Effect of Folic Acid on Cisplatin-Induced Ototoxicity: A Functional and Morphological Study.

OBJECTIVES: The aim of our study was to investigate the effects of folic acid on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Thirty Wistar albino rats were divided into five groups. Group I received intraperitoneal cisplatin (IP) 10 mg/kg/day and IP folic acid 10 mg/kg/day; Group II received IP cisplatin 10 mg/kg/day and IP physiological saline; Group III received IP cisplatin 10 mg/kg/day and intratympanic (IT) folic acid 0.15 mL/day; Group IV received IP cisplatin 10 mg/kg/day and IT physiological saline; and Group V received IT folic acid 0.15 mL/day. Before and after drug administration, plasma homocysteine, folic acid levels, and auditory brainstem evoked responses (ABR) were measured. The rats were then sacrificed, and the inner ears were processed for electron microscopy. RESULTS: The differences of ABR thresholds in Group I compared to Group II were significantly smaller at 4 kHz, 8 kHz, and 16 kHz, whereas they were smaller but not statistically significant at 12 kHz in ABR. The differences of ABR thresholds in Group III compared to Group IV were significantly smaller at 12 kHz, and smaller but not statistically significant at 4 kHz, 8 kHz, and 16 kHz. Cisplatin treatment resulted in the degeneration of the cells of the organ of Corti, stria vascularis, and spiral ganglion. The cells of the organ of Corti, stria vascularis, and spiral ganglion showed a partially preserved morphology in both Group I and Group III. CONCLUSION: Our study results suggests that folic acid is a potential agent in preventing cisplatin-induced ototoxicity.

Patient Characteristics and Frequent Localizations of Rhinoliths.

OBJECTIVE: A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the distribution in age and gender and the localization, side, and prominent symptoms of rhinoliths to identify the risk groups and characteristics of the rhinoliths in a large case series. METHODS: A retrospective review was performed from the medical charts of 28 patients who were diagnosed with rhinolith and underwent surgery between May 2011 and January 2015 in Ankara Research and Training Hospital. All data, including age, gender, duration of symptoms, localization of the lesion and accompanying pathologies, were documented. RESULTS: In total, 28 patients (18 females and 10 males) with a mean age of 26.2±16.6 (5-62) years who were diagnosed with rhinolithiasis were reviewed. Nasal obstruction (71.4%) and nasal discharge (64.3%) were the most common complaints. The rhinolith was located in the right nasal cavity in 24 patients and in the left in four; this difference was statistically significant (p<0.001). There were 11 accompanying pathologies including nasal septal deviation (n=6), nasal polyposis (n=2), concha bullosa (n=2), and adenoid vegetation (n=1). In 21 (75%) patients, the most common site was the nasal base of the cavity between the inferior turbinate and the nasal septum. CONCLUSION: If unilateral right-sided nasal obstruction with foul-smelling purulent discharge is detected in a young adult and a nasal examination reveals a mass in the floor of the cavity, a rhinolith should be strongly considered in the differential diagnosis.

Effect of Enoxaparin Sodium on Experimentally-Induced Myringosclerosis in Rats.

OBJECTIVE: To evaluate the effectiveness of enoxaparin sodium (ES) on experimentally-induced myringosclerosis in rats. MATERIALS AND METHODS: Twenty Wistar albino-type rats weighing up to 250-300 g each were randomized into four groups containing five rats each and were then bilaterally myringotomized. The control group (n=5) received intratympanic serum physiologic injections, whereas ES2 (n=5), ES4 (n=5), and ES6 groups (n=5) received intratympanic ES of 2000 IU, 4000 IU, and 6000 IU, respectively, for 10 days after myringotomy. Rats were sacrificed at 60 days after intratympanic application and were then prepared for histopathologic evaluation. RESULTS: As for tympanic membrane hyaline degeneration, there were statistically significant differences among the control, ES2, ES4, and ES6 groups (p<0.05). As for fibrosis formation on tympanic membranes, a statistically significant difference was observed among the control and study groups; however, although not statistically significant, the formation of fibrosis was slowed down in the ES2 and ES4 groups compared with the control group. The control and study groups did not show any significant difference for calcification, hyperemia, and tympanic membrane thickening (p>0.05). CONCLUSION: Although our study and control groups comprised limited number of animals, and only one parameter demonstrated a statistically significant difference between the groups, ES may have an ameliorating effect on myringosclerosis induced by myringotomy in the tympanic membranes of rats. ES proved to be effective in the prevention of hyaline disc formation. Further studies should be conducted for better understanding of the effects of low-molecular-weight heparin (LMWH) (i.e., enoxaparin) on myringosclerosis.

Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty.

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005-2008 or glass ionomer cement during 2008-2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6-38 months, 83.2 % of them was ≤ 9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.

Inferior turbinate composite graft for repair of nasal septal perforation.

BACKGROUND: Repair of nasal septal perforations is one of the most challenging procedures in nasal surgery. The aim of this prospective clinical study was to determine the efficacy of using an inferior turbinate composite graft (ITCG) for the repair of nasal septal perforation. METHODS: Between 2009 and 2011, 27 consecutive patients with nasal septal perforation underwent endoscopy-assisted, endonasal septal perforation repair by using an ITCG alone or in combination with bipedicled mucosal advancement flap. RESULTS: Complete closure of the perforation was achieved in 24 of 27 (88.8%) patients, and incomplete closure was observed in 2 patients with medium-sized perforation and 1 patient with large perforation. CONCLUSION: The ITCG technique provides three-layer repair of the defect under no tension in closure of small perforations located anteriorly, posterior perforations with mucosal atrophy, or previous unsuccessful surgical repair. In graft-depleted revision rhinoplasty cases with small-sized septal perforations, this technique provides a simple solution with autogenous grafts. In cases involving larger perforations, the ITCG technique can easily be combined with bipedicled flap and allows for more options to solve a challenging problem. Current data from this prospective study suggest that this surgical technique may be used in the repair of nasal septal perforation.

Bilateral oncocytoma in the parotid gland.

Oncocytomas are rare tumors in the head and neck region. They occur commonly in salivary glands, especially in parotid glands. The prevalence is 0.5% to 1.2% in parotideal neoplasms. Oncocytomas rarely occur bilaterally. To our knowledge, only 20 cases were reported in the literature. A case with bilateral oncocytoma was presented with clinical, radiologic, and pathologic findings and treatment options in this study.

A rare case of asymptomatic bilateral submandibular gland sialolithiasis: a giant, fistulized calculus on the right and multiple calculi on the left.

Sialolithiasis is the most common disease of the submandibular gland; sialoliths account for at least 80% of all salivary duct calculi. We present a rare case of asymptomatic bilateral submandibular gland sialoliths. On the right, the patient had a giant (35 × 35 mm) sialolith that had fistulized into the oral cavity. In the left submandibular gland, he had 30 differently sized sialoliths.

First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure.

OBJECTIVE: To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. DESIGN: A prospective nonrandomized clinical study. SETTING: Tertiary care referral center. PATIENTS: Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. INTERVENTIONS: Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. MAIN OUTCOME MEASURES: Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. RESULTS: The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). CONCLUSION: Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

Determination of Helicobacter pylori in patients with chronic nonspecific pharyngitis.

OBJECTIVES/HYPOTHESIS: To determine if there is a relationship between Helicobacter pylori colonization in the pharynx mucous membrane and chronic nonspecific pharyngitis. STUDY DESIGN: A prospective clinical study. METHODS: Seventy patients with chronic pharyngitis and 20 healthy control subjects were examined with polymerase chain reaction (PCR) and culture for H. pylori colonization in the pharynx mucous membrane between March 2008 and October 2008. Patients with pharyngitis were seperated into two groups (35 patients in each) by using C-14 urea breath test, according to the presence of gastric H. pylori infection. RESULTS: In the control group, none of the patients had H. pylori in the pharynx. In the chronic pharyngitis group, in 12 patients (34.3%) with gastric H. pylori infection and in seven patients (20%) without gastric infection, H. pylori colonization in pharynx mucosa was determined with the PCR method. In only two of chronic pharyngitis patients (5.8%), H. pylori infection was detected with culture. In the pharynx mucosa, the H. pylori infection rate was significantly higher in the chronic pharyngitis groups than in the control group (P = .002 between C-14 positive and control groups, P = .040 between C-14 negative and control groups). There was not a significant difference in H. pylori colonization in the pharynx of patients who had chronic pharyngitis with or without gastric ailments and H. pylori infection (P = .179). CONCLUSIONS: Chronic nonspecific pharyngitis without gastric H. pylori infection is significantly related to H. pylori colonization in the pharynx, and gastric involvement increases the rate of this spread. The gold standart for detection of H. pylori infection is the PCR method.

Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index.

CONCLUSIONS: In ossiculoplasty with intact stapes, using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses, improvement in hearing was nearly equal. In patients who had mild risk scores, the incus had better gain values compared with patients who had severe scores. OBJECTIVE: We aimed to prove the utility of the middle ear risk index score and its predictive value in hearing outcome. We also evaluated hearing results for different reconstruction materials. PATIENTS AND METHODS: This was a retrospective chart review of 189 patients who had ossiculoplasty with intact stapes using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses. Hearing outcomes and the average improvement in hearing with different reconstruction materials were analysed by using middle ear risk index scores. RESULTS: The average hearing improvements for incus, cortex and partial ossicular reconstruction prostheses were 12.77±14.58 (p<0.001), 12.34±15.98 (p=0.005) and 14.10±13.87 dB (p<0.001), respectively. The postoperative air-bone gap levels were 20.42±14.54 dB in incus, 17.33±16.86 dB in cortex and 17.59±11.66 dB in partial ossicular reconstruction prostheses. When the preoperative middle ear risk index scores and postoperative air-bone gap and gain values were compared, in the incus group, statistically significant associations were demonstrated between scores and hearing outcomes (p=0.009).

Ginkgo biloba, a free oxygen radical scavenger, affects inflammatory mediators to diminish the occurrence of experimental myringosclerosis.

CONCLUSION: Systemic Ginkgo biloba extract treatment reduces the levels of nitrite/nitrate, malondialdehyde, and superoxide dismutase and increases the levels of glutathione peroxidase. By scavenging free oxygen radicals, ginkgo extract prevents the formation of myringosclerosis. OBJECTIVE: Our objective was to evaluate inflammatory mediators to determine the antioxidant and anti-inflammatory effect of Ginkgo biloba extract to diminish myringosclerosis. MATERIALS AND METHODS: Thirty Wistar Albino rats, weighing 320-400 g were used. The upper posterior quadrants of both tympanic membranes were myringotomized and divided into four groups. Ginkgo biloba extract was given orally to groups 1 and 2 comprising eight rats with doses of 100 mg/kg/day and 200 mg/kg/day, respectively. Seven rats in group 3 received 1.5 ml/day saline and seven rats were left untreated. After 10 days of treatment, otomicroscopic evaluation of tympanic membranes and measurement of anti-inflammatory mediators such as superoxide dismutase, nitrite/nitrate, glutathione peroxidase and malondialdehyde were performed. RESULTS: Myringosclerosis was significantly more severe in control and saline groups than in Ginkgo biloba groups. The levels of nitrite in ginkgo-treated groups were significantly lower than in untreated and saline-treated groups, while glutathione peroxidase levels were significantly higher. The levels of malondialdehyde and superoxide dismutase were lower in ginkgo groups but not significantly.

Success is a matter of experience: type 1 tympanoplasty : influencing factors on type 1 tympanoplasty.

Our objective was to identify the factors that could influence the success rate of type 1 tympanoplasty in a tertiary care centre where both residents and senior surgeons perform this operation. Six hundred and seven patients who had been performed type 1 tympanoplasty as a primary otologic surgery between January 1997 and December 2004 were retrospectively chart reviewed. The patients had intact and mobile ossicular chain peroperatively. Patients with any other macroscopic otologic pathology like cholesteatoma, granulation in the middle ear and osteitis in mastoid cells were excluded from the study. Dry ear, intact and mobile tympanic membrane, improvement of the hearing by at least 10 dB and air-bone gap less than 25 dB were accepted as success criteria after 12 months of follow-up period. Chi-square test was used for statistical comparison of the different influencing factors. The male gender, younger age, smaller-sized perforations and experience of the surgeon were stated as good prognostic factors due to statistical evaluation. Afterwards the data of the study group was reanalysed in order to decide the cases for the residents. Finally, it was observed that seniors had better results in cases with perforations greater than 50%, dry ears and patients older than 16 years. In training and research clinics where both residents and senior surgeons perform type 1 tympanoplasty, the rate of success can be enhanced if patients with perforations greater than 50%, dry ears and patients older than 16 years are operated by the senior surgeons. The reason for this is that these groups have the overall worse results and should by argument be done by senior surgeons.