Presence of vascular loops entering internal acoustic channel may increase risk of Sudden sensorineural hearing loss and reduce recovery of these patients.

OBJECTIVES/HYPOTHESIS: To analyze whether there is correlation between branching patterns of anterior inferior cerebellar artery/posterior inferior cerebellar artery (AICA/PICA) in cerebellopontine angle (CPA) area, as demonstrated by three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) magnetic resonance imaging (MRI) and 1) idiopathic sudden sensorineural hearing loss (ISSNHL) outcomes and 2) recovery of ISSNHL. STUDY DESIGN: We evaluated patients with idiopathic SSNHL for branching patterns of AICA/PICA in CPA area, as demonstrated by 3D FIESTA MRI. METHODS: Sixty-eight patients with SSNHL (32 [47.1%] women; mean age 45.3 ± 14.6 [minimum-maximum: 18-77]) and 38 healthy volunteers [17 (44.7%) women; mean age 48.6 ± 14.0 (minimum-maximum: 26-81)] were included in this study. We evaluated patients for branching patterns and classified as type IA, IB, IIA, and IIB. Branching patterns were evaluated at the diseased side of the patients and both sides of the control group. Pretreatment and posttreatment audiological values were also studied. RESULTS: AICA/PICA branching patterns in control group versus study group in the affected side were: 26 (34.2%) versus 12 (17.6%) subjects had type IA; seven (9.2%) versus nine (13.2%) subjects had type IB; 31 (40.8%) versus 23 (33.8%) subjects had type IIA; and 12 (15.8) versus 24 (35.3%) subjects had type IIB branching patterns, respectively. Presence of vascular loops entering internal acoustic channel (type IIB branching pattern) was more prominent in the study group (P = 0.017). In addition, type IIB branching pattern was significantly associated with unresponsiveness to treatment (18 [75%] of 24 patients with type IIB were unresponsive and 14 [47.0%] of 30 patients with nontype IIB were unresponsive, P < 0.001). CONCLUSION: Type IIB branching pattern has been shown to be more common in patients with ISSNHL, and these patients come across with unresponsiveness to standard therapy more than the other branching types. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:210-215, 2017.

The Effect of Nasal Septal Perforation and its Treatment on Objective Sleep and Breathing Parameters.

BACKGROUND Nasal septal perforation (NSP) may alter nasal airflow patterns and physiology. To the best of our knowledge, no studies in the English literature have investigated the effect of NSP and its treatment on polysomnographic parameters. In this study, we aimed to investigate polysomnographic parameters in patients with NSP as well as changes in those parameters after treatment of NSP. MATERIAL AND METHODS Nineteen patients diagnosed with NSP were included in the study. All patients had baseline and post-procedure polysomnographies (PSG) after insertion of silicone septal button for closure of NSP. RESULTS Both median AHI [5.30 (14.40) vs. 2.40 (14.50)] and median supine AHI [10.00 (42.10) vs. 6.60 (37.00)] decreased after correction of the perforation. There was a large reduction in median supine AHI in patients with a perforation size >66 mm2 [10.10 (34.15) vs. 1.60 (28.30)]. CONCLUSIONS We conclude that NSP did not cause any deterioration in objective sleep parameters as determined by PSG, other than a decrease in REM sleep duration and an increase in supine AHI. Correction of NSP did not affect REM duration and supine AHI decreased after treatment.

Evaluation of upper airway in obstructive sleep apnea-hypopnea syndrome and habitual snorers.

OBJECTIVES: The purpose of this study was to evaluate upper airway in obstructive sleep apnea-hypopnea syndrome patients and habitual snorers, and to determine the correlation with apnea-hypopnea index. METHODS: 193 patients who applied to our Ear Nose Throat Clinic between years 2000 and 2002 with the complaint of witnessed snoring and/or apnea were included in the study. Each patient was evaluated by a complete head and neck examination and polysomnography. Physical examination included anterior rhinoscopy, nasal endoscopy, examination of oropharynx and hypopharynx and Muller maneuver. The correlation between the Ear Nose Throat examination parameters and the apnea/hypopnea index was investigated. RESULTS: Patients were distributed into two groups according to the apnea-hypopnea index: habitual snorers (34.3%) and obstructive sleep apnea-hypopnea (65.7%). There was a statistically significant correlation between apnea-hypopnea index and Muller maneuver, tongue base, lateral pharyngeal fold. There was a statistically significant correlation between body mass index, Muller maneuver and uvula. CONCLUSIONS: Obstructive sleep apnea-hypopnea patients results from changes in the upper airway. Anatomic and functional findings correlated with the apnea-hypopnea index. In the majority of patients with OSAHS, pharyngeal abnormalities and nasal obstruction were found to be statistically significant (Tab. 2, Fig. 1, Ref. 14).

[A case of laryngeal chondroradionecrosis]. / Larenjeal kondroradyonekroz: Olgu sunumu.

Chondroradionecrosis is one of the rare but important complications of radiation therapy for laryngeal carcinoma. A sixty-one-year-old male patient with glottic carcinoma (T1bN0M0) was treated with radiotherapy because he did not give consent to surgery. He developed difficulty in breathing and halitosis three months following radiotherapy. Radiologic and clinical signs were consistent with a diagnosis of laryngeal chondroradionecrosis. Medical treatment with steroids and antibiotics did not relieve his symptoms, so total laryngectomy was performed. No postoperative complications were seen. The surgical specimen was free of tumor.

Kimura's disease in the parotid and submandibular regions: two case reports.

Two male patients (aged 13 and 50 years) who presented with a complaint of painless mass in the parotid and submandibular regions, respectively, were found to have eosinophilia and increased blood immunoglobulin E (IgE) levels. Following ultrasonographic examination of the masses, surgical excision was performed. Histopathologic evaluation revealed massive lymphocytic and eosinophilic infiltration. Histopathologic findings and the presence of peripheral eosinophilia and high IgE levels led to a diagnosis of Kimura's disease. Postoperatively, no recurrences were detected within a year follow-up.

[The efficacy of combined medical treatment (antihistaminics, steroids, and macrolide antibiotics) in patients with nasal polyposis: preliminary results]. / Nazal polipozisli hastalarda kombine antihistaminik, steroid ve makrolid tedavisinin etkinligi: On sonuçlar.

OBJECTIVES: We evaluated the efficacy of combined medical treatment in cases with bilateral nasal polyposis without a history of any surgical or medical treatment. PATIENTS AND METHODS: Twenty-five patients (19 males, 6 females; mean age 45 years; range 30 to 60 years) who had not received any treatment for bilateral nasal polyposis were included. Treatment was comprised of an oral anti-histaminic agent (single dose daily for 3 weeks), and a topical steroid (as a nasal spray, twice daily for 6 months) and a single dose of intramuscular systemic steroid. Patients who did not respond to this therapy at the end of three weeks were administered a macrolide antibiotic (clarithromycin). The results were evaluated before treatment, and three weeks and six months after treatment with the use of a patient questionnaire, computed tomography and endoscopic examination findings. RESULTS: The patients' complaints improved by 85.5% and 79% at the end of three weeks and six months, respectively (p<0.005). Radiologic improvement was found to be 64% at the end of six months (p<0.005). The overall decrease in the size of the polyps was significant (p<0.005). No treatment-associated complications were encountered. CONCLUSION: Significant improvement achieved favors the use of combined medical treatment before surgery in selected patients with nasal polyposis.