A comprehensive study of oxidative stress in sudden hearing loss.

Little is known about the association between idiopathic sudden sensorineural hearing loss (ISSNHL) and oxidative stress. We investigated changes in a wide range of oxidants and antioxidants to create a comprehensive picture of oxidative imbalance. In the peripheral blood of 50 ISSNHL patients and 50 healthy subjects, total oxidant status (TOS), total antioxidant status (TAS), paraoxonase (PON), thiol/disulphide levels were measured. Moreover, a global oxidative stress index, reflecting both oxidative and antioxidant counterparts, was also calculated. One-way analysis between oxidative markers and severity of hearing loss were evaluated. The ISSNHL patients showed significantly higher TOS levels than controls (6.02 ± 3.17 vs. 4.5 ± 2.22; p = 0.018). The oxidative index was also significantly higher in patients than controls (0.39 ± 0.19 vs. 0.3 ± 0.14; p = 0.035). TAS, PON, native thiol, and total thiol were not altered. There was no statistical significance between oxidative markers and severity of hearing loss. The binary logistic regression model revealed that disulphide and TOS were associated with ISSNHL. There are alterations in a wide array of oxidants and antioxidants, with balance shifting toward increased oxidative stress in ISSNHL. Our findings may suggest endothelial dysfunction in ISSNHL etiopathogenesis.

Comparison of two different steroid treatments with hyperbaric oxygen for idiopathic sudden sensorineural hearing loss.

The purpose of the study was to assess the efficacy of the association of intratympanic (IT) steroid and hyperbaric oxygen (HBO) therapy in patients presenting with idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare this protocol with another consisting of intravenous (IV) steroid administration and HBO therapy. A total of 80 patients diagnosed with ISSNHL were included in this prospective trial. Patients were divided into three categories: a mild-to-moderate ISSNHL group with a pure-tone average (PTA) ≤60 decibels (dB), a severe ISSNHL group with a PTA of 60-80 dB, and a profound ISSNHL group with a PTA ≥81 dB. The first protocol consisted of 20 sessions of HBO therapy together with IV methylprednisolone 1 mg/kg body weight and a 10 mg taper every 3 days for 10 days. The second protocol consisted of HBO therapy for 20 sessions, together with an IT injection of dexamethasone at a dose of 4 mg/mL, 0.5-0.7 mL once a day for 7 consecutive days, performed 3 h before the HBO therapy. In the mild-to-moderate ISSNHL patients, the mean hearing gain and successful treatment rate was 19 (0-27) dB and 78.9 %, respectively in the IT + HBO treatment group, and 18 (3-44) dB and 70.5 % in the IV + HBO therapy group. In the severe ISSNHL patients, the mean hearing gain and successful treatment rate was 33 (1-54) dB and 81.8 %, respectively in the IT + HBO treatment group and 33.5 (7-57) dB and 58.2 % in the IV + HBO group. In the profound ISSNHL patients, the mean hearing gain and successful treatment rate was 36 (4-69) dB and 40 %, respectively in the IT + HBO therapy group, and 39.5 (0-92) dB and 72.7 % in the IV + HBO treatment group. The results demonstrated that patients with severe hearing loss success rate was superior in the group submitted to IT + HBO treatment, conversely IV + HBO therapy may be benefit for patients with profound hearing loss. Nevertheless, these clinical results were not statistically significant.

Pharmacological agents used for treatment and prevention in noise-induced hearing loss.

Noise is a stress factor that causes auditory, psychological and physiological effects. The realization that sudden loud noises or chronic exposure to noise in social and working environments can cause hearing loss has led to increased interest in noise-induced hearing loss (NIHL). The best means of preventing primary damage is protection against noise. Since this protection is not always possible for various reasons, the use of pharmacological agents to prevent or treat NIHL should also be considered. The purpose of this study is to discuss current pharmacological protection and treatment options in the light of the literature, since no such extensive reviews have been performed to date, including agents used for protection against and treatment of NIHL. We reviewed both animal and clinical studies, and these are discussed separately for ease of comprehension. For each agent, first animal studies, then clinical studies, if available, are discussed. We also performed a two-step search of the literature. In the first step, we searched the terms "noise induced hearing loss", "treatment" and "protection" in Pubmed. Based on the results obtained, we identified the agents used for the treatment of and protection against NIHL. In the second step, we searched the names of the agents identified in the first step, together with the term "noise induced hearing loss," and reviewed the results.

Oropharyngeal stenosis after transoral robotic lingual tonsillectomy.

Transoral robotic-assisted lingual tonsillectomy seems to confirm good tolerability with efficient results in both adult and pediatric populations, and the complication rate is usually dependent on the specific procedure and not related to the use of the robotic techniques. In these clinical reports, a 44-year-old woman (patient 1) and a 49-year-old woman (patient 2) were referred to our clinic with long-term complaints of dysphagia, snoring, and globus sensation. The patients were diagnosed with a lingual tonsillar hypertrophy, and lingual tonsillectomy was performed through transoral robotic surgery using the robotic da Vinci surgical system. After 2 months of uneventful follow-up, the patients returned with dysphagia, and examination of the patients revealed a cicatricial synechia surrounding the oropharynx. We report 2 cases of oropharyngeal stenosis that occurred during the late postoperative period after transoral assisted lingual tonsillectomy with epiglottoplasty. Possible risk factors and treatment alternatives were also discussed.

Surgical management of elongated styloid process: intraoral or transcervical?

The purpose of this study is to compare the results of surgical approaches in management of elongated styloid process. Eight patients with Eagle's syndrome due to elongated styloid process were included in this study. All necessary preoperative diagnostic work-ups were done and four of them were operated transorally and four were operated extraorally. Preoperative and postoperative symptoms and postoperative patient satisfaction were investigated. No early or late postoperative complications were encountered in transoral group. One of the patients who was operated transcervically experienced a transient weakness in the marginal mandibular branch of facial nerve which resolved spontaneously within 2 weeks. Complete remission of symptoms was achieved in seven patients at the final follow-up, only one of the patients, who was operated intraorally, had partial remission. Only one of the patients who had unilateral excision of elongated styloid process transcervically complained about the permanent scar. Transoral approach is a safe surgical alternative achieving adequate treatment. The advantages of intraoral approach include less surgical travma, less surgical time and lack of servical scar, with similar outcomes when compared with transcervical approach.

Giant paranasal sinus osteomas: surgical treatment options.

Giant paranasal sinus osteomas are rare tumors that may be very closely adherent to surrounding anatomical structures, and complete removal of these tumors may be very challenging. We report 6 cases of giant paranasal sinus osteomas that were removed completely and discussed their symptoms, diagnostic workup, and our surgical approach. We reviewed the patient files of our 6 cases with giant paranasal osteomas and summarized their history, symptoms, diagnosis, management, and follow-up. Three of our patients underwent endoscopic sinus surgery; the other 2 patients underwent open surgical approach (osteoplastic flap procedure with bicoronal incision), and 1 patient underwent both endoscopic and open approaches, all under general anesthesia. Mean patient age was 42.6 years (range, 18-54 years). Main symptoms were headache, proptosis, and diplopia. Physical examination findings include proptosis and frontal puffiness. Paranasal sinus computed tomography revealed larger than 3-cm-diameter tumors in the frontal and ethmoid sinuses. The surgical approach to each case was customized to the location, size, and presenting symptoms of the osteoma. Histopathology revealed osteoma in all cases. All patients were evaluated with paranasal sinus computed tomography scan postoperatively. At a mean follow-up of 15 months, complication was observed in 1 patient; no residual tumor or recurrence was detected following surgery. In symptomatic cases with huge tumors, open, endoscopic, or combined approaches could be applied because of the location and size of the tumor with successful outcomes. Both endoscopic and open approaches are safe and effective methods for removal of these tumors.

Management of frontal sinus fracture: reconstruction of the sinus with iliac bone graft.

One-third of frontal sinus fractures are isolated to the anterior table. Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. Traditional approaches to the reduction of an isolated anterior table fracture include the coronal incision, the bilateral brow incision, an endoscopic brow lift with an incision either directly over the fracture or in the brow, and delayed repair with a camouflaging implant. In our experience, autogenous bone graft is considered to be the best grafting material. It has the less short-term or long-term complications, and the donor site morbidity is insignificant. We describe a case involving a 45-year-old man with a depressed anterior table fracture that we successfully treated using an iliac bone graft.

Transoral robotic surgery for atypical carcinoid tumor of the larynx.

In recent years, transoral robotic surgery has been introduced as an efficient and a reliable method for excision of selected oral cavity, tongue base, and supraglottic tumors in otolaryngology. In this case report, a 39-year-old woman with a history of hoarseness and dysphagia for approximately 6 months is presented. The patient was diagnosed with atypical carcinoid tumor on the laryngeal aspect of the epiglottis, and excision of the tumor was performed through transoral robotic surgery using the robotic da Vinci surgical system, a 0-degree three-dimensional endoscope, 5-mm microinstruments compatible with the da Vinci robot, and a Feyh-Kastenbauer/Weinstein-O'Malley retractor. The mass was removed completely, and no complications occurred. The patient recovered without a need for tracheotomy. Findings of the 1-year clinical follow-up revealed no locoregional recurrence or distant metastasis. This case shows, once again, that transoral robotic surgery could be used safely and effectively regardless of pathologic diagnosis in the supraglottic region tumors.

[Postauricular cutaneous mastoid fistula: a case report]. / Postauriküler kütanöz mastoid fistül: Olgu sunumu.

Infections which involve the middle ear mucosa may easily cause mastoiditis due to the relation between the middle ear space and mastoid cavity. Postauricular cutaneous mastoid fistula is a rare complication of chronic otitis media. While most of the simple mastoid fistulas tend to heal spontaneously with the treatment of chronic suppurative otitis media, cutaneous mastoid fistulas tend to heal very slowly, as the ingrowth of the skin surrounding the fistula is followed by necrosis or epithelization of the skin edges. In this article, we report a 46-year-old female case of automastoidectomy secondary to the chronic otitis and postauricular cutaneous mastoid fistula in the light of surgical closure technique.

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery.

The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥ 4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.

Evaluation of labyrinthine fistula by MR cisternography.

Sensorineural hearing loss (SNHL) can develop after trauma and determination of its etiology is crucial for treatment planning. Computed tomography (CT) is the first-line imaging method in evaluation of trauma victims; however, its value is limited in visualization of perilymphatic fistula or in assessment of cochlear implant candidates. Herein, we present imaging findings of a patient with traumatic bilateral transverse fractures of temporal bones and resultant SNHL. This patient had a fistula between inner ear and subarachnoid space which was detected at non-contrast-enhanced MR cisternography (NCE-MRC) and contrast-enhanced MR cisternography (CE-MRC) scans. To the best of our knowledge, this is the first case in the literature. In conclusion, in patients with transverse fractures of temporal bone, in presence of otic capsule involvement at CT images, the inner ear structures and surrounding organs should be carefully evaluated via NCE-MRC. In case of a suspicion of a fistula, CE-MRC can help in early diagnosis and can also help to visualize the leakage location, which is of paramount importance for correct treatment and management of such cases.

SARS-CoV-2 is not found in the sweat of COVID-19 positive patients.

BACKGROUND: As the SARS-CoV-2 virus made a pandemic all over the world, its transmission routes became significant. Transmission from human to human is known, but other possible routes are not determined well. AIMS: This study aimed to reveal the presence of SARS-CoV-2 virus in sweat. METHODS: This prospective study was conducted in a tertiary care education and training hospital. Fifty patients were included in this study. Skin disinfection was done with an alcohol-based solution. Swabs for RT-PCR (real-time reverse transcriptase polymerase chain reaction) were taken from forehead and axilla skin after sweating patients for 30 min. After collection of sweat, swabs were placed into 2 ml of sterile viral transport medium, then transported quickly to the microbiology laboratory. RESULTS: No SARS-CoV-2 virus was detected in RT-PCR of forehead and axilla swabs. CONCLUSION: This study showed that there is no transmission of SARS-CoV-2 virus via sweat. However, general precautions must be taken while doing interventional procedures.

Assessment of SARS-CoV-2 in the Cerumen of COVID-19-Positive Patients.

OBJECTIVE: To evaluate the presence of SARS-CoV-2 virus in the cerumen of patients with COVID-19. METHODS: A prospective study was conducted in a tertiary care pandemic hospital. Sixty COVID-19 patients with cerumen in their external auditory canals were included in the study. Swabs were taken from the external auditory canal of the patients by an experienced otolaryngologist with the test swab. Sampling was done by rotating the sample swab 360° 10 times in each external auditory canal for a total of 20 times. After collection, swabs were placed into 2 mL of the sterile viral transport medium (various manufacturers), then transported and tested as soon as possible after collection. RESULTS: SARS-CoV-2 was not detected in the cerumen polymerase chain reaction (PCR) samples of any of the 60 patients with positive nasopharyngeal/oropharyngeal swabs. CONCLUSION: Cerumen cleaning is one of the most common procedures performed by otolaryngologists, and care should be taken during the procedure or due to the possibility of infection from the resulting contaminants. The cerumen contains the secretions of the glands in the external auditory canal and may contain certain pathogens that are actively found in the body. The presence of hepatitis B virus in the cerumen was examined and isolated in the cerumen. In our study, the presence of SARS-CoV-2 virus in the cerumen was evaluated in SARS-CoV-2 PCR-positive patients. SARS-CoV-2 virus was not detected in the cerumen samples of any of the patients.

The effect of N-acetyl cysteine on biofilm layers in an experimental model of chronic otitis media.

OBJECTIVE: The aim of this study was to investigate the efficacy of N-acetylcysteine (NAC) on biofilm layers and on the course of disease in chronic otitis media. METHODS: Twenty-five rats that were induced with chronic otitis media (COM) were separated into three groups. In Group 1 (N = 18), 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate + 0.5 mg/ml NAC solution was locally injected to the right ear of the rats; in Group 2, (N=18) 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate was locally injected to the left ear of the rats. No treatment was applied to either ear of rats in Group 3 (N = 5). Histopathological and scanning electron microscope (SEM) evaluations were performed in all groups. RESULTS: SEM revealed biofilm formation in all COM induced groups. No significant difference was seen between groups 1 and 2 in terms of suppuration levels, fibrosis, inner ear involvement, infection staging and biofilm formation (p > 0.05). CONCLUSIONS: In this study, while histopathological and SEM evaluation revealed no effect of 0.5 mg/ml NAC on the biofilm layer in COM-induced rats, further studies with NAC at different concentrations are still needed on different types of experimental animals.

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.

[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.

[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.

Pathologic Evaluation of Routine Nasopharynx Punch Biopsy in the Adult Population: Is It Really Necessary?

OBJECTIVES: To retrospectively evaluate the patients who underwent nasopharyngeal biopsy with imaging and biopsy results, who have or don't have symptoms for nasopharyngeal pathology and to determine the ratio of the nasopharyngeal cancer cases and other pathologic conditions. METHODS: In this retrospective study, 983 patients who underwent endoscopic nasopharyngeal biopsy for symptomatic nasopharyngeal lesions were included. All pathological results, benign or malign was recorded and classified due to the patients' presenting symptoms such as symptomatic for nasopharyngeal pathology or asymptomatic. Computed tomography (CT) or magnetic resonance imaging (MRI) reports were also recorded separately as group A for malignancy or group B for not malignancy. RESULTS: Forty-five (4.6%) of 983 biopsies were malignant. In this group, there is no statistically significant difference between symptomatic and asymptomatic group. For malignant pathologies, the sensitivity of MRI was found 88.2% and CT was 61.5%. CONCLUSION: For early diagnosis of nasopharyngeal cancer, all patients admitted to Ear, Nose and Throat (ENT) referral clinics should be examined endoscopically irrespective of their complaints and suspicious cases should be investigated by imaging especially by MRI. If MRI report clearly indicates Thornwaldt cyst or reactive lymphoid hyperplasia and this result is compatible with endoscopic findings, biopsy may not be necessary. Apart from these cases, all suspected lesions should be biopsied.

Unilateral sudden hearing loss: a rare symptom of Moyamoya disease.

A 38-year-old female patient experienced a sudden onset of unilateral sensorineural hearing loss due to Moyamoya disease. A detailed summary of audiological and neurological findings indicated that the sudden hearing loss might be due to Moyamoya disease resulting in occlusion of posterior and middle cerebral arteries. Intravenous prednisolone and trimetazidine dihydrochloride may improve hearing thresholds and speech understanding. To our knowledge, this is the first article in the literature reporting a case of sudden hearing loss as the first manifestation of Moyamoya disease in a young adult.

Intrapolyp steroid injection for nasal polyposis: Randomized trial of safety and efficacy.

OBJECTIVES/HYPOTHESIS: Local and systemic steroid treatment is the mainstay of therapy for nasal polyposis. This study aims to evaluate the safety and effectiveness of intrapolyp steroid injection on nasal polyposis and to compare the outcomes with short-term oral steroid treatment. STUDY DESIGN: Prospective, randomized, controlled endoscopic clinical trial. METHODS: Ninety patients with nasal polyps were randomly assigned in a 1:1 ratio to receive oral prednisolone 1 mg/kg/day, tapering by 5 mg/day, for 2 weeks, or to receive intrapolyp steroid injection (40 mg/mL triamcinolone, 1 mL) for up to five times with intervals of 1 week. Both groups received fluticasone propionate nasal drops twice daily for 12 weeks after initial treatment. Total nasal symptoms scores and total nasal polyp scores of both groups were evaluated before and 3 and 6 months after treatment, whereas computed tomography (CT) scores were evaluated before and 6 months after treatment. Also, plasma cortisol and adrenocorticotropic hormone (ACTH) levels of the patients in the intrapolyp steroid injection group were evaluated before, during, and after treatment. RESULTS: A total of 211 injections were given to 45 patients, and no serious complications were observed. Both groups showed significant decrease in symptom score, polyp score, and CT score (P > 0.001), with no significant difference between groups (P > 0.05). Plasma cortisol and ACTH levels of the injected patients were in normal limits before treatment, 1 week after the first injection, and 1 week after the last injection. CONCLUSION: Intrapolyp steroid injection appears to be an effective and safe method for treatment of nasal polyps, with comparable results to oral short-term steroid treatment. LEVEL OF EVIDENCE: 1b. Laryngoscope, 126:1730-1735, 2016.