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Plasma Selenium and Cadmium Levels in Patients with Chronic Otitis Media in a Turkish Population and Their Relation to Inflammation Markers

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Abstract

Chronic otitis media (COM) is a multifactorial process, for which a clear etiology has not yet been established. The aims of the present study were to evaluate selenium (Se) and cadmium (Cd) levels in patients with COM and to analyze the correlation between Se and Cd with inflammation markers. The study population consisted of 88 participants: 45 healthy controls (group 1) and 43 patients with COM (group 2). Demographic data, Se, Cd, C-reactive protein (CRP), and white blood cell count (WBC) levels were all recorded. Se and Cd measurements were performed in a graphite furnace atomic absorption spectrophotometer (Perkin Elmer Analyst 800) using Zeeman background correction. The Se and Cd levels were compared between the groups and the correlation between Se and Cd with inflammation markers was analyzed. No statistically significant difference was determined between the groups in terms of demographic data (p > 0.05). CRP and WBC levels were significantly higher in group 2 than in group 1 (p < 0.05). Se levels were significantly lower in group 2 than in group 1, at 23.40 ± 12.08 μg/L vs. 37.31 ± 22.44 μg/L (p < 0.05). Cd levels were significantly higher in group 2 than in group 1, at 1.79 ± 1.63 μg/L vs. 0.68 ± 0.45 μg/L (p < 0.05). When all the cases were evaluated together, a statistically significant negative correlation was determined between Se and CRP (r = − 0.239, p = 0.013) and a positive correlation between Cd and CRP (r = 0.266, p = 0.006), WBC (r = 0.258, p = 0.008). Our results could propose that Se deficiency and Cd excess could play a crucial and additive role in the etiopathogenesis of COM. However, further investigations with larger numbers of patients are warranted to determine the exact role of these elements.

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References

  1. Mahadevan M, Navarro-Locsin G, Tan HK et al (2012) A review of the burden of disease due to otitis media in the Asia-Pacific. Int J Pediatr Otorhinolaryngol 76(5):623–635

    Article  CAS  PubMed  Google Scholar 

  2. Grindler DJ, Blank SJ, Schulz KA, Witsell DL, Lieu JE (2014) Impact of otitis media severity on children’s quality of life. Otolaryngol Head Neck Surg 151:333–340

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yadav MK, Chae SW, Song JJ (2012) In vitro streptococcus pneumoniae biofilm formation and in vivo middle ear mucosal biofilm in a rat model of acute otitis induced by S. pneumoniae. Clin Exp Otorhinolaryngol 5(3):139–144

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vergison A, Dagan R, Arguedas A, Bonhoeffer J, Cohen R, DHooge I, Hoberman A, Liese J, Marchisio P, Palmu AA, Ray GT, Sanders EAM, Simões EAF, Uhari M, van Eldere J, Pelton SI (2010) Otitis media and its consequences: beyond the earache. Lancet Infect Dis 10(3):195–203

    Article  PubMed  Google Scholar 

  5. Karlidag T, Ilhan N, Kaygusuz I, Keles E, Yalcin S (2004) Comparison of free radicals and antioxidant enzymes in chronic otitis media with and without tympanosclerosis. Laryngoscope 114(1):85–89

    Article  CAS  PubMed  Google Scholar 

  6. Yilmaz T, Kocan EG, Besler HT (2004) The role of oxidants and antioxidants in chronic tonsillitis and adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol 68:1053–1058

    Article  PubMed  Google Scholar 

  7. Takoudes TG, Haddad J Jr (2001) Free radical production by antibiotic-killed bacteria in the Guinea pig middle ear. Laryngoscope 111:283–289

    Article  CAS  PubMed  Google Scholar 

  8. Takoudes TG, Haddad J Jr (1999) Evidence of oxygen free radical damage in human otitis media. Otolaryngol Head Neck Surg 120:638–642

    Article  CAS  PubMed  Google Scholar 

  9. Wacewicz M, Socha K, Soroczyńska J, Niczyporuk M, Aleksiejczuk P, Ostrowska J, Borawska MH (2018) Selenium, zinc, copper, cu/Zn ratio and total antioxidant status in the serum of vitiligo patients treated by narrow-band ultraviolet-B phototherapy. J Dermatol Treat 29:190–195

    Article  CAS  Google Scholar 

  10. Schwarz K, Foltz CM (1957) Selenium as an integral part of factor 3 against dietary necrotic liver degeneration. J Am Chem Soc 79:3292–3293

    Article  CAS  Google Scholar 

  11. Zhao X, Yao H, Fan R, Zhang Z, Xu S (2014) Selenium deficiency influences nitric oxide and selenoproteins in pancreas of chickens. Biol Trace Elem Res 161:341–349

    Article  CAS  PubMed  Google Scholar 

  12. Yilmaz T, Kocan EG, Besler HT, Yilmaz G, Gursel B (2004) The role of oxidants and antioxidants in otitis media with effusion in children. Otolaryngol Head Neck Surg 131:797–803

    Article  PubMed  Google Scholar 

  13. Bacic’Vrca V, Skreb F, Cepelak I, Mayer L (2004) Supplementation with antioxidants in the treatment of graves’ disease: the effect on the extracellular antioxidative parameters. Acta Pharma 54:79–89

    Google Scholar 

  14. Leite HP, Nogueira PCK, Iglesias SBDO, de Oliveira SV, Sarni ROS (2015) Increased plasma selenium is associated with beter outcomes in children with systemic inflammation. Nutrition 31:485–490

    Article  CAS  PubMed  Google Scholar 

  15. Zhu XK, Jiang MD, Song EQ, Jiang XJ, Song Y (2015) Selenium deficiency sensitizes the skin for UVB-induced oxidative damage and inflammation which involved the activation of p38 MAPK signaling. Food Chem Toxicol 75:139–145

    Article  CAS  PubMed  Google Scholar 

  16. Hall JA, Bobe G, Vorachek WR, Kasper K, Traber MG, Mosher WD, Pirelli GJ, Gamroth M (2014) Effect of supranutritional organic selenium supplementation on postpartum blood micronutrients, antioxidants, metabolites, and inflammation biomarkers in selenium-replete dairy cows. Biol Trace Elem Res 161:272–287

    Article  CAS  PubMed  Google Scholar 

  17. Kaygusuz I, Ilhan N, Karlıdag T, Keles E, Yalcın S, Cetiner H (2003) Free radicals and scavenging enzymes in chronic tonsillitis. Otolaryngol Head Neck Surg 129:265–268

    Article  PubMed  Google Scholar 

  18. Takoudes TG, Haddad J (1999) Lipid peroxides in middle ear fluid after acute otitis media in Guinea pigs. Ann Otol Rhinol Laryngol 108:564–568

    Article  CAS  PubMed  Google Scholar 

  19. Dogru H, Delibas N, Doner F, Tuz M, Uygur K (2001) Free radical damage in nasal polyp tissue. Otolaryngol Head Neck Surg 124:570–572

    Article  CAS  PubMed  Google Scholar 

  20. Inci E, Civelek S, Seven A, Inci F, Korkut N, Burcak G (2003) Laryngeal cancer: in relation with oxidative stress. Tohoku J Exp Med 200:17–23

    Article  PubMed  Google Scholar 

  21. Kaygusuz I, Ozturk A, Ustundag B, Yalcın S (2001) Role of free oxygen radicals in noise-related hearing impairment. Hear Res 162:43–47

    Article  CAS  PubMed  Google Scholar 

  22. Takumida M, Popa R, Anniko M (1999) Free radicals in the Guinea pig inner ear following gentamicin exposure. ORL J Otorhinolaryngol Relat Spec 61:63–70

    Article  CAS  PubMed  Google Scholar 

  23. Asher BF, Guilford FT (2016) Oxidative stress and low glutathione in common ear, nose, and throat conditions: a systematic review. Altern Ther Health Med 22:44–50

    PubMed  Google Scholar 

  24. Aydoğan F, Taştan E, Aydın E, Şenes M, Akgedik Ş, Berkem R, Tekeli A, Haklıgör A, Üstün H (2013) Antioxidant role of selenium in rats with experimental acute otitis media. Indian J Otolaryngol Head Neck Surg 65:541–547

    Article  PubMed  Google Scholar 

  25. Jarup L, Berglund M, Elinder CG, Nordberg G, Vahter M (1998) Health effects of cadmium exposure--a review of the literature and a risk estimate. Scand J Work Environ Health 24:1–51

    Article  PubMed  Google Scholar 

  26. Wang B, Du Y (2013) Cadmium and its neurotoxic effects. Oxid Med Cell Longev 2013:898034

    PubMed  PubMed Central  Google Scholar 

  27. Chauhan AJ, Johnston SL (2003) Air pollution and infection in respiratory illness. Br Med Bull 68:95–112

    Article  CAS  PubMed  Google Scholar 

  28. Preciado D, Kuo E, Ashktorab S, Manes P, Rose M (2010) Cigarette smoke activates NFkappa B-mediated Tnf-alpha release from mouse middle ear cells. Laryngoscope 120:2508–2515

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Song JJ, Lee JD, Lee BD, Chae SW, Park MK (2012) Effect of diesel exhaust particles on human middle ear epithelial cells. Int J Pediatr Otorhinolaryngol 76:334–338

    Article  PubMed  Google Scholar 

  30. Lee DW, Oh SH, Park MK, Lim YH, Hong YC (2018) Environmental cadmium exposure is associated with elevated risk of chronic otitis media in adults. Occup Environ Med 75:515–521

    Article  PubMed  Google Scholar 

  31. Gobe G, Crane D (2010) Mitochondria, reactive oxygen species and cadmium toxicity in the kidney. Toxicol Lett 198:49–55

    Article  CAS  PubMed  Google Scholar 

  32. Kim SJ, Jeong HJ, Myung NY, Kim MC, Lee JH, So HS, Park RK, Kim HM, Um JY, Hong SH (2008) The protective mechanism of antioxidants in cadmium-induced ototoxicity in vitro and in vivo. Environ Health Perspect 116:854–862

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Song JJ, Kim JY, Jang AS, Kim SH, Rah YC, Park M, Park MK (2015) Effect of cadmium on human middle ear epithelial cells. J Int Adv Otol 11:183–187

    Article  PubMed  Google Scholar 

  34. Murakami K, Yoshino M (2004) Aluminum decreases the glutathione regeneration by the inhibition of NADP-isocitrate dehydrogenase in mitochondria. J Cell Biochem 93:1267–1271

    Article  CAS  PubMed  Google Scholar 

  35. Liu T, He W, Yan C, Qi Y, Zhang Y (2011) Roles of reactive oxygen species and mitochondria in cadmium-induced injury of liver cells. Toxicol Ind Health 27:249–256

    Article  CAS  PubMed  Google Scholar 

  36. Min KB, Lee KJ, Park JB, Min JY (2012) Lead and cadmium levels and balance and vestibular dysfunction among adult participants in the National Health and nutrition examination survey (NHANES) 1999-2004. Environ Health Perspect 120:413–417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Correia PRM, Oliveira E, Oliveira PV (2002) Simultaneous determination of manganese and selenium in serum by electrothermal atomic absorption spectrometry. Talanta 57:527–535

    Article  CAS  PubMed  Google Scholar 

  38. Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE (2002) Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the secondary prevention of otitis media in young children: pilot research. Ann Otol Rhinol Laryngol 111:642–652

    Article  PubMed  Google Scholar 

  39. Valko M, Leibfritz D, Moncol J, Cronin MTD, Mazur M, Telser J (2007) Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol 39:44–84

    Article  CAS  PubMed  Google Scholar 

  40. Shukla GK, Mahajan A, Pandey S, Gujrati VR, Vrat S, Mishra SC, Shanker K (1996) A study of free radicals and scavenging enzyme in tonsillitis. Boll Chim Farm 135:653–655

    CAS  PubMed  Google Scholar 

  41. Pollack AZ, Mumford SL, Sjaarda L, Perkins NJ, Malik F, Wactawski-Wende J, Schisterman EF (2017) Blood lead ,cadmium and mercury in relation to homocysteine and C-reactive protein in women of reproductive age: a panel study. Environ Health 16:84

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Rayman MP (2000) The importance of selenium to human health. Lancet 356:233–234

    Article  CAS  PubMed  Google Scholar 

  43. Hoffmann PR, Berry MJ (2008) The influence of selenium on immune responses. Mol Nutr Food Res 52:1273–1280

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Parks RR, Huang CC, Haddad J (1994) Evidence of oxygen radical injury in experimental otitis media. Laryngoscope 104:1389–1392

    CAS  PubMed  Google Scholar 

  45. Doner F, Delibas N, Dogru H, Yariktas M, Demirci M (2002) The role of free oxygen radicals in experimental otitis media. J Basic Clin Physiol Pharmacol 13:33–40

    Article  CAS  PubMed  Google Scholar 

  46. Khakimov AM, Arifov SS, Faizulaeva FN (1997) Efficacy of antioxidant therapy in patients with acute and chronic purulent otitis media. Vestn Otorinolaringol 5:16–19

    Google Scholar 

  47. Shigemi H, Egashira T, Kurono Y, Mogi G (1998) Role of superoxide dismutase in otitis media with effusion. Ann Otol Rhinol Laryngol 107:327–331

    Article  CAS  PubMed  Google Scholar 

  48. Yariktas M, Doner F, Dogru H, Yasan H, Delibas N (2004) The role of free oxygen radicals on the development of otitis media with effusion. Int J Pediatr Otorhinolaryngol 68:889–894

    Article  PubMed  Google Scholar 

  49. Aktan B, Taysi S, Gumustekin K, Bakan N, Sutbeyaz Y (2003) Evaluation of oxidative stress in erythrocytes of Guinea pigs with experimental otitis media and effusion. Ann Clin Lab Sci 33:232–236

    CAS  PubMed  Google Scholar 

  50. Garça MF, Turan M, Avşar B, Kalkan F, Demir H, Kozan A, Bozan N (2015) The evaluation of oxidative stress in the serum and tissue specimens of patients with chronicotitis media. Clin Exp Otorhinolaryngol 8:97–101

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Elemraid MA, Mackenzie IJ, Fraser WD, Harper G, Faragher B, Atef Z, al-Aghbari N, Brabin BJ (2011) A case-control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children. Eur J Clin Nutr 65:895–902

    Article  CAS  PubMed  Google Scholar 

  52. Ozcaglar HU, Agirdir B, Dinc O, Turhan M, Kilinçarslan S, Oner G (2001) Effects of cadmium on the hearing system. Acta Otolaryngol 121:393–397

    Article  CAS  PubMed  Google Scholar 

  53. Czarnecki LA, Moberly AH, Rubinstein T, Turkel DJ, Pottackal J, McGann JP (2011) In vivo visualization of olfactory pathophysiology induced by intranasal cadmium instillation in mice. Neurotoxicology 32:441–449

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Bluestone CD (1996) Pathogenesis of otitis media: role of eustachian tube. Pediatr Infect Dis J 15:281–291

    Article  CAS  PubMed  Google Scholar 

  55. Agius AM, Wake M, Pahor AL, Smallman LA (1995) Nasal and middle ear ciliary beat frequency in chronic suppurative otititis media. Clin Otolaryngol Allied Sci 20:470–474

    Article  CAS  PubMed  Google Scholar 

  56. Gabridge MG, Meccoli RA (1982) Cytotoxicity and ciliostasis in tracheal explants exposed to cadmium salts. Environ Health Perspect 44:189–195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Yücetürk AV, Unlü HH, Okumuş M, Yildiz T, Filiz U (1997) The evaluation of eustachian tube function in patients with chronic otitis media. Clin Otolaryngol Allied Sci 22:449–452

    Article  PubMed  Google Scholar 

  58. Bernhoft RA (2013) Cadmium toxicity and treatment. Sci World J 2013:394652

    Article  CAS  Google Scholar 

  59. Chatterjee S, Kundu S, Sengupta S, Bhattacharyya A (2009) Divergence to apoptosis from ROS induced cell cycle arrest: effect of cadmium. Mutat Res 663:22–31

    Article  CAS  PubMed  Google Scholar 

  60. Olszowski T, Baranowska-Bosiacka I, Gutowska I, Chlubek D (2012) Pro-inflammatory properties of cadmium. Acta Biochim Pol 59:475–482

    Article  CAS  PubMed  Google Scholar 

  61. Messaoudi I, El Heni J, Hammouda F, Saïd K, Kerkeni A (2009) Protective effects of selenium, zinc, or their combination on cadmium-induced oxidative stress in rat kidney. Biol Trace Elem Res 130:152–161

    Article  CAS  PubMed  Google Scholar 

  62. Liu R, Jia T, Cui Y, Lin H, Li S (2018) The protective effect of selenium on the chicken pancreas against cadmium toxicity via alleviating oxidative stress and autophagy. Biol Trace Elem Res 184(1):240–246

    Article  CAS  PubMed  Google Scholar 

  63. Panjehpour M, Alaie SH (2014) N-acetylcysteine prevents cadmium-induced apoptosis in human breast cancer MDA-MB468 cell line. Cell Mol Biol 60:33–38

    CAS  PubMed  Google Scholar 

  64. Liu S, Xu FP, Yang ZJ, Li M, Min YH, Li S (2014) Cadmium-induced injury and the ameliorative effects of selenium on chicken spleniclymphocytes: mechanisms of oxidative stress and apoptosis. Biol Trace Elem Res 160(3):340–351

    Article  CAS  PubMed  Google Scholar 

  65. Jin X, Jia T, Liu R, Xu S (2018) The antagonistic effect of selenium on cadmium-induced apoptosis via PPAR-γ/PI3K/Akt pathway in chicken pancreas. J Hazard Mater 357:355–362

    Article  CAS  PubMed  Google Scholar 

  66. Lazarus M, Orct T, Jurasoviæ J, Blanuša M (2009) The effect of dietary selenium supplementation on cadmium absorption and retention in suckling rats. Biometals 22:973–983

    Article  CAS  PubMed  Google Scholar 

  67. Zhou YJ, Zhang SP, Liu CW, Cai YQ (2009) The protection of selenium on ROS mediated-apoptosis by mitochondria dysfunction in cadmium-induced LLC-PK(1) cells. Toxicol in Vitro 23(2):288–294

    Article  CAS  PubMed  Google Scholar 

  68. Liu LL, Zhang JL, Zhang ZW, Yao HD, Sun G, Xu SW (2014) Protective roles of selenium on nitric oxide-mediated apoptosis of immune organs induced by cadmium in chickens. Biol Trace Elem Res 159:199–209

    Article  CAS  PubMed  Google Scholar 

  69. Liu LL, Li CM, Zhang ZW, Zhang JL, Yao HD, Xu SW (2014) Protective effects of selenium on cadmium-induced brain damage in chickens. Biol Trace Elem Res 158:176–185

    Article  CAS  PubMed  Google Scholar 

  70. Zhang R, Yi R, Bi Y, Xing L, Bao J, Li J (2017) The effect of selenium on the cd-induced apoptosis via NO-mediated mitochondrial apoptosis pathway in chicken liver. Biol Trace Elem Res 178:310–319

    Article  CAS  PubMed  Google Scholar 

  71. El-Sharaky AS, Newairy AA, Badreldeen MM, Eweda SM, Sheweita SA (2007) Protective role of selenium against renal toxicity induced by cadmium in rats. Toxicology 235:185–193

    Article  CAS  PubMed  Google Scholar 

  72. Tellez-Plaza M, Navas-Acien A, Crainiceanu CM, Guallar E (2008) Cadmium exposure and hypertension in the 1999-2004 National Health and nutrition examination survey (NHANES). Environ Health Perspect 116:51–56

    Article  CAS  PubMed  Google Scholar 

  73. Wong SL, Lye EJ (2008) Lead, mercury, and cadmium levels in Canadians. Health Rep 19:31–36

    PubMed  Google Scholar 

  74. Yapici G, Can G, Kiziler AR, Aydemir B, Timur İH, Kaypmaz A (2006) Lead and cadmium exposure in children living around a coal-mining area in Yatağan, Turkey. Toxicol Ind Health 22:357–362

    Article  CAS  PubMed  Google Scholar 

  75. Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111:1805–1812

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Manzanares W, Hardy G (2012) Pharmaconutrition with antioxidants in the critically ill: is selenium the cornerstone of this strategy? ICU Manag 4:22

    Google Scholar 

  77. Manzanares W, Langlois PL, Hardy G (2013) Update on antioxidant micronutrients in the critically ill. Curr Opin Clin Nutr Metab Care 16:719–725

    Article  CAS  PubMed  Google Scholar 

  78. Bahmani F, Kia M, Soleimani A, Mohammadi AA, Asemi Z (2016) The effects of selenium supplementation on biomarkers of inflammation and oxidative stress in patients with diabetic nephropathy: a randomised, double-blind, placebo-controlled trial. Br J Nutr 116:1222–1228

    Article  CAS  PubMed  Google Scholar 

  79. Razavi M, Jamilian M, Kashan ZF, Heidar Z, Mohseni M, Ghandi Y, Bagherian T, Asemi Z (2016) Selenium supplementation and the effects on reproductive outcomes, biomarkers of inflammation, and oxidative stress in women with polycystic ovary syndrome. Horm Metab Res 48:185–190

    CAS  PubMed  Google Scholar 

  80. Knoflach M, Messner B, Shen YH, Frotschnig S, Liu G, Pfaller K, Wang X, Matosevic B, Willeit J, Kiechl S, Laufer G, Bernhard D (2011) Non-toxic cadmium concentrations induce vascular inflammation and promote atherosclerosis. Circ J 75:2491–2495

    Article  CAS  PubMed  Google Scholar 

  81. Lin YS, Rathod D, Ho WC, Caffrey JJ (2009) Cadmium exposure is associated with elevated blood C-reactive protein and fibrinogen in the U. S. Population: the third national health and nutrition examination survey (NHANES III, 1988-1994). Ann Epidemiol 19:592–596

    Article  CAS  PubMed  Google Scholar 

  82. Colacino JA, Arthur AE, Ferguson KK, Rozek LS (2014) Dietary antioxidant and anti-inflammatory intake modifies the effect of cadmium exposure on markers of systemic inflammation and oxidative stress. Environ Res 131:6–12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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  1. Education Faculty, Department of Elementary Science Teaching, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey

    Tugba Atilan Arikan

  2. Department of Otolaryngeology, Malatya Education and Research Hospital, Malatya, Turkey

    Mehmet Kelles

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Arikan, T.A., Kelles, M. Plasma Selenium and Cadmium Levels in Patients with Chronic Otitis Media in a Turkish Population and Their Relation to Inflammation Markers. Biol Trace Elem Res 189, 55–63 (2019). https://doi.org/10.1007/s12011-018-1520-x

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