Evaluation of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on Eustachian tube function with audiological tests: A randomized clinical trial.

OBJECTIVES: Maxillary expansion improves the hearing function. This trial aimed to examine the effects of Eustachian tube function (ETF) with audiological tests in orthodontic patients who underwent rapid maxillary expansion (RME) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) treatment. METHODS: Forty individuals (mean age = 13.35 years) included in the trial had a healthy eardrum, no history of orthodontic treatment, maxillary constriction, mandibular constriction and were not affected by acute or chronic otitis. Patients were randomly assigned to one of two groups (n = 20 each): the RME protocol or the Alt-RAMEC protocol. ETF was evaluated using Williams' test at three time points: before expansion (T0), after expansion (T1), and in the 3rd month of retention (T2). RESULTS: In the RME group, Eustachian tube dysfunction (ETD) was observed in 18 of 40 ears before expansion (T0). The RME group showed significant improvement in tube function in the 3rd month of retention (T2) (p = 0.003). In the Alt-RAMEC group, ETD was observed in 22 of the 40 ears at baseline (T0). Significant improvements in tubal function were observed in the Alt-RAMEC group after expansion (T1) (p = 0.008) and in the 3rd month of retention (T2) (p < 0.001). In the RME group, 17 of 18 ears recovered, while in the Alt-RAMEC group, 21 of 22 ears recovered. CONCLUSION: Eustachian tube function improved in the RME and Alt-RAMEC groups compared to the pre-expansion period. REGISTRATION: This trial was not registered.

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial.

PURPOSE: This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients. METHODS: This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ 2 test and independent samples t­test were used to evaluate the data. RESULTS: The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05). CONCLUSION: This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Evaluation of ovarian reserve using anti-müllerian hormone and antral follicle count in Sjögren's syndrome: Preliminary study.

AIM: The aim of this study was to determine ovarian reserve status using anti-müllerian hormone (AMH) level and antral follicle count (AFC) in patients with Sjögren's syndrome (SS). METHODS: Twenty-four women with SS diagnosed according to the classification criteria proposed by the American-European Consensus Group and 25 healthy women as controls were enrolled in this study. Ovarian reserve was assessed on clinical findings, AFC, and serum AMH and reproductive hormone levels. RESULTS: Compared with the healthy controls, in the SS patients, the duration of menstrual cycle was significantly shorter (P = 0.043); serum AMH (P = 0.001) and AFC (P = 0.001) were significantly lower, and serum luteinizing hormone (LH) was significantly higher (P = 0.019). The right (P = 0.555) and left ovarian (P = 0.386) volumes were also lower but this did not reach statistical significance. Serum follicle-stimulating hormone (P = 0.327), estradiol (P = 0.241), and prolactin (P = 0.55) were similar between the two groups. CONCLUSIONS: Ovarian reserve may be reduced in SS patients. For the assessment of ovarian reserve, serum AMH and ovarian AFC with serum LH may be useful. Further studies with long-term follow-up are required to determine the course of ovarian reserve abnormalities and best possible biomarkers of reduced ovarian reserve in SS patients.

Angiotensin-Converting Enzyme (ACE) I/D and Alpha-Adducin (ADD1) G460W Gene Polymorphisms in Turkish Patients with Severe Chronic Tinnitus.

OBJECTIVE: Tinnitus is described as a disturbing sound sensation in the absence of external stimulation. We aimed to investigate whether there is any relationship between severe chronic tinnitus and angiotensin-converting enzyme (ACE) I/D and α-adducin (ADD1) G460W gene polymorphisms. MATERIALS AND METHODS: The patient group and control group consisted of 89 and 104 individuals, respectively. The evaluation of tinnitus was performed using the Strukturiertes Tinnitus-Interview (STI). The Tinnitus Handicap Inventory (THI) was used to evaluate the tinnitus severity. Polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques were used for genotyping. RESULTS: With regard to the ACE I/D polymorphism, there was no significant difference in genotype and allele frequencies between the patient group and control group. However, a statistically significant difference was found in genotype (p<0.01) and allele frequencies (p=0.021) of the ADD1 G460W gene polymorphism. Combined genotype analysis showed that the ACE II /ADD1 GW genotype was statistically significantly higher in the patient group than in the control group (X2: 7.15, p=0.007). The odds ratio value of the GW genotype was 2.5 (95% CI=1.4-4.7) (p<0.01). CONCLUSION: Our results demonstrate an association between ADD1 G460W gene polymorphism and susceptibility to severe chronic tinnitus. It was found that the GW genotype increased the disease risk by 2.5-fold compared with other genotypes. This indicates that ADD1 G460W polymorphism could be an important factor in the pathophysiology of tinnitus.

Assessment of Hematological Factors Involved in Development and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: The aim of this study was to investigate the possible effects of routine hematological parameters on the development and prognosis of idiopathic sudden sensorineural hearing loss in patients applying to our clinic. STUDY DESIGN: A retrospective clinical study. SETTING: One academic health center from 2008 to 2014. PATIENTS AND INTERVENTION: One hundred forty patients with sudden hearing loss and 132 healthy controls were included in the present study. RESULTS: Patients having idiopathic sudden sensorineural hearing loss were divided into 2 subgroups based on whether they recovered (complete, partial, and slight recovery) (Group 1; n = 83, 59.3%) or not (Group 2; n = 57, 40.7%) during the follow-up term. Group 1, Group 2, and the controls differed statistically significantly in terms of neutrophil-to-lymphocyte ratio (P = 0.001), platelet-to-lymphocyte ratio (P = 0.001), lymphocytes % (P = 0.001), mean corpuscular hemoglobin (P = 0.019), mean corpuscular hemoglobin concentration (P = 0.015), platelet (P  = 0.001), mean platelet volume (P = 0.001), platelet distribution width (P = 0.009), and glucose (P = 0.001). The study groups and the controls did not have any significant difference in terms of other laboratory parameters affecting the prognosis of Idiopathic sudden sensorineural hearing loss. CONCLUSIONS: The results the authors obtained showed that laboratory parameters such as lymphocyte, lymphocyte%, platelet, mean platelet volume, platelet distribution width, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration may be indicative for prognosis and treatment success in groups of patients suffering idiopathic sudden sensorineural hearing loss in whose etiology many factors play a role.

A case of chronic suppurative otitis media caused by Kerstersia gyiorum.

Chronic suppurative otitis media is inflammation of the middle ear and mastoid that involves discharge and hearing loss. Kerstersia gyiorum is a member of the Alcaligenaceae family that who could not be treated with classical treatments such as patients with chronic otitis media, neck abscesses. K. gyiorum strain isolated from a patient with chronic suppurative otitis media.

Effects of high-frequency bio-oxidative ozone therapy in temporomandibular disorder-related pain.

OBJECTIVE: It was the aim of this study to compare the efficacy of ozone therapy and drug treatment in patients with painful temporomandibular joint (TMJ) disorder (TMD). SUBJECTS AND METHODS: A total of 63 patients with TMD were enrolled; 33 were treated with bio-oxidative therapy and 30 with a ketoprofen tablet thiocolchicoside capsule 2 × 1 for 7 days. Maximum voluntary interincisal mouth opening (MMO) was measured in millimeters using a scale and recorded during the pre- and posttreatment periods. The patients evaluated their subjective pain using a visual analogue scale (VAS). Data were analyzed using the Mann-Whitney U test, the Kolmogorov-Smirnov test, and the independent t test. RESULTS: The mean MMO of the group that received ozone therapy during the pretreatment period was 46.51 ± 8.2 mm, and it immediately increased to 48.78 ± 7.5 mm after 1 week of ozone therapy, which was statistically significant (p = 0.04). For those who received medication, the mean MMO during the pretreatment period was 46.30 mm, and at the end of 1 week it was 46.9 mm. In the ozone group, 29% of patients showed a gradual decrease in their VAS pain scores compared to pretreatment values (6.3 ± 2.1 to 3.0 ± 2.2). In the medication group, 24% of patients showed a significant decrease in VAS pain scores during the follow-up period (6.9 ± 1.4 to 5.0 ± 1.5). CONCLUSION: This study showed that bio-oxidative therapy was a more effective treatment than medication therapy for relieving TMJ pain.

[Evaluation of shrinkage of surgical margins on tongue specimens following formalin fixation]. / Formalin fiksasyonu sonrasi dil örneklerinde cerrahi sinir küçülmesinin degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the alterations in distances to the surgical margins on sheep tongue specimens, through resection, formalin fixation, frozen section, and microscopic examination. MATERIALS AND METHODS: Fifty fresh sheep tongues were used in the study. A metal plate was fixed on the lateral aspect of each tongue to represent tumor tissues. A total of 40 specimens with either 1 cm or 2 cm distances as surgical safety margins of the surrounding plate were prepared using either scalpel or monopolar cautery (10 specimens were prepared for each group). Additional 10 specimens with 1 cm safety margins were prepared using either scalpel or monopolar cautery (5 specimens per group) for frozen section examination. Distances to the metal plates before resection were compared with the ones which were determined after resection, frozen section examination, 24-hour formalin fixation and microscopic examination. RESULTS: Distances to the surgical margins were found to be decreased in all specimens after resection, 10% formalin fixation and microscopic examination. The distances to the surgical margins were observed to be reduced by 6.5-7.5% on average after resection, 10-12% on average after formalin fixation and 30% on average after microscopic examination, compared to the baseline values. The level of shrinkage was reduced by 6.3-10% following microscopic section preparation during frozen section examination. CONCLUSION: Seven to eight-millimeter distance to the surgical margin at minimum should be maintained to achieve a 5 mm in height surgical safety margin during sheep tongue resection. The distance defined by the pathologist may be multiplied with 1.42 to estimate around in-situ distance to the surgical margins. Therefore, 1.42 may be used as a corrective factor for sheep tongue tissues.

Oxaliplatin and ototoxicity: is it really safe for hearing?

BACKGROUND/AIM: Oxaliplatin is an effective and widely used chemotherapeutic agent in the treatment of many solid tumors. The most common side effects are peripheral neuropathy, gastrointestinal toxicity, and neutropenia. There have been some case reports about ototoxicity with oxaliplatin, but no clinical trials. In this trial, we explored whether or not oxaliplatin has ototoxic effects. MATERIALS AND METHODS: A total of 18 patients, 14 with colorectal cancer and 4 with pancreatic cancer, were included in this study. Four patients (22%) were treated with a capecitabine and oxaliplatin (CapeOx) regimen, and 14 patients (78%) were treated with fluorouracil, leucovorin, and oxaliplatin (FOLFOX-6). Patients' pretreatment and posttreatment hearing levels were assessed with high-frequency audiometry and otoacoustic emission tests. RESULTS: The median time between the first and the last oxaliplatin doses was 3.2 months (range: 2-7 months). There was no hearing loss in tests conducted for both ears of patients at frequencies of 500, 1000, 2000, 4000, 6000, 8000, 12,000, and 16,000 Hz. There was no difference between the pretreatment and posttreatment otoacoustic emission tests. CONCLUSION: Oxaliplatin is a reliable agent in terms of ototoxicity.

Comparison of the effects of desflurane and sevoflurane on middle ear pressure: a randomized controlled clinical trial.

OBJECTIVE: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. METHODS: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. RESULTS: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. CONCLUSION: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.

Chronic otitis media with multiple complications.

Chronic otitis media (COM) is defined as persistent infection or inflammation of the middle ear and mastoid air cells. The proximity of the middle ear cleft and mastoid air cells to the intratemporal and intracranial compartments places structures located in these areas at increased risk of infectious complications. The complications of COM are divided into intracranial and extracranial complications. The development and appropriate use of antibiotics have led to a decrease in these potentially devastating complications. However, they continue to occur, and clinical vigilance is required for early detection and treatment. We reported a case with multiple complications, both intracranial and extracranial secondary to COM.

A giant juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibromas are locally growing and highly vascular tumors. They are primarily treated through surgical excision ranging from an open approach to an endoscopic approach. We presented a 20-year-old man with a giant juvenile nasopharyngeal angiofibroma that bilaterally obliterated the pterygopalatine fossa, invaded the sphenoid bone, and extended to the left nasal passage. His complaints were epistaxis and nasal obstruction. After embolization, the patient was treated surgically using the endoscopic approach and declared cured and discharged without any complications.

Gastroesophageal reflux disease in children with chronic otitis media with effusion.

OBJECTIVE: We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children. METHODS: Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups. RESULTS: Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups. CONCLUSIONS: Upper respiratory tract infections were seen more frequently in gastroesophageal reflux disease positive group. Children who present with gastroesophageal reflux disease symptoms are more likely to have a positive gastroesophageal reflux disease test. However, no concordance may be found between the complaints and gastroesophageal reflux disease findings. For this reason, a decision about gastroesophageal reflux disease should not only be made by looking to complaints; diagnostic tests must also be performed.

Parotid tail pleomorphic adenoma extending to the parapharyngeal space.

Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.

Results of endoscopic endonasal dacryocystorhinostomy.

Nasolacrimal ductus obstruction cause Epifora. Two widely accepted treatment modalities are external and endoscopic dacryocystorhinostomy. Currently available rigid nasal endoscopes are safe for intranasal manipulation of structures of the nasal cavity, including the region of the lacrimal sac. Twenty-eight patients with complete stenosis of the nasolacrimal duct were treated with endoscopically controlled endonasal dacryocystorhinoslomy. Approximately 97% of the patients were symptom free, and 3% of these felt improved postoperatively. This procedure appears to be safe and effective, which should be considered as an alternative to external dacryocystorhinostomy for the surgical treatment of the nasolacrimal duct obstruction.

The effects of therapeutic x-ray doses on mechanical, chemical and physical properties of poly methyl methacrylate.

AIM: The aim of this study was to investigate the effect of radiation doses very close to the human dose for oral cancers on mechanical, chemical and physical properties for poly methyl-methacrylate (PMMA). METHODS: PMMA samples were divided into four different groups: no irradiated group, 25-Gy irradiated group, 50-Gy irradiated group and 75-Gy irradiated group. Each group contained nine samples. After 24 h, a three-point loading test was applied to each PMMA groups. The transverse strength and the elastic modulus were calculated using the test results. The results were analyzed statistically by using one-way analysis of variance. The structural characterizations of the PMMA samples were carried out by a Fourier Transform Infrared (FTIR) spectrophotometer to evaluate the chemical structure differences. RESULTS: The transverse strength values of 25-Gy, 50-Gy and 75-Gy radiation groups were significantly higher than that of the no radiation group (p < 0.05). There was no significant difference among the elastic modulus values of the study groups (p > 0.05). The FTIR findings demonstrated that the irradiation process did not change the chemical structure of the PMMA polymeric materials. CONCLUSION: The therapeutic radiation doses increase the mechanical properties of the PMMA; however, the chemical and structural properties have no effect. When the findings of this study are taken into account, it can be said that patients can wear dentures during the radiotherapy.

Canalicular adenoma of the palate.

Canalicular adenomas are uncommon, benign epithelial neoplasm of the salivary glands that usually involve the upper lip and the buccal mucosa of elderly people. Differential diagnosis of the canalicular adenoma versus adenocarcinoma is important because it may result in unjustified radiotherapy or extensive and aggressive surgery. Despite the benign nature of canalicular adenomas, complete surgical removal and a regular clinical follow-up are recommended. The current study describes the diagnostic procedures, surgical management, and follow-up of a canalicular adenoma involving the palate of a 79-year-old man.

Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: A double-blind, randomized, controlled trial.

BACKGROUND: Controlled hypotension is a technique that is used to limit intraoperative blood loss to provide the best possible surgical field during surgery. OBJECTIVE: The aim of this double-blind, randomized, controlled study was to compare the effects of desflurane combined with esmolol or dexmedetomidine on the amount of blood in the surgical field, recovery time, and tolerability in adult patients undergoing tympanoplasty. METHODS: Turkish patients aged 18 to 60 years, classified as American Society of Anesthesiologists physical status I or II, who were scheduled for tympanoplasty were randomly divided into 2 groups: the esmolol group or the dexmedetomidine group. After the anesthesia induction in the esmolol group, a loading dose of esmolol was infused intravenously over 1 minute at 1 mg/kg, followed by a maintenance rate of 0.4 to 0.8 mg/ kg/h. In the dexmedetomidine group, a loading dose of dexmedetomidine was infused intravenously over 10 minutes at a rate of 1 µg/kg, followed by a maintenance rate of 0.4 to 0.8 µg/kg/h. The infusion rates were then titrated to maintain mean arterial pressure (MAP) of 65 to 75 mm Hg. General anesthesia was maintained with desflurane 4% to 6%. Heart rate (HR) and MAP were recorded during anesthesia. The following 6-point scale was used to assess the amount of bleeding in the operative field: 0 = no bleeding, a virtually bloodless field; 1 = bleeding that was so mild that it was not a surgical nuisance; 2 = moderate bleeding that was a nuisance but did not interfere with accurate dissection; 3 = moderate bleeding that moderately compromised surgical dissection; 4 = bleeding that was heavy but controllable and that significantly interfered with surgical dissection; and 5 = massive bleeding that was uncontrollable and made dissection impossible. Scores ≤2 were considered to be optimal surgical conditions. The sedation score was determined at 15, 30, and 60 minutes after tracheal extubation using the following scale: 1 = anxious, agitated, or restless; 2 = cooperative, oriented, and tranquil; 3 = responsive to commands; 4 = asleep, but with brisk response to light, glabellar tap, or loud auditory stimulus; 5 = asleep, sluggish response to glabellar tap or auditory stimulus; and 6 = asleep, no response. Time to extubation and to total recovery from anesthesia (Aldrete score ≥9 on a scale of 0-10), adverse effects (eg, intraoperative hypotension [blood pressure <65 mm Hg], bradycardia [HR <50 beats/min]), intraoperative fentanyl consumption, and postoperative nausea and vomiting were recorded. Arterial blood gas analysis and kidney and liver function tests were conducted. All patients were evaluated by the same attending surgeon and anesthesiologist, both of whom were blinded to the administered study drugs. RESULTS: Fifty-two consecutive white patients undergoing tympanoplasty were identified. Two patients had to be excluded because of hypertension and 2 refused to participate. Forty-eight patients were equally randomized to either the esmolol group (n = 24 [16 women, 8 men]; mean [SD] age, 38.4 [10.5] years) or the dexmedetomi-dine group (n = 24 [17 women, 7 men]; mean age, 35.5 [14.7] years). Sedation scores were not collected for 1 patient in the esmolol group; therefore, analysis was conducted for 23 patients. The median (range) of the scores for the amount of blood in the surgical field in the esmolol and dexmedetomidine groups was 1 (0-3) and 1 (0-2), respectively (P = NS). Mean intraoperative fentanyl consumption in the esmolol group was significantly higher than in the dexmedetomidine group (50.0 [3.0] vs 25.0 [2.5] µg/min; P = 0.002). In the esmolol group, the mean times to extubation and to recovery from anesthesia were significantly shorter than those of the dexmedetomidine group (7.0 [1.4] vs 9.1 [1.9] minutes, respectively; 5.9 [2.1] vs 7.9 [2.3] minutes; both, P = 0.001). The mean sedation scores were significantly lower in the esmolol group (n = 23, because of intent-to-treat analysis) compared with the dexmedetomidine group at 15 minutes (2.5 [0.6] vs 3.6 [0.5]; P = 0.001) and 30 minutes (2.6 [0.6] vs 3.3 [0.6]; P = 0.001) postoperatively. No significant differences were found between the study groups in regard to blood urea nitrogen or creatinine concentration, aspartate aminotransferase or alanine aminotransferase activities, pH, partial pressure of carbon dioxide, or bicarbonate, before or after the operation. CONCLUSIONS: Both esmolol and dexmedetomidine, combined with desflurane, provided an effective and well-tolerated method of achieving controlled hypotension to limit the amount of blood in the surgical field in these adult patients undergoing tympanoplasty. Esmolol was associated with significantly shorter extubation and recovery times and significantly less postoperative sedation compared with dexmedetomidine.