a

WBC( /µL) 8, 34±2, 56 8, 03±2, 9 , 108

RBC(106/µL) 4, 65±0, 4 4, 66±0, 38 , 843

Hb(g/dL) 11, 67±1, 11 11, 89±1, 04 , 069

Hct(%) 36, 23±3, 13 36, 76±3, 12 , 162

PLT (103/µL) 330, 65±90, 91 307, 64±76, 18 , 026

MPV(fL) 7, 53±0, 98 7, 64±0, 9 , 195

PDW(fL) 13, 35±1, 85 14, 14±2, 26 , 001

Results Mean WBC, RBC, Hb, Hct values were not significantly

different between COME patients and controls (p>0. 05)

The mean MPV levels of the study group was 7, 53±0, 98 and the mean MPV levels of the study group was 7, 64±0, 9, There wasn’t statistically meaningful difference between the groups (p>0, 05)

Results The mean PDW levels of the study group was 13,

35±1, 85, the mean PDW levels of the control group was 14, 14±2, 26 and this difference was statistically significant (p<0, 05)

The mean platelet count of the study group was 330, 65±90, 91 and the mean platelet count of the control group was 307, 64±76, 18 and this is also statistically significant (p<0, 05)

Discussion In several studies it was reported that there

was a relationship between the platelets and some diseases like preeclampsia, unstabil angina, myocardial infarction, ulserative colitis and crohn disease (Kapsoritakis et al., 2001).

Sagit et al and Aktaş et al reported that the MPV levels of nasal polyposis patients were significantly higher than the healthy control group (Sagit et al., 2012)(Aktas et al., 2013).

Somuk et al reported from their study on 51 chronic otitis media with effusion that there wasn’t a statistically significant difference between the study and the control group (Somuk et al., 2014).

Discussion In our study the MPV levels of the study group was

not statistically different from the control group but on the other hand both the platelet count and PDW levels of the study group is statistically different from the control group

We think that the middle ear disease with effusion is a localized inflammation and it has no any impulse effect on bone marrow to produce young and active platelets, on the other hand the rise of platelet count and PDW levels have to be researched much more in detailed studies.

Discussion With this limited study we can only say that increase

in PDW levels of the study group may be an inflammatory indicator in chronic otitis media with effusion.

Although MPV is a valuable indicator in some diseases with atherosclerotic and inflammatory proceses like preeclampsia, unstable angina, myocardial infarction, ulserative colitis, Crohn disease, and nasal polyposis, we did not find a significant relationship between MPV levels and COME in our study.

Discussion In this limited study the platelet count and PDW

levels of the study group were significantly different from those in the control group.

Thus, they seem to have a diagnostic value in COME patients, but more detailed studies are needed to confirm this.

Thank you for listening

ahmethamdi.kepekci@yeniyuzyil.edu.tr