Understanding potential associations between anatomic and other factors in OSA severity.

PURPOSE: The aim of this prospective study was to investigate associations between nasal/oropharyngeal structures and a range of factors including age, gender, daytime sleepiness, and body mass index (BMI). METHODS: Patients with OSA were prospectively selected as research participants in rhinomanometric analysis as well as for otolaryngological evaluation. Participants were grouped as follows according to their apnea/hypopnea index (AHI) scores: no OSA (AHI < 5), mild OSA (5 ≤ AHI ≤ 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). One-way analysis of variance (ANOVA), Kruskal-Wallis H, and Mann-Whitney U tests were performed to assess OSA severity in terms of the relationships between nasal resistance (NR) and anthropometric indices (body mass index (BMI), Friedman tongue position (FTP)), age, and gender. RESULTS: The study cohort of 177 men and 81 women ranged in age between 21 and 76 years, with BMI ranging from 23 to 45. In total, 37 patients were simple snorers (AHI < 5), and 221 patients were diagnosed with OSA. There was no significant difference among the AHI groups in terms of nasal volume (Vol05) (p = 0.952), mean flow (p = 0.778), and mean NR total (p = 0.723). A statistically significant difference was found between the AHI groups in terms of mean BMI and median FTP scores (p < 0.001). CONCLUSION: This study provides evidence that that the oropharyngeal region (oropharynx, tongue, and vallecula) is a more important determinant of OSA severity than the nasal region.

Rhinolith in the concha bullosa as a rare location: a case report.

The presence of a rhinolith is a rare condition, which can cause long-standing symptoms, such as rhinorrhea, foul-smelling discharge, nasal obstruction, and headache. A rhinolith is usually easily diagnosed by a clinical examination and a paranasal computed tomographic scan. Rhinoliths are usually found in nasal cavities, but rare locations are also possible. We report a patient who was evaluated in our clinic for nasal obstruction, headache, and snoring symptoms. A clinical examination showed no major findings, but a paranasal computed tomographic scan of coronal sections showed a hyperdense mass within the right concha bullosa. A rhinolith in the concha bullosa is a rare condition. Our case is the third case of a rhinolith in the concha bullosa to be reported in the literature.

A Comparison of the Autologous Platelet-Rich Plasma Gel Fat Graft Myringoplasty and the Fat Graft Myringoplasty for the Closure of Different Sizes of Tympanic Membrane Perforations.

OBJECTIVE: We aimed to evaluate the effect of autologous platelet-rich plasma gel (PRPG) on fat graft myringoplasty (FGM) in tympanic membrane perforations caused by chronic otitis media. METHODS: This retrospective study involved 63 patients who underwent operations between 2015 and 2018. Fat graft myringoplasty was performed with the transcanal approach with and without the use of PRPG in the surgical field. The patients were classified into 2 groups: group A, which included 32 patients who underwent FGM with the use of autologous PRPG, and group B, which included 31 patients who underwent FGM alone. Tympanic membrane perforations were divided into 2 groups: small perforations (1-2 mm) in a single quadrant and large perforations (2-4 mm) in at least 2 quadrants. RESULTS: Both groups were statistically matched regarding age and sex. The mean postoperative follow-up was 11.6 and 12.1 months for groups A and B, respectively. Four months postoperatively, the success rate of the graft in group A (100%) was significantly higher than that in group B (83.8%; P = .03). The preoperative and postoperative median air-bone gaps of the groups were similar (P = .653 and P = .198, respectively). No worsening of the air-bone gap was noted postoperatively in either group. CONCLUSIONS: This study demonstrated that autologous PRPG application during FGM allows for a higher success rate than FGM alone. Furthermore, the use of PRPG with FGM for large perforations increases the success rate. Further studies are needed to investigate the PRPG healing effect on other tympanic membrane perforation closure techniques.

Evaluation of Serum Endocan Levels in Sensorineural Hearing Loss.

OBJECTIVES: The aim of this study was to reveal the possible role of endothelial dysfunction in sensorineural hearing loss (SNHL) by determining the serum endocan levels of patients with varying degrees of SNHL. MATERIALS AND METHODS: Patients with documented SNHL and healthy controls were included in the study, whereas those with a known history of chronic inflammatory condition were excluded. In addition, a recent history of use of glucocorticoids, nonsteroid anti-inflammatory drugs, or any ototoxic medications was also considered as an exclusion criterion due to its potential impact on endocan synthesis and metabolism. Following overnight fasting, blood samples were collected, and serum endocan levels were measured. For statistical analysis of the data, PASW Statistics for Windows version 18 was used. RESULTS: The comparison of the subgroups yielded no statistically significant difference between the control and mild-to-moderate SNHL groups. Despite the increase in hearing loss, the difference between the endocan levels in these patients did not increase proportionately and was not statistically significant (p>0.05). The patients in the severe SNHL group had a higher level of serum endocan than those in other groups, and the difference was statistically significant (p<0.05). CONCLUSION: The serum endocan levels failed to show a proportionate increase with increasing degree of SNHL, indicating that there is no precise association between SNHL and serum endocan levels. The serum endocan levels of patients with SNHL did not significantly differ from those of the healthy controls.

The evaluation of auditory system in obstructive sleep apnea syndrome (OSAS) patients.

OBJECTIVE: The authors of the present study aimed to investigate the impact of hypoxemia on the auditory functions of OSAS patients and discussed their findings under the scope of the existing literature. MATERIALS AND METHODS: 160 patients who underwent a polysomnographic analysis for the diagnosis of possible sleep disordered breathing between January 2015 and December 2015 were enrolled in this study. Polysomnography tests were conducted at the sleep laboratory of the department of neurology at the same institute. Comprehensive otorhinolaryngological examinations of all participants were conducted by the same senior otorhinolaryngologist. Three study groups and a control group were designated in the study. Each study group was designated according to the severity of the apnea hypopnea index (AHI) and blood oxygen saturation values of the participants. All participants underwent pure tone auditometry and otoacoustic emission testing (OAE). Statistical data analysis was performed using SPSS for Windows, version 17 (SPSS Inc., Chicago, IL, USA). RESULTS: Audiological assessment of the patients revealed that all patients in the control group and in mild OSAS group had normal hearing thresholds (lower than 26dB). However, the patients who had moderate and severe OSAS had varying degrees of sensorineural hearing losses. As far as body mass indexes are concerned, statistically significant differences were observed among the groups (p=0.038). CONCLUSION: There is convincing evidence that the risk of progressive dysfunction in vascular and neural structures of the body is inevitable for the patients who suffer from a chronic hypoxemic condition secondary to OSAS. The findings of the present study indicated auditory transduction and transmission mechanisms may also be affected in moderate and severe OSAS patients. Therefore, via taking necessary steps in preventing hypoxemia at the outset, OSAS patients may be protected from the long term detrimental effects of chronic hypoxemia on the auditory system.

Do we really need to coat the novel silicone intranasal splints with antibiotics?

PURPOSE: The novel silicone intranasal splints are suggested to resist biofilm formation due to their surface characteristics. We aimed to ascertain the necessity of coating these splints with antibiotics to prevent splint associated infections, in vitro. MATERIALS AND METHODS: Pieces of Doyle II airway nasal splints made of medical grade silicone were divided into two test groups, treated with either (i) 0.2% nitrofurazone solution or (ii) 0.2% nitrofurazone containing ointment, and a control group, treated with (iii) 0.9% saline. Splint pieces were then incubated with Staphylococcus aureus solutions at 37°C for 48 and 96h. Following this, the splint pieces were incubated in 20ml Mueller Hinton agar and appearing colonies were counted. RESULTS: Following 48and 96h of incubation, the colonization rates in the saline group were significantly higher than the nitrofurazone ointment group (p<0.001). The colonization rates in the liquid nitrofurazone group were significantly lower in comparison to the nitrofurazone ointment group (p<0.001 and p=0.019 respectively). CONCLUSIONS: The method of coating the splints with antibiotic was superior to using uncoated splints in terms of preventing S. aureus colonization. The rather smooth surfaces of the splints were insufficient to block bacterial colonization and coating them with antibiotics seems to be beneficial for the prevention of infections.

Magnetic Control of the Glottic Opening in an Ex Vivo Sheep Larynx Model: A Preliminary Study.

OBJECTIVE/HYPOTHESIS: So far, a number of techniques have been described for the treatment of bilateral vocal fold paralysis. These techniques were reported to be successful in maintaining an adequate airway but also found to be associated with an increased risk of aspiration, dysphonia, and granulation tissue formation at the operation site. We aimed to investigate the effectiveness of a novel mucosa-sparing technique based on the generation of a magnetic field within the larynx for the tailored lateralization of the ipsilateral vocal fold. STUDY DESIGN: This is an ex vivo experimental study. METHODS: Twenty sheep larynges that were procured from the local slaughterhouse were used as a model. For each specimen, two neodymium (Nd) disc magnets with marked poles were used to create a unilateral attractive magnetic force at the glottic level. Following insertion of the magnets, the level of vocal fold lateralization was assessed under an operating microscope. The results were analyzed for their statistical significance. RESULTS: Before the procedure, the mean value of the glottic openings of all the specimens was 4.985 mm. The postprocedure mean value was 5.640 mm. The mean amount of increase in the glottic openings after the procedure was 0.655 mm. This change was found to be statistically significant (P < 0.05). CONCLUSIONS: A statistically significant increase in the cross-sectional area of the glottic region could be achieved. The mucosal integrity of the laryngeal airway was also preserved. The idea of "magnetic control of the glottic airway" is a novel concept but seems to be a promising option.

In vitro analysis of a novel controlled release system designed for intratympanic administration of N-acetylcysteine: a preliminary report.

The aim of this in-vitro experimental study was to design a novel drug delivery system that may permit controlled release of N-acetylcysteine (NAC) following intratympanic administration. The system was composed of two different solutions that attained a hydrogel form within seconds after getting into contact with each other. The authors performed swelling, pH and temperature tests and analysis of controlled release of NAC from this novel controlled release system. For the structure and porosity analysis of the hydrogel, an environmental scanning electron microscope (SEM) was used. The diameter of designed hydrogel showed an increase when pH was increased. In addition, in comparison to acidic values, the pore diameter of the hydrogel increased significantly especially in physiological level. The increase in the pore diameter was also directly proportional to the increase in temperature. Spectrophotometric analysis showed that the amount of NAC released into the medium was statistically significant (p=0.038, t=-2.18, 95% CI; DF: 27). SEM analysis of the samples revealed a smooth surface topography and numerous porous structures. The authors are of the opinion that the designed hydrogel may be used as an alternative method for intratympanic delivery of NAC for otoprotective purposes. The disadvantages of intratympanic injection of the drug in its liquid form, including leakage through eustachian tube, restraining the patient in an uncomfortable position, necessity for repetitive injections and dose dependent inflammation of the middle ear epithelium, may also be avoided. Further in vivo studies should be conducted to assess its tolerability and effectivity.

Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy.

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients. Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated. Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation (p < 0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation (p > 0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors (p > 0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

[Can curcumin prevent the formation of Pseudomonas aeruginosa biofi lm on the surface of tympanostomy tubes?]. / Kurkumin, timpanostomi tüpleri yüzeyinde Pseudomonas aeruginosa biyofi lminin olusmasina engel olabilir mi?

Formation of bacterial biofilm on the surface of tympanostomy tubes are held responsible in the pathogenesis of post-tympanostomy tube otorrhea. To prevent the formation of biofilm, various methods were employed and varying degrees of success have been achieved. In some recent studies curcumin, which is the fenolic form of Curcuma longa (turmeric), has been pointed out to have inhibitory effects on virulence factors of Pseudomonas aeruginosa. The aim of this study was to investigate whether the administration of curcumin is able to prevent the formation of P.aeruginosa biofilm on the surface of silicone tympanostomy tubes in vitro conditions. For this purpose, qualitative and quantitative analysis of P.aeruginosa biofilm created on the surface of the tympanostomy tubes were performed following a period of 48 hours incubation in microplate wells that contained decreasing concentrations of curcumin. For qualitative analysis, specimens were evaluated with an environmental scanning electron microscope for the existence of biofilm. For the quantitative analysis, bacteria attached to the tube surface was detached using a combination of vortexing and sonication. Following serial dilutions, the obtained solution was then inoculated on the sheep blood agar plates using calibrated loop, incubated for 24 hours and the colony forming unit (CFU) per mL were recorded. Environmental scanning electron microscope analysis revealed that 100 µg/mL of curcumin could prevent formation of the biofilm. Lower concentrations of curcumin could not prevent the biofilm formation. Qualitative analysis also revealed that when the concentrations of curcumin in the wells were decreased, the number of CFU/mL was increased significantly. Mean number of CFU in 100 µg/mL and 12.5 µg/mL groups were 35±7.07 and 650±494, respectively. Curcumin could prevent formation of P.aeruginosa biofilm on the surface of tympanostomy tubes in vitro with concentrations lower than the MIC value. The results of the present study show that local administration of curcumin may prevent suppurative otitis media following tympanostomy tube insertion, keep the patency of the tube and decrease the rate of treatment failure. In vivo studies are needed to support the in vitro anti-biofilm action of curcumin on tympanostomy tubes.

Nasal mucociliary clearance in obstructive sleep apnea syndrome patients.

BACKGROUND: The main objective of this study was to investigate the correlation between the level of mucociliary dysfunction and severity of obstructive sleep apnea syndrome (OSAS). The effect of smoking in OSAS patients on mucociliary dysfunction was also assessed. METHODS: It is a descriptive study that compares variables between groups (univariate analysis). In this clinical trial 122 patients with varying degrees of OSAS and 49 healthy volunteers were included (n = 171). Patients were divided into three groups as having mild, moderate, and severe OSAS, according to their apnea hypopnea index (AHI) values. (AHI values are typically categorized as 5-15/hr, mild OSAS; 15-30/hr, moderate OSAS; and >30/hr, severe OSAS.) The control group was comprised of healthy subjects. Each group was divided into smoking and nonsmoking subgroups. The mucociliary rates of the subjects were measured using the saccharin test. Statistical analysis was performed with the GraphPad Prism Version 3 pocket program. RESULTS: Mild and moderate OSAS groups showed similar results with control group (p = 0.869), but severe OSAS patients showed a statistically significant difference with control group (Kruskal-Wallis [KW] = 32.28; p = 0.0032 and p < 0.05). Although in the moderate OSAS group the mucociliary clearance rates showed a tendency to decrease, this decrease was not significant (p = 0.453). A statistically significant difference was observed between smokers and nonsmokers in terms of mucociliary clearance times in all groups (KW = 18.24; p = 0.001). CONCLUSION: The nasal mucociliary system is significantly deteriorated in severe OSAS patients and they should be meticulously observed to prevent sinonasal infections. Measures to enhance mucociliary activity in these patients should be taken. Smoking, a well-known inhibitor of mucociliary activity, also has a negative impact on the mucociliary function of OSAS patients and quitting smoking would be of benefit for these patients.

The impact of different nasal packings on postoperative complications.

OBJECTIVE: The objective of this study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis in patients who underwent septoplasty and concha reduction operations. METHODS: This retrospective study was conducted at a tertiary referral center. One hundred thirty patients were randomly selected among patients who underwent endonasal surgery in Namik Kemal University Hospital between January 1st 2012 and August 1st 2013. Retrospective analysis of these patients' files, including operative reports and follow-up notes, was done. The postoperative findings of patients who had septal splints and Merocel nasal packings were compared and analyzed for statistical significance. RESULTS: The results of the study showed a statistically significant difference in the frequency of synechia formation between two groups (p<0.05). The frequency of synechia formation was found to be higher in the Merocel packing group. However, no statistically significant difference was found between groups in terms of postoperative infection, septal perforation, and epistaxis (p>0.05). CONCLUSION: Our findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Insertion of a septal splint after nasal surgery should be preferred to avoid this complication. On the other hand, other factors should be sought in the etiology of postoperative infection, septal perforation, and epistaxis.

A new horizon in the treatment of biofilm-associated tonsillitis.

OBJECTIVE: To demonstrate the efficacy of tonsil brushing in patients with chronic tonsillitis to remove the microbial biofilm on the tonsil surface using an in vitro model. DESIGN: Specimens from patients undergoing tonsillectomy were evaluated prior to and following surface cleaning methods, including rinsing and brushing, using scanning electron microscopy (SEM). PATIENTS: The study population consisted of 25 randomly selected patients with chronic tonsillitis. INTERVENTIONS: Specimens were collected and divided into four portions. Each portion received distinct surface cleaning methods and was immediately fixed for SEM examination. OUTCOME MEASURES: The biofilm layer on the surface of the tonsils was examined using SEM. The density of the biofilm layer and the degree of persistence of the biofilm after rinsing and brushing were measured. RESULTS: The surface biofilm of the tonsils in the first group, which were neither brushed nor rinsed, revealed a thick layer of biofilm on the mucosal surface. The second group of tonsils, which were only rinsed, also showed a thick layer of biofilm. The third group of tonsils, which were rinsed following gentle brushing using a soft toothbrush, showed a reduction in the thickness of the biofilm layer. The fourth group of tonsils, which were brushed with a hard brush, was almost devoid of a biofilm layer. CONCLUSION: Our results demonstrate that rinsing does not effectively remove the biofilm layer on the tonsil surface. The use of a harder brush was identified as a more powerful means of removing biofilm compared with a soft brush.

Endoscopic orbital decompression of an isolated medial orbital wall fracture: a case report.

Motor vehicle and bicycle accidents are the most common causes of blunt head trauma. Other common etiologies are falls, physical violence, and sports accidents. Blunt trauma toward the superior orbital rim, lateral orbital rim, frontal region, and cranium may lead to intraorbital hematoma. A fracture following the blunt head trauma may form a one-way valve, which leads to orbital emphysema and a more pronounced increase in orbital pressure. Increased tissue pressure in an enclosed space will eventually lead to an inevitable decrease in tissue perfusion. It is important to treat the patient within the first 48 hours following the trauma, which is accepted as the "critical period." In this report we present a case involving a 42-year-old man who was admitted to our clinic with left periorbital pain, edema, proptosis, and blurred vision after experiencing physical violence. The medical history and physical examination findings, along with imaging studies and a description of the endoscopic orbital decompression procedure within the first 24 hours, are reported.

Effects of neck dissection and radiotherapy on short-term speech success in voice prosthesis restoration patients.

OBJECTIVE: To compare the short-term speech success of voice prosthesis (VP) among patients who underwent total laryngectomy or total laryngectomy in combination with neck dissection and those who received postoperative radiotherapy. MATERIALS AND METHODS: Thirty-two male patients treated for laryngeal squamous cell carcinoma were included. Nine patients underwent total laryngectomy and 23 underwent total laryngectomy combined with neck dissection, and 17 of the 23 with neck dissection were managed with postoperative radiotherapy (45-75 Gy). All of the patients had indwelling intraoperative placement of the Provox VP (Atos Medical AB, Horby, Sweden; and Entermed BV, Woerden, The Netherlands) at the time of the primary tracheoesophageal puncture (TEP) completed in conjunction with total laryngectomy. Patients with pharyngoesophageal myotomy and pharyngeal plexus neurectomy were excluded. Patients' speech success was perceptually evaluated 3-4 weeks after the surgery and 3-4 weeks after the cessation of radiotherapy, using a 1-3 scale (1 = failure to develop speech (aphonia); 2=communicate with short phrases only; and 3 = communicate with fluency and long sentences). RESULTS: No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Eighteen of 32 patients (56%) demonstrated successful speech (rating of 3). Nine patients (28%) demonstrated less successful speech (rating of 2). Five patients (16%) were found to be aphonic (P > 0.05). Of the nine patients who underwent total laryngectomy only, six were found to have successful speech (66.6%), one (11.1%) was found to have less successful speech quality, and two (22.2%) patients were aphonic (P > 0.05). Of the six patients who underwent total laryngectomy in combination with neck dissection, three had successful speech (50%), one (16.6%) had less successful speech, and two (33.3%) were aphonic (P > 0.05). Of the 17 patients who received postoperative radiotherapy, nine (52.9%) had successful speech, three (17.6%) had less successful speech, and five (29.4%) were aphonic (P > 0.05). CONCLUSION: Neck dissection and postoperative radiotherapy have no significant influence on short-term speech success in VP restoration patients. Primary TEP should be preferred in patients who have laryngectomy in combination with neck dissection and/or will have postoperative radiation therapy, as it provides early and successful voice restoration without interfering with radiation treatment and avoids a second surgical intervention.

Erosive esophagitis worsens reflux signs and symptoms in asthma patients without affecting pulmonary function tests.

OBJECTIVES: To determine whether erosive esophagitis (EO) worsens reflux signs and symptoms and affects pulmonary function test in asthma patients. METHODS: Sixty asthma patients with gastroesophageal and laryngopharyngeal reflux symptoms were included. Spirometry, reversibility test, esophagogastroscopy, laryngoscopy, and esophagogastroscopic biopsies were conducted. RESULTS: EO was diagnosed in 25% (n = 15) of the patients. The remaining 45 patients were placed into the non-erosive esophagitis (NEO) group. Of the 15 EO patients, grade 1 esophagitis was identified in 75% (n = 9), grade 2 in 12.5% (n = 3), and grade 3 in 12.5% (n = 3). Pulmonary function test results were not significantly different between the EO and NEO groups. Gastroesophageal and laryngopharyngeal reflux symptoms such as regurgitation, dysphagia, dyspnea, globus sensation, dysphonia, and sore throat were more frequent in EO patients than in the NEO group. The reflux finding score (RFS) was 7.33 and 4.55 in EO and NEO patients, respectively (p < .001). Posterior commissure hypertrophy was the most common laryngoscopic finding in both of the groups followed by diffuse laryngeal edema, erythema, and pseudosulcus. CONCLUSIONS: Gastroesophageal and laryngopharyngeal reflux symptoms were more frequent in EO patients than in the NEO group. The laryngoscopic findings of laryngopharyngeal reflux were more severe and the RFS was significantly higher in EO patients than in NEO patients. The presence of EO seems to be associated with an increase in reflux without affecting pulmonary function as EO did not cause a significant decrease in pulmonary function tests.

Long-term histologic changes in nasal mucosa after total laryngectomy.

Objective. To determine the long-term histopathologic changes in nasal mucosa and the relationship between progression of the histopathologic changes and the duration without air current stimulation. Material and Method. Biopsies were taken from the inferior turbinates of 11 laryngeal cancer patients after total laryngectomy. Specimens were stained with hematoksilen-eosin and several histopathologic parameters were examined under light microscopy. Results. All of the patients demonstrated at least one histopathologic abnormality (100%, n = 11). Goblet destruction and stromal fibrosis were the most common findings (81%, n = 9), followed by focal epithelial atrophy and subepithelial seromusinous gland destruction (45%, n = 5), neovascularization and congestion (36%, n = 4), complete epithelial atrophy and mixoid degeneration (27%, n = 3). According to the duration between laryngectomy and biopsy, patients were grouped in to three: group 1; less than 12 months (36%, n = 4), group 2; 12-36 months (18%, n = 2), and group 3; more than 36 months (45%, n = 5). Only congestion was found to be decreased as the duration increased (P < .005). Conclusion. In laryngeal cancer patients histopathologic changes occur in nasal mucosa eventuate due to the cessation of air current stimulation, however there was no relation between progression of the histopathologic findings and the duration of cessation.

The effect of topical Castellani solution on outer hair cell function of rats.

OBJECTIVES/HYPOTHESIS: To evaluate if Castellani solution, which is used for the treatment of mycotic infections of the ear, has any ototoxic potential. There are some studies about the toxic effect of some of the ingredients of the Castellani solution, but the ototoxic effect is not known. The current study was designed to investigate the ototoxicity experimentally. STUDY DESIGN: Prospective controlled animal study. METHODS: Experiments were performed on 40 male Wistar albino rats. The animals were divided into four groups, each consisting of 10 rats. Under general anesthesia, the right tympanic membranes of the all of the rats were perforated and baseline distortion product otoacoustic emission (DPOAE) measurements were performed from the right ears before the use of solutions. The solutions were applied through the ear canal for 2 weeks using 0.1 mL twice a day. The rats in group I (study group) received Castellani solution. The rats in group II and group III received gentamicin (40 mg/mL) and saline solution respectively. The rats in group IV were followed without use of any medication. After 2 weeks DPOAE recordings were repeated. RESULTS: Baseline DPOAE results were normal in the right ears of all animals tested. Animals treated with either Castellani solution or saline and the rats in the control group showed no significant changes in the DPOAE amplitudes. The gentamicin group showed a significant decrease in the DPOAE values. CONCLUSIONS: In the rat, Castellani solution, which is topically applied to the middle ear cavity, does not affect DPOAE amplitudes.

Impairment of voice quality in paradoxical vocal fold motion dysfunction.

OBJECTIVES/HYPOTHESIS: To compare subjective and objective voice-quality parameters between asymptomatic paradoxical vocal fold motion dysfunction (PVFMD) patients and healthy individuals. STUDY DESIGN: Prospective. METHODS: A total number of 12 patients with PVFMD and 12 healthy control subjects had voice evaluations by means of laryngostroboscopy, acoustic analysis (jitter, shimmer, and harmonics-to-noise ratio [HNR]), aerodynamic measurements (maximum phonation time [MPT], s/z ratio), and perceptual analysis (Grade, Roughness, Breathiness, Asthenicity, and Strain Scale [GRBAS] and Voice Handicap Index-10 [VHI-10] scales). Evaluations were conducted when all the patients were asymptomatic. RESULTS: False vocal cord adduction, anteroposterior constriction of the supraglottic larynx, decreased amplitude, and decreased mucosal wave were observed in the great majority of the PVFMD patients during laryngostroboscopy. Mean jitter and shimmer rates were significantly high in PVFMD patients and there was no significant difference in mean HNR between groups (P<0.05). Mean MPT was significantly long in control subjects (P<0.05) and mean s/z ratio was nearly equal between patients and control subjects. There was a statistically significant difference between groups about GRBAS and VHI-10 scales (P<0.05). CONCLUSIONS: Based on the subjective and objective voice parameters, voice quality is significantly impaired in asymptomatic PVFMD patients when compared with the healthy control subjects.

Prevalence and risk factors for persistent otitis media with effusion in primary school children in Istanbul, Turkey.

OBJECTIVE: To determine the impact of environmental, epidemiologic and familial factors in the development of persistent otitis media with effusion (OME-OME treated with antibiotics and followed additional 12 weeks) in primary school children in Istanbul. MATERIALS AND METHODS: A total of 1800 children who were attending 4 different primary schools in Sisli and Beyoglu districts of Istanbul were screened and 1740 children who met the inclusion criteria were enrolled into this study. Questionnaires prepared in the Otorhinolaryngology Clinics of Taksim Research and Training Hospital and the forms were delivered to the parents to be filled the day before examination of each child. The forms were collected during the otoscopic examinations. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed as OME by otoscopic examination. The association between the children diagnosed as OME and the answers to the questionnaires was evaluated. RESULTS: The prevalence of persistent OME in this paper was 8.7% (152/1740). Frequency of smoking in both parents (p<0.01) and mothers alone (p<0.0001), the frequency of acute otitis media (AOM) and upper respiratory tract infection (URTI) in past 1 year (p<0.0001), incidence of attending day care centers and crèches (p<0.0001), allergy history (p<0.05), the number of siblings (p<0.0001) and poor educational status of the parents (p<0001) were statistically significant factors among children with OME compared to normal children. Sex factors (p>0.05), mothers smoke history during pregnancy (p>0.05), relative marriage (p>0.05), smoking history of the fathers (p>0.05) and duration of breastfeeding (p>0.05) were not statistically significant. CONCLUSION: Environmental, epidemiologic and familial factors in the etiology of OME are important. The parents must be informed about the risk factors and symptoms of OME and by this way, the development or delayed diagnosis of the disease that may lead to permanent hearing loss may be prevented.