CE: D.C.; SCS-17-0758; Total nos of Pages: 1; SCS-17-0758 BRIEF CLINICAL STUDIES Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratio for the Effusion Viscosity in Otitis Media Satvinder Singh Bakshi, MS, DNB Key Words: Neutrophil-lymphocyte ratio, otitis media, plateletlymphocyte ratio cut-off values of neutrophil-to-lymphocyte ratio in healthy individuals to determine whether it is abnormal or not. Without such standardization it is difficult to determine the significance of neutrophil-to-lymphocyte ratio in these patients. There are many other conditions such as Bells palsy4 and vestibular schwannoma,5 where the ratios can be deranged. Since the neutrophil-to-lymphocyte ratio can be influenced by so many common conditions, its specificity for using it as a diagnostic tool comes into doubt. I would like to conclude by stating that neutrophil-to-lymphocyte ratio may be used as corroborative evidence and our understanding of the significance of neutrophil-to-lymphocyte ratio is far from adequate. I read with great interest and article in your esteemed journal titled ‘‘The Predictive Value of Neutrophil-Lymphocyte and PlateletLymphocyte Ratio for the Effusion Viscosity in Otitis Media With Chronic Effusion’’ by Elbistanli et al.1 The study is interesting and the authors have done a commendable work. However, there are certain issues regarding the conclusion which I would like to express through your prestigious journal. Neutrophil–lymphocyte and platelet–lymphocyte ratios are simple and easy to perform, which represents an interesting opportunity for them to be used as markers for various clinical conditions. The change in the neutrophil–lymphocyte and platelet–lymphocyte ratios in otitis media with effusion has been studied in previous studies2 and the authors also concluded that the ratio could be used to predict the viscosity of the secretions. However, neutrophil-to-lymphocyte ratio varies with age and body mass index of the patients3 and therefore will vary from person to person. There are no REFERENCES 1. Elbistanli MS, Koçak HE, Acipayam H, et al. The predictive value of neutrophil-lymphocyte and platelet-lymphocyte ratio for the effusion viscosity in otitis media with chronic effusion. J Craniofac Surg 2017;28:e244–e247 2. Boztepe OF, Demir M, Gün T, et al. A novel predictive marker for the viscosity of otitis media with effusion. Int J Pediatr Otorhinolaryngol 2015;79:2355–2358 3. Li J, Chen Q, Luo X, et al. Neutrophil-to-lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal 2014;29:437–443 4. Kum RO, Yurtsever Kum N, Ozcan M, et al. Elevated neutrophil-tolymphocyte ratio in Bell’s palsy and its correlation with facial nerve enhancement on MRI. Otolaryngol Head Neck Surg 2015;152:130–135 5. Kontorinis G, Crowther JA, Iliodromiti S, et al. Neutrophil to lymphocyte ratio as a predictive marker of vestibular schwannoma growth. Otol Neurotol 2016;37:580–585 From the Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, India. Received May 7, 2017. Accepted for publication June 12, 2017. Address correspondence and reprint requests to Satvinder Singh Bakshi, MS, DNB, Associate Professor of ENT, Mahatma Gandhi Medical College and Research Institute, House number B2, Shree Pushpa Complex, 15th Bharathi Street, Ananda Nagar, Piliaiyarkuppam, Pondicherry 607402, India; E-mail: email@example.com Institution where the work was done—MGMCRI. The author reports no conflicts of interest. Copyright # 2017 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000004021 The Journal of Craniofacial Surgery Volume 00, Number 00, Month 2017 1 Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.