Can Systemic Immune-Inflammation Index (SII) be a prognostic factor of Bell's palsy patients?

OBJECTIVE: Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) and that platelet-to-lymphocyte ratio (PLR) can be used as inflammatory markers in Bell's palsy. In this study, the aim is to investigate a novel inflammatory index, the Systemic Immune-Inflammation Index (SII), defined as SII = platelets × neutrophils/lymphocytes, in Bell's palsy patients. STUDY DESIGN: Retrospective. SETTING: Clinical research center. PATIENTS: The study included 88 Bell's palsy patients and 50 healthy controls. INTERVENTIONS: Patients diagnosed with Bell's palsy from 2010 to 2019 in a university hospital and an age- and sex-matched healthy control group were included in the study retrospectively. A complete blood count was performed for all participants. Magnetic resonance imaging was applied for Bell's palsy patients for the exclusion of other diagnoses. MAIN OUTCOME MEASURES: The CBC parameters were analyzed and hemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, and platelet counts were measured. The PLR, NLR, and SII values were calculated with the formula. RESULTS: The patient group had higher neutrophil counts and higher SII and NLR values than the control group (p < 0.05). Also, SII value is a prognostic factor in Bell's palsy in our study. CONCLUSIONS: Bell's palsy has an inflammatory component. The SII value can indicate an inflammatory condition in these patients. It may be used as a marker and prognostic indicator in Bell's palsy.

New Approach for Endoscopic Endonasal Transsphenoidal Pituitary Surgery: Modified Nasoseptal Rescue Flap.

INTRODUCTION: Endoscopic endonasal approach has become popularly preferred for pituitary surgery in recent years. In this study we described a new technique which is developed by the first author and which is modified from The Rivera-Serrano "salvage" flap approach. With this new technique the septum morbidity was completely prevented and a wider and more comfortable vision was provided for the operation. MATERIALMETHOD: This study consists 7 patients who underwent endoscopic endonasal transsphenoidal pituitary surgery (EETPS) with the described technique (modified salvage flap technique) between 2017 and 2019 and 13 patients underwent EETPS using salvage flap technique. The follow-up period was at least 6 months (24-6 months) for septal integrity. RESULTS: Intraoperative septum integrity was observed in all 7 patients who were treated with modified rescue flap technique. In 9 of 13 patients who had salvage flap technique, intraoperative septum posterior defects were observed. In postoperative follow-up (min postop 3 months), endoscopic examination showed no septal perforation in 6 patients who were treated with modified rescue flap technique, and 1 patient had 2 × 2 mm perforation posteriorly. In postoperative endoscopic follow-up of 13 patients who underwent salvage flap technique (min postop 3 months), 4 patients had complete septal integrity, while 9 patients had different sizes of posterior septal perforation. CONCLUSION: According to other described approach techniques, our modification using a pedicle and septum protective-transposition technique provides improved access to the downstream side of the sphenoid sinus and clivus, allowing the pedicle to slide down and take a more horizontal position. The improved maneuverability of the pedicle created in the case of cerebrospinal fluid leakage as a complication also allows it to be used as a bilateral wing to cover the exposed bone. We think that this technique is the best method to be used for EETPS with modified saline flap technique.

Long-term management of patients with PFAPA syndrome.

OBJECTIVE: To evaluate the long-term treatment results of patients with PFAPA syndrome and to determine their need for tonsillectomy. MATERIALS AND METHODS: The clinical characteristics, treatments and long-term results of 16 patients admitted to the Pediatric and Otorhinolaryngology Clinic between 2015 and 2019 were retrospectively analyzed. RESULTS: Twelve male and four female patients were examined between 1.5 and 8 years (mean age 4.8 ± 1.1) (75% male, 25% female). The mean duration of attacks was 4.4 ± 1.4 weeks. Twelve patients recovered completely with single-dose steroid therapy. In the 4-year follow-up of 12 patients who were given a single dose of steroid therapy, there were no relapses. Surgical decisions were made for four patients whose attacks did not pass with steroid treatment. Two patients (75%) underwent adenotonsillectomy, and one patient underwent tonsillectomy While three of these patients did not have an attack again, one patient continued to have an attack every 8 weeks. At the age of 9, his attacks were completely resolved spontaneously. All patients had fever. The most common concomitant symptoms were pharyngitis (94%), cervical adenitis (82%) and aphthous stomatitis (77%). Exudative tonsillitis was present in 25% of the patients. CONCLUSION: Medical treatment should be the first treatment option in patients with PFAPA syndrome. Although single-dose steroid treatment is effective in these patients, tonsillectomy is an important treatment option in refractory cases.

An Otalgia Cause: Temporomandibular Joint Herniation From Foramen of Huschke to External Auditory Canal.

OBJECTIVES: The authors presented a rare case of temporomandibular joint hernation into the external auditory canal. The authors discuss 1 cause of otalgia. CASE REPORT: A 52 year old male patient complained about his left ear otalgia for 3 months. Patient said that it had occurred after a painful mastication. On physical examination he had a rounded expanded mass in left ear external auditory canal that is located at the anterior-inferior wall of EAC When patient open his mouth the mass turn back to original position and mass was disappeared. Magnetic resonance imaging of the temporomandibular joint was revealed. CONCLUSION: Foramen of Huschke a bony defect in tympanic plate that may cause the spontaneous herniation of temporomandibular joint to external auditory canal. This herniation cause otalgia commonly. Opening and closing the mouth and palpation of temporomandibuler joint should be a part of physical examination when finding out non-otological causes of otalgia.

Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

OBJECTIVE: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. MATERIALS AND METHODS: Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant. RESULTS: Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C. CONCLUSION: In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

The effect of septoplasty on pulmonary artery pressure and right ventricular function in nasal septum deviation.

Nasal septum deviation (NSD) can cause obstruction of the upper airway, which may lead to increased pulmonary artery pressure (PAP) and right ventricle dysfunction. The aim of the present study was to evaluate the effect of septoplasty on right ventricular function and mean PAP of patients with marked NSD. 25 patients with marked NSD (mean age = 31.8 ± 12.3 years) and 27 healthy volunteers (mean age = 34.5 ± 10.8 years) were enrolled. Echocardiography was performed for all subjects and right ventricular function and mean PAP were evaluated before and 3 months after septoplasty. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus early diastolic myocardial velocity (E') were significantly lower in patients with NSD than control subjects, while right ventricle myocardial performance index (RVMPI) and mean PAP were significantly higher (respectively, p = 0.006, 0.037, 0.049, 0.046). When preoperative and postoperative findings were compared, the mean PAP decreased whereas TAPSE increased significantly (respectively, p = 0.007, 0.03). The results of the present study demonstrated that mean PAP increased and right ventricular function worsened in patients with NSD. However, mean PAP decreased and right ventricular function tended to recover after septoplasty.

Neutrophil-lymphocyte ratio as a new predictive and prognostic factor at the hearing loss of diabetic patients.

Diabetes mellitus (DM) is a systemic inflammatory disease. Sensorineural hearing loss (SNHL) is seen more frequently in diabetic patients and it is believed that vascular complications of DM may be the cause of SNHL via inflammation. Neutrophil-to-lymphocyte ratio (NLR) was defined as a novel-potential marker to determine inflammation. We aimed to investigate the relationship between NLR levels and SNHL in diabetic patients using high-frequency audiometry (8­16 kHz) for the first time. The study included 58 patients diagnosed with DM. The control group was composed of 45 age­sex­BMI­matched healthy subjects. An automated blood cell counter was used for NLR measurements. The hearing assessments of the patients were carried out by Interacoustics Clinical Audiometer AC 40 device. The mean NLR values of the patients were significantly higher than the control group (p = 0.015). Speech recognition threshold values were higher and the speech discrimination values were lower in patients (p = 0.002, p < 0.001), respectively. Pure tone average of the patients at 500, 1,000, 2,000 Hz frequencies was divided into two groups (group 1 >25 dB and group 2 <25 dB). NLR levels of the diabetic patients with >25 dB were higher than the other diabetics (p = 0.007). In conclusion, while diabetic patients are evaluating, audiologic assessments of these patients should be performed because they are at more risk of SNHL and NLR may be considered as a predictive and prognostic marker of hearing loss or its beginning in these patients as a useful and reliable marker without any cost.

The Effect of Thymoquinone on Acoustic Trauma-Induced Hearing Loss in Rats.

Background The aim of this study was to investigate the protective effect of thymoquinone, an antioxidant, on hearing loss induced by acoustic trauma in rats. Material and methods This study included 32 Wistar Albino rats divided into four groups: control, acoustic trauma, thymoquinone + acoustic trauma, and thymoquinone only, with eight rats per group. The control group received 0.5 mL of corn oil intraperitoneally for 10 days. The acoustic trauma group was exposed to 100 dB white noise at 4 kHz for 16 hours. The thymoquinone + acoustic trauma group received thymoquinone (10 mg/kg) intraperitoneally for two days before acoustic trauma and eight days after acoustic trauma. The thymoquinone only group received thymoquinone (10 mg/kg) for 10 days. Distortion product otoacoustic emissions (DPOAEs) were measured before and after treatments on days 1, 4, and 10. Results In the control group, DPOAE measurements showed no significant change over the study period. The acoustic trauma group exhibited a significant decrease in DPOAE on the first day after trauma, followed by some recovery. The thymoquinone + acoustic trauma group showed no significant decrease in DPOAE on the first day post-trauma, suggesting a protective effect. The thymoquinone only group also indicated no significant change in DPOAE measurements, suggesting that thymoquinone alone did not affect hearing function. Conclusion Thymoquinone demonstrated a protective effect against acoustic trauma-induced hearing loss in rats, as evidenced by stable DPOAE measurements post-trauma. These findings suggest that thymoquinone may help preserve hearing function by reducing oxidative stress in the cochlea. Further studies are needed to confirm these results in humans and optimize dosage and treatment protocols.

Increased levels of mean platelet volume: a possible relationship with idiopathic sudden hearing loss.

Mean platelet volume (MPV) is one of the platelet function indices which reflects the platelet production rate and functions. While vascular occlusion, acute or chronic syndromes and vasculitis are increasing the MPV levels, infections, autoimmune diseases, and inflammatory situations reduce it. The indicator for idiopathic sudden sensorineural hearing loss (ISHL) etiology remains a matter of debate because it is associated with many different disorders. We evaluated MPV levels in ISHL patients. Forty patients with ISHL and 40 healthy, age and sex matched subjects were enrolled to the study. Audiometer and laboratory results were recorded. Comparative multivariate analyses between indicator factors and hearing outcomes were conducted. MPV and platelet distribution width is significantly higher in ISHL. Platelet count is lower in the ISHL than control group (p < 0.001), (p < 0.001), (p = 0.003), respectively. Our findings indicate that, ISHL appears to be characterized by ischaemic or thrombotic events. Considering the increased MPV levels; MPV may be used to evaluate ISHL as an hepler indicator.

Different navigation of the hypoglossal nerve in the same patient: in the light of the literature.

The hypoglossal nerve appears typically between the internal carotid artery and internal jugular vein and down in the lateral groove between these 2 anatomical structures on to the right common carotid artery bifurcation. In this case report, we presented a patient that was operated on for laryngeal carcinoma, and abnormal navigation of hypoglossal nerve was observed during the neck dissection.

Facial paralysis and mediastinitis due to odontogenic infection and poor prognosis.

Cervical necrotizing fasciitis (CNF) is a rare, rapidly advancing infection that involves the skin, the subcutaneous fibrofatty tissue, as well as the superficial and deep fascia and can cause life-threatening complications. The most frequent initiating factors in the head and neck region are a primary odontogenic infection, a peritonsillar infection, as well as posttraumatic or iatrogenic skin and mucosal injuries. Necrotizing fasciitis (NF) can expand within hours, and the reported mortality rate is up to 75% with delay interference. If the patients have any risk factors, poor prognosis can be seen. In this study, 1 patient with CNF with a history of peritonsillar infection and 2 patients with CNF who had a history of odontogenic infection with spreading to the temporal region and the mediastinum were described, with information of the literature and a clinical experience that was gained from 5 patients with NF who were seen at our clinic in the recent year, despite the fact that CNF was not seen up to last year. None of the patients had any risk factors. One of them had a worse clinical state with ascending infection to the temporal region, cranial nerve paralysis, and descending necrotizing mediastinitis, but he recovered from NF. After the oral intake began, dyspnea due to aspiration was seen and he died because of sepsis and multiorgan dysfunction. We aimed to attract attention to the importance of dental pathologies and increased mortality in a healthy patient.

Association of Chiari I malformation and cerebellar ectopia with sensorineural hearing loss.

We aimed to examine the prevalence of cerebellar tonsil ectopia and Chiari 1 malformation in sensorineural hearing loss (SHL) that has, to the best of our knowledge, not been studied previously. Magnetic resonance imaging records of 166 subjects with SHL and 50 controls without known otologic disturbances were included in the study. A tonsils descent more than 2 mm was assumed as cerebellar ectopia, and a descent equal to or more than 5 mm was assumed as Chiari 1 malformation. A tonsil descent group was also formed by summation of both groups. Transverse diameters of bilateral intracranial vertebral arteries and transverse sinuses were also measured, and all parameters were analyzed using appropriate statistics. A significant difference of frequencies of Chiari 1, ectopia, and tonsil descent was detected between patients and controls. In comparison of cerebellar ectopia and Chiari 1 groups, SHL did not show any significant difference. The left lateral sinus diameter showed positive correlation with tonsil descent. There was no significant correlation for the diameters of other vessels. A powerful correlation was detected between SHL and age. In addition, right and vertebral artery diameters showed positive correlations with age. Chiari 1 malformation and cerebellar ectopia showed an association with SHL. These patients should also be evaluated for otologic disturbances. Further high-resolution magnetic resonance imaging studies to explain the exact cause of this currently unknown association seems required.

A Role for Mast Cell-Mediated Antibodies in the Formation of Cholesteatoma and Cholesteatoma-Induced Bone Erosion.

The study aimed to evaluate the effects and relationships between mast cells in the matrix, mast cell enzymes tryptase and chymase, epithelial proliferation, microvascular density, and bone destruction in cholesteatoma. Thirty-five biopsies diagnosed with cholesteatoma and seven healthy skin tissues taken from the retro-auricular region for control were evaluated. Immunohistochemical studies were performed with CD117, CD34, Ki-67, chymase, and tryptase antibodies, in a single session for all cases and the control group. The relationship between erosion size and antibody load was determined. The mean cholesteatoma epithelium Ki-67 was higher than the control group (p < 0.001). CD117-positive mast cells, chymase-positive mast cells, tryptase-positive mast cells, and microvessel density were significantly higher in the cholesteatoma matrix compared to the control group (p < 0.002, p < 0.001, p < 0.005). In the group with bone erosion scores of two and above, immunohistochemical markers tended to be higher. A positive correlation was found between CD117 and chymase, tryptase, and microvessel density; between tryptase, chymase, and microvessel density; and between chymase and microvessel density. CD117-positive mast cells and chymase-positive mast cells stimulate angiogenesis, increase the epithelium's proliferative capacity in the cholesteatoma matrix, and form cholesteatoma. The increased proliferation of cholesteatoma epithelium and increased vascular density in the matrix exacerbate bone erosion.

Audiometric Evaluation of the Relationship between Sensorineural Hearing Loss and Chronic Glaucoma.

Objectives: To assess hearing function in chronic glaucoma patients in comparison to healthy individuals. Materials and Methods: This cross-sectional study included 24 primary open-angle glaucoma (POAG) patients (24 ears) and 22 pseudoexfoliative glaucoma (PEG) patients (22 ears) who were followed for at least 5 years in the Afyonkarahisar Health Sciences University Ophthalmology Department, as well as 21 age- and gender-matched healthy individuals (21 ears, control group). Following a thorough ophthalmological examination that included visual acuity and intraocular pressure measurements, as well as anterior and posterior slit-lamp biomicroscopy, audiometry was performed in all participants to determine hearing function. Results: Mean ages in the POAG, PEG, and control groups were 64.50±7, 66.90±4.51, and 64.38±4.36 years, respectively. The mean deviation in standard automated perimetry was -14.47±2.89 in the POAG group and -15.02±2.87 in the PEG group (p=0.306). When compared with the control group, the POAG group had significantly higher hearing thresholds at 500 (p=0.011) and 1,000 Hz (p=0.003), while the PEG group had significantly higher hearing thresholds at 250 (p=0.009), 500 (p=0.009), 1,000 (p=0.001), 2,000 (p=0.005), 4,000 (p=0.001), 8000 (p=0.010), and 10,000 Hz (p=0.009). Conclusion: Both glaucoma and hearing loss are common chronic diseases that have an impact on the well-being of older people. Potential hearing problems in chronic glaucoma patients make routine ocular and otolaryngology examinations in older patients critical for prompt diagnosis and treatment.

Cabazitaxel's ototoxicity: An animal study and histopathologic research.

Introduction: Chemotherapeutic agents can have both serious side effects and ototoxicity, which can be caused by direct toxic effects or by metabolic derangement by the agents. Cabazitaxel (CBZ) is a next-generation semi-synthetic taxane derivative that is effective in both preclinical models of human tumors that are sensitive or resistant to chemotherapy and in patients suffering from progressive prostate cancer despite docetaxel treatment. The primary aim of this study is to investigate the ototoxicity of CBZ in a rat model. Materials and Methods: : A total of 24 adult male Wistar-Albino rats were equally and randomly divided into four groups. CBZ (Jevtana, Sanofi-Aventis USA) was intraperitoneally administered to Groups 2, 3, and 4 at doses of 0.5, 1.0, and 1.5 mg/kg/week, respectively, for 4 consecutive weeks; Group 1 received only i.p. saline at the same time. At the end of the study, the animals were sacrificed and their cochlea removed for histopathological examination. Results: : Intraperitoneal administration of CBZ exerted an ototoxic effect on rats, and the histopathological results became worse in a dose-dependent manner (P < 0.05). Conclusion: : Our findings suggest that CBZ may be an ototoxic agent and can damage the cochlea. More clinical studies should be conducted to understand its ototoxicity.

Paralysis of cranial nerve and striking prognosis of cervical necrotizing fasciitis.

Necrotizing soft-tissue infection (NSTI) is a bacterial infection with necrosis of the cutaneous, subcutaneous tissue and fascia with sparing of the underlying muscle. The most frequent initiating factor reported, for necrotizing fasciitis, in the head and neck region is a primary odontogenic infection or postextraction infection, abrasion, and laceration of the face or scalp. Necrotizing fasciitis can progress rapidly to systemic toxicity and even death if not promptly diagnosed and treated. If the patient has any risk factors, this can worsen the prognosis. In this study, 2 cases of NSTI with dental pathology history (one with the spreading to mediastinum and the other spreading to suprahyoid) were discussed with a review of the literature. One of the cases had diabetes mellitus, but interestingly, she had a better prognosis, and she was discharged asymptomatic. In addition, the other case had no any risk factors, but he had a worse clinical cranial nerve paralysis (a rare complication of NSTI) and died. As a conclusion, despite the intensive therapy, large debridement, and antibiotics with large spectrum, the delay in the patient's diagnosis and treatment increased mortality. We aimed to attract attention to the importance of dental pathologies and early diagnosis.

Vestibular Function in Psoriasis Patients.

INTRODUCTION: Psoriasis is an inflammatory skin disease that is characterized by T-cell-mediated hyperproliferation of the keratinocytes. It develops through immune-mediated mechanisms and is defined as an immune-mediated inflammatory disease. The inner ear is susceptible to inflammatory attacks, and vertigo and dizziness can occur as a complication. There is little information about psoriasis and the vestibular system. OBJECTIVE: This study aimed to investigate the cervical vestibular-evoked myogenic potential (cVEMP) results of psoriasis patients and the effect of psoriasis on the vestibular system. MATERIALS AND METHODS: Randomly selected and included in the study were patients who had been admitted to the Dermatology Outpatient Clinic of the Afyon Kocatepe University Medical Faculty, between November 15, 2017, and March 15, 2018, with the diagnosis of psoriasis, in addition to a healthy control group. This research was designed as cross-sectional study. Ethics committee permission was received. Both cVEMP and distortion product otoacoustic emission (DPOAE) tests were administered to all of the participants. Values were compared between the control group and psoriasis patients. RESULTS: The study included 43 psoriasis patients and 40 controls. The duration of treatment of the patients and the drugs that they were using were noted. The psoriasis patients had lower p13-n23 amplitude differences in their cVEMP tests (P < .05). These patients also had lower signal to noise ratio values, at 4 and 6 kHz, on their DPOAE tests (P < .05). CONCLUSION: Psoriasis is an immune-mediated inflammatory disease that can be associated with vestibulocochlear dysfunction.

Rhinoliths: Analysis of 24 Interesting Forgotten Foreign Body Cases.

Rhinoliths are petrified masses formed by accumulation of endogenous or exogenous salts around a nidus. Although rarely formed by the body, the most common cause is foreign bodies forgotten in the nose at childhood. Rhinoliths are rare and have been reported as a single case report in the literature. In this study, 24 different and different cases will be analyzed. Twenty-four interesting patients who were operated for rhinolith in the otorhinolaryngology clinic between 2014 and 2019 and were not seen in the literature before were analyzed retrospectively. The characteristics of these patients such as age, sex, additional pathology, foreign body coexistence, type of anesthesia used, and previous surgical status were analyzed. Fourteen patients were male and 10 were female (58.3% male, 41.7% female). The mean age was 30.4 (minimum 2, maximum 62). Twelve of the foreign bodies were on the right and 12 on the left (50%). Foreign body localization was 13 (54.1%) between the inferior turbinate (IT) and septum and 11 (45.9%) between the middle turbinate and septum. Tissue destruction was seen in 12 (50%; 7 septum, 5 IT) patients. Fifteen patients had additional pathology (mostly septum deviation). General anesthesia was used in 14 patients and local anesthesia was used in 10 (58.3%-41.7%) patients. Two patients (n = 2) had rhinoliths due to forgotten nasal packing after surgery and forgotten silicone nasolacrimal tube after dacryocystorhinostomy surgery. Rhinoliths should be considered with unilateral malodorous runny nose and resistant sinusitis attacks. The diagnosis is rigid endoscope and computed tomography imaging. It usually occurs as a result of forgotten foreign bodies. Rhinoliths may also form as a result of forgotten tampon after previous nose or eye surgery.