The evaluation of tinnitus and auditory brainstem response in benign paroxysmal positional vertigo accompanied by tinnitus.

PURPOSE: The aim of this study is to investigate auditory brainstem response (ABR) in patients with benign paroxysmal positional vertigo (BPPV) accompanied by tinnitus and to suggest possible interpretative hypotheses. METHODS: Ninety individuals were included in the study. Individuals were separated into three groups: patients reporting tinnitus with BPPV (Group I), patients with BPPV (Group II), and a control group. The ABR test was applied at a low and at a high rate. RESULTS: For patients reporting tinnitus with BPPV, tinnitus was found to be localized in the ear affected by BPPV. Tinnitus disappeared after therapeutic interventions in 23 individuals with tinnitus. The difference between the Wave V latency at high rate and Wave V latency at a low rate in the affected ears of all individuals with BPPV (Groups I and II) was significantly long. In the affected ears of all BPPV patients, at a high rate of ABR, the absolute latency of the Wave III was found to be significantly longer than for the control group. CONCLUSIONS: Individuals with BPPV showed prolonged latencies in affected ears in a high rate of ABR without the effect of tinnitus. High rate of ABR in individuals with BPPV can be used to obtain preliminary information in cases where ischemia in the auditory pathways is suspected in BPPV formation.

Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials.

OBJECTIVE: Chronically increased blood glucose levels may affect the vestibular system by damaging cells and neural structures in diabetes mellitus (DM). We aimed to search the effects of neurovascular degeneration on the vestibular system in type 2 DM and prediabetic patients by using air-conducted ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials. DESIGN: Prospective study. STUDY SAMPLE: Thirty diabetic, 30 prediabetic patients, and 31 age- and sex-matched controls having no peripheral or central vestibular disease, were enrolled. All participants were evaluated by audiovestibular tests, oVEMP, and cVEMP. RESULTS: In the diabetic group, mean values of both oVEMP and cVEMP p1, n1 latencies were significantly longer compared to the prediabetic group and the control group, whereas latencies were similar in prediabetic and the control groups. Bilateral neural dysfunction was recognized in both tests and lateralization was not seen in VEMP asymmetric ratios. In the diabetic group, prevalence of pathological p1 and n1 latencies in oVEMP were 30.4% and 37.5%, whereas they were 53.7%, 59.3% in cVEMP, respectively. p1 latencies of cVEMP and oVEMP were positively correlated with HbA1c and fasting plasma glucose level in the diabetic group. CONCLUSION: Subclinical vestibular neuropathy can be a newly defined diabetes-related complication.

Single Sequence Magnetic Resonance Imaging in Serous Otitis Media.

INTRODUCTION: We evaluated the usability of short-term (approximately 3 minutes) T2 sequence temporal bone magnetic resonance imaging (MRI) in the diagnosis of serous otitis media (SOM) in our study. METHODS: A prospective study. Otoscopic examination and audiometry-tympanometry were performed on all 73 patients included in the study. All patients underwent short-term T2 sequence temporal bone MRI before the paracentesis procedure. RESULTS: The mean age of 73 patients (30 female and 43 male) was 7.78 ± 3.01 (3 to 17 years). A total of 134 ear paracentesis operations were performed. As a result of the intraoperative paracentesis procedure, 107 Type B tympanogram and 13 Type C tympanogram were found out of 120 ears that had fluid in the middle ear. Out of 14 ears without fluid flow in the middle ear, five were found to be Type B tympanogram and nine to be Type C tympanogram. The sensitivity of the type B tympanogram in the diagnosis of SOM was 89.1%, the specificity was 64.2%, the positive predictive value was 95.5%, and the negative predictive value was 40.9%. The sensitivity and specificity of short-term T2 sequence MRI in diagnosing SOM were found to be 100% and 100%. CONCLUSION:  Among the available methods, the short-term T2 sequence temporal MRI is the most effective method for evaluating fluid in mastoid cells.

Tympanoplasty with island cartilage or temporalis fascia: a comparative study.

PURPOSE: To compare clinical and audiological outcomes of the type 1 tympanoplasties where conchal cartilage (island graft) and temporalis fascia were used as the graft material. PROCEDURES: In this retrospective study, the results of type 1 tympanoplasty operations (n = 50) in which cartilage and temporalis fascia were used for graft material were compared. RESULTS: Pre- and postoperative otoscopic findings of both groups were similar (p > 0.05). Preoperatively, the pure tone averages (PTAs) and hearing thresholds of the fascia and cartilage groups were similar (p > 0.05). However, postoperatively, the PTAs and air-bone gap closure were better with temporalis fascia compared to cartilage grafting (p < 0.05). On frequency-specific comparisons, the pure tone thresholds at the frequencies of 0.5, 1 and 2 kHz recovered better with temporalis fascia compared to cartilage (p < 0.05). Although the pure tone recovery was better at 4 kHz with temporalis fascia, the difference between the groups were not significantly different (p > 0.05). CONCLUSION AND MESSAGE: In conclusion, in contrast to many reports in the literature, temporalis fascia grafting seems better in our study than grafting with conchal cartilage.

Treatment of Pott's Puffy tumor with balloon sinuplasty: report of three cases.

Pott's Puffy tumor (PPT) is a rare entity characterized by subperiosteal abscess associated with osteomyelitis of the frontal bone. It is usually managed by surgical curettage of the osteomyelitic bone and long-term antibiotic therapy. Balloon catheter dilatation is a new technique which was recently introduced for the treatment of chronic rhinosinusitis. In this article, we present three PPT cases (two of them were secondary to endoscopic sinus surgery) who were successfully treated with balloon catheter dilatation and long-term antibiotherapy.

Papillary thyroid carcinoma with metastasis to the temporooccipital skull: a case report.

The patient was admitted to our clinic with the complaint of swelling in his left post-auricular region. The medical history revealed that he underwent thyroid surgery eight years ago and the specimen was reported as papillary thyroid carcinoma. Following required analyses, total thyroidectomy and biopsy from mastoid region were performed. Total thyroidectomy specimen was proved thyroid papillary microcarcinomas at five foci of the thyroid gland, while biopsy samples obtained from the mastoid region were reported as metastatic papillary thyroid carcinoma. The patient underwent radioactive iodine, followed by radiotherapy. In this article, we present a 61-year-old male patient with papillary thyroid carcinoma metastatic to the temporooccipital region, accompanied by multiple cranial nerve paralysis.

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study.

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis. Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups. The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels. The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.

Periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus periorbital necrotizing fasciitis.

PURPOSE: To report a case of a patient with periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Case report. A previously healthy 33-year-old man was presented with pain and rapidly progressive swelling of the right upper eyelid following a minor trauma. Computed tomography scanning revealed soft tissue swelling and fracture of the anterior wall of the right frontal sinus. Oral amoxicillin + klavulanat 1 g, twice daily was started. Over the next 24 hours periorbital necrotizing fasciitis was developed. A wound swab was taken and sent for microscopic evaluation, culture, and antibiotic sensitivity. The patient was started on intravenous crystallized penicillin, third-generation cephalosporin, and metronidazol treatment. An urgent extensive necrotic tissue debridement and frontal sinus curettage were performed. RESULTS: Wound culture yielded MRSA which showed sensitivity to the given antibiotics. The patient responded to the treatment which was continued for 14 days. CONCLUSIONS: Monomicrobial MRSA should be considered in the etiology of periorbital necrotizing fasciitis. Early diagnosis and prompt surgical and medical therapy are essential in the management of periorbital necrotizing fasciitis.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis.

INTRODUCTION: Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. OBJECTIVES: To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. METHODS: Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). RESULTS: There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. CONCLUSION: The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

Endoscopic balloon dilation sinuplasty including ethmoidal air cells in chronic rhinosinusitis.

OBJECTIVES: We present the results of our experience with balloon catheter sinusotomy (BCS) in patients who had chronic rhinosinusitis. METHODS: The medical records of 30 patients who were treated for chronic sinusitis with the BCS technique between April 2007 and February 2008 were reviewed retrospectively. Preoperative and postoperative assessments were performed by endoscopic endonasal examination and Lund-Mackay radiologic staging of paranasal sinus computed tomography scans. The symptom scoring was performed with the Sino-Nasal Outcome Test-20 (SNOT-20). The postoperative follow-up period was at least 12 months. RESULTS: We performed BCS in 151 sinuses, excluding 2 maxillary and 2 frontal sinuses. No major complication attributable to BCS was observed. After operation, suctioning and crust removal was not needed in the area operated on in BCS patients. Revision surgery was needed in 2 patients after 6 months. From before to after operation, the SNOT-20 values and Lund-Mackay scores decreased significantly. CONCLUSIONS: We conclude that BCS helps to dilate the sinus ostia properly and effectively in the management of chronic rhinosinusitis. It can also be performed in the ethmoidal air cell area.

Comparison of the pupillometry during videonystagmography in asymmetric pseudoexfoliation patients.

PURPOSE: We aimed to evaluate the dynamic function of iris muscle in asymmetric pseudoexfoliation patients by videonystagmography. METHODS: 15 patients with asymmetric pseudoexfoliation and 15 control subjects were included. The function of iris muscle was assessed by the pupillometry test of the videonystagmography by calculating the percent of change in pupillary diameter in unit time during fixation to an accommodative target, light reaction, convergence, and divergence. RESULTS: There were significant differences between groups in the reaction during fixation (p: 0.01), in light reaction (p: 0.014), and in divergence-induced mydriasis (p: 0.003). In all of these, the difference between control eyes and pseudoexfoliative eyes of patients with PXS was significant. CONCLUSIONS: Pupillometry seems to be a promising noninvasive method to detect the clinical signs of PXS and may be useful for an accurate diagnosis.

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders.

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT-Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.

[Vascular leiomyoma mimicking a carotid body tumor]. / Karotis cisim tümörünü taklit eden vasküler leyomiyom.

Vascular leiomyomas are composed of smooth muscle cells and vascular endothelium. They are rarely seen in the head and neck region. A 32-year-old woman presented with a slowly-growing pulsatile mass in the right upper jugular region. Angiography showed a mass in the carotid bifurcation. It was not extensively vascularized, but displaced the internal and external carotid arteries. After neck exploration, the lesion was totally resected without any complications. Histopathologic diagnosis was vascular leiomyoma. No recurrence was detected during a two-year follow-up.

[Comparison between bipolar cautery dissection and classic dissection techniques in tonsillectomy]. / Tonsillektomide bipolar koter diseksiyon ve klasik diseksiyon tekniklerinin karsilastirilmasi.

OBJECTIVES: We compared the results of tonsillectomy performed by classical dissection and bipolar cautery dissection in pediatric patients. PATIENTS AND METHODS: A total of 201 pediatric patients were randomly assigned to two tonsillectomy groups. Ninety-five patients (62 boys, 33 girls; mean age 7+/-3 years) underwent bipolar cautery tonsillectomy, and 106 patients (58 boys, 48 girls; mean age 8+/-3 years) underwent classical dissection tonsillectomy. Patients were compared with respect to bleeding during tonsillectomy, operation time, tonsil volumes, primary and secondary bleeding, severity of pain at the first hour and on the tenth day, and time to first solid food intake. RESULTS: With bipolar cautery tonsillectomy, the mean operation time, amount of perioperative bleeding, and pain score at the first hour were significantly lower (p<0.001). However, the mean pain score on the tenth day was significantly higher with cautery tonsillectomy, which significantly prolonged initiation of solid food intake (p<0.001). There were no significant differences between the two groups with respect to tonsil volumes and initiation of cold fluid nutrition at the third postoperative hour (p>0.05). In the late postoperative period, one patient in each group required intervention under general anesthesia to control bleeding. CONCLUSION: Merits and demerits of both techniques should be taken into consideration for appropriate patient selection for the two tonsillectomy methods.

Treatment of mucoepidermoid carcinoma of the parotid gland and successful repair of iatrogenic facial nerve paralysis.

A 15-year-old female patient developed facial nerve paralysis following surgical excision of a right parotid mass at another center. The histopathologic diagnosis of the lesion was mucoepidermoid carcinoma. On admission to our clinic, she underwent extended total parotidectomy and functional neck dissection. For facial nerve reanimation, cervical plexus nerve grafting was performed for frontal and buccal branches, and ansa hypoglossi anastomosis for the marginal mandibular branch. Postoperative radiotherapy was administered. Facial nerve functions returned to normal in the postoperative sixth month (House-Brackmann grade II). No locoregional recurrence or distant metastasis occurred in the follow-up period.

[Treatment of olfactory neuroblastoma via subfrontal and midfacial degloving approaches: a case report]. / Olfaktör nöroblastomun subfrontal kraniofasyal ve midfasyal degloving yaklasimlarla tedavisi: Olgu sunumu.

A 12-year-old girl presented with complaints of nasal obstruction and a right infraorbital swelling. A biopsy obtained from the right nasal passage revealed olfactory neuroblastoma. The tumor was completely excised via subfrontal craniofacial and midfacial degloving approaches. No recurrence was observed during a three-year follow-up.

Relationship between sinusitis and adenoid size in pediatric age group.

OBJECTIVES: We sought to examine the relationship between adenoid volume and the stage of rhinosinusitis, as well as the relationship between age and adenoid size. METHODS: Forty-two children complaining of nasal discharge, whose paranasal sinus computed tomographic scans had been obtained, were involved in the study. The patients with adenoid enlargement underwent adenoidectomy. The volumes of adenoid vegetation were measured in square centimeters, and paranasal sinus computed tomographic scans were classified according to the Lund-Mackay staging system. RESULTS: No statistically significant difference existed between patients whose Lund-Mackay scores were 0 and those with scores greater than 0. There seems to be no correlation between the Lund-Mackay score and the degree of adenoid vegetation. CONCLUSIONS: Adenoid vegetation may cause nasal discharge that is not necessarily due to sinusitis. We could not find any supportive data for the statement "The greater the adenoid tissue, the more extensive the sinusitis."

[Evaluation of factors that affect the technique to be used in cholesteatoma surgery]. / Kolesteatomlu kronik otitis media tedavisinde cerrahi teknik seçimini etkileyen faktörlerin degerlendirilmesi.

OBJECTIVES: We investigated factors that affect the technique to be used in cholesteatoma surgery. PATIENTS AND METHODS: The study included 186 patients who underwent surgery for suppurative chronic otitis media with cholesteatoma. Open technique (group A) was used in 143 patients, and closed technique (group B) was used in 43 patients. The two groups were compared with respect to medical (age, sex, hearing loss, mastoid pneumatization, site of cholesteatoma, complications) and paramedical (education level, postoperative patient compliance, health insurance, the season at the time of operation) factors. RESULTS: Medical factors that differed significantly between the two groups included the degree of hearing loss, site of cholesteatoma, and presence of complications. The only significant difference was in education level among the paramedical factors. A great majority of patients with a hearing loss above 60 dB were in group A. Cholesteatoma was localized in the middle ear and attic in 10 patients, and in the antrum and/or mastoid cells in 133 patients in group A, compared to 37 and six patients in group B, respectively. All the patients (n=34) who had chronic otitis media complications associated with cholesteatoma were in group A. CONCLUSION: Our findings suggest that selection of the technique for cholesteatoma surgery depends on more than one factor.

Acute exudative tonsillitis in adults: the use of the Centor scoreand some laboratory tests.

BACKGROUND/AIM: The aim of our study was to determine the usefulness of the Centor score and some basic laboratory tests (complete blood count and C-reactive protein) for the differential diagnosis of exudative tonsillitis due to Group A β-hemolytic streptococcus (GABHS) or due to non-GABHS agents. MATERIALS AND METHODS: The data of clinical and laboratory characteristics of the patients diagnosed with exudative tonsillitis were collected and statistically compared between those having positive GABHS throat culture result and those who were negative for any bacterial agent. RESULTS: Totally 899 adult patients were included in our study; 56 (6.2%) of them were positive for GABHS, while 34 (3.8%) of the cases had a bacterial cause other than GABHS. The remaining 809 (90%) were accepted as non-GABHS cases. The percentages of patients having Centor score of 3 or greater, neutrophilia, lymphocytopenia, and CRP values of greater than 5-fold normal upper reference range were significantly higher in GABHS patients. CONCLUSION: Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis.