Superior semicircular canal dehiscence repair with small middle fossa craniotomy using an oto-microscopic and co-endoscopic assisted approach.

OBJECTIVE: Superior semicircular canal dehiscence is an uncommon neurotological disorder in which the petrous temporal bone overlying the superior semicircular canal lacks bone. Its most common symptoms include amplification of internal sounds, autophony, tinnitus, sound- and pressure-induced vertigo, hyperacusis, oscillopsia, and hearing loss. This video presentation aimed to demonstrate endoscopic-assisted repair of superior semicircular canal dehiscence with middle fossa craniotomy. METHOD: Eleven patients with superior semicircular canal dehiscence, verified with temporal computed tomography, were enrolled in the study. RESULT: An endoscopy-assisted middle fossa approach was applied to all patients. Superior semicircular canal dehiscence was successfully repaired with an endoscope in 11 patients. CONCLUSION: Endoscopic-assisted repair of superior semicircular canal dehiscence may be a superior approach compared with binocular operative microscopy.

Investigation of smell and taste function in patients with obstructive sleep apnoea syndrome.

OBJECTIVE: This study investigated the relationship between disease severity and taste and smell functions in patients with obstructive sleep apnoea syndrome. METHODS: A total of 65 patients with recurrent upper airway obstruction during sleep were included. Participants were divided into four groups according to apnoea-hypopnoea index, obtained on polysomnography. Smell and taste tests were performed on these patients. RESULTS: A significant difference was observed between the smell thresholds of the groups for the identification test (p = 0.016). In the taste test, significant differences were observed between the groups in terms of sweet, sour, salty and bitter taste test thresholds (p = 0.029, p = 0.0005, p = 0.001 and p = 0.017, respectively). CONCLUSION: As sleep apnoea severity increased (according to the apnoea-hypopnoea index) in obstructive sleep apnoea syndrome patients, the taste and smell thresholds decreased due to the effect of neuropathy and inflammation in the upper respiratory tract.

Choroidal thickness evaluation in paediatric patients with adenotonsillar hypertrophy.

OBJECTIVE: To investigate choroidal thickness using enhanced-depth imaging optical coherence tomography in paediatric patients with adenotonsillar hypertrophy, with comparison to healthy children, three months after adenotonsillectomy. METHODS: The patients were assigned to three groups: an adenotonsillar hypertrophy group, an adenotonsillectomy group and a healthy control group. In all groups, subfoveal, temporal and nasal choroidal thickness measurements were taken. RESULTS: In the subfoveal, temporal and nasal regions, choroidal tissue was found to be significantly thinner in adenotonsillar hypertrophy children than healthy children (p = 0.012, p = 0.027 and p = 0.020). The subfoveal and temporal choroidal thickness measurements of adenotonsillar hypertrophy group cases were significantly decreased compared to those in the adenotonsillectomy group (p = 0.038 and p = 0.048). CONCLUSION: There was a significant association between decreased choroidal thickness and adenotonsillar hypertrophy. Adenotonsillar hypertrophy may play an important role in decreased choroidal thickness.

Association of accessory sphenoid septa with variations in neighbouring structures.

OBJECTIVE: This study aimed to examine the relationship of the accessory sphenoidal septum with surrounding vital structures and their variations. METHODS: This cross-sectional retrospective study investigated the prevalence of accessory sphenoidal septa and their relationship with variations in surrounding vital structures in coronal and axial paranasal computed tomography images. RESULTS: Coronal and axial computed tomography images of 347 patients were assessed to evaluate the presence of accessory sphenoidal septa. Accessory sphenoidal septa originated from the internal carotid artery in 47.7 per cent of patients and from the optic nerve in 17.5 per cent. These structures were significantly associated with protrusion of the optic nerve, internal carotid canal or Vidian nerve canal. CONCLUSION: Accessory sphenoidal septa can originate from the internal carotid artery or the optic nerve. Therefore, the presence of an accessory sphenoidal septum indicates an increased risk of surgical complications including internal carotid artery injury and loss of vision due to optic nerve injury.

Classification of vertebral artery loop formation and association with cervicogenic dizziness.

OBJECTIVE: An examination was conducted of the number, level, clinical association and treatment approaches for vertebral arterial loop formation in patients with this condition with and without concurrent cervicogenic dizziness, and classified them according to the vertebral artery segment in which it was present. METHOD: A cross-sectional retrospective study. RESULTS: Thirty-seven patients who had undergone double-sided magnetic resonance angiography were examined; vertebral arterial loop formation was observed at only 1 level in 26 patients and at several levels in 9 patients. Segment one (V1) was involved in 78.3 per cent of cases and segment two (V2) was involved in 21.6 per cent. Symptoms in patients with vertebral arterial loop formation included: positional vertigo, in 100 per cent; and pulsatile tinnitus, in 83.7 per cent. CONCLUSION: Loop formation at the vertebral artery was observed most often on the proximal side in patients with cervicogenic dizziness (78.3 per cent). The incidence on the left side was twice as high as on the right side.

Hyperbaric oxygen therapy of olfactory dysfunction in diabetic neuropathy with type 2 diabetes mellitus and a new definition Diabetic Olfactopathy.

BACKGROUND: Hyperbaric Oxygen therapy is recommended as an adjuvant therapy for diabetic neuropathy. To investigate olfactory dysfunction and show the effectiveness of hyperbaric oxygen treatment in patients with type 2 diabetic neuropathy. MATERIAL AND METHODS: Patients diagnosed with Type 2 DM and diabetic neuropathy were included in the group 1. Patients of Group 1 were administered with a hyperbaric oxygen therapy for 30 sessions and patients who returned for a check up following 30 sessions were incorporated into the Group 2. Healthy volunteers with no medical problems were included in the study as a control group (Group 3). Connecticut Chemosensory Clinical Research (CCCRC) test and the subjective visual analog scale (VAS; 0-100) were utilized to evaluate the olfactory function. RESULTS: There was a statistically significant difference both between the control group and the patient group as well as before and after the HBO therapy in terms of total CCCRC scoring averages and VAS Scoring averages. CONCLUSION: When compared to normal individuals, type 2 diabetic neuropathy can cause an olfactory dysfunction, and a statistically significant improvement in olfaction can be obtained with HBO therapy. This is the first study demonstrating that the HBO therapy can play a role in treating olfactory dysfunctions suffered by the patients with diabetic olfactory neuropathies.

Investigation of the relationship between neutrophil-to-lymphocyte ratio and obstructive sleep apnoea syndrome.

OBJECTIVE: To investigate the neutrophil-to-lymphocyte ratio and sleep apnoea severity relationship. METHODS: Patients (n = 178) were assigned to five groups according to apnoea-hypopnea indices and continuous positive airway pressure use. White blood cell, neutrophil, lymphocyte and neutrophil-to-lymphocyte ratio values were compared for each group. RESULTS: The neutrophil-to-lymphocyte ratio values of severe obstructive sleep apnoea syndrome patients (group 4) were significantly higher than those of: control patients (group 1), mild obstructive sleep apnoea syndrome patients (group 2) and patients treated with continuous positive airway pressure (group 5) (p = 0.008, p = 0.008 and p = 0.003). Minimum oxygen saturation values of group 4 were significantly lower than those of groups 1, 2 and 5 (p = 0.0005, p = 0.011 and p = 0.001). There was a positive correlation between apnoea-hypopnea index and neutrophil-to-lymphocyte ratio (r = 0.758, p = 0.034), and a negative correlation between apnoea-hypopnea index and minimum oxygen saturation (r = -0.179, p = 0.012). CONCLUSION: Neutrophil-to-lymphocyte ratio may be used to determine disease severity, complementing polysomnography.

The efficacy of tonsillectomy in chronic tonsillitis patients as demonstrated by the neutrophil-to-lymphocyte ratio.

OBJECTIVES: Adenoidectomy and tonsillectomy are the oldest surgical procedures. The neutrophil-to-lymphocyte ratio is an inflammatory marker. This study aimed to investigate neutrophil-to-lymphocyte ratios in chronic tonsillitis patients and to determine whether this ratio reflects the pre- and post-operative inflammatory status in these patients. METHODS: Patients and healthy individuals were assigned to four groups: the adenoid hypertrophy, adenotonsillar hypertrophy, chronic tonsillitis and control groups. The neutrophil-to-lymphocyte ratio was calculated for each patient before surgery and one month post-surgery. Pre- and post-operative white blood cell, neutrophil and lymphocyte counts and neutrophil-to-lymphocyte ratios were compared both within and between groups. RESULTS: Pre- and post-operative neutrophil-to-lymphocyte ratios were significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy and adenotonsillar hypertrophy groups (p < 0.01 and p < 0.05, respectively). In the chronic tonsillitis group, post-operative neutrophil-to-lymphocyte ratios were significantly lower than pre-operative ratios (p = 0.045). The pre-operative neutrophil-to-lymphocyte ratio was significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy, adenotonsillar hypertrophy and control groups (p = 0.000). In contrast, there was no significant difference in post-operative neutrophil-to-lymphocyte ratios among all groups (p = 0.584). CONCLUSION: The neutrophil-to-lymphocyte ratio measurement can be used in chronic tonsillitis patients as an effective auxiliary method for determining the necessity and timing of tonsillectomy and post-operative follow up, thereby helping prevent complications due to delayed or inadequate treatment.

Thymoquinone treatment for inner-ear acoustic trauma in rats.

OBJECTIVE: To investigate whether thymoquinone has any eliminative effects against inner-ear damage caused by acoustic trauma. METHODS: Thirty-two male rats were divided into four groups. Group 1 was only exposed to acoustic trauma. Group 2 was given thymoquinone 24 hours before acoustic trauma and continued to receive it for 10 days after the trauma. Group 3 was only treated with thymoquinone, for 10 days. Group 4, the control group, suffered no trauma and received saline instead of thymoquinone. Groups 1 and 2 were exposed to acoustic trauma using 105 dB SPL white noise for 4 hours. RESULTS: There was a significant decrease in distortion product otoacoustic emission values and an increase in auditory brainstem response thresholds in group 1 on days 1, 5 and 10, compared with baseline measurements. In group 2, a decrease in distortion product otoacoustic emission values and an increase in auditory brainstem response threshold were observed on day 1 after acoustic trauma, but measurements were comparable to baseline values on days 5 and 10. In group 3, thymoquinone had no detrimental effects on hearing. Similarly, the control group showed stable results. CONCLUSION: Thymoquinone was demonstrated to be a reparative rather than preventive treatment that could be used to relieve acoustic trauma.

Investigation of the role of major respiratory viruses in the aetiology of nasal polyps using polymerase chain reaction technique.

Objective: We aimed to identify the role of major respiratory viruses in the aetiology of human nasal polyps using polymerase chain reaction technique. Methods: Thirty patients with nasal polyps and a group of 20 healthy patients (control group) were included in this study. Mucosa was obtained from the polyps of patients with nasal polyposis and from the middle turbinate of the control group patients by means of biopsy. The samples were stored at -80 °C until molecular analysis by polymerase chain reaction was carried out. Results: In the control group, the human coronavirus and human rhinovirus were diagnosed in one of the patients and the human respiratory syncytial virus in another. In the group with nasal polyposis, the influenza B virus was identified in one of the patients and the human coronavirus in another. Conclusion: The results did not demonstrate a statistically significant relationship between nasal polyposis and respiratory viruses.

'Conchae bullosis': a rare case with bilateral triple turbinate pneumatisations.

BACKGROUND: Concha bullosa is the pneumatisation of intranasal conchae (usually the middle turbinate, and rarely the inferior or superior turbinate); however, the term is generally used to describe aeration of the middle concha. Superior concha bullosa is a rare finding, and only a few cases of inferior concha bullosa have been reported in the medical literature. When symptomatic, concha bullosa may cause various problems including nasal congestion, headache, postnasal drip, anosmia and, sometimes, epiphora. METHODOLOGY: Computed tomography, following history-taking and physical examination, is a valuable tool in diagnosing turbinate pneumatisation. This article presents a very rare case with bilateral triple conchae pneumatisations. RESULTS: The symptomatology, diagnosis and treatment options for cases of multiple concha bullosa are discussed. The surgical interventions performed in the presented case are briefly described. CONCLUSION: The presented patient had pneumatisation of all six turbinates. In such cases, we propose that this condition be termed 'conchae bullosis' rather than 'conchae bullosa', in a similar fashion to the use of nasal polyposis as the plural form of nasal polyp.

Transcanalicular revision surgery for failed dacryocystorhinostomy.

AIM: To evaluate the effectiveness of transcanalicular multi diode laser in revision dacryocystorhinostomy and to determine the outcomes. MATERIALS AND METHODS: Fifty-three consecutive patients (19 males, 44 females) who were referred for recurrent dacryostenosis with epiphora after a failed primary dacryocystorhinostomy (DCR) operation were included in the study. Patients were assigned to two separate groups on the basis of primary DCR operation: either endonasal dacryocystorhinostomy (END-DCR) or transcanalicular multi diode laser dacryocystorhinostomy (TC-MDL DCR). TC-MDL DCR technique was used for revision surgeries in both groups. The mean age of the patients was 46.5 ± 13.1 (Range, 15 -71) and the average follow-up duration was 12 months. RESULTS: The success rate was 62% (18/29) in the primarily TC-MDL DCR operated group, and 85.2% (29/34) in the primarily END-DCR operated group respectively. The occlusion of internal ostium with granulation tissue was the leading etiology of unsuccessful surgical outcome in both group 1 and group 2 (42.8% and 28.5% respectively). CONCLUSIONS: TC-MDL DCR is a minimally invasive surgical method with relatively high success and low complication rates in patients with failed primary DCR requiring revision.

Successful desensitization of a case with desferrioxamine hypersensitivity.

Thalassaemia major is a severe chronic hemolytic disease, resulted with iron overload mainly due to regular blood transfusions. Iron overload may lead to serious organ toxicity and even fatal complications, if no iron excretion is achieved by a chelating agent. First introduced in 1976 as s.c. treatment for thalassaemia major, desferrioxamine (DFO) has substantially improved the life expectancy in the disease. While DFO can cause local allergic reactions including redness, itching, pain and lumps, on rare occasion anaphylactic reactions can occur. The mechanism of anaphylaxis like reactions is not well understood. In this case report, we presented a 10 years-old girl with thalassaemia major who had to stop DFO therapy after appearing of systemic allergic reactions with hypotension, tachycardia, pruritus and urticaria against this drug. Serum IgE level was normal, specific IgE and skin prick tests were negative. Intradermal test was resulted with positive reaction to DFO. The patient was hospitalized and desensitization protocol was initiated with rapid s.c. infusions per 15 min. The protocol was stopped at the 17th cycle because of local reaction reappeared. After that, DFO was further diluted and was restarted with lower dosage and longer infusion period. Then, DFO dosage was increased and the dilutions and infusion times were decreased gradually. By this desensitization programme, the patient would continue to use DFO chelation safely for 10 months.

Immediate adverse reactions to immunotherapy.

BACKGROUND: Immunotherapy, which has been used since the beginning of this century, has potential adverse reactions. The purpose of this study was to evaluate immediate local and systemic reactions to allergen immunotherapy and to compare rates of adverse reactions to aluminum-adsorbed versus calcium-adsorbed allergen vaccines. METHODS: 108 cases (38 girls and 70 boys) were given allergen immunotherapy between 1997 and 2001. The following data were recorded for each patient: primary disease being treated (allergic rhinitis, asthma, or allergic rhinitis and asthma), allergic sensitivities (dust mite or grass pollen), number of injections, the stage of immunotherapy (buildup or maintenance), dilution of allergen vaccine, and type of allergen vaccine (calcium- or aluminum-adsorbed). Adverse reactions were classified as systemic or local. Local reactions were classified as hyperemia and induration less than 5 cm, more than 5 cm, itching, and pain. RESULTS: 4783 injections were evaluated in 108 subjects with allergic rhinitis (44%), asthma (40%), allergic asthma, and rhinitis (16%). Frequency of immediate systemic reaction was 0.13%. Frequency of immediate local reactions were: hyperemia and induration less than 5 cm 3%, greater than 5 cm 0.16%, local itching 0.15%, and local pain 0.2%. There was no significant difference in systemic and local reactions between calcium- and aluminum-adsorbed vaccines. Immediate local reactions were more frequent during maintenance therapy compared to buildup. Subjects were more likely to have local reactions during maintenance therapy if they had allergic rhinitis (p < 0.05) or were receiving grass pollen vaccine (p < 0.01). CONCLUSION: Immediate adverse reactions were uncommon when given to children with asthma and allergic rhinitis. Aluminium- and calcium-adsorbed allergen vaccines showed similar rates of systemic and local reactions.

Two siblings with fetal hydantoin syndrome.

An association between anticonvulsant drugs taken during pregnancy and congenital abnormalities was first identified by Meadow et al. in 1968. Manson and Frederic clarified teratogenic effects of hydantoin in their epidemiological studies in 1973. Varied malformations due to hydantoin intake during pregnancy include digit and nail hypoplasia, growth retardation, typical facial appearance, rib anomalies, abnormal palmar creases, hirsutism, and low hairlines. Ambiguous genitalia is rarely associated with this syndrome. We present two siblings, aged three years and three months, with fetal hydantoin syndrome (FHS). Both were born to an epileptic mother who was given diphenylhydantoin (DPH) and phenobarbital throughout her pregnancies. The patients showed many characteristics of FHS, and ambiguous genitalia. Clinical and laboratory examinations revealed that both have normal female internal genital organs and female karyotypes.

A case of Lenz microphthalmia syndrome.

Lenz microphthalmia syndrome was first described by Lenz et al in 1955. The cardinal features of the syndrome are microphthalmia or anophthalmos, narrow shoulders, other skeletal anomalies, and dental and urogenital malformations. Here we present a case of Lenz microphthalmia syndrome who shows the typical characteristics and, additionally, dysgenesis of the corpus callosum associated with dilatation of the lateral ventricles. The patient, a 13 year old male, was referred to our hospital by a dental hospital for genetic counselling. On physical examination, height, weight, and head circumference were below the 3rd centile and he had brachymicrocephaly, a preauricular tag, microphthalmia, missing teeth, narrow shoulders, long, proximally placed thumbs, hypospadias, cryptorchidism, and a normal IQ. Ophthalmological examination showed microcornea, sclerocornea, absence of the pupil, no vision in the left eye and decreased vision and a small pupil in the right eye in addition to his bilateral microphthalmia. Cranial MRI showed dilatation of the lateral ventricles and dysgenesis of the corpus callosum.

The effect of immunization against tetanus during pregnancy for protective antibody titres and specific antibody responses of infants.

The protective effect of immunization against tetanus during pregnancy was examined by determining the serum antitoxin titres in 28 infants of twice immunized mothers and in 39 infants of non-immunized mothers during pregnancy. In addition, it was also determined whether transplacentally passive immunization of infants exerts a suppressive effect on active immunization with DPT vaccine. Before primary immunization with DPT, serum tetanus antitoxin (IgG) titres higher than protective level of 0.1 IU/ml were found in 100 per cent of infants of mothers immunized during pregnancy. Thirty-one per cent of infants born to non-immunized mothers had serum tetanus antitoxin titres below the protective level. In the sera obtained 1 month after the third dose of DPT vaccine, no significant difference was observed between the infants of both groups of mothers. It was concluded that specific antibody responses to three doses of DPT vaccine in infants who had received passive immunity from their mothers were not suppressed, and administration of two doses of tetanus toxoid to women during pregnancy provided passive transient protection of the infant against tetanus before administration of first dose of DPT vaccine.